Ontarians will have access to primary care co-ordination and - for those persons who need it - more than four million additional hours of home health care and support services if the Ministry of Health eliminates the costly duplication that currently exists within the province’s 14 Community Care Access Centres (CCACs).
That’s one of the key findings of a report titled, Enhancing Community Care for Ontarians (ECCO) released today by the Registered Nurses’ Association of Ontario (RNAO). The report examines high performing systems and concludes that Ontario has structural duplication that leaves taxpayers with less care and hampers the province’s capacity to achieve system integration. The result, RNAO concludes, is fragmented and delayed care for patients and an inefficient system overall.
The report recommends using Community Health Centres, Nurse Practitioner-led clinics, Family Health Teams, Aboriginal Health Access Centres, and other interprofessional and group practices by expanding their reach and roles to provide comprehensive care co-ordination and system navigation to all Ontarians - especially persons with complex health-care needs.
“We see care co-ordination and system navigation anchored best within primary care, as this is the health sector that knows their patients most intimately,” says RNAO’s President, Rhonda Seidman-Carlson, adding that “this means primary care providers would be the ones ordering home care and support services, linking and following-up with specialists, and facilitating people’s transitions from their homes to nursing homes.”
A key element of the ECCO plan is to redeploy the 3,500 CCAC case managers and care co-ordinators – 3,000 RNs and 500 non-RN health-care professionals – to primary care, where their expertise would be better used providing the care co-ordination, system navigation and same day access that Ontarians desperately need.
Seidman-Carlson says the creation of a Primary Care Transitional Secretariat placed within each LHIN on a temporary basis would help primary care providers assume the new functions until the model is fully up and running.
“Currently CCACs are the ones doing some of these functions, but they only come into the picture at times of crisis, with a set of rules that often don’t match the patient’s life context and needs,” says RNAO Chief Executive Officer Doris Grinspun, adding that “with the creation of LHINs and a more robust primary care system, CCACs are becoming redundant.”
“We recommend that a better use of taxpayer dollars is to move all planning, service agreements, funding, monitoring and accountability functions to LHINs to secure comprehensive and integrated local planning for all health-care sectors,” says Grinspun, adding that “this would free up the expensive operating costs of CCACs and add over four million hours of home care and support services.”
“As it stands right now with CCAC rules, many people aren’t eligible to receive the number of hours of nursing or support care they need while recovering from illness at home, dealing with a chronic condition, or receiving palliative care. In some instances, people don’t even qualify because they ‘don’t meet the rules.’ We think this is wrong because we know it costs far less to provide care for people at home where they want to be,” says Grinspun.
Collectively, CCACs consume nearly $2 billion of the overall health-care budget. According to the Auditor General of Ontario, in 2008/09, $163 million (9.3 per cent) was spent on administrative and operational costs alone. RNAO’s report points out administrative expenditures at the LHINs totaled less than one per cent.
“Nurses recognize that there is only so much money in the health-care pot and that we need to spend existing dollars wisely. That’s why we urge the McGuinty government to remove the duplication and streamline the health system so it is more integrated, delivers co-ordinated and timely access, and supports people to remain in their homes as vibrant members of our communities. If the government adopts our report, what you will see is a system that is more responsive to the needs of people who rely on our help,” emphasizes Grinspun.
The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the health-care system, and influenced decisions that affect nurses and the public they serve.
Read the report at www.RNAO.ca/ecco .
Read reactions to the report  from:
Joan Park, President - National Case Management Network of Canada
Adrianna Tetley, Executive Director, Association of Ontario Health Centres (AOHC)
Deborah Simon, Chief Executive Officer - Ontario Community Support Association (OCSA)
France Gélinas, Health Critic for the New Democratic Party of Ontario
Bill Walker, PC deputy health critic and MPP for Bruce-Grey-Owen Sound
Deb Matthews, Minister of Health and Long-Term Care