Caplan's Ontario home care review backs competition and quality controls.

TORONTO -- Ontario's review of home care, headed by Elinor Caplan, received mixed responses.

Because it recommends changes to assure continuity and quality controls and funding, it is supported by the Ontario Association of Community Access Care Centres and other agencies.

Caplan's report also supports the competitive bidding process with some changes. It has earned scorn from the labour unions involved, who wanted an end to the bidding challenges.

The government appointed Caplan, a former provincial Health Minister, to look into the problems that have arisen with the introduction of competitive bidding by the previous Tory government. Complaints about quality of services and continuity of care, and job uncertainty were raised as more than half of all of the home contracts were shifted from non-profit organizations to for profit companies. The non-profits complained that they were at a disadvantage in the process.

The Provincial Auditor called for a funding system that more fully allocates funds based on assessed needs; measures to demonstrate clients are in fact receiving quality care; and an information system to collect client service and costing data.

The review makes its recommendations "in the context of a competitive service delivery model." Among the 70 recommendations, are these:

* establish the Centre for Quality and Research in Home Care to collect consistent information and set key performance indicators aimed at providing more effective, higher quality service to home care clients;

* set up a province-wide, one-stop certification process to replace the current patchwork of prequalification requirements;

* longer-term contracts for those providers who demonstrate excellence in service to clients;

* change the way care agencies are paid, from "fee for service" or "per visit" to "fee for client," to a client-focused envelope of funding based on client needs rather than the number of visits made;

* more choice, more flexibility, more and better information for clients and their families about their care options and rights;

* standardize and collect better information for the use of service providers and CCACS to measure progress, improvements and success in the home care sector;

* Obtain better value for money in the procurement of medical equipment and supplies;

* Make home care a priority for the Government's Information Technology and Transformation agenda;

* Protect and enhance workers rights. Part-time casual and full-time work should both be encouraged and seen as valid employment practices, and all employees should benefit from the protections of the Employment Standards Act;

* Clarify the roles and responsibilities of the Ministry of Health and Long-Term Care, CCACS, Case Managers and Boards of Governors;

* Reverse the current decline home care funding a percentage of total health care spending over the past few years by allocating new investment in the sector;

* View home care in the context of the hospital sector for a "seamless continuum of care, when needed, as close to home as possible."

The review gives a renewed endorsement of home, pointing out that "Studies show that people get better faster at home..... are generally happier, and recover faster both physically and mentally at home."

The CCAC Procurement Review believes that the recommendations can be implemented at moderate cost over the next three years.