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Hurley is travelling throughout the province, to explain how over the last decade Ontario's acute hospital funding has been on the slide compared to other provinces. In 2005-06, Ontario was "in the ballpark," with per capita funding of $1,112 compared to $1,159 for the rest of Canada, Hurley said, citing figures from the Canadian Institute for Health Information. Ten years later, Ontario's funding was $1,396 compared to $1,750 for the rest of Canada. He said the numbers extrapolated for Windsor are conservative, taking into account only the City of Windsor's 211,000 population, even though Windsor Regional's patients come from all over the Windsor-Essex region (population 389,000) and beyond.

Hurley said while Ontario did increase its funding for hospitals during the last decade, it did not come close to accounting for inflation, population growth and the aging population. This year, hospitals received a one per cent increase, but their actual costs rose 4.5 per cent, he said. "So their budgets have been cut again." Windsor Regional declined to comment on Hurley's assertions. In a statement, Health Minister Eric Hoskins said his government is doing what citizens want - continuing to invest in a health-care system that "puts patients first," asserting that 94 per cent of Ontarians now have a family doctor, and that wait times for some procedures are among the shortest in the country.

This year, it's increasing health funding by $1 billion, a 2.1 per cent increase, and it's increasing funding to hospitals by $345 million this year. "In Windsor, (since 2003) we've increased funding for local hospitals by more than $126 million - an increase of almost 50 per cent," said Hoskins. He also said Ontario is investing additional millions into home care, community health centres and home-based hospice and palliative care, because people prefer to receive their health care at home instead of a hospital. Hurley said the province argues that while it has been actively downsizing the acute care system, at the same time it's increasing investments in home care and longterm care, to "pick up the slack." But he said Ontario is actually spending less on long-term care and home care than the rest of the provinces. He said Ontario's high readmission rates are a sign the system is suffering. "So we have fewer beds, there's tremendous pressure to get people out of those beds and send them home, and often when they're sent home they haven't been made well actually and they return to hospital for a more lengthy and expensive readmission." Hurley said his council is calling on the government to fund hospitals "at least" at a level that reflects their rising costs, to stop reducing the number of beds and staffing, and to increase access to the people who need it.

The people being hardest hit by this are elderly, he said, who often have lived a long time without serious health problems, until they're hit with a health crisis that lands them at a hospital doorstep. "First they queue up in an ER for hours, and if they're going to be admitted it's likely a stretcher in a hallway," he said. And once admitted, there's likely pressure to get them discharged before they're fully well, he added. "For the elderly in particular they feel the brunt because there's rationing going on, the beds are so scarce." bcross@postmedia.com

Michael Hurley, president of the Ontario Council of Hospital Unions, discussed health-care funding in the province Thursday during a news conference at the Royal Canadian Legion Branch 255.

Mr. Duma fell through one of the biggest cracks in Canada's fractured home-care system - a crack that has still not been repaired, despite all the attention political leaders have showered on the issue recently. The problem is that home care is not covered in the first two to three months after a patient moves to a new province. The federal, provincial and territorial health ministers made home care a priority at their meeting in Toronto last week and the Liberal government has singled it out as the only area of health care in line to receive new money from Ottawa.

But that reciprocal billing deal covers only "medically necessary" services guaranteed by the Canada Health Act. Home-care services do not count, even for patients such as Mr. Duma, who had less than three months to live. Mr. Duma, a maintenance planner for Suncor, had active hepatitis B and liver cirrhosis before a liver cancer diagnosis led surgeons to remove 60 per cent of the organ in October of 2015. In May, he was back in hospital in Fort McMurray, Alta., when the wildfires swept through, forcing him to travel with hundreds of other patients to Edmonton. Terminally ill and unable to return with his wife, Ana, to their Fort McMurray home, Mr. Duma decided to move back to Windsor to be with Laura, 29, a nurse practitioner, and his younger daughter, Andreea, 27, a registered nurse. "He spent the majority of the last year of his life in a hospital," Laura said. "It was the last place he wanted to die." But Mr. Duma's family quickly discovered how hard it would be to fulfill his final wish. He did not qualify for any services provided by his local Community Care Access Centre (CCAC), the public agency that co-ordinates home care in Ontario. That meant no nursing care, no help from personal support workers and no access to publicly funded equipment, such as a hospital bed.

Darren Cargill, the palliativecare leader for the Erie St. Clair Regional Cancer Program, found out about Mr. Duma's dilemma from his daughters. He did his best to help, asking nurse educators from the Hospice of Windsor and Essex County to support the family by phone and rummaging through the hospice's basement to find used equipment to donate to Mr. Duma. In the end, Dr. Cargill bent the rules to secure a bed for Mr. Duma at a hospice in Leamington, about 45 minutes from Windsor. Hospice services are also excluded from the interprovincial billing agreement. "It's a little bit tragic," Dr. Cargill said. "In the eyes of the Ministry [of Health and Long-Term Care,] he wasn't even in that bed. We never admitted him. We kind of snuck him in on a weekend, took care of him, and gave him a peaceful death." Mr. Duma was not the first dying patient Dr. Cargill has treated who did not qualify for home care because of a recent move. The doctor had already raised the issue with Lisa Gretzky, the NDP MPP for Windsor West, who wrote a letter to Health Minister Eric Hoskins about the problem last January, six months before Mr. Duma died. On Tuesday, Ms. Gretzky intends to introduce a private member's bill called Dan's Law that would amend the Home Care and Community Services Act to waive the three-month waiting period for home care for patients who move to Ontario from another province where they qualified for public health insurance. Opposition private member's bills rarely become law. In an e-mailed statement, Dr. Hoskins said he and Premier Kathleen Wynne have "indicated that this is an issue of concern for our government," but that Ontario on its own cannot close the temporary gap in home-care coverage.

