| February 22, 2021
- No. 9 Workers
Fight for Human-Centred Alternatives Ontario
Nurses Oppose Damaging Changes to Home and Community Care
 
• Role of Care Coordinators in Ontario's
Health Care System
• Anti-Social Changes to Health Care
Legislation and Regulations
For Your Information
• Record Job Losses in
Ontario
• Some Data from the Report Ontario's Labour Market in 2020
Workers
Fight for Human-Centred Alternatives
 
July
22-24, 2020. ONA actions against Ford government's attacks on health
care workers. The Ontario Nurses Association
(ONA), on February 17, wrote to Christine Elliott, Deputy Premier and
Minister of Health, on behalf of 419 of the 517 care coordinators of
the Central East Local Health Integrated Networks (LHINs) for Durham
Region, Haliburton County and City of Kawartha Lakes, Northumberland
County, Peterborough City and County, and Scarborough, on the subject:
"Protect home and community care -- save care coordinator jobs." The
ONA represents 68,000 Ontario nurses and it continues to sound the
alarm about regulations related to Bill 175, the Connecting
People to Home and Community Care Act, 2020 passed last July
which seriously jeopardizes the quality of organizing and delivering
care in local communities.  When the ONA made
a written submission to the Standing Committee of the Legislative
Assembly on Bill 175 on June 15, 2020, it raised serious concerns about
the legislation and the accompanying regulations. Of particular concern
was the role of care coordinators who are their members, whether or not
those members would have their employment (including compensation,
pension and union representation) automatically transferred to the new
Ontario Health Teams (OHTs) from the LHINs.
They
also raised concerns about the role of care coordinators in the new
system, whether the intent of the legislation was to open the door for
private home care contractors to manage their own care coordination,
and whether some of the care coordinators would be excluded by the new
requirement that home care assessments be performed by a regulated
health professional (some current care coordinators are social workers,
for example, a profession not part of the Regulated Health Professions Act).
The regulations speak of "care coordination functions" and do not even
use the term "care coordinator" and state that Health Service Providers
would be responsible for care coordination "and would have the
flexibility to assign care coordination functions to contracted
providers or, through mutual agreement, to partner organizations."
Below are excerpts from the letter the ONA sent Minister
Elliot on February 17: "Given the crucial role that
care coordinators play in reducing hospital overcrowding and ensuring
dignified and quality care for clients at home and in the community, we
urgently ask that you change the regulations under Bill 175 to ensure
they do not threaten our care coordinator jobs. [...] "Bill
175's regulations jeopardize care coordinator jobs by strongly
suggesting our jobs will either be cut entirely, as they are currently
structured, or privatized to for-profit health service providers.
Transferring our jobs to profit-making home care corporations would
mean lower pay and benefits and poorer working conditions, while the
profit-margins of the corporations prosper. It also poses a clear
conflict of interest if the corporation delivering the care is also
responsible for determining the amount of care that is approved. If
this transition proceeds, it risks sparking a major retention crisis
among the ranks of care coordinators, as our colleagues seek to
preserve pay and working conditions by moving to hospitals or other
public sector jobs. No one can afford this, least of all the clients
who depend on our full scope and experience as care coordinators. [...]
"We ask that you amend the provisions in the regulations under
Bill 175 to guarantee the protection of care coordinator jobs and the
continuity of vital care for their clients." 
The Ontario Nurses' Association describes the role of care
coordinators in its February 17 letter to Deputy Premier and Minister
of Health Christine Elliott. "Care coordinators
connect patients and their families with the right health care in a
complex system. These nurses and health-care professionals provide a
single point of contact for patients to get acute, chronic, mental
health, rehabilitation, maintenance, and end of life/palliative care in
the home. An in-depth face-to-face assessment process is used to
develop a comprehensive and customized patient-focused care plan,
including the input of individuals and their families. Assistance is
also provided with finding a family doctor, resources for patients and
caregivers, and care in schools and community such as assisted-living
settings. Care coordinators determine the eligibility for applications,
wait list management and admission to long-term care homes. While
assisting patient and families, LHIN care coordinators ensure the
allocation, accountability, and integrity of our home care system --
holding service providers to the highest standard. In the most
challenging of times, families, patients, and communities have depended
on care coordinators to divert emergency room visits from over-capacity
hospitals and for ongoing reassessments of patient needs, while working
with limited resources and a commitment to assisting patients to manage
their health care at home."
