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Current System’s Fundamentals

The Unique HHR Challenges Facing Home and Community Care in Ontario’s Competitive Bidding Environment OHA Conference: Labour Relations in a LHIN Environment Dr. Judith Shamian President & CEO of VON Canada May 30, 2008. Current System’s Fundamentals. Staff deployment patterns

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Current System’s Fundamentals

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  1. The Unique HHR Challenges Facing Home and Community Care in Ontario’s Competitive Bidding Environment OHA Conference: Labour Relations in a LHIN Environment Dr. Judith Shamian President & CEO of VON CanadaMay 30, 2008

  2. Current System’s Fundamentals • Staff deployment patterns • Staff compensation patterns • Turnover of providers and staff • Servant/Master relationship • Split between home and community services

  3. AGENDA • Home and Community Care in Ontario • Unique HHR challenges • MOHLTC’s HHR Strategy vs. Competitive bidding • Opportunities to strengthen HHR • Conclusion

  4. HOME & COMMUNITY CARE (HCC) IN ONTARIO • The demand for HCC is increasing: • Aging population • 4.3 million Canadians are 65 or older(Statistics Canada) • Consumer demand • 88% of Ontarians prefer to receive care and supports at home(Pollara, 2005) • E.g. end of life care; ALC beds • Cost effectiveness • Home care costs are 50-75% of facility care costs (Hollander, 2002) • Technology • Increased use of technology in the home (e.g. telehome monitoring) • Potential to address systems issues – ALC patients waiting for care could be cared for in the home • In 2005, approximately 774,000 Ontarians relied on home care services (MOHLTC, 2007/08) • Between 1996 and 2046, the number of people needing home care in Canada is expected to double (CHCA, 2004)

  5. HHR CHALLENGES • Sufficient numbers of well-trained HHRs are essential to meet current and future HCC needs of Ontarians. • The HCC sector faces a number of HHR challenges • Shortage of Workers • Progressive shortfall of professional staff in relation to home care clients • Employment instability • Cyclical contracts; irregular hours, casualization of workforce • Compensation inequality • Wages, benefits • Lack of recognition for the sector

  6. 1. Supply of Future Workforce • Progressive shortfall of professional staff to home care clients • if not addressed, the ratio of professional staff to consumers will fall from 1:37 in 2001 to 1:50 in 2006 and ultimately 1:100 by 2046 (Home Care Sector Study Corporation, 2003). • Older workforce • 50-70% of workforce is over 40 years of age • fewer students being trained to enter workforce than there are older workers

  7. 2. CHALLENGE: LENGTH OF CONTRACTS • Cyclical nature of contracts = employment instability • Staff are expected to follow contracts, but this doesn’t always happen. • Research shows that a significant portion of displaced workers leave the HCC sector: • 57% left sector (Mobility Study, 2006); ~ 52% left sector (Aronson et al., 2004) • No successor rights • Potential loss of pension, seniority, benefits • Casualization of the work force • Disengagement among nurses; decreased morale

  8. 3. LACK OF COMPENSATION EQUALITY • Inequitable compensation across health care sectors • Varying levels of wages, benefits, and pensions • Difference of ~$8,400 • Inequitable compensation within HCC sector • Varying compensation models • E.g. “institutional-based CA” vs: paid by visit (2008/09 – ONA)

  9. 4. CHALLENGE: LACK OF RECOGNITION • HHR feel undervalued and are frustrated with the sector • Client acuity at home is increasing • Increased pressure to do more with less • Compensation inequality • Yet government claims that R&R of HHR is critical for the success of the health care system and patient care.

  10. HHR Strategy Nurses 70% of nurses working F/T Recruitment & Retention Creating healthy work environments Expanding roles and maximizing scopes Managed Competition Nurses Casualization of the workforce Wage inequities, little money for training/ed. Little job security; occupational health and safety concerns Needs are assessed twice (CCAC’s & Providers) RELATIONSHIP BETWEEN ONTARIO’s HHR STRATEGY AND MANAGED COMPETITION

  11. OPPORTUNITIES – SHORT TERM • Protect employees from competitive bidding. Options include: • Guaranteeing portability of service, seniority and benefits between organizations • Level the playing field • Establish a transitional support program for displaced employees

  12. OPPORTUNITIES: LONG-TERM • LHINs have an opportunity to integrate services, as well as HHR and level the playing field. • Ensure comparable employment standards across LHIN • Equal compensation across health care sectors • Develop an integrated HHR database • LHINs develop a database for planning purposes to help with: • HHR planning • Emergency planning

  13. CONCLUSION • Competitive bidding negatively impacts the recruitment and retention of HHR in home and community care. This in turn, impacts other sectors (e.g. hospitals and ALC beds) as well as patient care. • If the Ontario government is serious about helping people live, heal and age and home successfully, we must ensure employment stability so providers can give the best of themselves to Ontarians.

  14. Thank You • Judith.Shamian@von.ca • www.von.ca

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