The Caplan Report

June 2005

After six months of hearings and deliberations. Elinor Caplan released her Home Care Report, "Realizing the Potential for HOME CARE" on May 30, 2005.

Why it took so long to deliver so little is a travesty for both home care workers and the clients they serve.

The potential of home care has not been realized. Home care continues to be the forgotten sector in our health care delivery system.

Caplan's Report makes 70 recommendations, but when one takes a closer look, they are nothing but rhetorical jargon. Nothing in the recommendation really improves working conditions or client services.

Caplan maintains the principles of competitive bidding. At her news conference, announcing the home care recommendations, she said, "Competition keeps everyone in their toes." Competion in the home care industry, however, has made home care services more expensive, now over 50 per cent of all home care services are delivered by for profit agencies.

The report also flies in the face of the McGuinty Liberal government's commitment to keep Ontario's health care system under public control, publicly owned and accountable to the public.

Home care staff turn over rates are as high as 60 per cent in certain areas of the province. There is little in Caplan's recommendations that will encourage workers to remain in home care. It may indeed worsen home care worker shortages.

1. The main recommendation to establish a Centre for Quality and Research in Home Care (CQR), which is to report on client outcomes, establish benchmarks, disseminate best practices and promote excellence, is a move in the right direction. SEIU Local 1.on has long advocated the establishment of a home care data base and province wide standards for home care.

   However, Caplan's recommendation that home care funding be increased by a mere 3 per cent per year over the next three years (about $39 million per year) will not solve the continuity of care issues. Most of the money will go to the CQR. There will be no money left over for service deliverables or human resources.

2. Caplan claims increased stability in the workforce can be attained through longer term contracts and through the creation of incentives by designating "Preferred Provider" status for agencies with good employment practices and demonstrated excellence of service to clients.

   Good human resources practices would include continuing education assistance, medical, dental, or disability insurance, pension plans, paid sick time and employee assistance plans.

   It will be years before any real changes to human resources can occur, because no current home care agency contract with a CCAC can be reviewed until it expires.

   All initial preferred provider contracts would be granted through an RFP process for three years. Only after the three year period, if the CCAC is satisfied the home care agency has met the contract requirements, will the contact be renewed for another three years.

   A second renewal period (year 7-9 of a contract) is only available to home care agencies who have been granted Preferred Provider Status. After nine years all contracts must again go through another RFP.

   Evaluation teams will not be established until June 2006 (why the wait?) and preferred providers designations will not come into effect until January 1, 2008.

   Caplan did not address the issues of travel time payments or did not in any way attempt to benchmark home care wage rates with similar jobs in institutional health care settings.

3. Caplan recommends that home care workers move from an elect to work environment to a part-time workforce.

   All workers would thus receive pay for statutory holidays and would receive severance pay under the Employment Standards Act when their agency loses a contract.

   You will note that there is no mention of granting home care workers full rights such as the right to move with the work when an agency loses a CCAC contract to another agency. (Severance pay under the Employment Standards Act for workers who have 5 years of service amounts to only one week of pay per year of service to a maximum of 26 weeks).

   SEIU Local 1.on, in meetings with Caplan, clearly expressed the view that a fair bid process should require new agencies to:

   1. Guarantee to employ the employees of the home care agency a new agency plans to replace.

   2. Recognize and provide the same working conditions, seniority, wages and benefits the employees had with the displaced agency. Wages and benefits must reflect the prevailing union or highest wage rate within the CCAC's geographical jurisdiction.

   3. Recognize the employees' union at the home care agency being displaced.

   4. The new agency must recognize and be bound by any existing collective agreement with union that represented the employees of the previous agency.

   What home care workers want is a right to their jobs. Currently, almost all home care workers must have a PSW certificate. Caplan recommends that home care agencies do not need to hire PSWs. New hires should have two years in which to attain their PSW certificate after being hired. This means agencies can hire workers with fewer skills and, therefore, pay less! What guarantees will there be lower paid workers, without a PSW certificate, will continue their employment after two years?

   Elect to work status will only be removed once new home care agency contracts are awarded. If your current employer's home care delivery contract does not expire for another three of four years, you will not be able to move out of the elect to work model until the contract expires.