Health Care and the Ontario Budget

April 21st, 2012

Ontario budget: Tiny increase in health spending fails the sick and the elderly

March 28, 2012          Bob Hepburn

“Despite all the rosy talk in this week’s Ontario budget about beefing up home care and community care, the reality is that it’s too little — and it may be too late.”

If you live on Manitoulin Island, pray you don’t suffer a stroke and need to see a health professional after you’ve been released from hospital to help you learn to swallow food again.  Or if you live near Credit Valley Hospital in Mississauga, hope that you don’t smash your head in a car crash and still have severe trouble speaking even after the hospital patches you up and sends you home. That’s because both home care and community care services, from northern Ontario to suburban Toronto, are a mess — underfunded, unequal, disorganized and arbitrary.

Despite all the rosy talk in this week’s Ontario budget about beefing up home care and community care, the reality is that it’s too little — and it may be too late.  Regrettably, Premier Dalton McGuinty fumbled a critical test with the “tough-times budget” of his commitment made during last fall’s provincial election to improve home and community care.

On the surface, the budget appears to give more priority to these chronically underfunded services by raising spending 4 per cent a year for the next three years, or about $526 million annually.  But over the last decade, the proportion of health-care spending on home care and community care has actually shrunk. At the rate of increase unveiled in this budget, it will take years just to get back to where we once were.

At the same time, Ontario’s 150 hospitals are facing a freeze in operating budgets and nursing homes are confronting $70 million in cuts. That will mean fewer hospital beds, longer wait lists for long-term care, shorter hospital stays and far more demands on home and community care than even the modest increase in the budget can handle.  And that doesn’t even start to address the backlog of more than 10,000 people already waiting for home-care services and up to 30,000 waiting for long-term care facilities.

Across Ontario, the cutbacks in home care and rehab services in recent years have been stunning. They affect such services as nursing, speech-language pathology, physiotherapy and personal support.  These are the professionals — some barely paid the minimum wage — who help you speak again after a stroke or head injury, help you walk again after hip surgery and change diapers on your elderly parents.

On Manitoulin Island, adult patients living at home or in nursing homes are allowed only six hours of speech-language therapy every three months. In Mississauga, Credit Valley Hospital cut its outpatient communication and swallowing services last year, forcing patients either to pay privately for such services or join long lists of people waiting for a government-funded therapist.

The budget increases won’t come anywhere close to meeting the increased needs caused by aging baby boomers, said Mary Cook, executive director of the Ontario Association of Speech-Language Pathologists and Audiologists. Her members, many of whom have master’s degrees or more, constantly complain they are limited in the amount of therapy services they can provide in both hospital and community settings.

“There has to be a clear policy directive from the government as to how, where and by whom our health-care dollars will be spent,” Cook said. “That’s because they are woefully inadequate to address the growing need in our health-care system.”

Natalie Mehra, director of the Ontario Health Coalition, agrees with Cook. “While increases in home care are needed and will help those who are eligible and appropriate for such services, they are not a total ‘trade-off’ with the hospital cuts,” she said. “To pretend otherwise is simplistic and manipulative, and ignores the real health needs of thousands of Ontarians.”

Still, any help is welcome, said Sue VanderBelt, executive director of the Ontario Home Care Association, whose members represent about 25,000 workers. VanderBelt believes the government has been “very bold and strong” in providing more home care funding despite tight economic times. But like others, VanderBelt said even more work is required to meet the growing needs of an aging society.

It’s work McGuinty must take more seriously if patients on Manitoulin Island, in Mississauga and elsewhere are to start receiving the level of care they deserve — and that McGuinty promised them.

Bob Hepburn’s column appears

Health care faces extreme measures

Growth to budgets cut even more than Drummond report recommended; home-care gets 4% increase

By Pauline Tam, Ottawa CitizenMarch 28, 2012

Ontario Finance Minister Dwight Duncan delivers the provincial budget at Queens Park Tuesday. The Liberals fulfilled their vow to shift funding from expensive hospitals and nursing homes to cheaper community care as part of their $48.7-billion budget.

The Ontario budget surprised many by delivering an even harsher dose of medicine to health care than what was prescribed by the province’s austerity czar.
Where economist Don Drummond called for the $47-billion health budget to rise by no more than 2.5 per cent, Tuesday’s budget capped growth at 2.1 per cent. That translates to $48.7 billion in total spending for 2012-13.
“Even Drummond was more generous than this,” said NDP health critic France Gélinas.
The shock therapy will hit everyone from high-income seniors, to nursing-home residents, doctors and hospital workers.
However, the governing Liberals made good on their pledge to shift funding from expensive hospitals and nursing homes to cheaper community care. So while the province’s 150 hospitals are bracing for a freeze to their base operating budgets and nursing homes are facing $70 million in cuts, home-care programs are getting a four-per-cent increase, up from the current three per cent, in a bid to keep more people out of hospital.
“It’s going to be a challenging year,” said Mark Rochon, interim chief executive of the Ontario Hospital Association. “But we have to look at these investments quite differently than in the past. We have to ensure there are appropriate community supports and primary-care supports so that patients don’t find their way to the hospital in the first place.”
However, Tory health critic Elizabeth Witmer is not convinced the extra community-care funding will make a dent in the high number of seniors languishing in hospitals. “Is this going to address the issue? I don’t know.”
The funding freeze on hospitals, combined with a new funding formula that pits the largest facilities against the fastest-growing ones, is likely to lead to more bed closures and staff layoffs, critics say.
Some hospitals could simply stop providing procedures with high overhead costs and low demand, resulting in more of that work being transferred to specialized clinics – an idea endorsed by the Liberals and the opposition Tories.
“It’s very likely that all hospitals will lose some services, and many will have to pick and choose what services they offer, and that’s very worrying,” said Natalie Mehra, executive director of the Ontario Health Coalition, a pro-medicare group.
The budget also indicated there was no money to increase the salaries of the province’s 25,000 doctors, even though the Ontario Medical Association is still in contract talks with the government.
And as suggested in Drummond’s austerity plan released last month, changes are coming to the $4.1-billion Ontario Drug Benefit program, which currently covers the cost of medications for the 1.9 million Ontarians over age 65.
Starting in 2014, the province’s wealthier seniors will pick up more of the bill for prescription drugs, saving the government $30 million a year. Under the plan, about 75,000 seniors with annual incomes of more than $100,000 will pay an average of $665 a year more for the drugs covered by the program.
The changes will not affect seniors earning less than $100,000, those living in nursing homes, or those receiving publicly funded home care.
Some critics fear such income testing could expand to other government programs for seniors. Others say the program may have unintentional consequences.
“Medications play a vital role in keeping people independent,” said Bernard Bouchard, executive director of the Council on Aging of Ottawa. “If seniors can’t get their medication because they can’t afford them, it might lead to more falls that put them in hospital. You may save on the medication costs, but it might increase the hospital costs.”

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