Monday, 15 April 2019

Private Solutions in a Public System

How do you feel about reaching out to the private sector for care or services? I think this is a question we are going to be called upon to answer more and more frequently in the coming years as our population demographic changes. It seems as if our healthcare system is already stretched and limited resources means that wait times for care and services will simply increase. For those that need or want services quickly, reaching out to the private system, for those that can afford it, seems like the next likely step.
This of course means that our system will increasingly become two-tiered but I would argue that to a certain degree, it already is. There are private medical clinics. There are private home health care services. There are retirement homes - all private. All of these services are provided for a fee outside of our public health system. They are responsive, provide quick services and resources, meet a need and fill in some significant cracks in our existing system.
Our current public system has some major holes. There are many who simply can't afford private service and must wait for what our government funded system can provide. For some this means living at risk in the community - needing care they simply can't access, until things worsen enough that they end up in hospital or in a nursing home. This is a problem that will only get worse, stretching our system further. For those on basic pension, this is truly an unfortunate scenario that there is no immediate solution to unless our government looks at innovative ways to resolve it.
But what about those who have the means to pay for extra care? There is an expectation of many that we should not have to pay for healthcare which is indeed what universal healthcare is all about. But what happens when what exists can't meet the needs? Is it fair to close the door to the private options, or simply not present them to people we help even if they can afford them? I ask this because I do know of colleagues who stand by the belief that people should not be 'told' or 'asked' to seek private solutions when our healthcare plan is meant to provide for us.
I would argue that you are doing people a disservice when you do not present all available options - public and private - allowing them to decide if they want to purchase care or services to supplement or replace what our government is able to provide. People need to be given the option of choosing for themselves, and if they can afford private care, it may indeed be their preference and a better option than waiting on the limited services our public system can provide.
When I first started visiting retirement homes many years ago, I was amazed at the stories of people who moved in needing assistance but who, over time, with proper care, nutrition, social stimulation, exercise and medication management, improved and became substantially more independent. If many of these people stayed in their homes, they would have eventually ended up in nursing homes. It speaks to the importance of retirement homes in our system on so many levels - of a private solution to a problem in our public system. So, I ask you, if an option exists that can meet a need, isn't it important to explore it, even if it is private pay?

Monday, 1 April 2019

Ontario's Changing Health Care Landscape

When I first worked as a hospital social worker close to 30 years ago, there were no LHINs, no CCACs, no central processing agency. If you needed to arrange home care for a patient, you called the home care office; if you needed to arrange for a nursing home, you completed an old photocopied form and sent it to every home you wanted and hoped it made it to the top of their pile. There was no standardized waiting list, no organized way of ensuring your patient got the same priority as someone else and no verification that the patient was competent to consent.

When CCACs were created, there was some resistance on our part without doubt. We had to do things differently. There were different forms. More forms. Capacity of an applicant became an issue and something we had to assess for. We couldn't rely on relationships we had created with long-term care homes. And our script for talking to families had to change.  Eventually, we all got on board. There was no choice but also, we eventually recognized that it did make our lives easier and it was a far more patient-centred way of doing things.

And then, about a dozen years ago, came the LHINs. The LHINs were created out of the idea that in a province as large as Ontario, health care should be decentralized. Given that different areas had different populations, it was surmised that those who live, provide services and use those services within a defined community were best equipped to determine where they needed to direct their health care dollars. The concept that one central government agency was not conducive to making decisions for the whole province was why the 14 LHINs were created. Each LHIN was a non-profit entity with a board of directors and was allotted their portion of the health budget to provide health services to their community through hospitals, CCACs, community health centres, long-term care homes, mental health and addiction services.

Another change happened again last year. it was decided that the CCACs needed to be  be disbanded as an agency because of the money spent on unnecessary management salaries, so the agencies that were once CCACs simply became the LHINs. It did not seem to disrupt patients when the transition happened though I'm certain there were jobs lost and it caused some internal agency disruption.

And now with a change in the ruling political party, our province is seeking to get rid of the LHINs completely. In fact, not just the LHINs. We are going to a 'super-agency' model that will house a host of other health care agencies including Cancer Care Ontario, eHealth, Trillium Gift of Life Network, Health Shared Services, Health Quality Ontario and Health Force Ontario Marketing and Recruitment Agency. So essentially, we are going back to 30 years ago; to a system that was flawed enough to require the creation of CCACs and LHINs. Except now we have many more seniors. And more people in general in Ontario. And an established system for some of those agencies that worked well. Yes, there are problems. And a shortage of nursing home beds. And a shortage of  staff/money for home care. And too many people in hospital emergency rooms. There are parts of the system that are broken, but not the entire system. Do they need fixing or scrapping completely? Are we 'throwing out the baby with the bathwater'? Are we really going to save money by doing this or will it cost us far more in the long run? We only seem to be hearing about what is being 'taken away', not about what we will be given to function and live better lives. Will this massive overhaul really result in better service, more service, less people waiting in hospital hallways for beds or service? How will  we transition from one system to another one seamlessly; how do we ensure that people will be adequately and properly served during this time? And what about emerging private sector services; will we end up with a two-tiered system as our public sector gets lost in the monumental changes to the way they do business?

I don't believe there is one easy solution to the flaws in the current system. It's a complex mechanism that can take years to fix, if that is even possible. But to try to fix it, really means to understand it and its complexities by living in it and talking to the people that work in it. There are many, many questions that Ontarians have about this monumental change in healthcare delivery but unfortunately, no one is giving answers to some very fundamental questions right now. I, for one, am worried about what this means for us; for our children; our seniors; and everyone in between.