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Controversies about Community Care Access Centres and home care


Shortened hospital lengths of stay, and a growing number of people living with chronic diseases has meant that more Ontarians than ever are receiving health care services in their homes.

In 2010, the Ontario Auditor General raised concerns about the quality and value of home care services, some of which remain outstanding.

Resolving these issues is important because the recently released Drummond Report suggests directing more resources towards home care. 

‘Delores’ is a fictional home care client in Ontario. She is 85 years of age, and lives alone in a bedroom community west of Toronto. She has mild dementia, diabetes, high blood pressure and heart failure. Delores needs help to take her medication and with activities around the home including bathing, meal preparation and grocery shopping. Delores has needed support for many years in order to live independently in her home, and over time has seen many nurses, rehabilitation therapists, personal support workers and other providers come and go. Currently, Delores has providers from four different agencies delivering care, all coordinated through the local Community Care Access Centre.

What kinds of services are delivered by Community Care Access Centres?

The 14 Community Care Access Centres (CCACs) in Ontario coordinate the delivery of a range of services in the home and community including highly complex medical care provided by nurses, rehabilitation services, personal support and homemaking services like food preparation, and community service supports such as transportation.

55% of CCAC clients are aged 65 and above. Although many are the frail elderly, CCAC clients also include those receiving end of life care, children living with chronic diseases or complex disabilities, and those recently discharged from hospital who receive medical treatment or rehabilitation in the community.

Who pays for home care?

Unlike physician services and hospital care, home care is not included in the Canada Health Act. However, in some provinces like Ontario, there is a long history of paying for some forms of home care with public dollars. For example, skilled nursing services and providers have been publicly funded in Ontario for decades. Compared to other provinces, Ontario has a relatively well-resourced home and community care sector.

CCACs received $1.9 billion in funding from the Ministry of Health and Long-Term Care in 2009, with which they served 600,000 Ontarians. However, the demand for home care often outstrips the resources available. In order to balance budgets, CCACs manage the volume of services provided to clients by restricting the number of hours of care per week, or placing patients on wait lists for services. Clients can also purchase additional services from service provider agencies directly.

Who delivers home care?

CCAC staff do virtually all the the care coordination and case management for home care services. But most care – representing more than 70% of CCAC budgets – is provided by external, private sector agencies which can be either for-profit or non-profit.

How are external providers chosen?

Traditionally home care were delivered through a patchwork of for-profit and non-profit agencies and organizations associated with different regions, ethnicities, religions and voluntary groups. When CCAC’s were established in 1997, the government determined that the service provider agencies would compete for contracts to provide home care services through a competitive bidding, or procurement, process. It was felt that the competitive process would lead to the selection of agencies which provided the best value for money. George Smitherman, Ontario’s Minister of Health from 2003 to 2008 says “the theory behind procurement is that the competitive tension can be a pathway to both improve quality and control costs.”

The competitive bidding process, however, has been modified over time. In 2003, motivated by concerns about the quality of home care services, the government froze procurement processes. Procurement was restarted in 2005 following a two-year review with longer terms for providers, and a greater focus on measuring quality of care. However, in 2008 the procurement process was frozen again, after a controversy broke out in Hamilton, Ontario when two large non-profit agencies were disqualified from the competitive bidding process. The procurement process remains frozen today.

Watch an episode of TVO’s The Agenda with Steve Paikin,‘The Cure for Home Care’ to learn more about the Hamilton controversy.

The Auditor General’s report

In 2010, the Auditor General of Ontario conducted a review to assess whether CCACs were meeting home care needs in an equitable, consistent and high quality way across the province.

The major findings of this review were that:

  • Funding to CCACs was based on the financial support they received historically, rather than on the needs of patients in their regions. This had led to substantial variation in the amount of services provided by CCACs across the province.
  • There were major differences in how much providers were paid, with CCACs indicating that they could not obtain the best cost and service value because of the procurement freeze.
  • There was a great deal of variation among CCACs on patient guidelines for services, as well as around how the quality of services and providers was measured.

What has been the response to the Auditor General’s report?

The Auditor General’s report made five recommendations, which included making services delivered across Ontario more consistent, obtaining cost savings from procurement and improving the measurement of quality and performance of CCAC services and providers.

Nevertheless, the procurement freeze put in place in 2008 remains today.

CCACs have been working to improve their ability to measure the quality of home care. Developing quality measures and standardizing data collection is a complex, time consuming undertaking. Margaret Mottershead, CEO of the Ontario Association of CCAC’s says that her organization has been working with Health Quality Ontario on “…testing ways to improve the approach to procuring services.” In addition, Mottershead indicated that “there has been a lot of progress made in the measurement and reporting of quality, beginning before the release of the Auditor’s Report and since, including working with Health Quality Ontario in development of performance indicators and with the LHINs on a common set of indicators based on our service accountability agreements.”

