1/29/15

Ontario elder care: fewer staff, more privatization, more private payment



Ontario LTC falls short of other provinces
New data  published by the Canadian Institute for Health Information (and based on a mandatory survey undertaken by Statistics Canada) indicates that staffing at Ontario long-term care facilities (LTC) falls short of other provinces. 

The Long-Term Care Facilities Survey indicates that Ontario has 0.598 health care full time equivalent staff (FTE) per LTC bed. Canada (excluding Quebec, which is not included in the survey) has 0.641 staff per bed.  

In other words, Canada as a whole has 7.2% more health care staff per resident compared to Ontario.

This despite the relatively low number of higher paid nursing staff in Ontario. RNs and especially RPNs are underrepresented among all health care staff in Ontario LTC facilities, with RNs comprising just 11.5% of health care FTEs and RPNs comprising just 19.3% of health care FTEs. Across Canada the corresponding figures are 13% and 25.6%.

Fewer RPNs to RNs: Ontario has a relatively low number of RPNs compared to RNs in LTC facilities. The Canada-wide ratio of RPN (or, in other provinces, LPN) FTEs to RN FTEs in LTC facilities is 1.96 to 1. But in Ontario, the ratio is only 1.67 to 1.

Fewer support staff: Administrative and support service staff are also more thin on the ground in Ontario, with only 0.225 FTE support staff per bed, while Canada has 0.248 (i.e. 10% more than Ontario).

Some of the under staffing in Ontario may be rationalized by the somewhat higher proportion of facilities classified as "Type II" in Ontario rather than Type III or higher.  (This report deals with Type II or higher facilities, excluding Type I facilities such as retirement homes in Ontario.  Type II facilities "require" 1.5 to 2.5 hours of care per resident per day, while Type III require 2.5 hours or more).  In Ontario 69% of facilities are rated as Type II, while across Canada 44% are rated Type II . However, given the very modest role hospitals play in Ontario, it is hard to believe that the residents in Ontario LTC are less in need of care than elsewhere.   Notably, 52% of residents in Ontario facilities are 85+, about the same as the cross-Canada percentage of 51.7%.

Higher private payment in Ontario: Residential “co-insurance” accounts for 24.7% of total revenue in Ontario, but 23.2% across Canada.  The extra for preferred accommodation accounts for 2.89% of revenue in Ontario, but only 1.92% across Canada. In total private payment accounts for 27.6% of revenue in Ontario but only 25.1% across Canada. Private payment for LTC is high in Ontario. 

More care in public facilities: Across Canada, public LTC facilities have 0.76 FTE health care staff per bed, compared with 0.566 in for-profit facilities and 0.632 in non-profit facilities. In other words public facilities have 34% more staff than for profit facilities. Unfortunately these figures are not broken down by province – and provincial differences could play a role in these reported differences (e.g. Ontario has both low staffing and a high number of for-profit beds).

For this study, 609 LTC facilities, with a total of 75,282 beds, reported in Ontario.   Unlike an older, now terminated survey done by Statistics Canada (the Residential Care Facility Survey), the new survey is based only on facilities that provide their residents with a minimum of professional nursing care or medical supervision (i.e. Type II or higher facilities, with at least 1.5 hours of care per resident per day). Also notable:
  • Just under 70% of residents are female in both Canada and Ontario. 
  • 61% of facilities in Ontario are for profit, but only 45% across Canada.  If Ontario is excluded from the Canada-wide percentage, only 30% of Canadian facilities are for-profit.  Indeed, most for-profit facilities are found in Ontario (370 of 591). 
  • A little over half of the total reported LTC beds were in Ontario, roughly equivalent to the population of Ontario compared to the rest of Canada excluding Quebec. Just under half of the total FTE staff were in Ontario (61,923 FTEs out of a total 126,389).
  • The mandatory survey covered April 1, 2013 through March 31 2014.
Photo: freeparking ;-| James E. Barna 1970

1/5/15

Ontario fastest growing province. But public services get zip

Ontario's economy bounds to first among the provinces
Four of the big Canadian banks have come out with new forecasts for the Ontario economy and they all indicate the economy is improving.  

The fall in the price of oil (and, with it, the Canadian dollar) is paying off for Ontario.   

All four banks predict that Ontario will have the fastest growing provincial economy in 2015. 

And all implicitly suggest that the Ontario government's Fall Economic and Fiscal Review is now out of date. (See the chart  below comparing bank and government forecasts.)

On average the banks predict that the economy will grow 0.3% more more quickly in 2014 than the Ontario government predicted in its Fall Economic Outlook and Fiscal Review. Nominal growth (real growth and changes in market prices due to inflation) is predicted to grow half a percent faster.  Similarly, growth is predicted to exceed the government's forecast for 2015 as well, with real growth reaching 2.7% and nominal growth reaching 4.7%.  

By 2015, the new bank forecasts suggest nominal growth will be a little under one percent more than the government's older, fall forecast.

That would mean significant extra revenue for the Ontario government. One percent growth in nominal GDP could mean another $850 million dollars in revenue for Ontario government coffers.  

The recently announced federal government transfer payments to Ontario for 2015/16 (for equalization, health and social transfers) are also much higher than expected.  In fact,  about $450 million more than the $800 million increase the provincial government anticipated for all federal transfers to the province.

