Tuesday, March 26, 2013

There are hidden costs of moving care out of hospitals

Ultimately, we pay less to those who care for seniors in their homes, but we also cannot control the type of care they receive. It is more expensive for workers to go from home-to-home, as many do not get mileage, and they are paid less that their counterparts in for-profit, larger institutions, with better working conditions, and peer support.

 Turnover as workers leave home care for higher paying jobs at hospitals

Turnover is high for home care, which means that frail, palliative clients often do not have consistent caregivers. This is upsetting for those who have built a relationship with professional caregivers, who provide intimate care. Personal support workers (PSW) do the work that nurses used to do, at a much lower rate of pay. They have minimal education, and are not trained using consistent curriculum.

Caregiver burnout is a hazard, as family member step in to provide extra support. Usually, this is a daughter, or daughter-in-law, who pays not only emotionally, but financially as they take time off work.

While many demand home care, the cost is not limited to saving money in hospitals or long-term care.
The government's position is that freeing up hospital resources for alternative level of care (ALC) patients, who could be cared for at home, means patients with acute care needs can go home. (see: 
However, hospitals in Ontario are also facing funding cuts, as the government is channeling money towards home care. It seems conservative seniors, the ones who vote the politicians in, don't want to pay higher taxes, but also don't want to die in hospital. This is a huge mistake.

She makes $16 per hour, but rarely gets paid for more than four hours a day, because most of her time is spent traveling on subways and buses between clients' homes, which are spread across the sprawl of North Toronto. She is paid only $1.50 for travel, even though getting between clients’ homes often takes an hour on the TTC. She does not make enough money as a PSW to make ends meet for her family, and so cleans homes when she is not providing home care.
Personal support workers in the home care sector can be paid as little as $12.50/hour compared to hourly rates of $18 to $23 for their hospital-based colleagues. Similar disparities have also been observed for other care workers, including registered nurses.
According to a report from the Ontario Health Coalition, another contributor to lower wages is the Ontario government’s procurement policy for Community Care Access Centres (CCAC), which requires CCACs to contract out home care services. While competitive bidding for contracts has been somewhat successful in keeping costs down for CCACs, it has done so largely by “driving down wages,” according to the authors of the report.

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