Questions?

Speaker, through you, my question is to the Minister for Seniors and Accessibility. Thank you, Minister, for your presentation. It was excellent.

The minister has been out to my riding several times, and more recently, we held a round table for my constituents in the seniors’ centre, about a month ago. We talked at that time about the importance of aging in place for seniors. I’d like the minister to expand beyond the time he was allocated today about what this legislation is going to do to allow seniors, not only in my riding but in other communities across Ontario, to age in place.

Well, I would respectfully say, absolutely, we are expanding the health care workforce. Does the member opposite, who voted against the Learn and Stay program that actually ensures we pay tuition and books for health care workers who are being trained in the province of Ontario—to then use that and practise in areas of highest need—that is the question. As we build our health care workforce, is the member opposite for or against that? Because her voting record would suggest that she is against that.

We need to make sure that we expand the program. The member opposite’s suggestion would actually lead to a shrinking of home care providers and home care access in the province of Ontario. I can’t believe there is anyone in this chamber who believes that we need to shrink home care in the province of Ontario. We need to expand it, which is exactly what we’re doing with this legislation.

The back-office support will be a key piece of this legislation to allow organizations that wish to provide in community the ability to do that and make it consistent, so that we don’t have these examples of “in Ottawa, I get three hours; in Orangeville, I get an hour.” That piece will be able to be consistent when we bring it together under one organization.

Home care is such a key part of the health care system, and where governments past—I’m looking right now at what former Premier Mike Harris did. He went into full private delivery of home care. He said it would make it better, faster, cheaper. None of this, of course, came true.

Our home care system is broken right now. There is no question that it’s broken. We have a labour shortage within that arena; there’s inconsistent care for seniors; and this bill will essentially create an arm’s-length agency to oversee home care, with the board of director members appointed by the government. This is also somewhat problematic, given the appointments that this government has made in the past.

How will this bill prevent private companies from taking over public home care services without governance, without any public accountability structure and without public interest protections?

It was interesting listening to the Minister of Health. I certainly agree with her that the demand for home care is increasing, and the number of people who are not getting the home care they need in Ontario is also increasing, exponentially. Does the minister agree that a lot of this has to do with how health care providers cannot recruit and retain a stable workforce? Because PSWs who work for home care cannot pay their rent and feed their kids. Does the minister agree that if we were to give PSWs permanent, full-time jobs with good pay, benefits, sick days, a bit of a pension plan, the 500 PSWs in my community that are not working could go back to doing what they love to do, what they want to do? Is any of this in the bill, to fix our broken home care system?

My question is for the Minister of Health. I know in my riding we have an unusually large demographic of the retired and seniors. I know that this government has committed $1 billion over three years to enhancing our home care experience.

In her comments today, the minister mentioned an increase of $128 million over the next three years to the Ontario health teams and I’m wondering if she can just explain further to the House how this will impact home care for our residents.

My question is to the minister. I got a letter from Cindy, who is a PSW in my riding. She has written, “I make a top wage of $22.50 after 10 years and we are struggling. With inflation we are having to go to food banks or get second jobs.... We actually hold people’s lives in our hands and enable people to live and die in their own homes but can’t afford to eat or live in our own home. There needs to be wage equity across all health care settings. All PSWs, nurses, etc. should make the same across all sectors. We deserve to be treated with respect for the jobs we do because without us how” do “your parents, grandparents or even yourselves live alone if they need care. Something needs to be done now! We need a living wage to continue in this profession and to be treated with respect, period.”

That’s from Cindy, but I’m sure it could be from any PSW: that they don’t feel respected, that they are overwhelmed and overloaded and driven out of the field.

What is in this bill that I can tell Cindy is going to make her life better?

Very quick question, the member from Mississauga–Lakeshore.

Mississauga Centre.

The minister spoke about the 12 Ontario health teams that have been chosen to work together with the Ministry of Health and Ontario Health to start focusing on a seamless transition for people experiencing chronic disease. Something that I’m very passionate about is people living with dementia, so can the minister explain how this transition and the local navigation services will also help patients living with dementia?

I would start by saying that I am quite happy that we will be talking about home care. As the minister of seniors’ affairs said, things have changed in our province: more and more frail elderly people—more and more people—live at home. They want to continue to live at home. They want to be supported and respected to be able to continue to live a good life in their home, and often this is made possible because they receive home and community care.

So do I want strong and robust home and community care? Absolutely. We all do. We all know people—we’re MPPs; I’m sure that I’m not the only one who receives complaints about home and community care, mainly about home care, pretty much every single day. When people get to my office in the morning, they will play the messages from the night before, and I guarantee you that there will be people calling in because of failures of their home care to support them. They will call my office, and I’m sure they call the offices of every other MPP.

Our home care system is broken. It fails more people than it helps every single day. Why is our home care system broken? Let me bring you back to the Mike Harris era, because before the last Conservative government, our home care system was offered throughout by not-for-profit agencies. In my area, it was the VON. VON had been providing home care for decades. They had staff, they had nurses and PSWs and others who worked for them for a career. They made a career of providing home care. They were really, really good at what they did. They shared best practices throughout the province, because if one thought of a better way to provide care, it was shared throughout. They had meetings together. They really tried to make home and community care as responsive to the patients’ needs as possible, and they were really good at it.

Then came Mike Harris. Mike Harris convinced Ontarians that bringing in a competitive bidding process, bringing in the for-profit companies was going to make home care better, faster and cheaper. That was the logo at the time: “Better, faster, cheaper.”

