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December 21, 2001
Rt. Hon. Roy Romanow, PC
Commission on the Future of Health Care in Canada
P.O. Box 160, Station Main
Saskatoon, Saskatchewan
S7K 3K4
Dear Mr. Romanow,
I am writing on behalf of the Ontario Association for Non-Profit Homes and Services for Seniors (OANHSS). Our Association represents 300 non-profit and charitable homes for the aged, nursing homes, seniors housing and community service agencies across Ontario. We are very interested in the future of our public health care system and are taking this opportunity to provide you with our observations and recommendations for your consideration.
As you are well aware, Canadians believe they are facing a crisis in health care that is often attributed to the growing proportion of seniors in the population and the increased demand for healthcare services they are expected to generate. As the Senate Committee on Science and Technology (chaired by Senator Michael J.L. Kirby) concluded, this concern is exaggerated because seniors are increasingly in better health and more independent. Nevertheless, aging demographics will require a reorientation of our healthcare delivery system and funding approaches.
That reorientation will require a rethinking of the Canada Health Act. The current Act covers only those healthcare services that are provided in hospitals or by physicians. Many medically-necessary services are provided in non-hospital venues and by a range of professionals other than physicians. Furthermore, despite its ostensible commitment to "promote and restore physical and mental well-being" (section 3) the insured services prescribed by the Canada Health Act are disease and cure oriented. Finally, the current Act ignores long-term care for seniors.
We suggest that the rethinking of the Canada Health Act include a number of principles that will accommodate our aging demographics:
With regard specifically to long-term care, it is essential that we build a balanced, coordinated and effective long-term care service delivery system that also allows for consumer input. In line with the Canadian values of universality and particularly reflected in the Canada Health Act, long-term care delivery and funding should be more consistent across Canada. Such a system would, however, require an increase in financial, professional, medical and communal resources.
We believe such a commitment can be accommodated within the existing health care system through a more effective use of existing dollars. Supporting seniors to maintain their independence or to maintain the highest level of functional ability whether in their own home or a long-term care facility will reduce the need for higher cost services such as acute hospital or physician care. Enabling facilities to better manage the problems experienced by those with dementia and chronic mental illness will reduce their demand for higher cost services. Such support also will enable residents of facilities to have a higher quality of life.
Long-term care facilities, community services and supportive housing are too frequently ignored or are inadequately considered in any discussion or review of Canada's health-care system. As I am sure you have heard from others, one of the fundamental obstacles to health-care reform is that rather than treating health-care as a true system, governments characteristically segregate the health-care system into "silos" when making funding and policy decisions. The silo approach means that health-care delivery is inadequately integrated and when policy or funding decisions are made in one silo, the impact on other silos is rarely addressed adequately, or addressed at all.
We are committed to the view that supportive housing and long-term care facilities and community services are critically-important parts of the health-care continuum and this importance will increase for the foreseeable future. Accordingly, the whole continuum of long term care simply must be included in any review of the health-care system that aims to be comprehensive.
Funding constraints imposed on hospitals have driven hospitals to release patients with unprecedented levels of acuity. This has resulted in substantially increased demand for community services and residential long-term care, not only in terms of sheer volume, but also in the type and the cost of services required for high-acuity patients.
In Ontario, with regard to facilities, the current government contribution amounts to on average $62.60 per resident per day. This per diem is for Nursing/Personal Care and Programs and Support Services. The resident pays a co-payment of about $40 per day for accommodation and food. The Nursing/Personal Care per diem amounts to $52.38, which provides for on average 2.09 hours of nursing and personal care per day. A study conducted by Pricewaterhouse Coopers found that Ontario is dead last (after Mississippi) among 10 jurisdictions studied in terms of public funding for Nursing/Personal Care. A copy of the report is attached. We believe that funding of the long-term care facilities sector is already at a crisis state and, because of the aging population, the crisis will only escalate if immediate and concerted action is not taken.
Furthermore, inadequate supply and support for supportive housing and community support services has resulted in growing waiting lists for service. Lengthening waiting lists means that those waiting for service or for admission into long-term care facilities are often occupying a bed in an acute care facility. This is hardly a cost-effective use of a hospital bed and also compounds the waiting list problem for acute care facilities.
In short, if funding decisions were made on a systemic basis, one impact of additional funding to the community and long-term care facilities would be to reduce waiting lists in acute care hospitals.
A subsidiary, but important issue is the appropriate balance in public funding between the for-profit and not-for-profit segments of the long-term care sectors. Publicly-funded health-care accounts for approximately 70 percent of all health-care expenditures in Canada. Multiple polls and studies show that Canadians continue to exhibit a strong preference for a health-care system that is predominantly publicly funded. A February 2001 Ipsos Reid poll indicated 56% favour a balance and a further 39% prefer to have all facilities operated solely by not-for-profit organizations. Historically, in Ontario, in the community sector government funding was directed primarily to not-for-profits while in the facility sector showed a slight preference for not-for-profit. This situation has been significantly eroded. Not-for-profit community agencies are providing far less of the service with many folding as a result. In the facility sector, with the recent new bed awards, the balance of 49% private and 51% not-for-profit providers over the past five years, the government preference for the for-profit sector has shifted to a 52:48 split in favour of the for-profit sector. On the positive side, many specific programs remain exclusive to not-for-profits such as adult day programs and supportive housing.
The view that the for-profit sector is more efficient appears to be driven more by ideological or philosophical theories about the impact of the profit motive than by empirical study. In that regard, we enclose a copy of a U.S. study that demonstrates that the not-for-profit sector is more effective at delivering quality care.
At OANHSS we also question the logic of allowing scarce health-care resources to flow out of the system in the form of dividends to shareholders or profits to owners. In our view, we believe that the funding objective should be the provision of quality, cost-effective care, not the enrichment of investors or owners. As a consequence, we believe that government funding to long-term care services should better reflect the 70:30 public:private ratio that exists in the health-care system generally.
We welcome this opportunity to express our views to your Commission and would be happy to provide you with further information if you wish.
Yours sincerely,
Donna A. Rubin
Chief Executive Officer
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Ontario Association of Non-Profit Homes & Services for Seniors
7050 Weston Road, Suite 700, Woodbridge, Ontario L4L 8G7
(P) 905-851-8821
(F) 905-851-0744
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OANHSS members include not-for-profit providers of long term care, services and
housing for seniors in Ontario.
Members include municipal and charitable long term care homes, non-profit
nursing homes,
seniors' housing projects and community
service agencies.