The future of home care in Ontario 

We have heard from a number of health care professionals that the quality and continuity of home care in Ontario is insufficient to meet the needs of some of their patients. They attribute this to the increasing number of patients with complex needs, the lack of an organized care delivery model that allows for routine measurement and reporting on quality, and their perception that increases in funding have not kept pace with the number and complexity of patients being served.

The Minister of Health and Long-Term Care, Deb Matthews, announced Ontario’s Action Plan for Health Care last month, which includes a commitment to provide seniors with “better quality care at home.” Matthews also argues that Ontario’s health care system requires increased efficiency, and a “shift of spending to where we get the highest value.”

The importance of care in the community has been echoed in the Commission on Reform in Ontario’s Public Services, led by Don Drummond, and released on February 15, 2012. While this report suggests reducing funding to many sectors of the health system, it recommends that Ontario “increase the focus on home care, supported by required resources, particularly at the community level”. The Auditor General’s Report and recommendations provides insights about how to improve the value and quality in home care services.

Should the freeze on CCAC procurement be lifted in Ontario?

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53 comments

  1. Mark MacLeod

    This seems a classic case for care guidelines, funding guidelines and so on. The idea of reducing the tails of the curve to ward the mean will improve quality of care at the low end and reduce overspending at the top end. This scenario cries out for one home care agency.

    • Faco

      While I do not trust Hudak, as a Health Care Employee the LHIN’s soulhd be most definitely disbanded. (just my opinion) Provincial auditor Andre Marin berated them as being borderline corrupt, with next to no public input on any decisions made with regards to the areas they service . The pseudo public input meetings and requests were just window dressing so they can claim they had public input. NO LHIN’s! If you don’t agree with me, perhaps check public input in Welland, Port Colborne, Fort Erie and St, Catherine’s and see how they feel about these wonderful LHIN’s . No thank you.

  2. Maya

    Just wondering…how does one actually measure the quality of home care? based on qualitative measurements like responses of patients or other home care workers? Because if some more focus is done on home care, then there can be reduction of chronic patients taking up hospital beds. This can in-turn reduce wait times say in the emergency section making them available to more immediate patients.

    I know that the relationship isn’t as simple I made it sound but just a thought…

  3. The Health Council of Canada

    In Ontario, it has been made clear that home and community care is being made a priority. In the Health Council’s upcoming report Seniors in need, caregivers in distress: What are the home care priorities for seniors in Canada? we discuss the issues and challenges related to home care for Canadian seniors and their caregivers. In our analyses of home care data in 5 regions across Canada, we are finding some very similar trends. Many seniors with complex needs are not getting the care they require and as a consequence their family caregivers are becoming distressed. Home care needs to become a cornerstone of the health care system and become integrated with other health care sectors in order to provide seamless care to Canadian seniors in the appropriate setting and to ensure that they are able to maintain their well being and quality of life.

    • Adama

      Government’s know pelrectfy well what impacts the patient and the family when discharged from hospital with little to no medical follow up care in the community. In some cases, follow up care never arrives because a referral for CCAC is not confirmed; so the patient, care giver or family are left without or they hire medical support privately. This is not providing access to medically necessary care and is against the Canada Health Act. The very fact that our government and / or its’ representatives do not enforce the law means only one thing; they support private health care in Ontario.

    • ronney

      Is there any way to negotiate CCAC’s mandate to find out if we are receiving the care we are entitled to? I would like more way more transparency !

      • ALSFighter

        I am a chronic terminal patient who receives 60 hours go psw services through the CACC. According to the lthc act, we are entitled to 90 hours of support and homemaking services. I am unable to feed myself, or care for myself, and could use the additional 30 hours a month. My worker continues to insist that I am only entitled to 60. Complaint process is lengthly and designed to discourage complaining.

  4. Aaron

    Sadly, all the investment in home care in recent years has not seen an improved system. Recent initiatives such as Home First emphasize the CCAC focus on clearing out hospitals. While this may be admirable, it has come at a price. The article notes 55% of CCAC service is for seniors. Many of these seniors do not need intenseive services like Home First but just a bit of support to remain independent. Reductions in personal support and therapy services by CCACs make these people so vulnerable, ultimately resulting in increased costs to the health system.