Let me tell you something, Speaker: We know now, three decades later, that none of that was true. Our home care system is not better, our home care system is not faster, and it certainly is not cheaper. But what has changed, though, is that VON in my community went bankrupt. They put in for the competitive bidding process when that happened. Bayshore won the contract and VON lost. They had to let go of all of those nurses. Those nurses that had 10, 20, 30, 35 years of experience working in home care, dedicated to their patients, dedicated to the profession, lost their jobs.

The American company who won the bid was supposed to do things better, faster, cheaper. You read the proposal. It looks like they were trying to have hundreds of Mother Teresas come and work for them for free, to offer all of those services. It was a beautiful thing to read. None of it was true.

All of those people who worked in home care for their entire life lost their job. Then the American for-profit company came in and offered them a job at less than what they used to make with no guarantee of full-time work, with no pension plan, with no benefits. They were not going to be paid in between patients anymore. VON used to pay them from, “You start in the morning, your first patients—we pay you for the whole shift.” Not anymore: “You are only going to be paid when you provide care.”

In my neck of the woods, they would come and show me, “Look, France, we submitted for over 600 kilometres between patients for the last two weeks.” They don’t get paid for that. Do you know how long it takes to drive 600 kilometres in northern Ontario in my riding? All of those hours they do for free. They get 33 cents for their mileage for that. What do you figure happened? All of those people who were good at what they did and who loved what they did, they had no problem finding jobs elsewhere in the health care system.

We all know that the need for nurses is there. It was there back then. They moved. Since then, the for-profit home care deliverers have not been able to recruit and retain a stable workforce. What does that mean when you cannot recruit and retain a stable workforce? It means that you are not able to provide quality home care. It’s as simple as that.

Think about it: You have a home care worker who is there to give you—in my neck of the woods it doesn’t matter how high your needs are, you get two baths a week. You need somebody to help you with the transfer. You need somebody to help you to eat. You don’t get any of this. Home care gives you two baths a week. Well, two baths a week from different providers every week—it doesn’t take very long that grandpa doesn’t want two baths a week anymore. He doesn’t want to have to strip naked in front of a different stranger every single day because they cannot recruit and retain a stable workforce. This is what our home care system looks like.

We have a bill in front of us that looks at changing home care. I sure hope that we take into account the fact that our home care system is broken. One way to make sure that our for-profit delivery of home care in Ontario—Ontario is the only one, by the way, that has privatized the delivery of their home care system. The home care system in every other province is better than ours. We are at the bottom of the list. We are on another page at the bottom of the list, our home care system is so broken.

My question to the minister is that one way to help right here, right now a home care system, to recruit and retain a stable workforce: Make PSW jobs good jobs in home care. Give them permanent, full-time and well-paid jobs with benefits, a few sick days, maybe a pension plan and a workload that a human being can handle and problem-solve.

We now have hundreds in my community alone. Throughout Ontario, it’s tens of thousands of PSWs, mainly women, who love what they do, who are good at providing home care, who would love to work home care if only it would mean enough money to pay the rent and feed their kids, but it’s not. It doesn’t matter how many hours you work home care, you’re not going to be able to pay rent and feed your kids because, even if you have been there for 20 years, the maximum you can hope for is 22 bucks an hour.

Let that sink in: 22 bucks an hour. You start your shift at 6 a.m. You’re not paid for travelling from one care to the other. You will put in a 10-hour day. You will work from 6 a.m. until 4 in the afternoon but only get paid for six, seven hours, if you’re lucky. For those other three hours that you travel between cases, you can’t. And those are those that are lucky enough to have a car because for many people who make 18, 19, 20 bucks an hour, owning a car, paying for fuel and insurance and everything else is not something they can afford. Those people travel by transit, which means it takes even longer to go from one client to the next, and that travel time, they don’t get paid for it, which means that you put in your 10-hour shift and you’re lucky if you get paid for six, at a maximum of 22 bucks an hour.

Can anybody see where we could easily fix a huge part of our home care system? Now, the first part of the bill is that 14 of what used to be CCACs—care and community, which became the LHINs and became the home care and community support services; it doesn’t matter how you call it—will now be called Ontario Health atHome. So we have 14 of them right now. We will be down to one.

Let me give you an example of what it means once things get centralized to one agency rather than others. We have Ontario Health right now, which is putting out a planned procurement. They have a request for proposals—it’s on their website. Anybody can go and see it; so did I. The request for proposal is, “The scope of the” request for proposal “will include supply, maintenance, delivery, set up and pickup of basic medical equipment in the following categories to support patient receiving care at home”—home care, so:

“—beds (beds, rollators, mattresses...;

“—mobility aids,” such as “walkers, wheelchairs,” canes, “etc.;

“—bath aids,” such as “(commodes, bath seats, etc.); and

“—lifts, slings, transfer devices”—the list goes on.

The RFP goes on to say that they intend to award—resulting from this request for proposals—“to a successful bidder that can service the entire province of Ontario. The term of any recurring contract will be for a period of three (3) years, with an option to extend for up to two (2) additional years.” And the request for proposals goes on—it’s on their website; anybody can read it.

When the minister made her statement today, she made it clear that the same type of request for proposals that is presently on the Ontario Health website will also happen for home care providers. So now think about it: We will have home care providers that are big enough to provide the entire province. No matter where you are, they should be big enough to be able to be a provider for the entire province. You know who can do this, Speaker?

