Question?

I always like to stand up here and tell the truth, and I’m not really sticking up for the Liberals, but the reality is, under Mike Harris, you laid off 6,000 nurses—let’s be clear on that—and you closed multiple hospitals. So let’s at least be accurate and tell the truth on that particular issue.

I see the labour minister is here, so I’m going to ask this question to the Liberal, hoping that he hears me. This bill does not guarantee that the Ontario Health atHome workers will be unionized or full-time positions with real wages, real benefits and pensions. So my question to the Liberal—either one; it doesn’t matter who answers: Do you believe that people who work in home care should be unionized, should have full-time jobs, should be respected, should have pensions and belong to a union? If you want to improve wages, you need to join a union in this province.

Well, that’s a bullet point on a leadership commitment; that is not a full-out bill.

When I asked ministry officials to explain how they were going to deliver on those business power words, they couldn’t tell me.

And while we’re talking about the things that have or not been done, let’s talk about what this government has accomplished. It has accomplished 2.2 million Ontarians without a family doctor. It has accomplished a backlog of medical services that exceeds 22 million. It has accomplished rampant ER closures in almost every community across this province, including in the Minister of Health’s own riding. That’s not a track record to be proud of.

Madam Speaker, through you: I would invite members of the government to tell me exactly how they propose to actually deliver integrated connected care, apart from just listing bullet points and finding things off websites.

I would like to direct my question to the member from Don Valley East. I understand that he’s a doctor, and his question was about what this government did to extend primary care, or how many millions of Ontarians don’t have doctors—and I would like to put the question back to him. I am one victim of this. My wife took seven years outside the province to be able to get her licence here. She is a doctor. It took her 10-plus years to be a doctor in Ontario. When we connected to the Minister of Health at the time, who was a Liberal, he said, “We can’t do anything. We don’t have the spots.” Not only that, all the IMGs across the country had 24 spots—to get an internship in this country, during the Liberals’ time.

Questions?

Response?

Mountain.

But she did talk about creating another team, and we’ve heard already in the House—we see the access to OAP and what that’s doing, and it’s really not creating any help within the system. There is no assistance to ensure that people are getting the services they need when they need them.

Also, she’s not thinking about the diversity across this province. We heard from the member from Mushkegowuk–James Bay that the services out there are completely different. People need doctors; they need family health care. Instead, they’re creating bureaucracy.

Now, we’re moving from 14 organizations to a single-organization model, and this is going to provide a strong and centralized foundation to support the stability of the home care services now and into the future.

The Ontario Health Teams—they’re going to be taking on the responsibility. The organization would provide ongoing operational supports and care coordination to those teams. This is not a layer, but a support partner for OHTs, and planning and delivery.

This being said, in the past, the opposition has voted against our government’s proposals to make health care delivery quicker and more reliable now for constituents in your community.

So I ask the member from Hamilton—

Thank you to the member from Niagara Falls. I said in my statement today that this was created by Mike Harris, and we’re seeing, just in that family alone, the money that is being made. The people across the long-term-care system, the for-profit—we’re seeing the money that is being made and what that does to the seniors’ care, and every little thing that’s extra, the seniors are paying for once again. I don’t know where the government thinks that seniors who are living—and so many of them below the poverty line are expected to be able to pay for services without the support necessary.

So it’s for-profit. It’s making a lot of people very rich. But it’s not helping the people it’s supposed to serve.

So there are so many challenges that people who need these PSW services face that are just not taken into consideration by this government. When you have a for-profit system, the shareholders and the stakeholders are only there for profit. At the end of the day, they want their return and it doesn’t matter, by the looks of it, what system is given to the province of Ontario. Patients and seniors and people with disabilities in our province deserve so much better than to be put at the end of the line and profit at the beginning.

So I’m not sure where it is confusing that we don’t trust them to put forward legislation that actually benefits the people of this province. We have serious concerns with pretty much every piece of legislation that they put forward, and that’s not just because it’s theirs, it’s because of what it’s written in: It’s written in the people of Ontario’s blood. It’s a mess. It is a mess, and we have seen it time and time again.

The government needs to get off the privatization track and actually invest in public health care instead of breaking it.

From reading this bill, it looks like it completely leaves open the service delivery arm of home care to private, for-profit companies. We know that private care almost always leads to worse care. We saw that in long-term care, where 6,000 of our seniors died in long-term care, but 78% of them died in private care. Could the member discuss why this government would allow private companies to continue to control home care in this province after seeing what’s happened in long-term care?

I’m honoured to rise on behalf of the residents of Ottawa West–Nepean to speak about Bill 135, the Convenient Care at Home Act. This bill amends the Continuing Care Act to create a subsidiary of Ontario Health called Ontario Health atHome, amalgamating the 14 current Home and Community Care Support Services into a single agency that will be responsible for home and community care services in the province.

