'It would just be chaotic'
A recent report from the Registered Nurses' Association of Ontario (RNAO) calling for the elimination of the province's 14 Community Care Access Centres (CCACs) doesn't make any sense, according to the CEO of the North East CCAC.
“It clearly demonstrates the lack of understanding of the complexity of CCACs and the role we play within the health-care system,” Richard Joly said.
Doris Grinspun, CEO of the RNAO, said the report, entitled Enhancing Community Care for Ontarians, looks at how “the health-care system can become more effective and provide more timely access to patients in a more seamless way.”
If CCACs were phased out, it could save $163 million a year, which, if applied to home care, would provide more than “four million more hours of home care services,” she said.
CCACs currently connect people with a variety of non-hospital care services, including home care and long-term care.
But the report suggests that all planning, service agreements, funding, monitoring and accountability functions currently carried out by the CCACs be transferred to the province's 14 Local Health Integration Networks (LHINs).
The North East LHIN, which services northeastern Ontario, integrates, plans and funds 186 health services providers.
“The LHINs are system planners,” Grinspun. “Right now, they're planning for part of the system, not for the entire continuum of health care, which is part of the problem. So we need to bring them to that level of maturity.”
Grinspun points out that according to the Auditor General of Ontario, in 2008-2009, CCACs spent 9.3 per cent of their budgets on administrative and operational costs alone, whereas the LHINs only spent 0.3 of their budget on such costs.
She said the CCACs' administrative costs are “absurdly expensive.”
“The administration should not be more than four per cent,” she said.
Joly, though, said the CCACs should not be compared to the LHINs. While the CCACs contract out some of their services, they have many direct employees, such as speech language pathologists and dietitians.
It clearly demonstrates the lack of understanding of the complexity of CCACs and the role we play within the health-care system.
CEO of the Northeast Community Care Access Centre
He said their administrative costs should instead be compared to those of hospitals.
“We are a service provider just like the hospital,” Joly said. “We deliver care to 16,000 clients every day. You cannot just give that to an administrative body.”
Grinspun said she understands that CCAC administrators are “defensive” about this point.
“These people have worked very hard,” she said.
“They have tried to do the best they can. But quite frankly they have not been cautious on the amount of resources from taxpayers' dollars that they put towards overall administration and operation of the CCACs.”
The report also suggests transferring comprehensive care co-ordination and system navigation services currently administered by the CCACs to community health centres, nurse practitioner-led clinics, family health teams and Aboriginal health access centres.
The CCACs' 3,500 case managers would work out of these organizations.
“These tremendously expert group of health-care professionals need to move to the primary care side, whether it is the community health centres or the family health teams,” Grinspun said.
“They'd create networks of primary care where these individuals work with the network, providing care co-ordination and system navigation from birth all the way to palliative care.”
But Joly said he thinks this idea would just make the “already overburdened” primary care system even worse.
“We all know there's limited access to those doctors and nurses,” he said. “They're already overworked. Now the RNAO is proposing to add the entire centralized structure that we already have onto these 500 entities.”
Joly points out that there's many family doctors in the northeast who practise on their own, and they'd have a difficult time taking on more responsibilities.
“It would be an administrative nightmare,” he said. “It would add confusion to the poor individual trying to access an already fragmented system ... There is no common sense to the report.”
Grinspun said the RNAO's plan would actually give primary care workers more resources to work with.
“Right now, they cannot provide the services that people need, which is why people end up in walk-in clinics and the emergency department,” she said.
In terms of primary care organization having the human-resources capacity to deal with care co-ordination and system navigation services, Grinspun said the plan would be phased in over three years to allow the new system to develop.
“We don't believe it will be further fragmenting the system,” she said. “We actually believe it would be solidifying primary care.”
Joly, though, said he does believe the CCAC should be integrating its services with primary care. Already, CCAC care co-ordinators are working with family health teams in the region, as well as North East Specialized Geriatric Services.
But responsibility for this service definitely shouldn't be given to primary care organizations, he said.
“It would be just chaotic,” Joly said.