One of the things that you can tell Cindy is, in fact, we’ve done the work on stabilizing the health care workforce. It is absolutely important that whether that PSW is working in a hospital setting or in a home care setting or in a long-term-care home, there is a much more consistent approach in terms of remuneration. We’ve done that, and that has been very welcomed in the sector.

But if we want to talk about affordability, perhaps the member opposite could explain to her constituent Cindy why she supported the carbon tax, in fact making her job that much more expensive as she moves using a vehicle, moving from patient’s to patient’s home. Those are the types of affordability pieces that the member opposite and the party opposite don’t want to talk about. There is a cause and effect when you support the carbon tax that was put on by the federal government, which we oppose, and now we’re seeing the outcome, which is, of course, higher tax, higher inflation.

Nurse Next Door?

Interjection.

You’re funny—big, for-profit home care providers. They are the only ones who will be able to answer that bid. You know what that means for the people of Nickel Belt, the people I represent? That means that there will never be people available.

Don’t take that from me; I will read you some examples of my constituents. I will start with the constituents who just contacted my office on October 5:

“Dear France,

“My mother ... had an assessment from the local LHIN today.” Home and community care keeps changing names. “She previously had a stroke in 2019 and then broke her hip in 2020 and then her back in 2021. She lives alone and was receiving four showers per week (often workers do not show up so it can be less than that in reality) as she tries to do everything else herself. She was visited” by “an assessment officer from the LHIN today and the woman said Mom would be cut back to two showers per week since that is the standard.... Mom then called their office and they said she could continue” to have “four showers per week. Then Mom received a call from the assessment officer who visited her in the morning and the woman told my mom, ‘You were fine with the two showers when I was there with you today.’ My mom was given no choice” so that she could say during the visit. “The woman said she would bring the matter up with her boss about the showers.

“I find it very sad that health care staff would put an elderly person through such” difficulty “when her life is already hard enough as it is. It seems like a power play at my mother’s expense. After a stroke, elderly people cannot handle stress the same as before and are vulnerable. Does the province want elderly people to have to go to long-term-care homes and occupy hospital beds when simple services are not available in their homes? Often workers do not show up or called to cancel in the past, so two showers a week will either be one per week or none” at all. “This is the reality of the system. Mom currently has a pretty stable PSW for her four showers per week but if these are cut back this PSW may have to find other work, and Mom will lose out in the end. Having a stable PSW is so important for things as personal as a shower. We are ... entitled to dignity. I hope you can help with this situation.”

That was one example. I have many, many that I could go through.

Maybe I’ll do another one right now. This is from Lionel Rudd, again from my riding—a very nice man. He says:

“Hi again,

“A follow-up to my previous email.... I was anticipating a call from a Bayshore nurse last evening (Saturday) or at least early this morning (Sunday) when I would be informed as to the time of the nurse’s visit.

“I did not receive any call—so I had to phone Bayshore. I was told that someone would call me at 10 ... no call. After 11:30 a.m. I called Bayshore again and was told eventually that a ‘nurse’ was coming on duty at 3 p.m. who would be able to see me.

“At around 2:15 p.m. I received a call from Bayshore telling me that there was no nurse available to see me today—maybe Monday.

“I was told that I was a level 3 patient ... whatever that might mean except that I was not in a critical condition ... and that I could miss the odd visit! Of course none of this was ever conveyed to me ... I had no idea of the whole set-up. It seems that Bayshore is not at all organized and appears that there is a level of management incompetence.

“It is most troubling that Bayshore did not have the common decency to pick up the phone and at least be honest and straight with me. I sat around for many hours not knowing anything. They appear to have an extremely arrogant attitude and uncaring culture towards at least me. I wonder who else goes through the same kind of dealings with Bayshore.

“Maybe you can raise this issue where it counts—or maybe add it to the pile that you already have.

“Best regards,

“Lionel Rudd”—a resident in my riding.

I wanted to share that with you because he is not—we have complaints like this non-stop. I wanted to make the link between having one care-at-home provider and looking for providers who can service the entire province. I’ll just read into the record and then show you how those two are related:

“Dear France Gélinas,

“I am writing to you because I have a growing concern” with Bayshore “not being provided for days at a time to the French River area.” The French River is an area in the south of my riding. “My husband is terminally ill and requires daily nursing for checkup and drawing up of medication. On”—she gave the date—“at 2:19 p.m. I received a phone message from Bayshore telling me that there was no nurse for the weekend, that they would be doing a virtual visit on the phone. I called back to Bay-shore at 2:29 p.m. and left a message that this was not acceptable as my husband needs meds drawn up daily and I missed the nurse that day as I had to go into Sudbury myself to pick up the meds needed for my husband, which meant the meds were not there when the nurse came on Friday....

“I then called my husband’s caseworker, Linda Emms, at the North East LHIN to report this to her. Linda said she would look into it and then called me back to verify no nurse was coming for the weekend. After I verified once again no nurse she then called Bayshore and told them that this was not acceptable, that my husband had to have daily care. Bayshore assured Linda ... that my husband would have a nurse, but no nurse came that weekend. Our nurse practitioner”—there’s a nurse practitioner who doesn’t work for home care who is in the French River area—“Ann Desrosiers came to the house every day that weekend,” on Friday, Saturday and Sunday.