    It seems the home care system in Ontario has lost its way…

    • Maria

      It is very disgraceful the way CCAC responds to client’s needs. My mother is at the advance stages of dementia and the case worker told me that she is only entitle to 2 hours per week. His reason is that we decided that my mother was better off at home rather than in one of the undesirable, dirty and with a record of mistreatment ltc facilities that the CCAC keeps pushing to us. The case worker of the Mississauga Hlton CCAC told me that if I thought that my mother needed more care and that if I was under distress; that I should bring my mother to the nearest hospital and abandon her there and to let the region place her any were the CCAC decides. My mother is not able to wash herself, prepare food, clean, she suffers from bladder and bowel incontinence, is not able to sit in the toilet properly, can not dress herself, does not know the time, date or use the phone. However, the case worker informed me that it was not their problem due to our decision to keep her home. So I asked him what happens if she falls down? To what he responded that it depends on her injuries. That due to our decision the only way that she will be entitle to more help is if she was completely paralyzed and unable to swallow. I told him that I am spending over 38 hrs per week and that i have not been able to work and my financial situation is drastic. He then repeated the same suggestion. To bring my mother to the nearest hospital and to leave her there and to tell the hospital that I was walking away and abandoning her. So either that organization is very corrupted and not really working for the seniors or Mr Jason Darnell should not be working for any government organization any longer. I am a shamed to tell people the kind of respond that we received for the 4 additional hours per week that i was requesting.

      • bloomoonBonnie

        Your mother sounds like mine was. Get her in a privately owned care facility & sell her house for the funds. You may notice in the publicly funded ones, alzheimer patients are trying to escape when you visit but private care places seem to give meds to calm those ones; making it a more pleasant atmosphere. (if things are still the same) As long as your mother is not violent or a wander risk, you can keep a vigilant watch that they DON’T medicate her. My mother just sat there, no trouble but they did medicate her for 2 weeks without telling me until I stopped it. You have to make your presence known to the care workers with unscheduled visits ….& 😉 be extra nice to them – it is in your mother’s best interest! Then cost was $3,600 a month for everything.

  5. Jana Keller, M.Sc. HRM

    LHINs are only labeled local integrated and networked. They are the least transparent of any of the local health administrative “bodies” have too much power and employ way too many people who spin wheels rather than think creatively, particularly when it comes to measuring and modifying quality service toward community driven care. There is very little actual input from the community about needs. It seems to be provincial summary data driven. A huge paradigm shift in culture of quality indicator monitoring is required before any real community sensitivity and responsiveness will occur.

  6. Heather

    As a current family member of someone receiving CCAC services I can only say stay tuned. We are preparing our story and preparing to share with Ontario how the current system DOES NOT work. It is also my opinion that giving CCAC the ability to procure services, takes away the choices of the service recipient, inhibits the abilities of persons in their homes to make informed decisions in regard to their health care and essentially if not utterly discriminates against those who receives services. The LHIN from where I sit is an utter waste of tax payers dollars and the CCAC is a bureucratic nightmare who cannot seem to communicate amongst themselves never mind with the people whose lives depend on them. Creating a LHIN and a CCAC in our opinion is like having a “wallless” institution but make no mistake an institution and we have proven in this country time and time again that institutions do not work. There are better answers, there is a way to measure quality of service and there are ways to keep our aging populations in their homes with the supports and services they require we just need someone in government with a core values who doesn’t at their core believe that human beings that don’t “appear” to contribute to our society, actually do. Think about this….without service provision in this province, where would alll the PSW’s work? The aging and disabled are actually driving our service-driven economy, keeping our citizens working and therefore ARE contributing to our society. There are better answers, LHIN and CCAC are not two of them. My opinion

    • Denise

      Heather, your comments are excellent and I believe they sum up what many of us think, myself included.

      • Heather Marsh

        My words meant nothing, our complaints, nothing. We went as far to the top of the complaint chain and nothing, except more useless meetings, happened. My mother-in-law now resides in long term care and I can barely muster the strength to go and visit her most days. When I do visit, Mom hasn’t been bathed in days, she is forced to eat last because she requires assistance and then is told – RIGHT in front of us that the food she would like to eat is not available, because they have run out of it???????? I find Mom wearing other people’s clothing when she has a closet full of her own and even have found her wearing a recently deceased woman’s clothing. I’ve also seen Mom in men’s clothing and rarely see her smile anymore. My partner and I could no longer physically care for Mom as CCAC cut us back to 3 hours per week which allowed for banking and groceries and not much else. Nothing happened that we are aware of to the PSW that left Mom alone in an up down bed in fully upright position, nothing happened to the agencies that we are aware of that could not seem to get their scheduling straight. Nothing happened to our knowledge to the “Upper Management” of the CCAC and the care provider who sat in our home making promise after promise and delivering ABSOLUTELY nothing. My husband’s back is now forever damaged for assisting me to carry Mom in and out of the tub and in and out of bed. We are today, the day before Mother’s Day wishing nothing more than for Mom to be with us but she isn’t 🙁 🙁 🙁 🙁 One day we will get a call that Mom has died and we will to degree blame CCAC and the care providers because at home, Mom was happy and somewhat healthy despite her disabilities. Mom TOLD everyone she wanted to remain at home until the end of her days, with us, her ONLY family and there she lays, day after day being plunked in front of tv in her wheelchair, tipped back to encourage her to sleep, with nothing to look forward to except her next shot at maybe getting food she likes. We visit often and take dinner often but it’s hard because we now live with guilt, and the place is hard to be in as it ALWAYS smells like bowel movements. HOmecare? what’s that and how does the elusive HOMECARE benefit anyone?? Sad that people year after year buy into their garbage! I hope what happened to our family and continues to happen, NEVER happens to your family. Anyone reading this at the beginning of your journey – move to AUSTRALIA – at least they value human life there.

