By Sally Barnes
Just a note to send along our best wishes at Christmas and to say we hope the new year is blessed with good health and better times.
Christmas is certainly different this year. Part of it is the lingering hangover from pandemic days. Last year at this time the gravy was getting cold while families fought over the dangers of isolation and whether vaccinations and masks should be mandatory.
This year, politics are focused on the shortage and high cost of food, the crisis in housing and health care, and increasing hatred and violence in the world.
‘Merry Christmas’ becomes harder to say when there is so much misery around us. My own recent encounter with the health care system provided our family with a bird’s eye view of some of the humongous problems we face on that one issue alone.
Suffice it to say it was an interesting experience and I will refrain from easy criticism because there are so many working their hearts out under pitiful conditions and they deserve to be encouraged rather than reminded just how bad things are.
Patients’ families also pay a high price. Over several days I watched how the stress, worry, obvious shortages in staff and equipment in the system, and fear of the unknown took its toll on families and friends.
Bone-weary front-line workers are covering long shifts to meet standards of hygiene and care—not always hitting the target. Patients and staff are shuffled about like chess pieces to make maximum use of every bed, space, piece of equipment or operating room.
An anonymous surgical team of creatures wrapped in enough plastic to cover a football field completes a procedure that may take hours and then the facility is prepared by staff to receive the next cast of characters being wheeled in.
Lucky are those whose numbers have come up. The waiting lists grow longer by the day.
Compared to the complexity of life and death procedures that take place in every hospital every day, my recent experience took only a few hours to complete.
Basically, a surgeon was making adjustments to vertebrae with the end game of pain relief and preventing further deterioration. Enough said.
Fear of the unknown is the toughest part. Husband Fred is a take-control kind of guy and while he underwent open heart surgery many years ago, he calmly slept through most of that one.
He was mightily grateful and impressed that my hospital stay would be limited to just a few days and he was assured that home care would be provided. He can fix a toaster or disentangle a fishing line and a string of Christmas lights. But health care? Fergitaboutit.
Whoever drafts the material for patients and their families on the merits and availability of home care should get the Nobel Prize for fiction.
It is impossible to describe the joy of the day of our escape from hospital. Goodbye, sinister hospital gown. Hello to some hot coffee and return to normalcy.
All we needed was a home care worker who would change the bandage according to doctors’ orders.
My husband spent most of a whole day talking to a squad of home care experts, agencies, and government offices who patiently described the benefits and reliability of their programs.
For the first few hours he was shuffled back and forth among the various players. They all wanted to be helpful but it would be some time before anyone would be available.
After numerous transfers and disconnects it was all too apparent the home care system has been well-researched and seems to have no shortage of officials with great ideas and are true disciples of home care and its benefits.
Many of the agencies on the list of home care providers have impressive business models in place—but it became painfully obvious that there is an abundance of managers and promoters but actual boots on the ground were as scarce as hens’ teeth.
There were protocols to be followed. Forms to fill out. Travel times to consider. Juggling of work schedules and enough data to choke a horse.
Did I mention that the task at hand in my case was removing and replacing a bandage on an incision that fortunately was healing well and was no cause for concern beyond fear of dying from old age before the home care began?
This story has a happy ending. My husband is a sharp guy and concluded that the battle to secure home care was more difficult than imagined. You have to cut out the pleading with managers with big titles and little solutions. Lots of apologies but few commitments.
He made a decision on his own and it paid off. “It’s okay…everyone keep calm…I’ve got a glove on this…they won’t be taking us alive….help is on the way.”
He had succeeded where others failed.
Cheers all around.
Soon, our kitchen door opened and there appeared my lifelong neighbour and good friend (we’re talking pre-kindergarten here) and long retired as a registered nurse. Cool as a cucumber, she went to work, my husband’s heart rate returned to normal, I had a brand new bandage and our own Florence Nightingale accepted our thanks and disappeared into the night.
Many lessons were learned. In these days when healthcare workers have become our most valuable resource and those shortest in supply, we need fewer people filling out forms, duplicating background questions, and writing reports.
Piles of reports by experts about health care reform sit on desks across the country. Some have been highly praised but show me the action it has produced.
The public cries out for change. While I’m whining about the frustration of dealing with home care, millions of Canadians are without access to family doctors, waiting months or even years for diagnostic tests, treatment, and surgery.
Should it really be that hard to get someone who can change a bandage? Apparently so.
It’s one thing to get ourselves out of this current healthcare crisis. It took years for this mess to develop and it will take decades to try to catch up and make sure we don’t just repeat old mistakes.
Many are rightly mad as hell and say they won’t take it anymore.
They should begin by demanding to know what happened to all those studies and recommendations that sit on the desks of politicians and various experts (including health care professionals themselves) and go nowhere.
Today’s “brilliant idea” to fight disease and salvage health care can grab headlines and raise the hopes of patients and investors. Just as quickly, critics with their own agenda can move in and destroy innovation and change.
