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?

Thank you so much to the member for Nickel Belt for those remarks. I don’t think there’s a person in the House who understands our health care system better than the member for Nickel Belt. The government would do well to listen to her.

I’ve been speaking with organizations in Ottawa West–Nepean that are providing not-for-profit home care and community care services—Carefor, the Olde Forge Community Resource Centre, Jewish Family Services, Meals on Wheels—and all of them are struggling so much due to the underfunding of these home care and community care services by this government. They are struggling because, yes, the government promised additional funding but then hasn’t delivered it, so they are bleeding money every single month, waiting for this money to actually flow. They are losing staff every month because they can no longer compete with other sectors. The staff feel like they are being asked to do the impossible, to fill in the gaps of the social safety net this government has broadened.

My question to the member from Nickel Belt is why should anybody trust this government’s changes on home care and community care when they’ve done such a bad job managing the system to date?

Everybody will remember two weeks ago, on September 25, the day we were back at Queen’s Park, there were 10,000 people on the front lawn of Queen’s Park asking this government to not further privatize our health care system. They came from all over the place. Not one member of the Conservative Party went and saw their constituents out there. There were people from North Bay, people from Timmins, people from Sault Ste. Marie, people from all over Ontario. They were asking us not to further privatize our health care system.

This bill continues to open the door to privatization. The small, not-for-profit agencies that the member mentioned have not seen a base budget increase in 12 years. They need more money in order to meet the needs of the people of Ontario.

Questions?

Questions?

To the member from Eglinton–Lawrence: In Niagara, many residents have expressed concern about privatization of our home care system. While other provinces, like BC, choose to reinvest in their public health care, Ontario has looked to privatization. Seniors who built our province and have supported health care for a lifetime with their wages want to know public health care will be there when they need it the most.

Niagara has a mix of not-for-profit care providers. Speaker, to the member: Why doesn’t the bill explicitly prevent for-profit entities from dominating the home and community care sector in regions like Niagara, ensuring patient care remains paramount?

I’ve enjoyed the debate this afternoon very much. I like this bill and everything I’ve heard so far. Can the member from Eglinton–Lawrence tell us what other steps the government is taking to ensure people in my riding and across Ontario have access to home care when they need it?

I listened to the member’s comments closely, and I’m going to ask her, through you, Speaker: Given that the government is proposing this billion-dollar expansion in home care, how does the member feel about the fact that we have an Auditor General report that tells us that we lose as much as 32% of every dollar we invest in home care when we do it through for-profit agencies? And what is the government’s answer to a guy like Paul, a home care attendant I met in a grocery store the other day who tells me that when he travels around the city of Ottawa—he doesn’t have a car; he uses transit—travel is not covered?

As the member from Nickel Belt said, in three different pieces of home care legislation offered by this government, no one is covering Paul’s travel. He is looking in on neighbours; he’s looking in on people with disabilities and seniors. My question to the member: Why are you allowing 30% of the government funding to be lost to for-profit agencies, and why aren’t we covering Paul’s travel? Doesn’t that matter to you?

I work in the ER, and one of my biggest pet peeves when I’m filling out that CCAC referral for my patients is that I actually don’t always know if or when that home care nurse or PSW will actually come to change the wound care or provide the care that I know that patient needs. Sometimes they do not come, and then the patient ends up right back in the emergency room two or three days later.

Can the member please elaborate on how this particular bill will solve that issue by putting home care right into Ontario health teams, which we have started the transition to through the People’s Health Care Act back in 2018? And how are we continuing taking significant milestones in investing in home care and in other programs like paramedicine, which is another very successful program that has worked in my community? Can the member elaborate on that, please?

I thank the member opposite for the question. I really don’t know where the member is getting this. This bill has nothing to do with privatizing anything. This bill is about making sure that we have home care services to deliver throughout the province, and making sure those home care services are the same, as the minister said, for every part of the province and that people get the home care that they need and are looking for. That’s what we’re here to do.

The opposition seems to focus on issues that I don’t think are what people are focused on. What I think people are focused on is making sure they actually get the home care that they’re looking for, and that that home care provides what they need so that they can stay in their home as long as possible.

We’ve all talked about the importance of integrating care, and making sure it’s connected and convenient and that there’s one care plan. That’s what people want. They don’t want to have to go to several different places. They want their health care providers to know that one health care provider is saying that they can rely on that care plan going forward, and so that’s what this is going to do: It’s going to bring it home.

But there’s also that billion dollars that we’re investing in home care, to make more home care available across the province of Ontario, which is a huge investment in a sector which never gets enough. This is the first government that stepped up and put a billion dollars into it.

This bill, like some of the other bills, is about changing the structure of home care and integrating it into our Ontario health teams, so that home care and community care are a fundamental part of our health care system, where it should always have been. It is now going to be integrated and part of the entire system, and that is where it should be, because that way, home care will get the attention it deserves.

The whole objective of this program is to make sure that everything is continuous and seamless for the patient, and also to make sure that the patients have the care they need at home, so they can stay healthy, so they don’t have to come back to the hospital in a few days because they didn’t get the bandage changed or whatever care they needed at home. It’s working very well at Southlake, and it’s a model that we can look to. The virtue of these Ontario health teams is when one Ontario health team has a good idea that works, it can be shared with others.

Questions?

Kind of in line with what the member from Mississauga Centre just said, we know that our home care system fails more people than it helps every single day. There’s more of a wait-list to get the home care you need and more missed appointments than in any other parts of the health care system put together. We know how to fix this.

How do you fix this? You make the PSW job a good career. You give them a permanent, full-time job with good pay, benefits, sick days, a pension plan—

Travel costs.

The member opposite who asked the question, the member from Nickel Belt, whom I respect a great deal, who has been here for 16 years, knows that not everything is in each bill. We don’t do that. We don’t reiterate all the promises in every bill and discuss everything at once. So it’s kind of a disingenuous question, I think.

Interjection.

We know we have more work to do, but part of what we’re doing here with this bill, with Ontario health teams and with the expansion of interprofessional primary care teams, is making sure that the care is provided within the integrated context of a team so that the PSWs can have better schedules, can be part of a team, can have people to talk to, can talk to the nurse or the doctor or the other care providers and be part of a team and not be isolated. So, it’s not just about the money for the PSWs. That’s part of it for sure and that’s why we raised wages, but it’s also about better work conditions.

Everybody wants to make sure when they need home care that it’s going to be there when they need it. We all want that. I have constituents too who want to make sure it’s there. We want to deliver it for them. That’s what this is about.