The South East Community Care Access Centre is pleased to respond to Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario.
We have reviewed the document Response to Consultation - Strengthening Home and Community Care: Successful Transition to a New Model submitted by the Ontario Association of Community Care Access Centres (OACCAC) on February 16, 2016. The principles, barriers and opportunities and considerations for effective change management identified in our provincial response reflect the thinking of our staff and Board of Directors.
There are three areas that we believe to be very important to minimize unintended consequences related to this transition:
• Continuity of patient care;
• Workforce stability; and
• Provincial oversight and monitoring of a consistent implementation approach
Continuity of Patient Care
The ministry’s proposal suggests that home care services will continue to be provided by current service providers and that contracts will be addressed over time to be better coordinated and aligned with sub-LHIN planning regions. To achieve the goal of more consistent, integrated care, priority must be given to streamlining and modernizing the current contracting model for home care services to reduce duplication that is inherent in the current contracting model.
We are pleased to see that public health units and primary care will be brought under the LHINs as many CCACs suggested during the provincial Local Health Integration Network Act review undertaken in 2014. We are also pleased to offer additional input into improving continuity of patient care.
Aligning care coordination with primary care in Health Links and other primary care settings, will go a long way toward delivering seamless, integrated care. However, it is incumbent on us to ensure that there is continuity of care for patients and families during and after the transition of Home and Community Care to the LHINs.
CCACs provide care to over 700,000 Ontarians. Many of these patients have complex needs requiring complicated care plans involving many health service providers as well as families and informal caregivers.
While it is prudent to work toward standardized pathways and bundled care, we must keep in mind that at the heart of the Home and Community Care philosophy is that individualized assessments and care plans that meet the expressed needs of the individual. The services provided through the care plans are of a personal nature and make the difference between remaining in one’s home and having to live in an institution. As registered health professionals, we must continue to place the Care Coordinator’s professional judgement in high regard to ensure we continue to provide the best possible outcomes to the 700,000 Ontarians who count on us for care.
The transformative change proposed by the government depends on a clear transition plan and consistent implementation. The Home and Community Care workforce has demonstrated its value as evidenced by high patient satisfaction with the services they received from the CCAC including Care Coordination.
CCAC Care Coordinators are regulated health professionals with expertise in nursing, social work, occupational therapy, physiotherapy or speech therapy. Many CCAC patients, particularly complex patients, benefit from specialized knowledge and Ontario’s CCACs have completed a great deal of work to create specialized teams to meet the specific needs of various populations. This expertise should be recognized and embedded across the health system.
To ensure successful transition, it is important to recognize the complexity of CCAC operations and the diverse skill sets that enable Home and Community Care. The delivery of high-quality care to more than 700,000 individuals each year involves not just care coordinators and direct patient care providers. The staff supporting contract management, quality improvement, finance management, decision support and information systems also make critical contributions to patient care and should be transitioned intact to the LHINs.
Provincial Oversight of Implementation Plan
Ensuring consistent transition across Ontario requires a framework to guide the transition. To do this we recommend that the establishment of a provincial table to oversee and monitor the work. Furthermore, to ensure consistency and equity across Ontario, individual LHINs should not be empowered to make local decisions that are inconsistent with a provincial framework for change.
Adjusting boundaries can contribute to unintended consequences for Ontarians seeking to access care. CCACs know this firsthand after navigating the necessary changes to facilitate the creation of LHINs and the corresponding boundaries.
We recommend that CCACs be given a strong voice at the provincial planning table to lend our leadership, knowledge and capacity to lead a transition of this magnitude and scope.
Min Hoskins Patients First Response February 29 2016.pdf