‘Ottawa’ Champlain Region’s Home Care Funding Less than Expected, Says Consultant
The Ottawa region is in a “unfortunate and unique” position when it comes to provincial funding for home care, says the consultant commissioned to crunch data for the Champlain Local Health Integration Network. (LHIN)
As it stands the LHIN, which co-ordinates health care services for about 1.3 million people in Eastern Ontario, has a list of more than 3,000 people waiting for home care. That number is growing, and the waiting list is likely an “undercount” of the number of people who need services, said Colin Preyra, who analyzes health care pricing and funding.
The Champlain LHIN is taking over home care responsibilities from the Community Care Access Centre, part of a series of transitions across the province under sweeping “Patients First” legislation introduced last June. While the LHIN can set its own priorities to suit its population needs, it can’t run a deficit. As the population ages, the home care crunch isn’t going to go away, and the LHIN must decide how to strategically deploy limited provincial funds.
The Champlain LHIN’s funding is a lot less than would be expected for a population of this size, Preyra told the LHIN’s board. About $240.5 million is spent annually on home care in the Champlain LHIN, but this would change if tweaks were made to various funding formulas. For example, under a population-based funding model, the LHIN should get $31.5 million more, allowing it to serve 6,000 more clients and eliminating the waiting list, said Preyra. But getting that funding, or even a portion of it, would be a matter of lobbying and negotiation with the provincial government.
Among the other numbers:
• Fee for services rates are higher in the Champlain region because of higher wages for nurses and personal support workers. Overall, Champlain pays nine per cent more for contracted services than other regions. If rates were at the provincial average, nine per cent more clients could be served on an annual basis. The rates are not controlled by the LHIN, but provincial funding does not account for the difference, said Preyra.
• The Champlain LHIN already does a good job of realizing cost efficiencies. It spends about $16.8 million, or about seven per cent on administration and overhead, which is slightly lower than the provincial average, said Preyra. Administrative and overhead inefficiency “does not explain in any part why Champlain cannot provide more services within its budget.”
• Champlain has already deployed innovative strategies to expand services. That includes providing more nursing visits in clinic than at home than any other LHIN. Under the traditional home care model, patients who need treatment for services such as dialysis and diabetic foot care would get it at home. When patients are able to attend a nursing clinic, the cost is about 50 per cent less than care at home because nurses need less time for travel and setup. Champlain’s nursing costs per client were lower than other regions. By substituting nursing clinics for home visits, Champlain is able to offer 2.5 per cent more nursing visits, said Preyra.
• Across the province, informal caregivers such as family members provide 2.9 hours of unpaid care for every hour of paid care. In the Champlain region, it was 14 per cent less — 2.66 hours of unpaid care for every hour of paid care. The number of informal caregivers will fall over time, Preyra warned.
• There were inconsistencies in service within the LHIN. For example, services in the eastern part of Ottawa are about 22 per cent less than expected, but 11 per cent less in the western part.
Jean-Pierre Boisclair, chair of the Champlain LHIN board, said Preyra’s report was sobering but valuable. “Unless we understand this, we can’t make rational decisions.”
The LHIN will digest the information and produce a list of priorities within the next few months.
“Every LHIN has to set priorities. This LHIN’s choices will be harder,” said Boisclair.