“I followed up with Linda ... on Monday ... and she said she would file a complaint against Bayshore. Our nurse practitioner, Ann Desrosiers, has had to come to our house several times to draw up meds because” the home care nurse does not “draw up enough or none at all or the meds are not here as we are waiting on the delivery. It’s not just my husband that was without a nurse for the weekend but several others in the French River community that some are even sicker than my husband and they did not have care” at all this weekend.

“I had put this letter away for a while but here we are again ... and my husband has no nurse for the weekend. The nurse from Bayshore came today and drew up a lot of (syringes) meds to last the weekend. She told me no nurse” would be coming this weekend. “I did not receive a phone call out of courtesy from Bayshore as of yet. I have left a message again with my husband’s care coordinator Linda Emms at the North East LHIN but have not heard back from her as of yet. Again not just my terminally ill husband without a nurse for the weekend but several other French River residents that require home care will be without home care as well. If Bayshore has a contract to fulfill they need to fulfill it. Maybe Bayshore should make it mandatory that their staff should have to come to the French River one weekend every other month and maybe then French River will have a nurse every weekend. I have cc’ed our nurse practitioner ... on this.

“With kindness...” and she signed her name. She is from Alban in my riding.

I wanted to share that with you because there are solutions available. There is a little home care provider in the French River called Aide aux Séniors. Aide aux Séniors is a not-for-profit group of health care providers who are more than willing to go and help their neighbours, who are more than willing to provide home care on weekends, on day shift, to people who need it.

But do you really think that the little Aide aux Séniors in Alban in the French River will be able to fill out a request for proposals like you see on the website for Ontario Health? No, there’s absolutely no chance of that, Speaker. The only one who will be able to meet the new requirement that the minister was so proud of saying, “Oh, we will have a centralized procurement process to make sure that everybody is treated the same”—what that means for the people in northern Ontario, what that means for the people that I represent, is that more and more people will never have the home care that they need.

That Bayshore will get those contracts I have no doubt. When it comes to writing up proposals, as I said, it looks like Mother Teresa works for them and will be delivering care to every single home care patient in Ontario. It’s just a beautiful thing to read. But in reality, none of this comes through. In reality, they cannot recruit and retain a stable workforce.

Why can they not recruit and retain a stable workforce? Because they don’t offer good jobs. What do good jobs look like? They look like permanent, full-time jobs, well paid with benefits, sick days, a pension plan and a workload that people can handle.

Do you feel like I’m repeating myself a bit there, Speaker? It’s because I am. We have been saying this for a decade now. For decades, since Mike Harris brought us the privatization of the delivery of our home care system, our home care system has not been able to recruit and retain a stable workforce, because they don’t offer good jobs, and people suffer.

Now, for the few not-for-profit home care deliverers that still exist in parts of the province, because the local CCAC, LHIN, home and community care support services, call it whatever you want—they existed locally. They knew the number of complaints they were getting about the people who get the big contract. Bayshore has a contract in my area. They know how many complaints that they get. They know the areas that they’re not able to support and they go, sometimes, out of contract.

Sometimes they do have a small contract with a not-for-profit agency that will service a little pocket. In Nickel Belt, it’s 33 little communities, none of them big enough to be a city. They don’t have a municipality. They don’t have a mayor. But they have good people who live there, who love where they live, who work there, who age there, who become frail there and who need care.

Does Bayshore have a nurse who goes to Westree, Shining Tree, Biscotasing, Gogama, Mattagami First Nation or Alba? No. Do they have the contract for them? Yes. Do they provide care? No.

Things will get even worse with the change that this bill will bring forward because now it won’t be that you have a contract for the city of Greater Sudbury and the little communities around; you will have to sign a contract that is province-wide. Aide aux Séniors is not going to be able to bid on one of those contracts—and neither are the other little home care providers that exist in my community—to help in those little communities. And what will happen to those good people? The same thing that I just read to you, and I have many, many more.

Before I go on to share more of the problems that we already have, I want to talk a little bit about the second part of the bill that would allow care coordinators to be incorporated into other health care providers. This is such a good idea that it is already happening. If you come to Health Sciences North, the name of our hospital in Sudbury, you will see that we have a health and community support—call them whatever you want—care coordinator who works there. We have very good family health teams called City of Lakes Family Health Teams in Sudbury that have many sites in my riding, one in Lively and one in Val Caron. They also have a care coordinator who is part of that family health team.

Actually, the Ontario Medical Association is at Queen’s Park today. They came with three asks. The first was to ask for integrated primary health care teams. They all want to work in an integrated, interdisciplinary team. That means a community health centre. That means Indigenous primary health care. That means nurse-practitioner-led clinics. That means family health teams. That means a place where a physician is not a fee-for-service solo practitioner anymore. They are supported by nurse practitioners, nurses, dietitians, social workers, physiotherapists, psychotherapists, development workers and health promoters who work as part of a team so that they can focus on being a family physician and have the support of the integrated, multidisciplinary team to work with them. That was their number 1.

Number 2: Decrease the amount of paperwork that they have to do. We still have to go to a family physician three days after we feel better to ask them to sign a sick note; it is a capital waste of resources and we could do away with it. An electronic health record that works would be really good.

Then, number 3 of their recommendations to us is home care. They want a strong and robust home care system that meets the needs of the patients, that meets the needs of the patients where they are. Those care coordinators should be available to most integrated primary care teams, but they are not.

We all know that the government has dedicated $30 million to new integrated primary health care teams. We expect those 17 teams to be announced any time now. Well, Ontario has 15 million people. What do you want 17 teams to do? We need 25 times that amount. In the northeast alone, we could use that $30 million and those 17 teams, never mind the rest of the province.

