Volunteer-based groups which provide in-home service for the disabled and elderly question whether bureaucratic centralization will save money or pave the way to healthcare rationing.

Ontario has a long history of community-based, volunteer-supported agencies helping the disabled and elderly to remain in their homes.

All of this tradition was erased last December when the provincial government passed Bill 173.  What were the 12,000 agencies, will be reduced to 150 multi-service agencies (MSAs).

Supporters argue that the MSAs will streamline the system and offer the disabled and seniors one-stop shopping for all their in-home health-care needs at great savings to the taxpayer; but opponents say the MSAs will be too bureaucratic, too impersonal and too costly.

According to Sylvia Cheuy of the Senior Citizens’ Alliance for Long Term Health Care Reform, “The government had originally expected the not-for-profit agencies to amalgamate smoothly into MSAs and that 20% of the MSA budget would be spent purchasing the services of for-profit organizations such as Paramed and Environmed which would cover the evening and weekend needs of home care.  Confusion has come about as the not-for-profit agencies have not been given clear enough incentives to merge.”

Traditional agencies that have been part of Ontario society for decades (The Victorian Order of Nurses turns 100 soon), fear they will lose their identity and independence, their volunteer base and their donation funding.  They argue that with MSAs, clients will lose the right to choose the agency they prefer.

Amber Wong, spokesperson for the Saint Elizabeth Visiting Nurses Association, said, “We took part in the hearings but our concerns were not considered.  With MSAs the client’s choice is restricted.  People choose an agency because they like its philosophy and values.  Will people volunteer for a government agency?”

Catholic Charities Executive Director, Michael Fullan, explained, “We welcome change to the system.  We certainly need a central registry and a strong co-ordination of agencies, but will the MSAs be sensitive to the customs and traditions of the client?  There will be a loss of volunteer hours with the new structure.  Volunteering for a government agency is foreign to our culture.”

“We provide a value-added service because it is a value-based service.  It talks to who we are, the way we approach our work, why we do what we do.  With MSAs those most at need may fall through the cracks because government bureaucracy is less personal.  And there will be less choice.  If you don’t want to accept the options offered you, you will have to go back to the end of the queue as we have seen in access to nursing homes.”

Director of Senior Services for the Scott Mission, Lydia Monaco-Brown, said her 25-year-old agency won’t be part of the MSA because it doesn’t receive government funding.  “We will be a link service.  With MSAs there will be a huge layer of bureaucracy.  It’s good to standardize the price of a meal delivered to the home, but too much centralizing will be destructive.  We know our boundaries and we network well.  We are quick to make referrals.  But if we were part of the MSAs our jobs would be on the line: executive director one day; out the next.”

“Our clients are used to us.  The client base will change.  Agencies will get directives, there will be no more self-referrals.  Case management will be government run, including assessment, a care plan, determining what services a person needs.”

Barb Track, Public Relations for the Victorian Order of Nurses, said that the VON has approximately 5,000 employees and another 5,000 volunteers with 33 branches across Ontario.  Ninety-two per cent of the employees are women; most are over 40. “We are concerned about pensions in the new legislation and we’re concerned that non-union and union personnel won’t be treated equally,” she said.

“It is not really the hot meal coming in to the shut-in that is important, it is the person who brings it.  That ten-minute chat may be the client’s only contact with the world that day.  An emotional tie has been established that will be disturbed, the confidence and continuity that is vital to feeling secure.  Will she open the door to a stranger?”

Barbara Selkirk, spokesperson for the Ministry of Health, disagrees with Track.  “A more integrated system will offer more continuity of care.  Consumers need equal access to the same services.  In the past the government has funded project by project rather than region by region.  Each MSA will have a Board of Directors one third of which will be consumers or those whose family members are consumers.  Each MSA will have a community name and identity and be community run.”

“While government will specify a minimum core of services that each MSA must provide, each local Board will determine the community’s unique population needs.  As money is raised by local United Ways, so money can be raised for local MSAs.”

Cheuy of the Senior Citizens Consumers’ Alliance said a more comprehensive service without duplication will save at least $45 million, a conservative estimate.

“Our future demands that we reconfigure and form more innovative infrastructures in the face of growing public debt and the aging population,” says Chuey.  Currently 300,000 Ontarians have home care.

“In the past the consumers have had to bow to the pressures of the providers’ group.  Now the providers are fighting a turf war,” Chuey argues.  If the not-for-profit agencies don’t merge and funding drops, quality could deteriorate across the system, with waiting lists increasing.  Then a two tier home health care system would emerge, in which those who can afford it will purchase from the for-profit groups.”

Many questions remain.  Could a chaplaincy service be part of an MSA?  Local ministerial associations could provide chaplaincy services to MSAs as they do for hospitals.  Will there be any religiously-affiliated MSAs such as a Catholic or Jewish MSA in large metropolitan areas as there is currently a Catholic Children’s Aid and a Children’s Aid, to provide services that will be culturally and spiritually sensitive to their clients, such as Kosher meals for observant Jews?

Will the streamlining in fact free up funds; and if so, will those funds be used to strengthen palliative care; or will the elimination of faith-based agencies allow those advocating euthanasia a freer reign in a totally secular bureaucracy?