        • Tracey

          Heather, I am living your nightmare now. I have had workers brush my mother’s teeth with a denture brush, injuring her gums, arrive at 11pm for a 9pm visit and drag my mother out of bed for toileting and bathing then drop her in the bathroom, fracturing her wrist. I have had PSWs leave the print of their hand on her arm. One PSW smashed her bathroom sink by knocking a soap dispenser into the sink and she didn’t even tell me about it. Most of the time they don’t brush her teeth or clean her dentures at all. Many meetings, all amount to nothing. Yesterday I received a letter from CCAC warning me that PSWs have complained about me because I point out to them when they claim to have brushed her teeth but her toothbrush is dry, etc. They say if PSWs complain again, service will be terminated. I was even asked to sit on a committee at the LHIN, but at the first meeting when I was very honest about my experiences, they emailed me before the next meeting and told me I would not be needed for that meeting and they would let me know the date of the next monthly meeting. That was 6 months ago and I still haven’t heard. My heart breaks for your mom and mine. Why can’t we come together as a group and fight this inhumane system?

  7. StuckonOutcomes

    Having worked with CCAC’s as a vendor, the CCAC’s have to work on their procurement processes. Typically, most CCAC’s follow the government mindset whereby their underlying assumption is that “if they ensure that they have the right process” then the outcomes they desire will naturally follow. If they don’t achieve their desired outcomes, their solution is to layer in more process. The unintended consequence of this is that the vendor spends more time and effort getting ready to do the work (i.e.responding to more and more detailed RFP’s) than they actually do doing the work! The whole procurement process is broken. The CCAC sees increased costs because guess who pays for the increased procurement costs. If the CCAC wants to see improved return on their money – base the procurement process on outcomes of the larger picture. For example: how well is the CCAC working with other primary care providers to ensure better home care. How much traffic has been diverted from emergency rooms? How long is the waiting list for LTC? If the primary purpose of the CCAC is to promote and provide home care then the measure of effectiveness of any CCAC (and consequentially – vendors to the CCAC) is how much pressure did they remove from other health delivery organizations? Right now all I see is a bunch of dedicated persons (CCAC’s) so bound by process that they have no time to view the big picture and really accomplish their mandate.

  8. anomynous fool

    I have been waiting over 3 months for a basic service, walker replacement and they will not address other needs that a 87 year old lady has even though she has falls, dementia and needs some assistance or simply programs that ccac is suppose to provide. the frontline caseworker keeps stalling and not responding. maybe she has family or friends to take care of first?

  9. Maria

    I hope my message wont be deleted, it’s because when some one tells what is real happen some people don’t like what is written and they delete the messages, and the only positive ones are heard, any people people who see the problems their messages I seeing then all deleted!
    I am responsible for this old lady who needs home care services from CACC in London Ontario and one big problem is I can’t find in the internet how to evaluate poor or fine how the agency operates I believe this is a big mistake because if the government provides the funds for these type of agencies the families have the rights to evaluate their services so reads can see who are the people who comes to take care of their love one in their home! Today families don’t have the time or cannot loose their jobs to take care of their parents but as government offers service to help them part time (28 days if they come home from the hospital and need 24/7 care for that period of time) and 3 hours after the limit. When we bring strangers to our homes we have the right to evaluate their services so other families could go on the internet and check the performance of the agency, so we should have the right to choose another company if we are not happy??? We are deal wit St Elizabeth and I find the girls very aggressive and not well trained for the job! Another thing is they damp the food in front of the person if they eat fine if not that’s to bad! Then they refuse to do anything else. They never touch a broom to clean the floor if they leave thing fall into the floor! What is the point complain to the manager she said is not their jobs! And is more to it! Those agencies should be investigate by the government what they do! Because they always right and we the families are wrong, nothing happens to them we the families are the complainers and they always are right with their work in the home!!

    • HM

      Call the Ombudsman after you’ve notified the Ministry of Health. Good Luck to you and those you care about, the system is frustrating, wrought with issues and needs an overhaul that is one thing that is evident, but never stop telling people because that would mean giving up on those you care about.