Public health care advocates in Ontario point out that laws
passed in 2019 and 2020 make significant changes to the way home and
community care services are organized and delivered which are causing
serious problems in caring for the sick and elderly. These changes have
a number of consequences that are destructive to the public health care
system including lack of standardization across the province,
deregulation, fragmentation and loss of consistency in services, and
increased privatization. For example, Ontario Health Teams (OHTs) and
Health Service Providers (HSPs) contain both for-profit and
not-for-profit organizations, including private home care agencies
which creates a conflict of interest where organizations making
decisions about service coordination and delivery are also bidding on
contracts to deliver those services.  Ontario Bill 175,
the Connecting People to Home and Community Care Act, 2020 was
introduced in the Ontario legislature on February 25, 2020 and received
royal assent on July 8, 2020.
It follows and
complements two pieces of legislation passed in 2019 which were part of
major restructuring of the health care system to serve private
interests. The People's Health Care Act, 2019 and
the Connecting Care Act, 2019 (CCA) led to the
creation of a new agency, Ontario Health, which is responsible for
managing health care services throughout the province, including the
elimination of the regional health authorities, Local Health
Integration Networks (LHINs), as well as other organizations including
Cancer Care Ontario and eHealth Ontario. The
legislation also created a new model of care, OHTs, which the Ministry
of Health describes as "a new way of organizing and delivering care
that is more connected to patients in their local communities. Under
Ontario Health Teams, health care providers (including hospitals,
doctors and home and community care providers) work as one coordinated
team -- no matter where they provide care... Ontario Health Teams are
groups of providers and organizations that, at maturity, will be
clinically and fiscally accountable for delivering a full and
coordinated continuum of care to a defined population." The transition
from LHINs to OHTs is in progress so health care services are currently
being regionally managed by a mix of the two. The operation of Ontario
Health is governed by a board of directors, many of whom are current or
past executives of, for example, TD Bank, Invesco Canada, Brookfield
Asset Management, GE Canada, the C.D. Howe Institute, and others.[1] Bill
175 repealed the Home and Community Services Act, 1994 and
moved home and community care into the CCA, and makes OHTs and other
HSPs responsible for the coordination and delivery of these services.
Another result is that much of what was included in the previous
legislation was moved to regulations and policies, including the
definition of community care services, the settings of care,
eligibility for services, an updated version of the Bill of Rights and
requirements for handling complaints. Unlike changes to legislation,
which require decisions of the legislature, changes to policies and
regulations can be made by cabinet, without any public consultation or
scrutiny. Giving ministries carte blanche to
privatize on the basis of introducing regulations which go against the
public interest is a form of legalizing impunity which health care
workers do not accept. Note1. Ontario
Health Board of Directors, Ontario Health website.
For Your Information 
On February 18, the Financial Accountability Office of Ontario released
the report Ontario's
Labour Market in 2020. The report provides detailed data
about the job situation in Ontario for the whole year of 2020. The data
are indeed alarming. Over the year, 355,300 jobs were lost, which is
the largest annual loss of employment in the history of the province.
In addition, 342,690 more Ontarians had close to no hours worked, while
67,350 worked less than half their usual hours. The total number of
workers affected by loss of employment was 765,340, which is about one
in five Ontario workers. This is a huge number of workers affected,
with all the devastating consequences in terms of loss of income,
anxiety, mental health problems of various kinds, family problems, not
to speak about the further damage done to the economy.
While the data are useful in terms of revealing the extent of
the devastation, the report attributes the job losses to the pandemic
alone, specifically to the measures taken to lock down sectors of the
economy that were decreed by the government, measures which reached
their peak during the spring. After the relaxation of restrictions
during the summer the second wave resulted in renewed restrictions
later in the year until the end of 2020. The report does not examine
the occurrence and impact of closures over the year that were the
decisions of companies, such as the airlines, because their profits
went down during the pandemic. In essence, it is presented that
economic collapse is an unavoidable result of COVID-19.  That is what
workers cannot accept. It does not have to be like this. It is this way
because our socialized economy is organized to ensure the profits of
the narrow private interests in control and ownership of the economy
and because those in authority impose this aim and claim there can be
no other way to organize the economy. Decisions on shutting down, as
well as reopening without guaranteeing safe conditions, are motivated
by this narrow aim, whatever the costs for the people.