We need to be mindful that governments and special interest groups change and take their headlines, priorities, lobbyist friends, supporters, career aspirations, and promises with them.
One of the biggest enemies of progress in health care is a lack of vision, a fear of change and innovation, and a failure of the people who operate the system to abandon the well-established turf wars that put personal gain ahead of the public interest.
Healthcare policy is ripe with politics. Trying to avoid or deny that is like whistling in the wind.
Governments at all levels have a voice in where a healthcare institution will be situated. In whose jurisdiction will the facility and jobs be located? In other words, which politicians will get the credit and perhaps influence the outcome of the next election?
In smaller communities, the local hospital is often the lifeline of the local economy.
If two or more neighbouring jurisdictions are competing for the same institutions the battle can be brutal. Property values, economic development, the ability to attract staff (especially specialists), and equipment will be pawns very much at play.
And so goes the health care debate and how its roots run deep in our communities both small and large.
Every member of the community has so much at stake in making sure our policymakers fix today’s problems and prepare ourselves for older and larger populations, burgeoning costs, and more complex health issues in the months and years ahead.
It is not a subject for the faint-hearted. Get in your two cents’ worth before the gravy gets cold.
Sally Barnes has enjoyed a distinguished career as a writer, journalist and author. Her work has been recognized in a number of ways, including receiving a Southam Fellowship in Journalism at Massey College at the University of Toronto. A self-confessed political junkie, she has worked in the back-rooms for several Ontario premiers. In addition to a number of other community contributions, Sally Barnes served a term as president of the Ontario Council on the Status of Women. She is a former business colleague of Doppler’s publisher, Hugh Mackenzie, and lives in Kingston, Ontario. You can find her online at sallybarnesauthor.com.
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As a follow up to the nay sayers, I would suggest that they go to the C.D. Howe Institute’s newly released document: The Nature of Private Healthcare in Canada.
The document lays out the evolving move to private clinical care in Canada.
It is a fact that over time, multi level choices of care (private vs. public) are and will be part of the delivery model over time.
Those who deny this reality should spend more time being informed and tuned in to the slow but ever present changes to provincial healthcare.
Hello Sally, unfortunately, though the pandemic was not predictable as to the year of occurance, the demise of our Provincial Home Care Program was. As a former manager (nurse, B.Sc.N., M.Ed.) of an area non-proft home care agency in Ontario, which held a reasonably high standard of care, accountability, and client satisfaction Mike Harris Required that home care contracts be MANDITORILY open to for-profit engagement and bidding.
We were not having difficulty recruiting and retaining staff, our local CCAC knew the costs of providing the care to the 2 non-profit agencies overseeing and providing both nursing and personal support homeworker care. Local care, arranged, scheduled locally went in the garbage. Many times we were able to meet the gold standard of personal support worker assignment consistency in providing services.
Things started to change as Mike Harris and Conservative policy disrupted what was working; after all, isn’t scheduling the same as ordering pizza and providing a delivery person? That was all home care services were to the golf pro. These were all part of those “tough decisions” Harris Conservatives had to make.
To quote a friend in a recent email. Ford Conservatives have continued this legacy by creating a “pig’s breakfast of our Province”.
For Erin Jones: CCACs were reduced from 43 to @ 13 in the Province – so lots of supervisory oversight lost in the ’90’s to save money. Many, Many less chiefs and the loss of quality that accompanied.
Erin, it would be interesting to understand your credentials as it relates to public healthcare. Name calling of Australians as chumps and believing conspiracies myths does not qualify you for anything other than your opinion (which is evidently limited on this topic). Best wishes however to you in 2024.
I don’t understand the basic concept of home care. I have had some experience, found the care excellent. Unfortunately, the PSW has to have a reliable vehicle, their pay rate would be minimal. The various agencies have little or no recruitment success.
Good article Sally Barnes. Many in Ontario will agree that Home Care is NO CARE. My 90 year old mother who lived alone independently and struggled with health issues qualified for NO CARE. Wasted hours of forms and bureaucratic assessments were not worth the frustration. It’s a make work project for those at the top. I tip my hat to the field workers that are fighting in the trenches to keep some of us alive.
So then, Ross Maund, you are proposing a two-tiered system where only the wealthy and well-connected are cared for adequately? Frankly, the Aussies are chumps for putting up with a system where the healthcare bureaucracy seeks more and more power and dictatorial control through the equally power-hungry public health bureaucracy. During the height of the pandemic hysteria, quite a few Australian citizens were actually locked into concentration camps (read the accounts and look at the pictures of the little cubicles they were forced to live in). Their system is hardly what most Canadians would envision as anything acceptable.
Well said Erin Jones !!!
Sally, you nailed it!! Way too many box checkers…all well-intentioned, but parroting the bureaucratic BS, and not being able to supply “boots in the house”. My wife just passed away after a long illness, and while the homecare providers were good, they were way too few…five chiefs for every two workies. It was a constant frustration.
