May 18, 2004

Home care quality and capacity decrease

McMaster researchers find provincial policies lead to fewer workers, poorer service

Hamilton, ON - Ontario’s current home care policy has led to deteriorating working conditions for home support workers, a decreased number of qualified workers in the Hamilton area, and diminished service for home care recipients, McMaster researchers have found.

Jane Aronson, professor of social work at McMaster University, and colleagues Margaret Denton and Isik Zeytinoglu recently examined the effects of the closure of a large, non-profit home support agency in Hamilton.

At the root of their study is the policy of managed competition introduced in home care by the provincial government in 1996. This business-modeled approach requires local coordinating organizations—Community Care Access Centres (CCACs)—to contract out all service delivery to competing non-profit and for-profit agencies. The policy presses agencies to cut costs in order to win contracts.

In August of 2002, the Hamilton VHA Health and Home Support Services (VHA) closed as a result of this policy. Says Aronson, “Across the province, the pressures of efficiency- rather than service-driven competition have squeezed out many well-regarded non-profit agencies. These pressures, coupled with deep government cuts in supportive care for senior and disabled citizens, eroded the viability of VHA in Hamilton.”

Following its bankruptcy, VHA’s 2,500 clients, representing 58 per cent of local provision, were transferred to the five other home support providers with which the CCAC had contracts; four of these were for-profit providers, four were non-unionized, and all had higher contracted prices than VHA.

The findings of a follow-up survey of the 317 home support workers laid off when VHA closed revealed that only 38 per cent of respondents stayed in the home care sector, most being absorbed by the four for-profit agencies with which the Hamilton CCAC had contracts. There, they faced a deterioration in their working conditions and, on average, a dollar an hour drop in pay. Many anticipated leaving home care work as they no longer felt it could provide them with either a living wage or a tolerable level of security.

At the local level, VHA’s closure reduced Hamilton’s stock of trained and experienced home care workers just as the need for their skills can be expected to increase. Further, the deterioration in working conditions reported by former VHA workers is likely to result in higher worker turnover which, for home care recipients, will mean inconsistent and changing service providers in their homes.

“The results of this study underscore the need to revisit current provincial policy,” says Aronson. “The CCACs have to act as much more than enforcers of short-term contractual relations. Evidence from the U.K. and elsewhere confirms the importance of governments’ playing an active developmental role in enhancing the quality of home care work and service and in stabilizing the supply of care.”