I just want to clarify for my constituents that what we’re talking about here is the agencies that used to be called community care access centres, then local health integration networks, then Home and Community Care Support Services and now Ontario Health atHome. That’s a lot of name changes in just six years—I hate to think how much money has gone to updating business cards and letterhead—and the result is that, when constituents talk to me, they usually end up picking one of the names and then tagging on, “or whatever it’s called now.” If one of the goals is easier and simpler access to care, I’m not sure another name change would have been at the top of my list, but here we are.

Last year, I had the opportunity to tour the Queensway Carleton Hospital in my riding of Ottawa West–Nepean, an important institution which provides incredible care to residents in the west end of Ottawa and the Ottawa Valley. Dr. Falconer, the CEO of the Queensway Carleton, made a point of taking me to the acute care for the elderly unit, a relatively new unit at the hospital. He told me that the acute care for the elderly unit was created because a significant number of the admissions to the Queensway Carleton are seniors, and they know that every day that a senior spends in a hospital bed they are 50% less likely to ever live independently once again. The acute care for the elderly unit works incredibly hard to shorten hospital stays for seniors to get them up and moving again, get them back on their feet as quickly as possible so that a hospital stay doesn’t rob seniors of their independence. But oftentimes, going home safely means having home care and community care services available, and this is where the system is breaking down, Speaker.

Earlier this year, hospital CEOs in eastern Ontario sent a letter to this government, and I’m going to read it to you. It’s addressed to the Minister of Health: “We, the undersigned representatives of acute care hospitals in eastern Ontario, are writing in support of Ontarians who require community support services to live at home.

“We clearly understand both the challenges and the potential of our health care system. The sustainability of supports in the patient’s home and in the community is critical to our ability to effectively respond to the acute care needs of our communities.

“Community support services are a key part of a proactive and responsive solution to health care pressures. We are writing to raise the alarm that a robust, well-funded community support sector is required to respond to the needs of Ontarians, in partnership with hospitals. Without realistic and meaningful funding to community support services, patients in our community will suffer and acute care hospitals will continue to see growing numbers of ALC patients.”

It’s signed by 12 CEOs of acute care hospitals in eastern Ontario, including Dr. Falconer of Queensway Carleton.

These CEOs signed this letter because they understand that when we don’t have a strong community care sector, more patients end up in the hospital and they stay in the hospital longer, because the supports are not there to get them home. Our hospitals depend on a strong home and community care sector so that patients can go home safely, with the supports they need to help them on their recovery journey. But you would never guess that from the way this government funds home and community care, Speaker. The sector is so vastly underfunded that they are in crisis, and what funding the government has promised they don’t seem to be able to actually get out the door, deepening the crisis and pushing organizations to the brink of collapse.

One executive director of a not-for-profit home care organization told me this summer that he’s not sure how much longer his organization can keep subsidizing the government as they wait for promised funding to flow. He is warning of collapse. What I am hearing from all of the community support sector organizations in Ottawa West–Nepean is that their workers cannot continue to subsidize this government’s underfunding of this sector. The workers feel that they are being asked to make up for the government’s stinginess with their time, their hearts and even their wallets. They are burning out trying to fill in the gaps left by this government’s failure to properly invest in and stabilize the system, and so they are leaving the sector.

The organizations that are providing not-for-profit home and community care in my riding—Carefor, the Olde Forge, Jewish Family Services of Ottawa, Meals on Wheels—are all having difficulty recruiting and retaining staff, and a big part of that is fair compensation. But you can’t offer fair compensation if demand is going up and inflation is going up but your funding is not. Between 2012 and 2023, the community support sector received only a 3.5% increase in funding. Inflation over this period, meanwhile, was 27.5%.

The people who work in this sector are great. I have really enjoyed getting to know them and seeing them in action. They are compassionate, energized and committed, but they are not magicians. They cannot make less money, provide more care and better wages.

Last year and earlier this year, community support sector organizations in eastern Ontario worked hard to draw the Minister of Health’s attention to this issue. They warned of the serious situation in the sector and the need for more funding in order to be able to continue providing care for seniors, for people living with disabilities and for people coming home from the hospital in eastern Ontario.

Let me read from a memo that was submitted to Ontario Health East and signed by 31 community support sector organizations in eastern Ontario: “The community support sector is faced with presenting and/or living within annual budgets that are not sustainable and simply cannot be balanced. In many cases, providers are anticipating significant deficits—percentage in the double digits.”

The memo goes on to say, “Organizational foundations are crumbling, in the face of exponentially greater challenges and pressures. Timely and significant funding increases are needed to build organizational responsiveness and resilience.

