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Over the coming months, the Ministry of Health and Long-term Care and the LHINs will engage physiotherapy providers and community partners interested in delivering these services in communities across Ontario.

Community Care Access Centres will receive $33 million in additional funding to reduce the waitlist for in-home physiotherapy services, which will help to keep more seniors and eligible patients healthy and at home longer. Up to 60,000 more people, mostly seniors, will receive physiotherapy in the comfort of their own homes, benefitting 150,000 people in total.

Until now, a small number of for-profit companies have had almost exclusive control over the delivery of publicly-funded physiotherapy.

69 beds the Niagara Health System cut in the fall of 2011 and spring of 2012

the hospital, which had to cancel or postpone 758 surgeries due to “bed pressures.”

after-hours clinic, pain clinic, audiology clinic and cardiac rehabilitation program closed by Toronto’s St. Joseph’s Health Centre

The Coalition released its first “Austerity Index” December 5th to let Ontarians know just what is happening with their health services. The index will be an ongoing document as news of specific health care cuts emerge over the coming months.

Base funding for Ontario hospitals has been set at zero this year. The OHC estimates that between inflation (1.6%), population growth (1.1%) and aging (1%) the funding gap represents about a 3.7 per cent gap.

within the last two years (2010-11) 50 per cent of hospitals have reduced or cut outpatient physiotherapy services

We’re witnessing even more this year, such as the 3.1 physiotherapy positions just cut at the Perth and Smiths Falls District Hospital or the 24 combined therapist positions lost at the Ottawa Hospital.

the province hasn’t designated a new community-based OHIP physiotherapy clinic in the entire province since 1964

significant out-of-pocket payment even for those who qualify for OHIP coverage

Think the Champlain CCAC will be able to pick up the slack in Eastern Ontario? Not likely. The LHIN covered last year’s CCAC deficit under the proviso that it balance its budget this year, which includes a freeze on hiring and cuts to home visits for wound care and IV therapy.

The coalition said home care is being more strictly rationed and a recent increase in funding for home care is nowhere near enough to deal with lengthy waiting lists.

“They’re seeing much more complex patients, who cost more to provide for, but home care funding per client is shrinking because there are so many more patients being dumped into home care.”

Some patients are forced to pay $50 to $70 for every physiotherapy treatment when hospital clinics close and they are sent to private facilities

Ontario ranks eighth out of 10 in provincial health care funding, and dead last when it comes to per capita funding of hospitals.

Rosebush says the services will fill a gap left by the private providers that were unable to maintain the out-patient program in Walkerton and Kincardine. The service continues to be available in Durham through a private clinic which receives provincial funding. Rosebush said the service in Kincardine could begin by Dec. 1.

Although they discussed that incident during a press conference Thursday at the Orillia legion and referenced it in a press release, neither O'Sullivan nor Carrothers could say it relates to the care issues they are now raising. For her part, O'Sullivan said staffing levels need to be increased to ensure nursing-home residents receive better care and remain safe. To that end, the two groups are calling on local byelection candidates to commit to creating a new law that would create a four-hour daily care standard mandatory throughout the province. "With a four-hour care standard and the increased care levels that would bring, residents will be safer and better cared for," O'Sullivan said, noting the need is all the more important in a riding like Simcoe North that has many residents who are 65 and older. Oct. 1, the two organizations will join an Ontario Health Coalition ceremony at Queen's Park in memory of long-term-care residents who have been killed by other residents.

Progressive Conservative Leader and Simcoe North candidate Patrick Brown said the government needs to stop reducing long-termcare spaces and ensure homes have access to other important programs. "I would also restore physiotherapy (services for seniors) that was cut to $50 million," he said, noting his 101-year-old grandmother broke her hip five years ago but recovered thanks to physiotherapy. NDP candidate Elizabeth Van Houtte said the byelection is a chance to send a clear message to Premier Kathleen Wynne and her government.

