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

Ontario Nurses Oppose Damaging Changes to
Home and Community Care

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."

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Role of Care Coordinators in 
Ontario's Health Care System

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."

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Anti-Social Changes to Health Care
Legislation and Regulations

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.


1. Ontario Health Board of Directors, Ontario Health website. 

(Photos: WF, OFL)

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For Your Information 

Record Job Losses in Ontario

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.

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Some Data from the Report 
Ontario's Labour Market in 2020

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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