  10. Beverly Thomson

    Consistency is critical for the senior requiring home care especially if they are failing mentally and are easily confused. They feel vulnerable as it is having strangers constantly in and out of their homes. Because I have experienced the lack of consistency with my mother who requires home care, I know what I speak of! On one occasion, a male PSW turned up at my mother’s door at 9 o’clock at night! to put her to bed. She had never seen him before.
    In my mother’s case, CCAC uses an agency where they simply cannot keep staff. The good PSW’s leave. The exit rate is so high, they have orientation weekly!! I’ve lost count of the different PSW’s who have cared for my mother. The problem: The agency that hires these workers don’t pay them enough and have them, in some cases, double booked and running from one end of the city to the other.

    Question: Who is responsble for regulating these Home Care Agencies that the CCAC hires?

    • HM

      Hi Beverly

      We had the same issue with my mother-in-law. Call the Cssemanger for CCAC if that person won’t listen, doesn’t address the issue, contact the Ministry of Health. If that doesn’t work, CALL the OMBUDSMAN.

      People like you, like me need to speak up – this system is nuts!

      If you refuse the male putting your vulnerable person to bed – they call that refusal of service! If you are expecting service at 0800hrs and they come at 0900 hrs and you say that’s too late – they call that “refusal of service”

      If you complain too much you are a “difficult client”

      What this system needs to do, is the work it commits to doing in the manner in which they commit to doing it and the minute they cannot, they need to step aside, stopping making excuses and let someone who can do the job, the way it is needed!

      Apply for dedicated funding!! Then you make the rules, the times and have some semblance of care and control over who and when the care is provided.

      Good luck to you! Stay strong! Keeping our elderly loved ones out of institutions is worth it in the end!

  11. Shay

    The funds are not being distributed to the front line care providers. Furthermore, the strict parameters given to provide care are ridiculously unreasonable and set by people who do not actually provide the care and see the issues at hand. Simply looking at statistics is not a way to provide healthcare, it simply justifies funds..yet the stats on’t even capture the real issues. %featured%We need to pay health care providers properly to entice people to want to work in the community%featured%, we need nursing homes, we need less strict parameters such as offering a client 2 hours a week of care for a shower to a more reasonable amount ( this is just one small example) All these and many more factors are a vicious circle in the healthcare loop that will not improve unless the real barriers are considered.

  12. HM

    In my opinion, CCAC is a non-value added government organization robbing our most vulnerable citizens of much needing funding to have dignity and quality of life and care in their final days (years) and to do so in a place they are comfortable – home! Our seniors for the most part, have paid a lifetime of taxes! I’ve been involved with CCAC in my life for the past 8 months and have seen them do no work other than have “meetings” . They come to my home, talk a good talk, make promises they do not keep, leave and when you dare to get upset, even slightly that nothing changes, they label you “difficult” and stop working to make things better. Wish I could get away with that at my job! – NOT. These CCAC are making huge amounts of money, dictating who we can or cannot have come into our home, dictating who can or cannot provide OT/|PT supports to our loved ones, dictating, dictating, dictating – this is the nuttiest system I have ever had to deal with!!!

    • lo

      that it was only me. ccac is a front that does not deliver what it promotes, plain and simple. they had 3 interviews with us (me and mother) promised services and never delivered. at times she was in dire need of help especially when released from hospital after serious injuries from falls (she lives alone). no phone call from them, no nurse to check in on her, no social worker or grieve counsellor when she lost her only son, on and on. oh yeah a psw for one hour once or twice a week. i was given wrong infor. about applying for nursing homes and they would often ignore me, the only caretake and pow and preferred to deal directly with her (with dementia) to make decisions. very very bad management, numerous oversights and errors and also staff who do not have a proper comprehension of english. it was a burden on top of everything else. i had to find other resources on my own which they should have given info about. what a lazy inept bunch!

  13. Len

    I don’t understand why ccac is even necessary. It’s health care money that ends up not actually going to patient care. Meanwhile nurses and psws working for organizations under ccac are under payed and overworked, living by the rules of ccac.

    The ministry of health should cut out ccac and referrals be sent to the nursing organizations or personal support organizations directly. That way there would be lots of money savings and the government money could actually go to good quality care.

    • trish

      the workers are great it’s the red cross who is funded by ccac is the problem they simply don’t care about the seniors and they don’t have a voice.

  14. Trish

    My friend is 85 years old and is having so many problem with the red cross, the workers are great it’s the disorganization of red cross is the problem. She is now very upset because they are sending different people to her home, she used to have a regular and she was happy and trusting. Now they cut her off and are sending different people strangers I must add to her home. From the perspective of the elderly client, they want to be able to trust who is bathing them and coming into their home. When a call went out to red cross to explain the unhappiness she now has, the conversation was very cold on their part. They simply didn’t care. They even threatened to cut the service off if she was not happy with the service. One time a lady who was the coordinator said do not interrupt me when I am talking, and the lady who is a friend to the senior said I was not interrupting you I just wanted to correct your words as she was quoting a statement that was said previous but had it all wrong. She could not believe the rudeness.o as it stands now take it or leave it we don’t care what you want we are in control Burlington division I will contact the ccac complaint dept about this problem after all they are funding this rude girl.

