Staying focused on the balance in health care

July 1999

Pay equity imbalances in long term care

Issue: Two residents with similar care needs, but living in two different long term care facilities, could receive widely different care due solely to different treatment of pay equity plans by the government. In one case a facility with a "Proxy" pay equity plan will have received full funding for the plan up to and beyond December 31, 1998, based on the increases provided under the plan to that date. Another facility with a "Job to Job" or "Proportional" value plan will have received no funding for the plan. This can result in a substantial imbalance in funding to these two facilities which are, in every other way, identical. While we, members of OANHSS, support pay equity and want to fulfil our obligations, we are concerned about its impact on residents and staff, when unequal treatment can affect levels of service and staffing significantly.

Solution: OANHSS is continuing to monitor the impact of pay equity with the help of Bass Associates Ltd. We would like to work with the government to come up with a solution that will have the best results for the residents in our care.

Continuing health care reinvestment
Issue: The Ministry of Health has pledged to continue the restructuring of the health care system away from a hospital-centred system and towards expanded community and long term care services. To be effective, and ensure that Ontarians have access to health care in the communities where they live, the process has to integrate two elements: restructuring and reinvestment.

Solution:

• Continue with restructuring so that hospitals are not the "gateway" to the long term care system.
• Reinvest in community services to ensure the effectiveness of restructuring.

Investment in nursing

Issue: Increasingly, long term care facilities are dealing with residents who have complex medical needs, Alzheimer disease, other dementias and mental illness. Currently, the resources to meet the added care requirements for this changing population are insufficient. The availability of special care wards, programs and environments, professional nursing staff and specialist expertise are limited.

Solution: Continued reinvestment in nursing services is essential, especially for the long term care sector, to meet the increasing demand for complex medical care and specialized psychiatric and geriatric services.

• Establish staff ratios, nursing costs and acuity levels in long term care facilities.
• Expand nursing resources, including nursing specialists (i.e. nurse practitioners and clinical nurse specialists) in facilities based on the established need.
• Invest in more educational programs for nurses, especially in gerontology and mental health.

Balance of for-profit and not-for-profit providers in the long term care system

Issue: In the first round of new long term care bed allocations earlier this year, a disproportionately small number (18 per cent) of beds was awarded to non-profit organizations.

• Of the 6,700 beds awarded, over 63 per cent were allocated to for-profit groups.
• 83 per cent of the for-profit beds went to five large nursing home chains.

Also, important considerations such as a facility's history, or the services it offers related to residents' special needs (language, culture, religion) were ignored.

In the next four years, 13,300 more beds will be allocated. A balance between for-profit and not-for-profit sectors provides healthy competition between sectors to provide the best care.

Solution:

• Ensure the next round of new beds supports the maintenance of a proper balance between for-profit and not-for-profit organizations running long term care facilities.
• Ensure that enough facilities are running culturally sensitive programs to meet the needs of the elderly in these populations.

Supportive Housing
Issue: Supportive housing services, as part of the health care system, are underfunded and in insufficient supply.

Solution: Reinvestment in supportive services delivered to seniors in their homes or in long term care facilities is necessary to increase people's independence and reduce pressure on hospitals and on the limited number of supportive housing organizations.

• Increase funding for supportive housing, as recommended by both the Health Services Restructuring Commission and the Golden Report.
• Allow non-profit housing providers flexibility and choice, i.e. linked and de-linked services, in offering supportive services to their tenants.
• Modify bureaucratic restrictions and rules related to the provision of supportive housing to allow for flexibility and choice.

OANHSS members, providers of housing and long term care services in the community, believe in the underlying principle that staying focused on a vision of a health care system that puts the client at the centre of the system will keep us on the right path of change. The Ontario people need an balanced, co-ordinated, and effective health care system to support their changing health care needs into the 21st century.

If you need more information, please call:

Donna Rubin, Acting CEO
OANHSS, 905-851-8821, ext. 230

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.