Just to put an emphasis as to how important home care is, you have a group of physicians represented by their association. The Ontario Medical Association represents 42,000 physicians, and what are they asking us for? They’re asking us to fix home care so that they know that if their patient needs somebody to help them transfer from their bed to their wheelchair, or somebody needs help to transfer into the tub or onto the toilet, or needs help with feeding themselves or changing beds or whatever, the service will be there. This is what their patients want. This is what the OMA and their 42,000 members came to Queen’s Park to tell us, but none of that is in the bill.

The bill talks about basically creating province-wide home care, Ontario Health atHome, and then that would be responsible for procurement of home care services. Let me tell you that the inequality that you see—somebody who gets assessed and scores an 18, 20, 21 or 22 in my riding gets two baths a week. That’s all they have resources for. Somebody in Ottawa who gets assessed for a 21 or 22 will get a whole lot more. They will have one or two hours of home care a day. They will get two or three hours of respite per day for their family caregiver.

It’s not because the people in the north don’t know that the need is there; it’s because there is no money. If you look at the home care and support services, some of those agencies—not on the home care side, but on the support services side—there are still lots of not-for-profit agencies that do that work. They haven’t seen a base budget increase in 12 years. That is when the Liberals were in power. For the last five and a half years that we’ve had a PC government in power—they have not seen a base budget increase for 12 years. Has the demand for their services increased during that period of time? Absolutely. Has the cost of providing those services increased during that period of time? Absolutely. Have they seen any of this actually acted upon by government after government? Absolutely not.

And now we see a bill—there is money in the bill, $122.2 million, that would be to help the teams learn to work together. There’s nothing wrong with helping teams work together, but that doesn’t provide one hour of home care to anybody who needs it. That does not provide one extra bath a week to people who would like to have more than two baths a week, because they know full well that for at least one of those two, the PSW is not going to be able to show up. Having one bath a week—I couldn’t live like that; I can guarantee you that. Why are we asking frail elderly people and people who need home care to live like this? Why aren’t we able to show them respect? Why aren’t we able to meet the needs where they are? This is what people are asking for.

The minister also talks about new models of care. So rather than being paid for—you get 50 bucks to send a PSW for one visit to Mrs. Such-and-Such to do whatever needs to be done—usually a bath—and leave, and Bayshore gets 50 bucks, the PSW gets $8.50, and end of story.

Now there’s what they call care bundles. A lot of people have heard about total knee surgery. A lot of people have heard about total hip replacement, total knee replacement. The care afterward is being standardized. After you have a hip replacement, we know that you will need somebody to come and change your dressing. For a hip replacement, you used to have to stay in the hospital for 10 days, then you stayed in the hospital for seven days, then you stayed in the hospital for four days, then you stayed in the hospital for two days. Now you go home that day—yay! Nobody wants to stay in the hospital. You go home with home care. So we know that you will need somebody to come and change your dressing. We know that you will need access to a physiotherapist so that you regain strength, balance and range of motion. We know that you will need support from a PSW to make sure that you do your transfer in and out of bed, to the toilet, to the bath etc. Now they bundle that care together.

So now Bayshore will get an amount of money to look after you after a total hip replacement or total knee replacement that includes that we will have at least four visits by the nurse, three visits by the physiotherapist and 10 visits by the PSW to look after you as a care bundle after you have your hip replacement. That all makes sense. The first visit, the physio will do the assessment; after the second, we’ll make sure your range of motion is coming; and by the third, make sure the strength and balance is back. The nurse will go make sure that you’ve had the dressing changed, make sure that the staples came out when they were supposed to come out. The PSW will be there to help you with your bath while you have a big bandage on your hip, blah blah blah. It all works—on paper. Bayshore gets paid to do all of that.

How much of that do they deliver? Very little. How many people who were put through the bundle process actually got what the bundle was supposed to include? Very little.

Did you know, Speaker, that 25% of the people who have a hip replacement will never walk again if they don’t have access to physiotherapy? Let that sink in. We do those expensive surgeries so that people can continue to be active, and 25% of them won’t be able to walk again—never mind going up and down the stairs or on an incline or on uneven ground—if they don’t have access to physiotherapy.

But, coming back to Bayshore, who now gets a bundle of money to offer the four visits from the nurses, the three visits from the physio, the 10 visits from the PSW, because this is what you need to make a good recovery from your hip replacement—well, they had one physiotherapist, but she has been on maternity leave for the last two months, with a brand new, very cute little baby, and is not available to work. The nurse never came to change the dressing. The stitches got infected. You had to be admitted back into the hospital and treated because we were afraid you were going to get septic because your stitches were badly infected because the nurse never came to change the bandages. And the PSW did come some of the time. She was not supposed to change the dressing. She ended up lifting the dressing because it didn’t look too good and had been there too long, and she’s the one who said you had to go back to the hospital really quickly. Bayshore got the money for the bundle of care.

This is supposed to be the innovation that comes from this new way of providing home care, but this innovation has already been tried here in Ontario. But because we have for-profit companies who dominate the home care system, the for-profit companies’ number one objective is to make money. They exist to make money for their shareholders—and they do, in the hundreds of millions of dollars for their shareholders, at the expense of not being able to recruit and retain a stable workforce because they don’t provide good enough jobs to allow PSWs to pay their rent and feed their kids.

Interjection: So out of touch.

This is completely, completely out of touch.