  15. Stephanie

    Hi All,

    I was reading through all post and I was sadly surprised to see all the issues with CCAC. I was planing to start my own Home Care business to help seniors. When I start planning my business first thing came to my mind was provide high paying salaries to staff (PSW, RN etc) to get good quality service. For example if I can make my staff happy with high pay, I trust that the staff will provide great service to clients.

    My current challenge is getting access to CCAC referrals, I am not big enough to be part of their contracts!! Anyway for now, I am just trying to find my own clients and unfortunately they have to pay them-self.

    Thank you,
    Stephanie

    • Jay

      Stephanie if you pay a high wage then the seniors have to pick up the bill most of them are on pension only, They would not be able to afford your service and there are plenty of them, only the rich can afford this type of private service something to keep in mind.

  16. Heather Marsh

    There is no such thing as quality service in Southwestern Ontario.

    • Stephanie

      Hi Heather,

      Would you be able to suggest few improvements, specially since I am starting my business that will help me to improve our service.

      I really appreciate your insight on this.

      Thank you,

      Stephanie

      • Angry & depressed

        How about:

        Respect your client. If they are yelling at you, you are probably doing something wrong.
        Listen to their family members. They have been there longer than you and are much more concerned than you with their family member’s well being.
        Understand that your client (and their family) is often not rich. Don’t expect them to foot all of your high wages or be able to give you a raise.
        Employ multiple races and make sure no language is spoken around the client that the client doesn’t understand.
        Talk to your client. Treat them like a person. Help them, don’t ignore them. Never ignore client
        Be firm but gentle when cleaning.
        Don’t spend your entire visit talking on your cellphone.
        Cook real food for your client. Don’t feed them fruit and muffins or candy all day. It will just make them poo messy and leave them uncomfortable.
        Engage your client. This is true even when they don’t look engaged. The more you do it, the more likely they are to engage back.
        Smile. Don’t yell. Help them if they need it.
        Don’t steal from their homes.

  17. Toni

    I have started my own Senior Care business, and have been trying to figure out how to get some new clients. I also was thinking about getting into CCAC but as I read all of your comments, I have no doubt that I have made the best decision to go at it on my own. I would love to help give Senior In-home care a better name, as apparently some of the bigger companies have forgotten how to do. I don’t know how many people who have commented actually return to look at the comments, but perhaps you should look at some of the smaller businesses such as myself, who actually care, and have compassion for Seniors and not in it just for the money. I can’t speak for all small home care businesses, but you would probably get a more personal touch with having the same person coming to your house every time, and a quicker fix to your complaints if you went that route. Don’t just settle for what is given to you, explore your options. Just because a company is BIG and WELL-KNOWN doesn’t mean that you are going to get the best quality or service for your dollar. I have been in customer service for many years, some days I was absolutely mortified at how a customer can be treated and ashamed to have my name attached to that business. Thats why I now have my OWN business and am able to treat people the way they deserve to be treated.

    • Monika Croydon

      Hi Toni,
      I’m reading this thread and am more and more concerned about having the CCAC provide a PCW to help my mum. I’d like to know more about your business.

      thanks
      Monika

    • Margaret

      Hi Toni, i have read your thread as well and feel that what you are saying is right on the money.
      I am not here to bash the bigger companies but I know from my own experience that people can be second to money. I to have left the bigger companies and set out on my own because I feel that one-on-one experience is not is good for the person being cared for. I have seen patients who just want someone to sit and talk to and due to the rushing around of the care giver the person was left feeling the same way at the end of the day ( lonely). I feel that caring for someone is a gift and not everyone poses that gift.
      But it seems sometimes the gift of true care giving is not enough when you are starting your own care giving business. I truly believe that a person needs to feel safe and happy. and there is no better way than having that one-on-one atmosphere.
      I was also thinking about connecting with CCAC but all ways felt that i need to do this on my own as add my personal touch to the home care sector.

    • Esther

      Hi Toni, someone is looking for good care for an elderly lady who is in a nursing home and is not getting the money’s worth. Is there anyway we could check into your company. How do we go about connecting with your little agency for starters. Essie

  18. Toni

    I don’t know that I would be concerned with CCAC providing care, some of them are good at what they do, just my opinion, but it’s pretty far and few that do care about the people. My Senior home care business is up and running and I have a few clients, who I care very much for and don’t charge an arm and a leg for services! I have been doing some research, and discovered that it is getting harder to keep PSWs in the home care sector because of the low pay and all the traveling they have to do, the most recent article I just read said that 7000 PSWs are trained yearly in Ontario, and most of them are 50 or over, and we are loosing 9000 PSWS yearly….most of them are going into LTC, or hospitals where they can make up to $25/hr. …keep in mind people…this is also YOUR future, private homecare?Government provided homecare? Or long term care?
    Question…if YOU have someone new coming to your home everyday/week to help you bathe…rather then the same person every week, how likely are you going to want to bathe??
    Do your research, you get what you pay for! I would rather be in charge of my care (private care) then someone tell me what they are allowed to do for me (government care) and how long they can spend with me!