And it’s not just homecare. The amount of CYA paperwork our medical professionals are required to do is monstrous…up to 60% of their time.
Thank you Sally for this wonderfully written commentary. As a career healthcare
consulting executive your comments ring true. Throughout Canada – not just in Ontario, creating a forward vision for a better healthcare delivery system pivots endlessly by both successive governments in power and the mix of views between the fed’s and the provinces. Everyone recognises the lack of operating funding and lack of capital for the active treatment institutions but in many respects the heart of this issue is how we deliver healthcare in a dwindling environment of funding.
The provinces currently spend an ever-increasing percent of their general revenues on healthcare. Healthcare is the largest single part of all provinces operating expenditures and has doubled over the past several decades. Yet demand for services, for equipment and for new (or renovated) facilities rises dramatically each year.
Canadians generally define the attributes of our country by referring to ‘free healthcare’.
Well, healthcare is anything but free – more often than not, rising costs of healthcare are likely the biggest cause of provincial deficits while at the same time is one of the biggest frustrations of Canadians.
Maybe it is time for politicians to be candidate with Canadians – let citizens better understand the forces that are causing the wait times, the seeming reduced services and the ageing infrastructure so that the electorate can be armed with knowledge and t can participate in priority setting and decisions on how alternate services delivery might over time solve the current healthcare dilemma.
As is the situation in many sectors, sufficiency of public capital is limited and often found through debt financing which only passes the financial burden on to future generations of Canadians. More progressive sectors have opted to partner with private capital providers, especially for infrastructure. On the services side – it might be time to be more open to the possibility of alternate delivery mechanisms that provide users with wider options. In Australia for example they have a very robust healthcare system that is punctuated with public & private healthcare. If you talk with Aussies, they will tell you that the system allows for much shorter wait times, faster treatments and because doctors must work in both systems, better well being.
Thank you for this article. Our homecare needs a major overhaul. The third party agencies contracted by the government are taking advantage of the privilege to provide homecare. The LHIN (or whatever they are now) turns a blind eye. I went through a nightmare with my mom for over two years. I could write a book and you would be shocked. All she wanted was to be at home with her family, not to mention the push from the hospital staff to encourage her to stay at home. The hospital made all these promises and made it seem like mom would be well cared for. I do not believe the hospital staff are aware of what homecare is really like. The system in place let us down. I could not care for my mom alone. I needed the support not just for the healthcare she required but for my own health. That one hour visit a day can make a such a difference to the client and their family. I shower even once a week would have been appreciate – but it was “I don’t have time” or they don’t show up. I wrote letters to our Premiere, Minister of Health (Elliot), my local MPP (Bethlenfalvy) and our Muskoka MPP(Miller – who my mom probably voted for) to voice my concerns and even offered to assist in anyway to make improvements to the system. I was so happy to get a meeting with my local MPP only for him to blow me off at the last minute. I did get a meeting with his “assistant” only to follow up and discover the LHIN told them a different story and they consider the LHIN’s word over mine. I never heard from anyone again. I burnt out and ended up in the hospital myself. We ended up having to move Mom to LTC and she declined from that moment on. LTC by the way did the best they could, but understaffed.
Excellent commentary, Sally.
What it all boils down to is that there are too many chiefs and not enough front line workers and equipment, and yet, the very weary and burnt-out front line workers are challenged “to do more with less.” In Canada, we have an ENORMOUS healthcare bureaucracy with HIGHLY paid bureaucrats at the top–and the rationed gravy pours from the top down through the system, leaving an inadequate amount to moisten the mashed potatoes at the bottom of the pile (if you’ll pardon the metaphor). Here, it is government which restricts the supply of adequate healthcare, by spreading the gravy on the bureaucracy.
On the other hand, it could be worse. In the States, it is the absolutely awful insurance maze bureaucracy, and the medical corporations controlling the for-profit institutions, that mashes the potatoes into dry pulp (read the doctors, nurses and healthcare workers, along with the patients). By restricting the supply from their side of things, (while making sure that the system is VERY profitable for their corporations’ stockholders) they arrive at approximately the same or even worse place as our system. I have heard from American friends how difficult it is to get adequate homecare there. Their system is quite broken, leaking exhausted and discouraged workers like a sieve. The Obama Administration’s “Affordable Care Act” is a joke. (The Act was actually written by the healthcare insurance industry, by the way). With its HUGE up-front deductibles, a vast number of middle class workers and retirees say that they simply cannot afford to get sick.
Both systems have moral hazards built in and both systems destroy the lives and dignity of the most vulnerable.
I read an article written by an anonymous doctor who had worked here and in the States. The article was urging specific reforms, now that he is back in Canada. (Does anyone in government actually listen to those who work on the front line of the system?) Will his words be heeded? Hope so.
My two cents’ worth while the gravy is still somewhat warm, but getting colder by the minute.