The new care pathways that the minister was talking about have been tried, and they make sense on paper. We know what a patient needs after a total hip replacement in order to be able to stand up, walk, do stairs, walk on an incline, walk on uneven ground. We’re talking Ontario here. There’s not a physiotherapist in Ontario that does not know how to make sure that their patients know how to do that. There’s not a nurse in Ontario that does not know how to change a dressing. There’s not a PSW in Ontario that does not know how to transfer somebody into a bathtub. But this can only happen when the people they work with are able to recruit and retain a stable workforce, and this only happens when the for-profit companies put the wellness of the patient ahead of the payments to the shareholders. But that’s not what’s happening in Ontario. The shareholders always make up; the patients suffer and so does the staff who work there.

The Ontario health teams right now in Ontario include hospitals, long-term care, primary care, mental health, palliative care, and now we will add home and community care. In theory, all of this makes sense; all of those people should work with one another. A patient who goes through an episode of illness, of sickness, of injury, of surgery or whatever, they may very well very well need from one to the other, and to have them work as a team makes sense. But when you look at what the team looks like—I will take the team in my neck of the woods, in and around Sudbury. The team starts in Manitoulin Island, goes all the way to the French River and north for about a four-hour drive. What do the people of Alban have in common with the people of Manitoulin Island? Absolutely nothing. I bet you they could not even name the names of the hospitals on Manitoulin Island, but they are in the same team. That’s not a team. A team are people who know one another, who care for the same patients, who work together, who refer to one another. None of that is happening in my neck of the woods. It’s a team on paper. But what will happen is that more and more parts of that team will be for-profit delivery, because right now, our hospitals, most of them—152 out of 156—are not-for-profit hospitals. Most of the palliative care is not-for-profit. Most of the mental health and addictions are not-for-profit. Those are three partners, but the other partners are for-profit.

Long-term care: Ontario is the only province where—remember Mike Harris?—where long-term care is dominated by the for-profits. We all know what that means. That means that, in the last three quarters, Extendicare paid $300 million through their shareholders. That’s $300 million that never saw the bedsides of the people. That means that every Extendicare home in Ontario—I guarantee you that those workers were short because there was not enough staff, because they were working really hard to try to meet the needs of their residents in situations that are really hard. Long-term-care homes are part of those teams.

We also have primary care. A lot of primary care is not-for-profit. But I’ll make a parenthesis around primary care: It is very different for physicians to run their own small business, because they’re one on one with the patients. They know what their patients need and they have a relationship. This is really different from Extendicare shareholders, who have never set foot in one of their homes, who don’t know any of the staff, who don’t know any of the patients. Do they care or not? It doesn’t look, from where I’m sitting—maybe they do. But they care about the $300 million that they get in dividends. They care an awful lot about that.

So now we’re bringing in the home care—home care that has been dominated by the for-profit companies. You start to see a bit of a—hmm.

Interjection: Pattern.

I see a further opening of the door to for-profit delivery, so that the people who will receive the money on behalf of the teams—because the teams don’t have their own boards of directors; they don’t have their own executive directors or anything like this. They are made up of different health care providers, and in some of the teams, it will be a for-profit long-term-care home that becomes in charge of the entire team. I am really worried about this. Nothing good will come of that. More money will go to shareholders, and less resources will be available for the ever-increasing needs in our health care system.

We have a bill in front of us that aims at changing home care. Does home care need to be changed? Yes, absolutely. We cannot continue the way things are. Is there anything in the bill that will change home care so that it focuses on the patients who need care? Absolutely not.

I will share into the record a few more of my constituents who are receiving home care and reaching out to me—all of those have been shared with the Minister of Health, and the Minister of Long-Term Care sometimes, depending on the situation.

“Dear Minister Jones,

“I am writing to you today as a deeply concerned parent whose son has received substandard care from the Bayshore nursing agency. It is my duty to bring to your attention the alarming situation within the current system of utilizing contract nursing agencies to provide care to students requiring G-tube feeds and/or hydration while attending school in the Sudbury region. To outline the current practice, a care coordinator with Home and Community Care Support Services performs an assessment and allocates the appropriate number of visits which is then contracted out to an external nursing provider. This practice dates to a PPM from 1984, which indicates that G-tubes will be managed by a nursing provider and not school personnel. I would like to mention, that as a registered nurse with over 20 years of acute care experience, I expressed concerns about having an external provider come in to set up the feeds or hydration and then leave my son with individuals that have no training regarding G-tubes. They told me that I was anticipating problems where none existed, and the current system would remain as it was.

“I have tried to work within the broken system for over two years but, unfortunately several situations have occurred which have led me to write to you to advocate for my son and others in his position. There have been instances when the assigned nurse would not be able to visit, and the agency could not find a replacement. When this occurred, it was my responsibility to leave work and provide the hydration or nutrition to my son. There were days when I had to leave work three times to manage my son’s G-tube feeds and hydration. There were also instances when the school would call to say that the nurse set up the treatment and left, and now the pump was ‘beeping,’ and they were not sure what to do. It was very puzzling to me that the nurse and Bayshore were allowed to bill for a one-hour visit with my son and be billing for a visit with another client at the same time and were not available to attend to my son. The stress of this was a contributing factor leading to my resignation after 24 years of being gainfully employed” by “the same employer.

