CUPE Health Care

The Who Cares? campaign wants to see the creation of a Community Care Services Authority modeled after the province’s health authorities. Bringing community care service providers under direct public administration will help eliminate administrative duplication and help focus increasingly limited public funds on front-line service delivery and better working conditions for workers.

There's no guarantee that a coroner's investigation would have uncovered the alleged medication murders of eight elderly residents in Woodstock and London. Ontario Provincial Police announced this week that 49-year-old registered nurse Elizabeth Wettlaufer is facing eight first-degree murder charges related to deaths in homes from 2007 to 2014. Cheryl Mahyr, spokesperson for the coroner's office, said the requirement for an investigation in every 10 deaths was added in the mid-1990s because government oversight was lax. It was dropped in 2013 after the office concluded that the 2010 long-term care legislation had "robust investigation requirements." Ministry inspections do expose problems. The issue, say critics, is that Ontario's long-term care system is so cash-strapped and short-staffed that systemic failures - filthy unchanged diapers, resident-on-resident violence - are never really fixed. For the past two days, Premier Kathleen Wynne and Health Minister Eric Hoskins have been grilled in the legislature on the issue. NDP leader Andrea Horwath asked "exactly what's being done by the premier to ensure that something this horrific and heartbreaking never happens again?"

In response, Wynne said the government might conduct an independent review "at some point not because of political pressure from the NDP, but because we all need to have the answers." Wynne committed to improvements on Sept. 23 - six days before Wettlaufer's arrest - when she sent Hoskins his new "mandate letter." Long-term-care goals were to include: "Increased safety (and) an ongoing commitment to annual inspections." Earlier this year, the ministry said its inspections - which were supposed to include private interviews with roughly 40 residents and families - will be done every three years, instead of annually as promised around the time when the coroner's office made its changes. (The ministry continues to do shorter inspections every year.)

By law, all deaths in nursing homes must be reported to the local coroner, who can decide whether further investigation is needed. The number of coroner investigations has fallen by more than half since it dropped the one-in-ten-deaths requirement - in 2013, there were 2,027 investigations, followed by 890 in 2014.

This painful issue should not become a political football. The crimes of a rogue nurse, if that is indeed what is involved here, cannot be blamed on any particular party or government. No one will respect a politician who tries to score cheap points on the backs of murdered seniors. But neither should Ontarians be expected to wait silently for months before hearing more specifics of what went on, whether any weaknesses in the system can be identified, and what steps might be taken to reduce the likelihood of anything remotely similar from happening again. The stakes are too high for that.

In that light, Health Minister Eric Hoskins' blanket assurance that there is no danger to any care home resident and his assertion that Ontario has one of the best oversight systems for nursing homes "in the world," fall short of what is needed. There are legitimate questions that can and should be addressed without getting into the details of the Woodstock case or interfering with the police and judicial processes. For example: Does the province need to take another look at how often coroner's inquests are held into the deaths of people in care homes? As recently as three years ago the provincial coroner's office automatically investigated every tenth death in every care home. It was intended as a way of identifying any problematic patterns in the deaths of residents.

But in 2013 that was stopped on the grounds that it turned up no useful information. At the time, critics said it was a short-sighted move. In light of the Wettlaufer case, should that be re-visited? And are there any gaps in the system for reporting residents' deaths to the province or local coroners? Are there gaps in the system for making sure drugs are accounted for in nursing homes? According to police, the eight seniors who died were given fatal overdoses of a drug.

There are supposed to be fail-safe systems for ensuring that drugs cannot go unaccounted for in care homes. How exactly do they work, and can improvements be made following this tragedy? Are there adequate systems to monitor the stability and mental health of medical professionals? Wettlaufer apparently had problems with addiction and she was reportedly identified by police when she shared information about the deaths with staff at the Centre for Addiction and Mental Health in Toronto. Were there measures in place that might have picked up earlier on any problems she was experiencing?

There are much broader concerns, too, about the general condition and funding of the long-term-care system. There's no question that the needs are enormous and growing and more robust staffing would improve service all around. But for now, the focus should be on reassuring care home residents and their families.

Premier Kathleen Wynne says the government is prepared to conduct an independent review or inquiry into safety procedures in nursing homes "at some point, if there is a need." In the meantime, her government would do everyone a service by more clearly addressing specific points directly relevant to the sickening allegations in Woodstock and London.

