A report on the Manitoba Home Care Program released this month by the Auditor General of Manitoba has identified key areas where service quality needs improvement.
“We found that the regions need to pay more attention to the timeliness and reliability of services, to ensuring equal access to services and to their quality assurance processes,” said Auditor General Norm Ricard.
“Left unaddressed, these and other issues … may jeopardize the well-being of home care clients.”
In preparing the report, two of Manitoba’s five health regions were studied: the Southern Health-Santé Sud Health Authority (SHR) and the Winnipeg Regional Health Authority (WRHA). These were selected because approximately 75 per cent of home care clients are served within these two health regions.
Home care services help elderly people, as well as people with disabilities or chronic health conditions, to live independently at home for as long as possible. Most of the program’s clients are seniors.
Annual home care funding in the province totals about $330 million and serves about 24,000 clients each month.
Although the Northern Health Region was not studied, the auditor general encouraged all health regions in the province to consider the report findings and recommendations when assessing the quality of their home care services.
Protest
The WRHA saw a protest earlier this month when about 200 workers from the Manitoba Government and General Employees Union (MGEU) staged a rally outside WRHA headquarters.
Among workers’ concerns was that they were being allotted too little time to perform tasks such as bathing clients. One MGEU worker told the Winnipeg Free Press that times to give a client a bath had been slashed from 45 to 25 minutes. Staff also complained about being double- or triple-booked.
“Task times are a definite issue across the province,” Michelle Gawronsky, president of MGEU, told
The Reminder last week.
In Flin Flon, where 31 unionized health workers care for 173 home care patients, NHR communications coordinator Twyla Storey said she doesn’t believe NHR home-care workers have similar concerns.
“The amount of scheduled time for specific tasks has been reduced for some clients strictly based on the periodic reassessments done with the individual client,” Storey told The Reminder.
She added that, when workers run into unforeseen circumstances that require scheduling changes, they are addressed through communication between workers, the NHR and clients.
Wait times
One of the biggest concerns outlined in the auditor general’s report was long wait times for services to begin.
The SHR had wait times of 31 days, the WRHA 37 days.
Storey said that in most cases in the NHR, services begin within a week.
“The standard in the [regional health authority] is the case coordinators meet with the client either in person or via phone to do a needs assessment within 48 hours of receiving the referral,” she said.
Exceptions included cases when clients’ assessed needs exceeded what the NHR can provide or when clients live in more remote areas.
Other factors affecting service start times include the time of day a client requires services, specialized equipment needs and the lack of client back-up plans.
Guaranteed hours
In both the SHR and the WRHA there were problems linked to a province-wide staffing initiative that resulted in wage payments for guaranteed hours.
An agreement between the union and regional health authorities in 2011 changed a number of home care attendants from casual to equivalent full-time (EFT) status.
However, SHR and the WRHA were both unable to fully schedule guaranteed hours. This resulted in cases when full-time workers did not always work a full schedule, although they continued to be paid.
“As a result, the regions were paying some staff for hours not worked, while at the same time using private agencies to cover some visits and cancelling others,” read the report.
The auditor general estimated that in the two health regions, more than 16,000 visits were cancelled at the same time as about $4 million was paid for over 230,000 hours not matched to client assignments.
The WHRA paid another $4 million to private agencies in a 12-month period to hire workers to cover unfilled visits. The SHR did not use private agency services.
Storey said that in the NHR, there are times when guaranteed hours cannot be matched to client assignments.
“One of the challenges is that some staff prefer a more scheduled week or month, and some prefer to work more casual type hours,” said Storey. “We then need to match available staffing to client needs. “At times there can be gaps.”
Storey said that staffing turnover rates and vacant home care positions also affect the delivery of home care services in the NHR.
Patient view
Flin Flon resident Glenda Walker-Hobbs has accessed home care for about two years. A home care worker helps her with bathing once a week.
Walker-Hobbs noted that the experience has been positive overall, though she gave one example when scheduling was changed without notice.
“My bath date was Thursday,” she told The Reminder. “Then, several months along, the home care worker came, and I was like, ‘What are you doing here?’ and she said, ‘I’m here for your bath…they didn’t tell you they changed the date?’”
Walker-Hobbs also noted that if a cancellation is made, due to a worker’s illness or the client being unavailable, often the spot can’t be filled.
In her case, that could mean waiting two weeks for help with bathing.
Storey said schedules are adjusted daily to ensure the essential clients receive service within the NHR.
“This can mean that other clients’ service may be disrupted,” she said.
“We always try to avoid situations where there are service disruptions. However, sometimes it is unavoidable due to times of high service needs.” These can include morning care, breakfast and occasionally bedtime care.
“When service is disrupted, the client’s back up plan is implemented. Our priority is high needs/high risk clients.”
Aging population
Over the long term, the auditor general noted that a growing senior population could pose a risk to future delivery of home care services.
“Manitoba’s senior population is expected to grow rapidly between 2021 and 2036, and a corresponding growth in the demand for home care services is likely.”
He added that the Department of Health, Healthy Living and Seniors, which funds and oversees the Manitoba Home Care Program, has a strategic plan for continuing care that does not forecast the likely increase in the demand for senior care.
Future planning
Storey said planning for the health care needs of people in the NHR is an ongoing exercise. The region has a five-year plan in place, and is always looking for better ways to utilize resources and plan for the future.
“Delivering services to clients in the future may need to change as the demand increases,” she said. “When a client is accepted into the program, there should be discharge planning in place right from the start.”
Storey added that clients and their families should not assume that once they receive home care, their responsibilities end.
“The Home Care Program supplements families in supporting people to continue to live in their own home. The goal is to keep folks in their homes longer as part of the Aging in Place initiative. We want to work with our clients and their families to help facilitate that as long as it is practical and safe to do so.”
Provincial response
Manitoba Health Minister Sharon Blady announced a new home care leadership team to guide the province’s response to the auditor general’s report.
Blady said the team would look at the most appropriate and efficient structure for the delivery of home care.
She said the implementation plan would look at ensuring that short and long-term human resource plans are in place to meet client needs while also recognizing the role of those who work in the system; harmonizing services offered by home care throughout Manitoba; and developing a reliable service for clients, families and informal caregivers, regardless of one’s ability to pay.
The home care leadership team is expected to complete its implementation plan in late 2016, with a progress report later this year, Blady said in a press release.
Contract negotiations
Manitoba Government and General Employees Union president Michelle Gawronsky said that the Community Support Bargaining Committee, which represents MGEU home care workers, had reached a tentative agreement with the committee representing employers last week.
The previous agreement expired more than two years ago.
Gawronsky said the agreement aimed to address some of the concerns around scheduling, task times and meeting patient needs.
She added that a member representing the North was at the table for these talks.
According to the MGEU website, details of the agreement will not be shared publicly until the 4,800 members of the component have had an opportunity to review them.
Home care services
provided by Manitoba’s health regions
• Personal care support
• Home maintenance
• Meal preparation
• Assistance with activities of daily living
• Respite in the home
• Nursing care
• Equipment such as walkers and mobility aids & some supplies
• Restorative care program
• Occupational therapy
• A bathing program
• Self and family managed care
• Entry point for adult day programs
• Facility respite and long term care
• Oxygen therapy
• Community palliative care support