"It's time to stop the deep, painful cuts that this Liberal government is making to health care and take real steps to improve care and safety for our aging parents and grandparents," she said. Liberal hopeful Fred Larsen wants to assure constituents the safety of residents in provincial homes remains a government priority. "The government has committed to performing annual, comprehensive inspections of every long-termcare home in Ontario to ensure residents remain safe, comfortable and cared for," he said.

At the same time, public funds allocated for at-home and community-based therapy services have been cut. This means more and more patients are being forced to pay for private therapists, whose fees start at about $60 an hour.

Between 2007 and 2012, the number of community-based visits to patients by physiotherapists plunged by 22 per cent, or 130,000 visits, according to the government’s own most recently published figures. Visits by occupational therapists fell by 30 per cent, speech-language pathologists 47 per cent, social workers 22 per cent and dietitians 20 per cent.

seniors represent 14 per cent of the population, but they use 40 per cent of hospital services and account for about 45 per cent of health spending of provincial and territorial government

an acute-care bed costs about $1,100 a day. In comparison, Turnbull estimated it costs a quarter of that to care for the same senior in the community.

services include traditional health-care services such as nursing and physiotherapy as well as transportation or help with household chores

93 per cent of seniors who live at home

Only 8.3 per cent of patients from cities were readmitted, compared to 9.5 of rural residents.

a shortage of home-care services like palliative care and physiotherapy outside major centres could be to blame

nearly one in 10 of those discharged from a hospital end up in an ER within a week.

When Serco made its bid to run NHS community-health services in Suffolk – district nursing, physiotherapy, OT, end-of-life palliative care, wheelchair services – it reckoned it could do it for £140m over three years – £16m less than the existing NHS "provider" had managed, which would eventually allow for their standard profit margin of around 6% a year. When it started to become clear that Serco was the frontrunner, there was some opposition, but perhaps not nearly enough.

We are meant to be known by the 5,000 not the five billion.

"There's also the inability of the public sector to monitor effectively,

The strangest thing, though, is the gap between Serco's size and how little the public knows about it. Not for nothing does so much coverage of its work include the sentence "the biggest company you've never heard of".

We've still got the same number of patients," she says, "so the workload has massively increased." As a result, she and her colleagues are having to cut people out of their previous entitlement to treatment at home. "That completely goes against our ethics," she says, "but that's what we're having to do.

The NHS is a relatively new area of controversy for Serco, but concerns about their practices run across many other areas

Serco was officially awarded the contract in October 2012, which meant that hundreds of staff would leave the NHS, and become company employees. Within weeks, the company proposed a huge reorganisation, which involved getting rid of one in six jobs. This has since come down to one in seven, two thirds of which will apparently go via natural wastage. In terms of their pay and conditions, the hundreds of people who have been transferred from the NHS to Serco are protected by provisions laid down by the last government, but it is already becoming clear that many new staff are on inferior contracts: as one local source puts it, "they've got less annual leave, less sick pay … it's significantly worse."

great wall of commercial confidentiality

they're good at winning contracts, but too often, they're bad at running services."

The National Audit Office is doing work around the development of quasi-monopoly private providers, which is the world we're moving into. We don't really understand the size of their empires.

That's because home care needs a leader who cares deeply about a system that for too long has seen patients struggle to receive basic services they deserve, suffer when their therapy sessions or personal support visits are cut off or reduced, or who are sent home from hospitals with false promises of services to come to their door. "We know from the feedback that we have received from literally thousands of individuals and families that the care that they are currently receiving is patchy, uneven and fragmented," Hoskins admitted last week. It was just six months ago that Hoskins was refusing even to acknowledge that any patients had their services terminated or reduced because of cutbacks by Community Care Access Centres, which oversee home- and community-care services. In fact, those cuts affected thousand of sick and elderly patients across the province.

Encouragingly, Hoskins unveiled several new measures last week that potentially could help patients receive better and more cost-efficient care. One pilot program would give patients money to hire their own home-care services and health professionals to provide care in their homes. For example, hospitals might be able to work with discharged patients in regards to co-ordinating community supports. Ultimately that could spell the demise of CCACs, which now co-ordinate community care, usually through private companies and non-profit organizations. As good as such steps are, Hoskins could have done so much more to truly improve home care.

