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.