Workers
are presenting human-centred alternatives that would be beneficial to
the health and safety of all and to the economy but they are blocked
because they are not in control of the agenda for society and don't
have decision-making power. In a recent news release, the Canadian
Union of Public Employees (CUPE) Ontario proposes that increased
investment in public services would provide productive
employment and is badly needed in the current conditions. It
raises, for example, that thousands of personal support workers are
needed in long-term care, which is in crisis, that thousands of contact
tracers are needed for public health units, and more education workers
are needed to restructure schools to make them safe. Instead of being
reduced, mass transit could be expanded, with more buses and trains
each carrying fewer passengers, with constant cleaning and with other
workers mobilized to assist passengers to use the service safely.
Workers are demanding that agri-business, construction and
other sectors be reorganized to provide safe working conditions, taking
into account the need for physical distancing and other safety
measures, mobilizing people to guarantee safe operation. However the
discussion does not even get started because the aim of guaranteeing
companies' profits is pitted against people's proposals which are
discarded on the basis that if the costs for these companies increase
they may close their operations. The first thing
that workers are doing within this situation is rejecting the blackmail
that if they insist on the recognition of their rights, then there will
be no jobs. An economy based on human-centred alternatives is
not only necessary but possible and the voice of workers is crucial to
make it so.
According to the report of the Financial Accountability
Office of Ontario, the province's employment declined by 355,300 jobs
(or -4.8 per cent) in 2020, marking the largest annual loss of
employment on record. In addition to the job losses, 342,690 more
Ontarians had close to no hours worked, while a further 67,350
employees worked less than half their usual hours. Combined, the total
number of employees affected by the loss of employment was 765,340 in
2020. The Office essentially attributes this loss
to the COVID-19 pandemic, particularly to the height of the initial
lockdowns during the spring of 2020. According to the report, the
number of workers affected by the loss of employment reached 2.1
million in May, declining rapidly as lockdown restrictions were eased
through the summer, and increasing again with the targeted restrictions
later in the year. The province's annual
unemployment rate jumped to 9.6 per cent in 2020, the highest since
1993. The report acknowledges that the actual unemployment rate is much
higher, because there was a surge over the year in workers who did not
look for a job although they wanted one and therefore were not counted
as unemployed. The report estimates that one in five Ontario workers
were either unemployed, did not look for a job although they wanted
one, or worked fewer hours than they desired. Ontario's
youth employment (ages 15-24 years), declined by 156,900 (or -15.5 per
cent) in 2020, representing more than four in 10 jobs lost in the
province, and bringing youth employment to a level not seen since 1999.
With the sharp job loss, the youth unemployment rate reached 22.0 per
cent, the highest on record. Ontario's core-age (25-54) employment
declined by 175,200 (or -3.7 per cent) in 2020, the largest drop on
record. Women workers (-202,600 or -5.8 per cent)
experienced larger job losses compared to male workers (-152,600 or
-3.9 per cent). Employment among core-age (25-54)
immigrants, who represent more than one-third of total employment in
this age group, declined by 6.6 per cent, nearly three times the rate
of job loss among those born in Canada (-2.3 per cent). The
unemployment rate increased more sharply for both recent immigrants
(-11.1 per cent) and long-term immigrants (-8.4 per cent), compared to
those born in Canada (-6.7 per cent). Ontario
employees in low-wage jobs saw their employment decline by 27.0 per
cent, while employment in other wage categories increased by 1.4 per
cent. Nearly all industries experienced sharp job
losses in 2020. The services-producing sector
experienced sharper job losses in 2020 (-298,800 or -5.1 per cent)
compared to the decline in the goods-producing sector (-56,600 or -3.9
per cent). In the service sector, some of the
largest job losses were concentrated in accommodation and food services
(-110,700 or -24.7 per cent), retail trade (-47,000 or -5.6 per cent),
and transportation and warehousing (-38,200 or -9.7 per cent). In
health care and social assistance, 30,500 jobs were lost (-3.3 per
cent) while educational services lost 25,000 jobs (-4.5 per cent).
Almost all the goods-producing industries (agriculture, natural
resources, utilities, construction and manufacturing) saw fewer jobs in
2020, with the majority of losses in construction (-25,200 or -4.7 per
cent) and manufacturing (-24,000 or -3.2 per cent). All
provinces experienced sharp declines in employment. Ontario recorded
the fourth deepest rate of job loss, tied with Quebec (-4.8 per cent),
trailing British Columbia (-6.6 per cent), Alberta (-6.6 per cent), and
Newfoundland and Labrador (-5.7 per cent).
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