First, Hoskins should radically reform the overall bureaucratic structure of home and community care. Gail Donner, former dean of nursing at the University of Toronto who headed a recent government-appointed panel on home care, has called the issue of structure "the elephant in the room" when it comes to poor delivery and co-ordination of services to patients. The most obvious starting point is the 14 CCACs across Ontario. These government agencies, which are filled with many hard-working and dedicated staffers, have been rightly criticized as being too bureaucratic, inefficient and top heavy with high-paid executives. Hoskins said last week he will wait until Auditor General Bonnie Lysyk releases two reports on CCACs before making any moves. The first report looking into CCACs' financial operations, which was requested by an Ontario all-party legislative committee in March 2014, was to have been ready this spring. It now won't be ready until late fall. The second report, which will look into other aspects of home care, will be included in the auditor general's annual report, tentatively set for early December.

Second, Hoskins should demand more money for rehab services, such as physiotherapy and speech-language pathology. This growing area of need has been effectively gutted over the years in the name of cost-saving, with patients getting as few as two visits from front-line health professionals after being sent home from hospitals. At the same time, hospitals have closed in-patient and outpatient rehab clinics, forcing patients to fight for limited home-care services or pay privately. Third, Hoskins should reverse a unilateral decision by CCACs that forbids charitable non-profit home-care organizations to fundraise among former clients.

Such a move would open the door for not-for-profit organizations to provide vital home-care services that are not now being met or are being under-delivered by CCACs. Low-income and aboriginal groups would be among those most likely to benefit from such a move. If non-profit hospitals can fundraise among former patients, it seems logical that not-for-profit home-care organizations should be allowed to do the same thing. Home-care patients can draw some encouragement from Hoskins' small steps forward. But now is the time for bolder steps that will make a real difference in the lives of patients and caregivers around the province. Bob Hepburn's column appears Thursday. bhepburn@thestar.ca.

Berti, a member of the family health team of physicians, said they would be tenants in the proposed health-care building. She said patients would also be able to meet face-to-face with other health-care professionals, rather than trying to travel outside the town with the limited public transportation available. "What we are striving for is care close to home," said Berti. "We can provide great care, helping people live longer and healthier." She added there is also a need for after-hours medical services for local residents and tourists, particularly considering the large number of visitors to the town.

Berti said she believes Niagara-on-the-Lake would be a good place in the province to start a health-centre hub because it is a small community. She said she hopes the proposal would receive some infrastructure funding from the Ontario government. In February, the Ministry of Health released a report that calls for better and more co-ordinated health care including more community para-medicine programs, more models for collaborative care and improved services for seniors. According to the 2011 census, the percentage of seniors living in Niagara-on-the-Lake was 26%, compared to the provincial average of 15%for the 65 and up age category. The steering committee's funding request goes to council next week for approval.

But if union workers are still on the job, it seems highly likely to us that all union rights previously achieved by way of collective bargaining with the actual employer - you taxpayers by way of government - are still in play. CUPE representative Norma Robinson has already voiced concerns. She says the department has already told the union that it is taking bids from three big private-sector providers - Sodexo, Aramark and Compass Group - toward signing a 10-year contract in three or four months. She is certainly within her rights to ask what impact that contract will have on the contract public sector workers have with government.

Perhaps the minister prefers to wait until the contract is signed before saying more, but it seems to us that whatever efficiencies the successful bidder intends to achieve will depend a lot on how it and the union co-operate within the strictures of collective agreements. It is one thing to centralize a kitchen service, for example, and another to respect any pertinent contractual language, such as 'manning' and seniority. Ms. Robinson already sees this move as the first step toward privatization of health care. While Ms. Robinson has said nothing further in that regard, some might interpret that statement as a harbinger of labour unrest for the health department over the course of that private 'management contract.'