    Good luck with your business Margaret! I wish you all the best 🙂

  19. Mrs Joan Norgaard

    CCAC is a valuable necessity for seniors in need of health care at home- whether the person lives alone, or is taken care of by a caregiver spouse who needs hours for the loved one in nursing, physio therapy, occupational therapy or hours from a supportive personal support worker. This keeps people in their homes, and out of Nursing Homes as long as is possible.
    The need does not only include seniors, but is required for all ages of life.. CCAC is an amazingly organized health care seriously required in Ontario Communities.
    My husband has had a speech pathologist come to our home to assess his swallowing; and was diagnosed with Dysphagia related to his illness. The service was very professional, and from caring people. I would always recommend CCAC to others.
    Thank you,
    Mrs Joan Norgaard
    Caregiver for husband with Lewy Body Dementia/ Multiple System Atrophy

  20. Angry and depressed

    CCAC has a few carers who are good, and then a whole host of lazy, irresponsible, untrustworthy, and frankly stupid carers. At first they only gave us 1 hr a day, 5 days a week. Granted, my mother could at least walk on her own then – if nothing else. Only after she ended up in the hospital (which was a whole other bad care story), did we get 50 hours over 7 days. We’ve been through a host of horrible psws and CCAC has done everything possible to cut our hours to a measly 15 per business week, which, if you do the math, is not enough to help a person with severe dementia when you have a reliable carer, let alone when you have a lousy one who does nothing except talk on her phone and watch tv. The quality of care provided is so poor that other agencies immediately sympathise (though you probably can’t afford their care) and go, “oh yeah they’re really bad. We never hire someone who has worked with CCAC.” The government needs to get it together and start providing reliable, safe home care.

  21. David Lawrence

    Monopoly of the contracts sends the wrong message for contracted services in Ontario. Those currently servicing the CCAC contracts should not feel so comfortable in their service contracts , it is like a gift of taxpayers dollars.

    • John

      True!!! Its a rip off. CCAC has contracts with so called brokers ( Profit and Non profit companies) that eat 60% of reimbursements dollars and pay the direct provider only 30-40% of the reimbursement rate be it Nurse, PT, PSW, OT’s or SLP . What do you expect these professionals to do? Maintain sanity, provide care or otherwise…Its pathetic.

  22. Laurie McGoldrick

    I have been the sole caregiver to my Mother, who is now 87 years of age, for the past 4 years. Initially I bought into the rhetoric of the Community Care Access Center but within a short time I came to realize the nature of the beast. The CCAC (government loves their acronyms) is not your friend nor advocate for your aging parent. The CCAC does not directly provide services. All services are contracted out to private companies. The Ontario Government has put in place a program for support services to seniors to allow them to stay in their homes. The sole and ONLY purpose of the CCAC is to ensure that the patient/client receive the absolute MINIMUM care and services under the mandate. The CCAC is comprised of bloated bureaucrats making arbitrary decisions.

  23. dong

    where do i start? nothing but trouble with ccac. terrible management and services. they mislead people and keep them in the dark. they promote the idea that they will provide all types of services and do not deliver even when they say they will send someone. social workers or grieve counsellors, forget it. and all that homecare, one hour a day if lucky. rapid response when released from hospital after serious injury, no show. it goes on and on. they are deliberately slow, misleading and deceptive. what a terrible time i had like tooth and nail to get anything basically done. they also screwed up file, late on transferring vital inform. for hospital purposes, made numerous errors on file, on and on. it was obvious to see that someone there at the top was trying to cache the money for the agency to make the numbers look good. what a bogus, misrepresentation of government services under the taxed paid ministry of health. should be a federal investigation into this which i believe they are conducting right now. terrible.

  24. f.c.Muller

    The Ont. CCAC is a terrible run unit way to heavy in layers of management who have no authority of
    much having to go to several more layers of management for even the smallest decisions.
    The case Managers are all mostly overworked and work 1 to 2 hours of their own time on a daily basis trying to keep up to there heavy work load.
    more than 35 % of the budget goes to management running the ccac?
    could it be that management is totally incompetent.