“—Service reductions are inevitable in the absence of realistic annual budgets. As the aging population with complex health conditions increases, service reductions will be counterproductive to building a responsive health care system.

“—Current deficit budgets may result in increasing client fees to a level that would limit access for the most vulnerable, low-income clients striving to age at home. Raising the client co-pay fee for service adds yet another barrier to Ontarians in need.

“—Inflation rates currently sit around 6.8%. Patients are finding it difficult to make ends meet and are often faced with tough economic trade-offs, when considering their health care needs. Employees are leaving CSS employers, and the health care sector in general, in favour of employers able to offer higher compensation rates, and incentives.”

The memo concludes, “Community support service providers seek to be viewed as valuable contributors to a robust health care system for Ontario. We are part of the solution to current pressures. We share Ontario Health’s goal to ‘connect, coordinate and modernize our province’s health care system, working with all partners so that everyone in Ontario has an opportunity for better health and well-being.’ Current Ontario Health funding does not support the effort needed to align with OHE goals.”

These organizations warned that they needed a funding increase of 10% to 15% in order to be able to continue to provide the same level of service, and that without this level of funding they would have to implement service cuts of up to 40%. And let’s be very clear what we’re talking about here, Speaker, because I know 15% sounds like a lot of money, but home and community care are actually some of the most cost-effective forms of care that we have in Ontario. The average cost of a hospital stay is just under $7,000 in Ontario, which is actually on the low side when we look at health care in Canada, because our government grossly underfunds hospital care too.

But hospital care is an expensive form of care. The daily cost of hospital care for an individual, according to the Financial Accountability Office, is $722. The daily cost of home care for an individual is just $36. And what did the community support sector organizations in eastern Ontario say they needed to maintain service levels and not have to implement any cuts or fee hikes for patients? Just $7 million. The government’s health budget for 2023-24 is $81 billion, Speaker; $7 million isn’t even a rounding error for a budget of that size. And yet the government could not bring itself to act, despite the fact that community support services are incredibly important and far more cost-effective than acute care services, despite the fact that they reduce the need for acute care services and despite the fact that there is strong demand from Ontarians, who after the past few years have been very clear that they want to age in place—not in long-term-care facilities, not in hospitals, but at home.

I raised these concerns on their behalf multiple times in this House. On March 30, I asked the government about imminent cuts to the dementia program at the Olde Forge Community Resource Centre, leaving 95 seniors with dementia without their day program. The government House leader smirked about how this government wants seniors to work and participate in the economy.

On April 19, along with the member from Ottawa Centre, I asked the government why they were allowing prices to increase 300% for Meals on Wheels for the lowest-income members of our community. The Minister of Health stood and said she had increased funding—an increase that was absolutely not seen on the ground by those members of our community now paying 300 times more for their food.

The government did not heed the warnings of so many health care leaders in eastern Ontario that increased funding for the sector was vital. They ignored the call for urgent investments. They allowed those 95 seniors at the Olde Forge to lose their dementia day program. They allowed prices at Meals on Wheels to skyrocket, resulting in some community members having to cancel because they could no longer afford food.

And then finally—finally, Speaker—a glimmer of light: The provincial association for home and community care organizations, the Ontario Community Support Association, received a verbal assurance from the minister that some additional funding was going to be coming to the sector, but what followed is what I call the summer of chaos, because for a long time no one in the sector knew what was happening. The cuts and the price hikes were already implemented. The minister refused to put the commitment in writing. Organizations were being told different things by Ontario Health about how much funding might actually be coming, then finally, an increase was confirmed, an increase of around 3% for most of the organizations in my riding, but no one could tell them whether it was one-time funding or base funding. You cannot hire more staff with one-time funding. You can’t offer wage increases to staff and then take them away. Ontario Health’s communication could not have been more abysmal.

Finally, in September, organizations received confirmation that funding increases will be considered base funding, but they’re being told they must raise wages and serve more clients with just 3%. What the organizations in eastern Ontario are telling me is that this is just a drop in the bucket compared to what they need. What they really need is funding increases of 15% in order to be able to increase wages, lower fees and expand services to meet the level of demand. This is staving off near death; it is not sustainability.

Furthermore, in order to make a difference, the money actually has to flow, and what I am hearing is that it is still a commitment that has not materialized. You can’t pay workers with promises, because workers can’t pay for rent and groceries with promises.

I wish this was a unique circumstance, but sadly, it’s not. In early 2022, the Conservative government promised a billion dollars for home care and $100 million for community support services. Sounds pretty good, right? But a year later, only a fraction of that money had actually been delivered, just over 10% of the money for home care and less than 30% of the money for community care. Organizations were left to plead with the government to actually deliver what they promised.