Having said that, we are optimistic that some efficiencies will be achieved immediately if all management functions are removed from the collective agreements; it is logical to expect as much given the bidding process should get taxpayers to the lowest price possible for those specific functions. And while we sympathize with union concerns, we endorse privatization of health care; the more the better.

Not long ago union voices were predicting dire consequences when laundry services were centralized for the sake of efficiency. They didn't happen. Should anyone voice similar concerns about a private-sector management contract about, for example, the quality of hospital food, many a patient might chuckle. This government is trying to reduce massive debt and stop deficit spending. Thus it is welcome news to also hear Horizon Health Network CEO John McGarry suggest private health-care firms could move such professions as physiotherapy, audiology and dietetics out of the province's hospitals, which he also notes are too numerous.

The update features additional anecdotal experiences of patients who have been let down by the health care system as a result of issues such as understaffing, overcrowding, early discharge and insufficient community support or home care. It also focuses specifically on cuts in the North. The report indicates that cutbacks in North Bay, which is the first stop of the campaign, include the closure of an eight-bed mental health rehabilitation unit and more than 56 positions -representing an estimate of more than 50,000 nursing care hours per year, affecting departments throughout the facility.

Although the local hospital has indicated resources are being transferred to the community, Hurley suggested such transfers do not commensurate with the cutbacks and often come at the expense of acute care services. "With the cuts that are happening across Northern Ontario, this is only going to get worse," said Richer, who share some the anecdotal experiences of patients included in the report. One account was that of an elderly man who had suffered a stroke and whose family believed he had been discharged too soon from hospital and did not receive adequate physiotherapy. Although the family struggled to pay for some private therapy, but the man never regained the ability to walk and died within two years of his stroke.

Hurley said hospitals have been forced to make cuts because they are now in the fourth year of a five-year freeze on their budgets. And he said estimates cited by the auditor general calculate that hospitals need a 5.8% increase annually to meet their basic costs. The report calls for the reopening of chronic and alternate level of care beds, a halt to the closure of acute care beds, adequate hospital funding, hospital reinvestment, the elimination of fees for home care, therapies and services and a move away from private for-profit home care, long-term care and pharmaceuticals. Hurley said the OCHU is also preparing to file a complaint to the Ontario Human Rights Commission of discrimination in the health care system against the elderly when it comes to acute care services.

The report, entitled Pushed out of Hospital, Abandoned at Home, chronicled the experiences of hundreds of patients and their families from more than 30 Ontario communities who called a 1-800 patient hotline set up for a year by the OCHU and Ontario Association of Speech-Language Pathologists and Audiologists. The update features additional anecdotal experiences of patients who have been let down by the health-care system as a result of issues such as understaffing, overcrowding, early discharge and insufficient community support or home care. It also focuses specifically on cuts in the North.

The report indicates that cutbacks in North Bay, which is the first stop of the campaign, include the closure of an eight-bed mental health rehabilitation unit and more than 56 positions - representing an estimate of more than 50,000 nursing care hours per year, affecting departments throughout the facility. Although the local hospital has indicated resources are being transferred to the community, Hurley suggested such transfers do not commensurate with the cutbacks and often come at the expense of acute care services. With the cuts that are happening across Northern Ontario, this is only going to get worse," said Richer, who shared some the anecdotal experiences of patients included in the report.

One account was that of an elderly man who had suffered a stroke and whose family believed he had been discharged too soon from hospital and did not receive adequate physiotherapy. Although the family struggled to pay for some private therapy, the man never regained the ability to walk and died within two years of his stroke. Hurley said hospitals have been forced to make cuts because they are now in the fourth year of a five-year freeze on their budgets. And, he said, estimates cited by the auditor general calculate that hospitals need a 5.8% increase annually to meet their basic costs. The report calls for the reopening of chronic and alternate level of care beds, a halt to the closure of acute care beds, adequate hospital funding, hospital reinvestment, the elimination of fees for home care, therapies and services and a move away from private for-profit home care, long-term care and pharmaceuticals. Hurley said the OCHU is preparing to file a complaint to the Ontario Human Rights Commission of discrimination in the health-care system against the elderly when it comes to acute care services.