Slow care for elderly, disabled cited by Ontario auditor general

Many elderly and disabled Ontarians are not getting much-needed home-care services on time, with some waiting more than a year just for assessments, the government watchdog says.

The level of home-care services that Community Care Access Centres provide vary widely across the province, as each CCAC develops its own criteria as a result of funding inequities, Auditor General Bonnie Lysyk said in her annual report.

Her office audited three Community Care Access Centres and found that 65 per cent of initial assessments for home care were not done within the required time frames.

"Although the (Health) ministry has recognized the importance of strengthening the home and community care sector, clients still face long wait times for personal support services," Lysyk said.

She found delays in assessments of a year or more.

Assessment delayed

Lysyk highlighted one case of a client in her 90s living alone in a retirement home who waited 52 days for a phone assessment for physiotherapy and personal support services -- "well beyond the three-day timeline for initial contact assessments."

The client was only approved for 16 hours of personal support per month and not physiotherapy, but when the family requested more services after the client fell and sustained a fracture, they were told those services were wait-listed, Lysyk said.

When the elderly patient's cast came off the family again requested physiotherapy and the CCAC made a home visit two months later – well beyond the seven days required for that assessment – and though they determined the client needed more personal support services, the client didn't get them because of a long wait list and was not approved for physiotherapy, Lysyk said.

Though by law, home-care clients can receive up to 90 hours of personal support services per month, care coordinators at the CCACs usually allow a maximum of 60 hours, Lysyk said.

Accountability structure 

The report explains Ontario's health-delivery bureaucracy: "Each CCAC is accountable to one of the 14 Local Health Integration Networks (LHINs), which are mandated to fund health-service providers such as hospitals, CCACs and support agencies in defined geographic regions."

The CCACs, which determine home-care needs then contract private providers to deliver the services, are also not consistently conducting site visits to ensure those providers are complying with their contract requirements, Lysyk found.

During the last fiscal year Ontario spent $2.5 billion to provide home care to 713,500 clients. The ministry changed the funding formula in 2012, but the CCACs are still receiving different levels of funding.

The report charted the cost-per-client in the home care sector, noting a high in North Simcoe Muskoka of $4027 to a low of $2879 in the Central West care region.

North West, South West, Central and Waterloo-Wellington health care CCACs ranked in the middle, at a cost between $3403-$3564 per client served. 

LHIN goals not met

Looking at Local Health Integration Networks, measuring performance largely through the effectiveness of hospitals, Lysyk found that none of the 14 LHINs has ever met all of the targets in 15 performance areas.

One of the LHINs hadn't met its wait-time target for MRI scans in six out of eight years, while another hadn't met its hip-replacement wait-time target in seven of eight years, she said.

"The ministry responded by relaxing targets for some LHINs, but keeping targets the same, or making them tougher for others," Lysyk said.

Long-term care backlog

In the long-term care sector, Lysyk found the ministry did complete comprehensive inspections of Ontario's 630 facilities and will continue to do so annually.

But the backlog of critical incident and complaint inspections has doubled between December 2013 and March 2015, from 1,300 to 2,800, Lysyk said.

The Health Ministry committed to addressing all of Lysyk's recommendations.