Phase out CCACs to get improved access and system integration: ECCO report

TORONTO, Oct. 11, 2012 /CNW/ - Ontarians will have access to primary care co-ordination and - for those persons who need it - more than four million additional hours of home health care and support services if the Ministry of Health eliminates the costly duplication that currently exists within the province's 14 Community Care Access Centres (CCACs).

That's one of the key findings of a report titled, Enhancing Community Care for Ontarians (ECCO) released today by the Registered Nurses' Association of Ontario (RNAO). The report examines high performing systems and concludes that Ontario has structural duplication that leaves taxpayers with less care and hampers the province's capacity to achieve system integration. The result, RNAO concludes, is fragmented and delayed care for patients and an inefficient system overall.

The report recommends using Community Health Centres, Nurse Practitioner-led clinics, Family Health Teams, Aboriginal Health Access Centres, and other interprofessional and group practices by expanding their reach and roles to provide comprehensive care co-ordination and system navigation to all Ontarians - especially persons with complex health-care needs.

"We see care co-ordination and system navigation anchored best within primary care, as this is the health sector that knows their patients most intimately," says RNAO's President, Rhonda Seidman-Carlson, adding that "this means primary care providers would be the ones ordering home care and support services, linking and following-up with specialists, and facilitating people's transitions from their homes to nursing homes."

A key element of the ECCO plan is to redeploy the 3,500 CCAC case managers and care co-ordinators - 3,000 RNs and 500 non-RN health-care professionals - to primary care, where their expertise would be better used providing the care co-ordination, system navigation and same day access that Ontarians desperately need.

Seidman-Carlson says the creation of a Primary Care Transitional Secretariat placed within each LHIN on a temporary basis would help primary care providers assume the new functions until the model is fully up and running.

"Currently CCACs are the ones doing some of these functions, but they only come into the picture at times of crisis, with a set of rules that often don't match the patient's life context and needs," says RNAO Chief Executive Officer Doris Grinspun, adding that "with the creation of LHINs and a more robust primary care system, CCACs are becoming redundant."

"We recommend that a better use of taxpayer dollars is to move all planning, service agreements, funding, monitoring and accountability functions to LHINs to secure comprehensive and integrated local planning for all health-care sectors," says Grinspun, adding that "this would free up the expensive operating costs of CCACs and add over four million hours of home care and support services."

"As it stands right now with CCAC rules, many people aren't eligible to receive the number of hours of nursing or support care they need while recovering from illness at home, dealing with a chronic condition, or receiving palliative care. In some instances, people don't even qualify because they 'don't meet the rules.' We think this is wrong because we know it costs far less to provide care for people at home where they want to be," says Grinspun.

Collectively, CCACs consume nearly $2 billion of the overall health-care budget. According to the Auditor General of Ontario, in 2008/09, $163 million (9.3 per cent) was spent on administrative and operational costs alone. RNAO's report points out administrative expenditures at the LHINs totaled less than one per cent.

"Nurses recognize that there is only so much money in the health-care pot and that we need to spend existing dollars wisely. That's why we urge the McGuinty government to remove the duplication and streamline the health system so it is more integrated, delivers co-ordinated and timely access, and supports people to remain in their homes as vibrant members of our communities. If the government adopts our report, what you will see is a system that is more responsive to the needs of people who rely on our help," emphasizes Grinspun.

The Registered Nurses' Association of Ontario (RNAO) is the professional association representing registered nurses in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses' contribution to shaping the health-care system, and influenced decisions that affect nurses and the public they serve.

Read the report at www.RNAO.ca/ecco.

For more information about RNAO, visit our website at www.rnao.ca.  Check out our Facebook page at www.rnao.ca/facebook or follow us on Twitter at www.twitter.com/rnao.

Reaction to the report

"Case management is a vital and dynamic strategy for the health-care system across Canada as we all age, as we all live with chronic illness, and as we survive catastrophic injuries. Primary care is the sector where the process and role of the case management provider will have the biggest impact in the future."
Joan Park, President - National Case Management Network of Canada

"The Registered Nurses' Association of Ontario' is right on track in its prescription that care co-ordination and system navigation should be handled by interprofessional primary health organizations. Our association's 73 Community Health Centres, 10 Aboriginal Health Access Centres, four Nurse-Practitioner- led clinics and 15 Community Health Teams look forward to actively supporting the transition from Community Care Access Centres to primary health care."
Adrianna Tetley, Executive Director, Association of Ontario Health Centres (AOHC)

"The Ontario Community Support Association commends the RNAO for proactively examining the structure of the province's publicly-funded, not-for-profit health system. We are particularly encouraged that the report considers issues of efficiency and duplication in our health care system and calls for greater access to home care and community support services for Ontarians. In the coming weeks, we look forward to working with RNAO, other stakeholders and the Ontario Government in designing a more integrated, client-centred health system."
Deborah Simon, Chief Executive Officer - Ontario Community Support Association (OCSA)

"For too long, Ontario's home care system has placed profit ahead of people, failing to meet the needs of those requiring care. The work that RNAO has done on developing models to revive the home care system, increase timely access to care, and strengthen interdisciplinary, collaborative primary care in Ontario is impressive. All Ontarians want a health care system that is centred around the needs of patients. Today, we are presented with a report that lays out a concrete vision for change and Ontario's New Democrats are looking closely at these ideas."
France Gélinas, Health Critic for the New Democratic Party of Ontario

"I support the values of the RNAO plan as its ultimate goal is to reduce bureaucracy in the system. This is exactly what our Paths to Prosperity: Patient-Centred Health Care white paper seeks to accomplish: to place patients, not bureaucrats, at the centre of all decisions concerning the patient's health and wellness. This includes a bold proposal to eliminate middle management, like the CCACs, and instead use this money for home care and frontline patient care." 
Bill Walker, PC deputy health critic and MPP for Bruce-Grey-Owen Sound

"Ontarians receiving care in their home are increasingly benefiting from the quality care provided by Ontario nurses and other health care workers.  Our government is increasing our investment in community care so that, with the help of nurses, 90,000 more seniors will get the care they need at home.  Part of Ontario's Action Plan for Health Care is a new Seniors Care Strategy, led by Dr. Samir Sinha, that will help us do an even better job of caring for seniors and supporting their independence. I welcome the advice of the RNAO, as well as many other partners, as we work together to gain the greatest value for the unprecedented investment we are making in community care."
Deb Matthews, Minister of Health and Long-Term Care

SOURCE: Registered Nurses' Association of Ontario

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