With the new growth, the banks are forecasting a significant increase in Ontario employment in 2015, with employment increasing 1.4%, up from just a 0.8% increase in 2014.  Consumer inflation (CPI) is also forecast to fall to 1.4% (down from the government projection of 2% consumer inflation).

The improved outlook from the banks is actually consistent with the government's thinking-- they too have suggested a significant upside for Ontario to lower oil prices and a lower Canadian dollar value.

Who will benefit? It won't be those who benefit from public services.  Despite an improving economy and extra federal cash, the Liberals are sticking to their hard talk on public services.    

Far from real growth, the plan is to cut public services. Indeed, the Liberal government's official plan is to make even sharper cuts in real public services, with 0.6% increase in program spending planned for 2015/16 ($700 million), about a quarter of the cost pressures from inflation and population growth.   

After that it only gets worse, with a minuscule 0.08% increase planned for 2016/17 ($100 million) and minus 0.7% in 2017/18 (minus $800 million).

And there are no signs of any move away from that plan - yet. 



2014
2015
2016
GDP Real
                           %
            %
           %
TD
2.3
2.6
2.3
Royal Bank
2.3
3.1
2.3
CIBC
2.1
2.8
2.9
BMO
2.1
2.4
2.2
Bank Average
2.20
2.73
2.43
Ontario Gov.
1.9
2.4
2.4




GDP Nominal



TD
4.2
4.1
4.4
Royal Bank
4.1
5.2
3.9
CIBC
3.8
4.9
5.1
BMO



Bank Average
4.03
4.73
4.47
Ontario Gov.
3.5
4.4
4.4




CPI



TD
2.3
1.7
2
Royal Bank
2.2
1.4
2.2
CIBC



BMO
2.3
1.2
2.2
Bank Average
2.27
1.43
2.13
Ontario Gov.
2.1
2
2




Employment



TD
0.8
1.3
1.1
Royal Bank
0.8
1.4
1.1
CIBC



BMO
0.8
1.5
1.1
Bank Average
0.80
1.40
1.10
Ontario Gov.
0.8
1.3
1.4

[Photo credit: Lending Memo]

12/16/14

Ontario Liberal funding plan is LESS than Harper's federal transfers

Federal transfers to Ontario 2015-16
The federal transfers are out for 2015/16 and Ontario has done well –$1.253 billion or 6.5% more than the total federal transfers to Ontario for 2014/15. 

Apparently, the Wynne government's attack on the Harper government's stingy cash transfers to Ontario are convincing the Conservatives to cough up some more dough for Ontario.  (Just in time for the federal election.)  

The total increase in federal transfers ($1.253 billion) equals a 1.1% increase in overall provincial program spending.  In contrast, the current provincial government spending plan is to increase program spending 0.6% next year, a tiny 0.08% the following year, and then impose a cut of 0.7% the year following that.  

In other words, federal Conservative transfer increases to the provincial government far outstrip total provincial Liberal spending plans.  Ontario "own source" revenue would play no role at all in new program spending.

This is very odd - -in the normal scheme of things federal transfers should make up only a small portion of the overall provincial program spending increase.  It is odder still when you considered that the extra cash is coming from a government that makes few pretenses about its interest in spending cash on programs that benefit working people.  The Ontario Liberals however won an election on defending public services -- there just isn't any funding from them to actually implement that policy it seems. 

Not yet anyway.   We will see if they keep to their hard, hard line line when the Budget rolls around in the new year. They certainly have a bit more cash from the Feds to help make change happen.  


Federal Health Transfers:  The health transfer is up $735 million or 5.95%.  That is $364 million more than it would have been if we had not won a two year extension to the 6% federal health transfer increases in the last federal election (and were instead already stuck with the 3% minimum increase that the Harper Conservatives plan).   

This $735 million federal health transfer represents about a 1.5% increase in total Ontario health care funding. 

Ontario needs to fight for federal health funding:  A Toronto Star  article on Charles Sousa and the federal transfers had not a word on fighting to improve the federal health transfers.   Likewise,  health care funding was largely passed over in media accounts of Kathleen Wynne's note  to Harper earlier this week either.  

Unless the Wynne government picks up their health care game,  Ontario will be stuck with a loss of an extra $364 million for health care every year. 

Federal Support to Ontario (millions of dollars)

2009
2010
2011
2012
2013
2014
2015
–2010
–2011
–2012
–2013
–2014
–2015
–2016
Canada Health Transfer2
9,722
10,141
10,673
11,328
11,980
12,356
13,091
Canada Social Transfer
4,205
4,332
4,463
4,577
4,709
4,843
4,986
Equalization
347
972
2,200
3,261
3,169
1,988
2,363
Total - Federal Support
14,274
15,446
17,335
19,166
19,858
19,187
20,440
Per Capita Allocation (dollars)
1,100
1,178
1,309
1,431
1,467
1,404
1,482
One-time recoverable payment of $150 million for 2011–12 not included.
CHT includes separate payments to Ontario in respect of the Canada Health Transfer for 2009-10 ($489 million) and 2010-11 ($246 million) to ensure Ontario receives the same CHT cash support as other Equalization-receiving provinces.
Photo: Chalmers Butterfield

My blogger tricks - Adding floating facebook & +1

Share

Widgets