“The most concerning event, however, occurred on June 8, 2023, when my son came home dehydrated after receiving none of his required hydration and nutrition that day. He came home with a dry diaper and did not void until much later that evening. The nurse from Bayshore had contacted me earlier that day and said that his pump did not seem to be working properly. Unfortunately, I could not get to the school that day, so I tried to troubleshoot some solution with her and instructed her to make sure I was contacted if there were more issues. Another nurse attended the remaining visit that day and just kept adding more fluid to the bag, but none of the solution infused. That nurse did not follow up or contact anyone about the issue. I had to keep my son up late that night to administer the fluids he had missed.

“I was in contact with his regular nurse, and I instructed her to submit an incident report for this event and informed her that I expected to hear back from her manager about a resolution to ensure this would not occur again. She suggested that I call the manager, but I informed her that I would instead be calling the care coordinator at Home and Community Care Support Services. I followed up with my son’s care coordinator, and she sent a clarification to the nursing provider, Bayshore, indicating that they must stay for the entire duration of the treatment. They did not end up changing their practice before the end of the school year and I never received any correspondence from the manager of Bayshore. The care coordinator sent another clarification to the provider over the summer and a third reminder was sent in mid-September as the nurses were still not staying for the duration of the treatment.

“On September 14 ... I received a call from Jennifer, the nursing coordinator at Bayshore, to notify me that because of the instruction indicating that the nurse needed to stay for the entire hour, all the nurses were refusing the visit. I asked for more clarification, and she said that even though the nurses are scheduled for the hour, they ‘can’t stay because they have other places that they need to be.’ I asked for further clarification and said, ‘Just to be clear, you are telling me that all the nurses are refusing the visit if they have to stay for the entire time that they are being paid for?’ She replied, ‘Yes.’ I then told her that I would be reporting the nurses and agency to the College of Nurses as this was not ethical. I then called Bayshore back and requested to be transferred to the manager and left a voicemail expressing my concern and requesting a return phone call.

“I have still not received a phone call from management at Bayshore. I have two major concerns with the above-described situation that I would like to bring to your attention. Firstly, I cannot understand why the school board would continue to follow a PPM from 1984 and not consider that there could be better ways of providing care to students with a G-tube. Secondly, I have grave concerns about the nursing standards upheld by Bayshore and question if they should still be considered the province’s preferred provider.

“I want to expand on my concern with the current practice of utilizing a contracted nursing provider to administer G-tube feeds to students while at school. Firstly, this practice is dangerous as it leaves the students in the care of teachers and EAs who have no knowledge or training regarding the management of their G-tubes and feeds. This model is also not client-centred and does not promote inclusivity. The individuals caring for the student all day cannot adjust to meet his/her needs and students cannot participate in all activities if they conflict with the timing of a nursing visit. Another issue is the stress this causes for the student’s caregivers. It is incredibly stressful to know that if there is an issue with the nurse’s availability, your child may not receive any hydration and/or nutrition if you cannot make it to the school. Lastly, the system is very wasteful on our province’s scarce resources....

“I would also like to expand on my concern with Bayshore’s business practices and their status as a preferred provider in Ontario. It is genuinely concerning that the agency and nurses are being permitted to bill for care which they are not providing. This incentivizes nurses for providing quick visits and does not promote high-quality, client-centred care. I feel that the privatization of nursing services in the community has led to a decline in the quality of care provided, which is endangering the well-being of Ontarians who require health care services at home. If this private system is to remain in place, the province must impose strict standards and regulations to ensure the highest quality of care for all patients. Moreover, a more equitable system should be established, where multiple agencies can bid on contracts and providers are selected based on their merits, rather than favouritism. Allowing clients to choose their providers will motivate them to fulfill the contracts properly and have their staff provide good care, instead of trying to maximize income by ‘double billing’ or turning down less profitable contracts.

“It is crucial that we urgently address these issues. I implore you to consider implementing reforms in both the system of hiring contract nursing agencies to provide care within the school and the practice of giving preferential treatment to a single agency.

“I trust that you will recognize the gravity of this situation and take immediate action to rectify these concerns. The well-being of our most vulnerable citizens is at stake and it is our moral obligation to provide them with the care they deserve.

“I appreciate your attention to this matter and look forward to hearing your response and proposed actions.”

And it’s signed by the mother.

I wanted to read this letter that she has written to the Minister of Health and to directors, because those are real-life examples of people who depend on our home care system, of people who have front-line views of our broken home care system. Everybody agrees that this child needs G-tube feeding. Everybody agrees that Bayshore will be paid for an hour to deliver that care. Bayshore never stayed, the nurses never stayed for an hour. They hook him up, and they go. The systems start to beep and now the mother or the dad needs to leave their work to come to school to make sure that they can fix whatever is wrong with the G-tube feeding machine. There are so many ways that we could make this better.

PSWs, the mental support workers handle G-tubes in group homes; why can they not do this with kids in school? Why is it that when she confronted Bayshore and said, “You are being paid for a full hour, but you will not stay for the full hour,” they said, no, they cannot find a nurse who is willing to stay for the full hour, because, in order to make money and make ends meet, they will receive the money for a full hour but just set up the G-tube feeding machine and go on to the next patient. If that does not convince you that our home care system is broken, I don’t know what will.

The bill—I see that I’m running out of time—has two parts: the first one is to create Ontario Health atHome, which, again, will centralize all of the decision-making process regarding providers at the provincial level, which means that little, community-governed not-for-profit agencies that provide good-quality home care in little communities throughout Ontario will never be able to win any of those bids. They won’t even have the capacity to answer the requests for proposals that come from Ontario Health atHome. The big, for-profit companies—Bayshore, the care partners: They will fill that up and they will be the ones who will have the contract. That means further privatization of our already very privatized home care system that fails more people than it helps every single day.