Why were these deaths not investigated? "While all nursing home deaths are reported to the coroner, an autopsy is not scheduled except in specific circumstances, including those that are considered suspicious.

Women are more likely to work less than 30 hours per week with no benefits. Young workers, or those below 35 years of age, are less likely to have workplace pensions, or sick leave.

Racialized workers, non-citizens, those whose first language is other than English or French, are far more likely to be precariously employed. This is not the way to build a better Canada.

Our campaigns and political action work are an important part of this fight, but we must never lose sight of the most powerful tool we have. We must organize these workers, allowing them the single best way to fight precarity and inequality in the workplace – a union.

But the health consequences of PTSD can be calamitous - suicide rates are high - and the resources to deal with the problem are not keeping up with the surging demand. As it stands, the federal and provincial health systems are not equipped to get first responders the help they urgently need. As federal employees, Mounties can turn to the overburdened Veterans Affairs ministry, which is plagued by delays and inefficiency. Their local and provincial counterparts aren't even that lucky. They face a patchwork of support programs that vary widely according to region.

Some provinces include PTSD in their workplace injury compensation plans; others don't. In some places, certain classes of workers, such as nurses, aren't covered. Last month, the federal military ombudsman, Gary Walbourne, called for the creation of a national "concierge service" - a onestop shop for the Department of National Defence's PTSD sufferers. It's a good idea that should spawn imitators across Canada. Emergency workers perform dangerous, harrowing work on society's behalf, and they are hurting because of it. Governments at all levels have the urgent duty to help them recover.

Polls show Canadians overwhelmingly support these conditions. Medicare's key limitation, however, is that it applies only to services offered by doctors and hospitals. It does not apply to home care. Increasingly, provincial governments are trying to save money by encouraging acute-care hospitals to discharge patients as quickly as possible. In most provinces, these patients find themselves reliant on badly underfunded home-care services. Unlike hospital care, such services are usually neither comprehensive nor universal. As an Alberta oil worker with incurable cancer found when he tried unsuccessfully to come home to Ontario to die near his family, they are not even portable. Ontario pays $3 billion on home care each year. But Queen's Park saves more than that in foregone hospital and nursing home costs. In that sense, home care is a revenue tool. It allows provincial governments to evade the spirit, if not the letter, of the Canada Health Act. In Ontario, as my Star colleague Bob Hepburn has pointed out, the results are sometimes absurd. When the provincial Liberal government boosted wages for badly paid home-care workers earlier this year, some cost-conscious agencies responded by cutting services. In the weird world of Canadian health care, it was the logical thing to do. But there is a way to fix the home-care anomaly. Roy Romanow's royal commission on health care pointed to it 14 years ago.

Romanow argued it made no sense to exclude home care from medicare. He recommended home care services for the mentally ill, for patients just released from acute care hospitals and for those needing palliative care be written into the Canada Health Act immediately. By 2020, he said, all home care services should be covered by medicare. Interestingly, federal Health Minister Jane Philpott is also focusing on home care, mental health and palliative care. How would she get the provinces onside? Many assume a final deal over medicare spending can be hammered out only by the first ministers meeting in a marathon bargaining session - as happened in 2004. In that session, the premiers ran roughshod over then Prime Minister Paul Martin. Quebec demanded and received the principle of asymmetric federalism - that it could do whatever it wished with the massive health transfers Martin was offering. Alberta then demanded and received the principle of provincial equality - which meant any province could mimic Quebec. As a result, no real conditions applied to any of the money Ottawa agreed to hand over.

This is one way of doing things. The other is for Ottawa to ignore provincial objections. That's what Lester Pearson's Liberal government did in 1966 when, in concert with the New Democrats and over the strident objections of Ontario, Quebec, Alberta and the federal Conservatives, it passed Canada's first national medicare act. The Canada Health Act is the successor to that 1966 law. It is a federal statute that can be amended unilaterally by Parliament. In 2016, it makes sense that it be amended to include home care as a core medicare service. Some provinces may disagree. If so, they won't have to take any extra money that Ottawa puts on offer. Thomas Walkom's column appears Monday, Wednesday and Friday.

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."