Bill 135, the Convenient Care at Home Act has passed First and Second Reading in the Ontario Legislature. After Second Reading, bills are sent to Committees of the Legislature for public consultation. In this case, the bill has been referred to the Standing Committee on Social Policy and there will be just two days of public hearings before it returns to the Legislature for Third Reading and final passage.
Since they took office, the Ford government has, piece by piece, been setting up its new structure for home and community care. This new bill amends their previous legislation to make more specific the structures for home care.
In 2019, the Ford government introduced a sweeping new omnibus bill that restructured Ontario’s health care system. COVID-19 was spreading around the globe at the time the bill was introduced, and the legislation was subsequently passed with virtually no public hearings during the first year of the pandemic. This was the first step in restructuring health care by the Ford government. The part of this bill that subsequently became the Connecting Care Act (2019) is what is amended by the new legislation about which we are concerned now.
In 2020, at the height of the pandemic, the Ford government passed a major new home care bill. Euphemistically titled Connecting People to Home and Community Care Act (2020), Bill 175 gutted the existing home and community care legislation. The Ontario Health Coalition’s public statement on that legislation gives a sense of how profoundly disappointing and disturbing that legislation is:
“This bill was rushed through First and Second Reading in the Legislature in ten business days with very little time for stakeholders to learn about its implications and without adequate time for proper parliamentary debate. Yet the bill has profound implications. It will result in the wholesale restructuring of home care, the dismantling of much of the existing public governance and oversight, the privatization of existing public and non-profit home care, the creation of a new tier of residential “congregate care”, the potential expansion of private for-profit hospitals and the privatization of public hospital care, among other major changes. It repeals significant clauses in existing legislation that protect clients’ and the public’s interests in home and community care including the Bill of Rights and complaint processes. It does nothing to improve the major problems in home care including poor and inequitable access, missed visits and staffing shortages. It moves all of the key items of governance and democracy, and of public protection and client protections, to regulations that may or may not ever be written and that can be changed by Cabinet without ever going back to the Legislature. In this way, it takes Ontario’s home and community care backward more than 25 years. It would fragment home care and destabilize the workforce, which already suffers from severe staffing shortages.
“There is no justification that would warrant moving forward with this legislation even under normal circumstances. Currently, Ontario is in the midst of the first wave of the COVID-19 pandemic. The last thing that is needed in home care, community care and hospitals in Ontario is significant destabilization and more privatization. Given the terrible experience of COVID-19 in long-term care homes and other congregate care settings, and in the for-profit homes in particular, we cannot understand how the government could countenance the expansion of another tier of congregate care without any clarity about the purposes; total permissiveness regarding for-profit privatization; no regulatory, inspections and enforcement system; and no governance regime.
“For all of these reasons, Bill 175 should be withdrawn and a proper consultation process regarding reform of home and community care in the public interest should be undertaken when the pandemic is under control and the context is appropriate.”
The Ontario Health Coalition has only twice in more than 20 years found legislation to be so problematic that it should be withdrawn.
This new legislation is the latest in the process of the Ford government fundamentally restructuring home and community care, following the 2019 Connecting Care Act and the 2020 Connecting People to Home and Community Care Act, and the new legislation needs to be understood in this context.
What Bill 135, Ford’s new home care legislation does
This bill does not improve home care. It has nothing in it about improved access to care, any rights for patients to access care, quality of care, democratic governance, responsiveness to communities etc.
This bill is all about the provider companies. At core, the new bill creates two new entities or types of entities: “Ontario Health atHome” and “client service providers.”
Ontario Health atHome will be a subsidiary of the Ford government’s Ontario Health super agency and will be an amalgamation of the LHINs (Local Health Integration Networks) which will formally cease to exist. Ontario Health atHome will be able to subcontract home and community care provider agencies or Ontario Health Teams to privatize functions like care coordination – formerly done by the LHINs as public entities.
There are no real details in the legislation, but it clearly sets up the structure and specifically enables the contracting of this work to provider companies or Ontario Health Teams (which are made up of provider companies – both for- and non-profit – and in home care the majority of services are in the hands of the for-profits). This is what the Ontario Health Coalition warned of in the preceding two pieces of legislation.
“Client service providers” can be health provider companies (for- or non-profit) or Ontario Health Teams (which are groups of provider companies) that can be subcontracted to provide home and community care services, including care coordination functions and other functions that have been public to date (provided by LHINs’ staff).
Ontario Health Coalition
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