Saturday, November 19, 2011

Gag orders, for-profit contracts, TPAs, PSWs, LHINs, elder abuse

The beauty of the healthcare system in Ontario, is the ability of each LHIN Board of Directors to create policy, advocate and create initiatives for a particular region. Unfortunately, individual cases of inequities are only coming to light when the media becomes involved.

The beauty of Ontario's patient-centred healthcare includes the SMILE program(PDF), the Aging at Home initiatives, initiatives directed at frail seniors (PDF), EASIER–geriatric case managers, all empowering seniors and their family members to get needed supports in place.

The ugliness of this system in each LHIN's regionally-driven program, as an example, means that the Sunshine List (employees making more than $100,000 in salary) has increased while real wages for lower level staff have not seen such increases. This isn't sitting well with most. This is why the Occupy movement has impacted us all.

 If we want everyone to have accountability, PSWs as much as doctors, nurses and hospitals, if we want to draw the best PSWs, as well as the best nurses, with the most upgrading, education and training, we're going to have to shorten the chasm between hospital CEOs and PSW wages. I firmly believe we draw the best leaders with good salaries. I also believe we must pay a fair wage to those seeking to earn a living in the homes, institutions, and facilities where our frail, vulnerable seniors live.

My local S.E. LHIN Red Cross-employed union of support workers has resulted in fixed wages for 3 years for these PSWs. This means, in real terms, $15.03/ per hour to go into people's homes, change adult incontinence products, change bedding, and provide intimate care for loved ones unable to care for themselves. And no salary increase for three years.

Local citizens find it hard to stay on top of their local LHINs, and those who do are blocked (specifically in cyberspace–for that is how taxpayers can keep up an awareness and generate buzz) in a politically driven healthcare system. The famously, highly-touted Aging at Home Project is one of the tax-payer driven systems to help seniors stay in their homes longer, with some support. A Win-Win for politicians, it is an elderhood issue, driven by those who need a bit of help. In my region, SE LHIN, it is estimated that by 2016 1/6 citizens will be seniors. Again, there is a need for locally-driven responses to specific populations. It is an important part of the LHIN. But the provincial government cannot stand back and stand by, washing their hands to avoid particular issues.

Gag orders, it has been written, are the norm in Guelph, says the Guelph Mercury.
The matter was most recently advanced by Mercury letter writer David Williams.

In our area, according to the Waterloo Wellington Community Care Access Centre’s own statistics, between the 2008-09 and 2009-10 fiscal years, funding increased from $87 million to $100 million. Despite this increase, in the same period, again according to their published numbers, total nursing visits went down, total therapy visits went down, information calls went down, and the total number of clients serviced went down. The only service provision increase was in personal support worker hours, which was marginal.

There are many for-profit Transfer Payment Agencies (TPA) who operate on tax dollars, through the LHINs, having bid in an above-board RFP process to deliver services to our frail children and seniors in their homes. Agencies include for-profits and non-profits. There appears to be no distinction to me. What is risky, to me, is that there is much opportunity for abuse of the system and of individuals, and it is a slap in the face to all those who fight for transparency in the healthcare system.

What is the impact of a gag order on individuals? 
It is specific, harsh, and turns into issues such as Elder Abuse. An issue toward which huge sums of money have been devoted provincially and federally.
Our government transfers tax dollars to for-profits, and non-profits alike: hospitals, senior's supportive living facilities, long-term care and retirement homes. The CCACs, Community Care Access Centres, also contract out services, such as nursing and PSWs, to local for-profits, to ensure that seniors in their homes have the care they need for their ADLs (activities of daily living): toileting, meals, light housekeeping, grocery shopping, bedding changes, on the part of PSWs; and IV lines and wound care, for example, on the part of nurses.

With the vast numbers of seniors, and developmentally disabled children, in their homes or institutions, the government does not have enough resources to take care of these needs themselves. They must outsource to these agencies and institutions. HOWEVER, and this is a big one, the for-profit long-term care (LTC) homes consist of about 5/6 of the 600 LTC homes in Ontario. The evidence is clear: there is abuse. I volunteer, or have had access to, several retirement homes and many LTC homes (for-profit and non-profit), and have never seen an incident of abuse.  I have seen many incidences of neglect. It has been quite frequent that I have seen far below standard services delivered to those in dire economic straights. Poverty is a huge predictor of ill-health. It is also, in my experience being caregiver to mom sine 2006, and volunteering in healthcare since then after her passing.

In these situations, a TPA sends in support, but with no standard education, no regulation, training, monitoring or accountability for these PSWs, with an inability to speak truth to power, i.e., gag orders, this is the reason why we will continue to face horror stories in the media. This is why we may come to believe that the millions we spend in creating Elder Abuse prevention initiatives are the political panacea for elder abuse. This is why and how politicians can smugly purport to have studied, and created a solution for these issues. This, also, is the reason why we need an OMBUDSMAN for the MUSH sector; Municipalities, Universities, Schools, Hospitals. There must be an avenue for whistle-blowers.

In the news:

Nursing home neglectDiaper rationing, short staffed homes, plague elderly

AND:Nursing home residents being beaten, neglected and raped
Abuser is usually a staff member or other residentnt
A private nursing home chain enforced such strict rations on diapers that staff wrapped residents in towels and plastic garbage bags to keep their beds dry.

Public Sector Salary Disclosure 'Sunshine List' The Public Sector Salary Disclosure Act, 1996 (the act) makes Ontario's public sector more open and accountable to taxpayers. The act requires organizations that receive public funding from the Province of Ontario to disclose annually the names, positions, salaries and total taxable benefits of employees paid $100,000 or more in a calendar year
A GREAT part of the LHINs Home FIrst Program:

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