‘We need help’: Home care in Ontario — the lynchpin of the health system — faces a staffing crisis

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Thousands of nurses have left jobs providing home care during the pandemic for better-paid work in public health, hospitals and long-term care homes. The result is a crisis that home care officials warn could jeopardize the province’s entire health system.

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“We need help. We are in a crisis,” said Sue VanderBent, CEO of Home Care Ontario, which represents most home care providers in Ontario.

During the pandemic, money was poured into long-term care and hospitals to help retain and increase staffing. Many of those workers came from home care, which has received no additional support from the province during the pandemic, said VanderBent.

Home care officials say it is not surprising workers are opting to go elsewhere where they can earn between $6 to $15 more an hour. But the funding in home care has not kept up.

Home Care Ontario says additional funding is needed urgently to keep the crucial home care system running so hospitals can begin catching up on surgeries and people in need of care can get it.

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The organization is asking for “an urgent $600-million investment in order to give patients the care they need,” according to Home Care Ontario.

VanderBent said home care is the often forgotten, but crucial, link in the province’s health-care system. People with complex medical needs and those leaving hospital after surgery rely on it in order to remain in their homes.

Steve Perry, CEO of Carefor, a not-for-profit home care provider that is one of the largest in Eastern Ontario, said the company lost about 20-25 per cent of its staff during the pandemic for a variety of reasons. Moving elsewhere for better paying jobs was one of them.

Problems in home care existed before the pandemic, he said, but COVID-19 has exacerbated them.

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“Home care is a foundational piece of the health-care system, but it remains largely misunderstood and grossly under-resourced,” he said. “At least if there was a mechanism for greater wage parity across the system, we might have more stability.”

VanderBent said the staffing crisis in home care will spill over to the rest of the system at a time when it is under acute pressure.

If home care is not available, many patients cannot be discharged from hospital, which creates backlogs, she said. That issue is more urgent now as hospitals attempt to catch up on more than 450,000 surgeries that were delayed during the pandemic. Without more money into home care now, VanderBent said, some of those surgeries could be at risk.

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“Where is the plan to help these people in the hospital to get home? It is just shocking lack of foresight in terms of system planning.”

She said the home care sector was stunned there was no additional pandemic money offered in Ontario’s budget.

During the pandemic, 3,000 home care nurses have taken other, better paid jobs in health care. Large numbers of PSWs have also left. At a time when everyone is struggling to recruit workers, she said it has reached crisis levels in home care. Where more than 90 per cent of people with complex medical conditions being discharged from hospital would previously be accepted for home care, that number has dropped to just 60 per cent, leaving a widening and costly gap. The average daily cost of acute care is $730, compared to about $95 to care for a patient at home.

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Still, there is a nursing shortage in other health sectors as well right now which further complicates efforts to hire more for home care.

For decades, home care has been pointed to by politicians and officials as a lynchpin of the health system — allowing people to remain where they want at less cost. But it receives less than five per cent of health-care funding, according to VanderBent.

“This is a quiet crisis that is affecting everyone who has got a loved one at home.”

At a time when there are fewer home care workers available, the need is greater, said Perry, as more people, with more complex needs, seek care at home.

“More referrals are coming in to the system with our capacity lower than it ever was. It is creating a very challenging situation for individuals. People are going without the care that they need.”

Home Care Ontario has begun a campaign to draw attention to its role in providing health care. “The province can’t continue to overlook home care,” said VanderBent.