Carefor CEO Steve Perry told the Ottawa Citizen, “We are going to run the risk of collapse, or at minimum of service rationalization.” Carefor’s inability to compete for staff with other parts of the health care system meant that between 2020 and 2023 Carefor’s workforce was down 25% of its nurses, 28% of its PSWs and 15% of its community support staff. According to the Citizen, these shortages meant a 21% reduction in home nurse visits, a 14% reduction in PSW visits and a 13% reduction in community care services, all because this government can’t seem to get promised funding out the door.

So how long will home care and community support sector organizations have to wait for this new, still inadequate amount of funding to actually arrive? This is the reality of home care and community care in eastern Ontario.

What will this bill, the Convenient Care At Home Act, do to address these challenges in the sector? Not a darn thing. In fact, the procurement process envisioned by this bill has the potential to make things much, much worse, because what this bill envisions and what the Minister of Health has said is that once Ontario Health atHome is created, the plan is for this new agency to procure home care services through requests for proposals, similar to the process Ontario Health is currently using, and as my colleague the member for Nickel Belt, the official opposition’s health care critic, has pointed out, if this is just like the current procurement process, then what we are talking about is RFPs that will go out for service providers that can provide care to the whole province. And who is going to be able to bid on a multi-year contract to provide home care to all of Ontario? Not Carefor, a not-for-profit home and community care organization that has provided excellent care in Ottawa for 125 years; not Jewish Family Services, which provides excellent, culturally sensitive care for Jewish seniors and diverse seniors, many with language barriers, in Ottawa; not the Olde Forge, which has provided supports to seniors in Ottawa’s west end for more than 50 years. These local, not-for-profit organizations don’t have the resources or, frankly, the mandate to bid on contracts to provide care for the entire province. It will be the big, for-profit companies, like Bayshore and Extendicare, that will be in a position to bid for province-wide contracts.

Let’s talk about what that will mean for seniors, for people living with disabilities, for people with chronic or complex health needs in Ottawa West–Nepean. These are companies that siphon off our precious health care dollars for the pockets of their shareholders. How do they do that? They pay their workers extremely low wages and then bill the province double, sometimes triple, what the workers are paid, with the difference going to the shareholders, not the workers. They also refuse to pay workers for travel time and travel costs, so home care workers in some parts of the province work 10-hour days, but they’re only paid for six of them and they’re not compensated for the cost of gas or of using public transportation.

As you might well imagine, Speaker, this makes it very difficult to recruit and retain workers, because who would want to work in these conditions? These workers are essentially subsidizing the shareholders of large, for-profit companies with their time and their expenses. Nobody can sustain that over time, so workers are constantly leaving, for-profit companies are perpetually short-staffed and patients are left to deal with shortages and a revolving door of care providers.

Another thing these companies do is book patients back-to-back even though they live miles apart, as if workers are going to apparate from one location to another as if they’re wizards in a Harry Potter novel. Or they double-book patients as if workers have a time-turner that they can just turn back to go back in time to serve another patient at the exact same time.

The result of these unreasonable demands and the workforce instability is complete chaos and lack of care for patients. Care visits are routinely being missed or cut short. Caregivers change on a weekly basis. Family members are being told by caregivers that they are supposed to provide key elements of care. These are complaints that my office hears constantly from local residents receiving care from for-profit health care providers.

What my constituents need is not something that opens the door to further privatization of home and community care. What they need is high-quality, reliable care delivered by a qualified, well-compensated and stable workforce. But that means making the necessary investments to actually stabilize the workforce—to expand care rather than to cut it.

Unfortunately, what we see from this government time and time again is the opposite, and now we have another bill that opens the door to further privatization. It’s time for the government to stop its ideological attack on our public health care system and focus its attention on delivering high-quality care to Ontario residents who deserve no less instead of rewarding health care profiteers.

Report continues in volume B.

Questions?

I agree. I think it’s really important that that home care nurse, the CCAC nurse, does show up—or the PSW—after the patient has been discharged from ER. I think that’s precisely what this bill is doing, because we need to embed our home care into our Ontario health teams. This is part of the modernization of our restructuring of our health care system, because the status quo back in 2018 was not working. That is why every single term we are putting in a new bill to move forward on our transition and our transformation of our health care system.

So to the member opposite, why can’t can the NDP just support what we are doing in transforming our health care system so that the care is centred around the patient and not around the brick and mortar where the patient happens to be?

Historically, Ontario residents have seen major amalgamation in health sectors that have led to major—and I say major—service disruptions. This is, and will be, detrimental, and could be very problematic if this Conservative government cannot guarantee that patients will not experience any lapse in care, considering the strain the health care system is already under due to amalgamation bills and Bill 124.

To the member from Hamilton Mountain, can you explain how problematic it will be if this government cannot guarantee that patients will not experience any lapse in care?