He said the provincial and territorial health ministers have formed a working group to "modernize and expand" their reciprocal billing agreements. But Ms. Gretzky said that "we can't wait for them [health ministers] to actually sit down, have this conversation, and really get this done."

According to PSAC, the bill authorizes the treasury board to modify collective agreements to remove sick leave and impose a short-and long-term disability plan outside of collective agreements. "This government continues to trample on collective agreements and this will cause irreparable damage to workplaces across this country for generations to come," DeCarolis said. The goal was to make a statement and educate others about Bill C-51's violations to the charter right to collectively bargain. "We're here to show that we will not stand by while our hard-earned charter rights are erased by a stroke of a pen. This bill will set the landmark for union relations in this country."

Other groups like the Windsor Peace Coalition showed resistance to The Anti-Terrorism Act - Bill C-51. "We're here to show that there is broad opposition to a policy of war and aggression abroad with these proposed new laws," said Margaret Villamizar, a spokesperson for the coalition. She said that Canada's involvement in Iraq, Syria and Ukraine doesn't favour Canada and violates the sovereign rights of those nations. A.G. Smith, while bearing a flag for the peace coalition, said there is little difference between how each of these bills will affect Canadians. "There's no security for anyone," Smith said. "You have autoworkers, postal workers - the Harper government is destroying their rights. We will fight until everyone has rights."

The protests come during a two-day visit to Windsor where Harper is expected to name the new international bridge and make an announcement about manufacturing. dwanniarachige@windsorstar.com

The story actually begins even earlier than that, with Dr. Cargill and his fellow palliative care specialists trying to solve a thorny problem: How can the healthcare system help more people to die comfortably at home? Dr. Cargill worked with the Ontario Medical Association, which represents the province's 28,000 doctors, and the Ministry of Health and Long-Term Care, to develop a solution that was essentially an extension of the traditional hospital on-call program.

Hospital physicians are paid a basic fee to be on-call; if they are summoned to the hospital, they bill the Ontario Health Insurance Plan for whatever services they provide. Dr. Cargill's idea was to assemble teams of palliative care experts to provide that same level of 24/7 support to patients who want to die at home, something he and his colleagues were already doing for patients in the border city of Windsor. The province and the OMA together agreed in the spring of 2013 to set aside $5-million per year from the pot of money Queen's Park pays to doctors to cover the on-call fees for as many as 30 palliative care teams in what came to be known as the Community Palliative Care OnCall Program.

But then red tape choked the plan. None of the new on-call money was distributed as the ministry and the OMA worked together to hammer out details, such as which teams would qualify for the funding. In the meantime, Dr. Cargill and other community palliative care teams elsewhere in Ontario carried on, doing their on-call duty free. If they made house calls during an on-call shift, they could bill OHIP, but if not, they were not compensated for providing overthe-phone support such as taking calls for medical advice and refilling prescriptions by phone in the middle of the night.

Dr. Cargill's community palliative care team fielded more than 38,000 phone calls in 2014. "A large number of those occur outside of business hours ... If our program didn't exist, what would have happened with those phone calls and more important, what would have happened to those patients?" OMA president Ved Tandan said his organization shares some of the blame for the delay in setting up a complicated new program, but he fully expected the money to begin flowing after a formal deal was inked last fall, just a few months before contract negotiations between doctors and the province collapsed.

"There was no action until there was media interest in this," Dr. Tandan said. A spokesman for Health Minister Eric Hoskins confirmed that the ministry informed 26 community palliative care teams on Friday that they had been formally accepted to the program and that funding would begin to flow. "Our government is dedicated to ensuring Ontarians can access quality care throughout their lives, and that includes palliative and end-of-life care," Dr. Hoskins said in an e-mailed statement.

"Last year, physician groups were invited to apply for funding to the [Community Palliative Care On-Call Coverage] program. Since that time, the ministry has been working jointly with the OMA to review applications, construct accountability mechanisms and finalize program details."

“A 1% wage increase for all WRH staff would cost $2 million dollars to implement. For senior staff 1% increase is $15,000,” he said. “A salary increase for senior staff barely impacts the $330 million dollar hospital budget.

Windsor Regional Hospital chair of the board Gay Wrye said the wage freezes could hamper efforts to lure new doctors to the area, with further examination needed of such a practice.