The second part, where we bring those home care providers into Ontario health teams, does the exact same thing, Speaker: further privatization of our Ontario health teams. The Ontario health teams’ having health care providers work together, whether it’s hospitals, long-term care, home and community care now, mental health and addictions, palliative care and primary care—it makes sense that those care providers work together, but it also has to make sense at the local level. In order to work together, they have to be within a geographical area that makes sense. Linking in the same team people who live a six hours’ drive away on a good day in the summer—because in northern Ontario, we’ve already had snow; we’ve already had highway closures—makes no sense. Do we want hospitals and long-term care and primary care and palliative care and mental health and addictions to work together? Yes, but we want them to work together in a geographical area that makes sense.

Also, there is nothing in there that would provide for maintaining what’s culturally appropriate and made in northern Ontario. That means that the few francophone health care providers that we have will now be part of huge English Ontario health teams. They don’t want to be part of this. They’ve tried to refuse and stay out of this as long as they can because they know full well that once they are part of a big English Ontario health team, it will become almost impossible to continue to serve the French population that exists in my riding and elsewhere.

There’s lots that needs to be done in home care. This bill doesn’t do any of it.

Thank you to the member opposite for her comments. I listened intently and the strangest thing is that we were in the Ontario Medical Association thing at lunch and the member was talking about how important team-based care is; the OMA was talking about how important team-based care is, and what this bill is about is moving home care into Ontario health teams, which are team-based care.

The member seems to think that this does nothing to improve home care, but Sue VanderBent, for example, and Matthew Anderson say it will help transform the delivery of home care by making home care part of team-based care through Ontario health teams. This bill is getting us to that point.

Will the member not stand up and support this? Or does she love the status quo, which she says isn’t working, so much that she won’t support us improving the system?

The member opposite talked about how there’s no money in this bill. I think she said $122 million, but it’s actually $128.2 million, and that won’t provide a single bath for a single senior. Does the member want to perhaps elaborate about the $1 billion that was in budget 2022 over three years, including $569 million brought up to the beginning, that she neglected to mention that will provide baths for seniors?

Questions?

I want to talk about an example of what happened in the long-term-care system, because the Ontario health teams now, as was pointed out, oversee that.

This is a CBC article from October 5, 2023, and I’m going to read:

“Less than a year after the province heralded its opening as a safe option for seniors, a new long-term care home in Owen Sound ... has been forced to close its doors to new admissions due to serious problems found during inspections.

“The province’s Ministry of Long-Term Care issued a cease of admissions order to Southbridge Owen Sound on Aug. 16 due to ‘significant instances of non-compliance,’ a spokesperson for the Minister of Long-Term Care said. Inspection reports show those issues include residents wandering away from their rooms or the facility altogether, as well as a report of a resident lying in a room with urine on the floor left with no way to call for help.”

How do we trust that this government is going to get health care right if they can’t even get long-term care right?

The Ontario Medical Association is at Queen’s Park today and they want more interdisciplinary primary health care teams; that is, a physician who works with a nurse practitioner, with a nurse, with a social worker, with a dietitian, with a physiotherapist, with a psychotherapist, with a health promoter, with a community development worker as part of a community health centre, as part of a family health team. They were talking specifically about primary care.

So, primary care of interdisciplinary care teams? Yes, absolutely. We need those, the sooner, the better. This is but one little component of Ontario health teams. Ontario health teams look at hospitals, look at long-term care, mental health and addictions, palliative care, primary care and home and community care. The physicians were not talking about Ontario health teams.

Ontario welcomes the for-profit company in long-term care. The for-profit companies are able to give hundreds of millions of dollars to their shareholders at the expense of quality care. The pandemic showed us how bad that was: people dying of starvation, people dying of dehydration, people dying because they’re covered in bedsores because they haven’t been changed.

Ontario knows better than that, and that’s no more for-profit in long-term care.

Pendant l’heure que je viens de passer, j’ai lu extrait après extrait de lettres des résidents de Nickel Belt qui démontrent que, dans les petites communautés, c’est Bayshore qui a le contrat; dans les petites communautés, ils ne sont pas bien desservis parce que celui qui a le contrat, Bayshore, n’est pas capable de recruter du personnel pour aller y travailler.

D’avoir maintenant un organisme provincial pour s’occuper des services à domicile va rendre ça pire, pas mieux, que ce qu’on a là.

I quoted the minister who had quoted $128.2 million over three years at $2.2 million per team to help the teams work together. That’s the comment that I had made.

I also made the comment that home and community care have not seen a base budget increase in the last 12 years; that is the five and a half years that this government has been in power as well as when the Liberals were in power. This is a very long time where the needs of residents have increased, the demand for those services have increased but those little, mainly community-based not-for-profit agencies have not seen a base budget increase.

C’est un plaisir de continuer le débat avec la députée de Nickel Belt.

Ce projet de loi devant nous propose de remplacer des réseaux locaux d’intégration de services avec un nouvel organisme. Le nouvel organisme s’appelle Santé à domicile Ontario. C’est quelque chose qui a été demandé par des professionnels : de remplacer les réseaux locaux d’intégration de services avec quelque chose de nouveau.

Est-ce que la députée est d’accord avec les professionnels qui veulent remplacer les réseaux locaux? Est-ce qu’elle est d’accord avec ces professionnels?