  25. Errol JOHNSTON

    should the police investigate why ccac employees are assisting health store owners to gouge elder people in nursing homes? An example is a wheel chair cushion which retails at $50.00 is sold at $594.00 by a private health store owner. The sales person is a CCAC employee. The product is not shown to the buyer nor is any paper trail in existence. The cushion for all the person knows could of came from the city dump. CCAC and the health store send an invoice when no agreement of purchase was ever agreed upon. They hoped to take a cushion and go to the Care Home and ram it into the patients wheel chair receiver and probably play strong arm tactics to get payment. Why is a govt. agency employee carrying on like this. Is he getting a share of the spoils and how deep in the chain is this practice going on? I can tell more stories of how CCAC employees are trying to scam elder people through private companies. Does the O.P.P. stop citizens and sell cars for the local car dealers. If no then why is CCAC DOING ALL THE SALES PITCH FOR PRIVATE HEALTH STORES.

  26. Thereishope

    I am the owner of a “in-home” care organization, and provide “private pay” home making and personal care services. Having read all the comments on this thread, I would agree that cost of private care is very prohibitive and most individuals cannot afford it. Especially if they are seniors who are frail and have dementia and other chronic ailments.

    The CCAC allotment of hours and the care provided by their contracted agencies is only as good as the cost to the patient. Therefore, if you pay peanuts you should expect monkeys. (It is human nature).

    Good service is never free. A private pay agency is 100% answerable to you and will give you tremendous value for your money. After all, they do not want to lose your business. (Again it is human nature).
    Private pay agencies are expensive because they charge for the cost of finding, training, educating, monitoring, retaining, scheduling, administering, insuring, bonding, and paying a caregiver a decent wage, not to forget the tremendous cost of having to network and advertise to win your business.

    That said, private pay is not the answer or alternative for those who cannot afford it. So……I suggest the following technique that can resolve the issue.
    1.) Let us all first acknowledge that it is time we all took responsibility for our own care that will come in the future and save and invest as much of our income as possible.
    2.) Invest the savings in an account that will return a high interest (At least 13% – talk to an investment broker)
    3.) Use the interest only, to fund the care needed for your loved one, while building your investment portfolio.
    I have used this technique successfully and am currently generating over $3000 per month for my self and my loved one if we ever need home care. No need to pay for expensive long term care Insurance either (which is a huge saving on its own!).
    A cooperative family could cash pool and start a large investment to pay for the care for their parents. Home Equity loans are available at 3% and the interest paid on the loan is tax deductible. In some cases the caregiving expenses are tax deductible too (Ask your accountant)

    Hope this helps remove some of the bitterness and pain which has been expressed in these posts

  27. Susan Rocco

    I see there is no mention of the extradinary wages that are paid out to the Case Managers who work for CCAC .
    I believe there were more on the Sunshine List this year than ever.
    The Audit touched base on that as well!

  28. Annoynmous

    As a PSW who works through contracts with CCAC, I believe that CCAC needs to take a look at what some of their clients are using their hours for. There are so many people out there who need the help for ADL’S, and yet a TON of clients use their “psw’s” as personal maids, chefs or beauticians. I believe that as a psw, we should be there to help clients remain independent in their homes, but using 90 hours of “free” services to them is just an easy way to have their house cleaned, meals made and their hair/nails done (just to name a few things). There are so many people out there who would love to have the help to get dressed, or have a shower but so many existing clients use and abuse the taxpayers dollars. These are health care dollars not molly maid or chef ramsay hours. These hours could be used for others who have posted who are waiting for services or posters who haven’t got enough hours. I’ve seen personally many clients who abuse the system.

    • invisigal

      Well Annoymomous, believe it or not, meal preparation and housecleaning are also ADL’s and are necessary for someone to remain independent in their homes. Why do PSW’s think they can pick and choose as to what they will or won’t do for a client? If a client needs it done, then your mandate is to do it.

      • Annonymous

        Your point is valid. I’m saying it moreso for the clients who don’t use the hours for personal care and strictly toward housekeeping etc. I don’t mind doing these tasks, but when it becomes more of these tasks than actual personal care, then I feel it’s just taking advantage. I am well aware these tasks are necessary to remain independent. Are you a PSW? Do you work in home care? If you do/did then you’d know exactly what I’m talking about. You know thr difference between doing what is expected with this job, vs being taken advantage of.

      • MouseMan

        It’s true that meal prep and housecleaning can be apart of the care plan but if it’s through CCAC then we’re talking about simple meal prep and very light tiding. The problem with those things is that people are given 45 minutes to complete a shower/sponge bath, dressing, grooming, toileting and exercises and then want “extra” things done when there’s insufficient time and/or prohibited tasks.

        No where in a psw job description does it say, “do whatever the client wants you to do.” You erroneously assume that’s our mandate but in actuality our mandate is, “complete the client’s care plan.” So yes, PSWs do get to choose what is acceptable and what isn’t.

  29. Abdirisaq

    hi we are home health care agency the name is EXCESS HOME HEALTH CARE.com here in Ottawa we do have people who need our service but CCAC told them we are not going to Transfer your service you have have to stay with the agency that we are sending you

    bylaw they have to offer to choose but in this case no way stay or no care for you..

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