“This has to be monitored to ensure our fiscal responsibility does not interfere with being able to recruit and retain staff in order to continue being an employer of choice,” stated Wrye. “As a result of the long standing freeze on senior staff salaries the ability to recruit and retain them into the future with the changes upon us will be difficult without some necessary changes.”

"I've never had anything like that before in my life - home care - but the one time I needed it I had to struggle to have it," said Mueller, a La-Salle resident who supports Gretzky's bill because "everyone who needs home care should get it." Gretzky's Bill 92 reduces the appeals process when providers such as a local Community Care Access Centre deny or reduce the home care a patient receives, from a maximum of 60 days to 30 days. If the CCAC rejects the appeal, the CCAC would be required to inform patients they have the right to appeal to the Health Services Appeal and Review Board - something it doesn't have to do now. And while that HSARB appeal is underway, the patients would be entitled to the care they were receiving before it was cut.

In the legislature, Gretzky (NDP - Windsor West) said she saw the need for the changes last year when, shortly after being elected, she began receiving calls from residents whose home-care hours were being cut as the Erie St. Clair CCAC coped with a $5-million deficit. One particularly hardhit group was the families of severely disabled children attending the John McGivney Children's Centre in Windsor, she said. "These families were told they weren't going to receive home care, they were going to just be arbitrarily cut and they didn't know where to turn," said Gretzky, citing also the case of a woman in her 90s, paralyzed by strokes, whose hours were cuts because she was considered "low to mild needs."

The CCAC eventually received an injection of government cash to quell the crisis. But Gretzky said the experience showed her the need for a better process for people to appeal decisions they think are unfair. Many people didn't even know they could appeal the CCAC's cuts, she said. Gretzky hopes her bill will give people some breathing room instead of suddenly being cut off.

Her bill also received support from a number of agencies that advocate for patients and the elderly, including the Alzheimer's Society of Ontario. "We're really concerned because from the caregiver's standpoint, the home-care system really rests on the backs of unpaid caregivers - family, friends, neighbours," said Delia Sinclair Frigault, the society's public policy and stakeholder relations coordinator. And the idea that caregivers have to not only appeal a homecare decision, but also go out and hire someone to supply the home care while the appeal proceeds, "adds a lot more stress." The bill now goes to committee for review. Gretzky is hoping it will be passed into law by the fall.

On Tuesday he said whether Switzer collects the entire amount is unknown at this point, because the LHIN recently learned that Switzer was hired at the Alzheimer Society but hasn't learned how much he'll be paid. According to Switzer's contract, if he lands a job during the 23 months that pays at least 75 per cent of his former pay, the LHIN will pay out 50 per cent of the balance owed. If he makes less than 75 per cent, the LHIN owes him a lump sum equivalent to the balance owed, less statutory deductions. "So the amount he's going to get in terms of severance isn't determined yet," said Girash, who described the 22-month provision as "generous." But he explained it was part of Switzer's original contract from 10 years ago. Last year, when the LHIN board was negotiating a new contract for Switzer, members really wanted to get rid of some costly provisions, particularly a 14 per cent performance bonus. "We wanted to eliminate that, which we were successful in doing," said Girash.

He said to get that bonus provision eliminated, the board felt it had to agree to continue with the 22-month severance clause. "It looks big but it was, I think, a good stewardship of what we were dealing with from 10 years ago and moving to make it better," said Girash. "The 22 months is really almost a safety net if the individual can't get anything else, but obviously he has." The board agreed to the one-time $16,150 payment in 2015 during negotiations in order to eliminate the 14 per cent bonus clause, he said. Switzer started working at the Alzheimer Society on Aug. 15. Attempts to reach him Tuesday - to ask what he makes - were not successful. He was replaced at the LHIN on an interim basis by the second in command, Ralph Ganter, who remains the acting CEO. The LHIN is a planning agency that co-ordinates health care in the Windsor/Essex, Chatham-Kent and Sarnia-Lambton region. It's responsible for almost 100 different agencies - including hospitals - doling out more than $1 billion annually in Ministry of Health funding. Girash wouldn't say what Ganter makes but indicated it's less than what Switzer made, and because Ganter's old job hasn't been filled, the actual cost of Switzer's termination amounts to the topup Ganter receives. Ganter made $201,920.69 in 2015 when he was senior director at the LHIN. Girash said the board isn't going to decide on a permanent CEO at this time because the LHIN is in the midst of planning for big changes expected when the Ontario government passes its Patients First legislation. Patients First would see LHINs take on big new roles, including co-ordinating primary care (family doctors) and home care.

It's very, very demanding and takes a lot of stafftime, a lot of board time," said Girash. "So it wouldn't be fair to lay on top of everyone a recruiting process." bcross@postmedia.com twitter.com/winstarcross © 2016 Postmedia Network Inc. All rights reserved. Illustration: • Nick Brancaccio, Files / Former LHIN CEO Gary Switzer, right, sits on a panel with David Musyj, Dave Cooke and Janice Kaffer at a hospital town hall meeting in November 2015. Switzer was terminated in May. His severance of more than $500,000 is being described as "one hell of a golden parachute."