Report addresses NE CCAC budget woes

Overly generous service allotments, head count growth and excessive bureaucracy cited as contributing to deficit

A recently released Hay Group report on the operation of the North East Community Care Access Centre (CCAC) concludes the organization is too generous with its home care services, too top heavy and overly bureaucratic.

On the other hand, it acknowledges that delivering services over the vast expanse of northeastern Ontario presents unique challenges and notes that funding for new programs such as Health Care Connect or exercise and falls prevention generally don’t cover the cost of administering them. The report commissioned by the North East Local Health Integration Network (LHIN) concludes that the North East CCAC “seems to have lacked the capacity to simultaneously implement new programs, ensure a balanced budget and protect pre-existing services that it’s responsible for.”

Alarm bells began ringing in September 2013 when the CCAC projected a 2013/2014 budget deficit of $12.5 million. The LHIN responded with a base funding increase of $5 million and directed the CCAC “to prepare a plan detailing strategies to ensure a balanced position at year-end.”

However, cost savings achieved in the CCAC’s Balanced Financial Plan “were counter-balanced by significant increases in nursing and personal support worker service.

“In the end,” notes the report, “the LHIN provided an extra $11 million in funding to the CCAC to address the $12.5 million budget deficit.”

The increased costs for nursing and personal support services are attributable to the provision of services “in excess of allocation guidelines.”

Excessive hours

As of the end of March 2014, “52 per cent of clients (excluding those receiving enhanced service levels) were receiving PSW hours beyond the service allocation guidelines,” costing an additional $217,000 per week, or $11.3 million per year.

“A significant number of the NE CCAC patients receive more hours of service per week than what is currently allowed,” notes the report.

“Reportedly, there are a large number of longer-term patients that were assessed and began receiving services under old, more generous guidelines. While there have been attempts to bring these allocations in line with current guidelines on an individual patient basis as their status changes and a reassessment occurs…there has been reluctance to implement any policy aimed at reducing services for this group as a whole.”

The report concludes, “either the guidelines need to be revisited, or there are still opportunities to further reduce the frequency that clients are provided care in excess of the guidelines.”

The Hay Group also questions the 32.3 per cent increase in staffing at the North East CCAC from 2009/2010 to Q2 2013/2014, during which time staffing at all other CCACs in Ontario increased 13.9 per cent. During the same timeframe, patient volumes increased only 4.1 per cent in the northeast and 8.6 per cent in the rest of the province.

The report notes that a proportionally high percentage of total staffing at the North East CCAC appears to be allocated to management and operational support, but suggests that may be attributable to the challenges associated with rolling out new programs in a sparsely populated region.

Expanded role

“Like other CCACs, the role and mandate of the NE CCAC has grown exponentially in the last few years,” observes the report. “The North East CCAC’s role has grown from one of primarily information and referral, case management, homecare supports and services, and placement to include elements of primary care, preventative care, complex service delivery, chronic disease management and placement in specialized settings.

“While there have been dedicated operational funds for many of the expanded services…these programs have not always been accompanied by administrative funding or support. Successful launch of new programs requires a significant effort of time, energy and attention, particularly when the program is to be delivered in a challenging geography and requires the participation of multiple stakeholders.

“There is an overwhelming concern… that the mandate of the CCAC has grown too quickly,” jeopardizing the delivery of core services, the report notes. Nevertheless, the authors urge the CCAC to “consider whether there are opportunities to reduce its administrative staffing levels,” and underline the importance of being seen to operate as leanly as possible given the current climate of fiscal restraint.

The CCAC is also taken to task for “cumbersome, multi-step processes” that slow down the ability to provide care. “Multiple approvals, or approvals by higher authorities, are currently needed, adding multiple steps to each process and resulting in local area co-ordinators and managers having very little decisionmaking authority or ability to exercise flexibility to meet the needs of the local community or specific individuals.

Bureaucracy

“…employees consistently communicated that they believed the current management structure of the NE CCAC was too directive and cumbersome and that it did not allow managers and their employees the ability to make decisions or react to situations/issues that arose in an appropriate and timely way.”

Hospital staff consulted by the report authors “routinely reported that clients have had to wait for several days, sometimes even up to a week, to receive a call from a care co-ordinator for assessment purposes,” keeping patients in hospital longer than necessary.

Wait times for French language services and the CCAC’s new rapid response nursing program are singled out as particularly troubling.

The report urges the expansion and optimization of new service delivery models, including nursing and therapy clinics for mobile patients, and recommends increased partnering with hospitals and other health-care providers, especially in smaller communities.

“Stakeholders feel that the consolidation of several CCACs into one large CCAC has meant that the capability to engage with local partners in smaller communities has been reduced,” notes the report.

Creative models such as the North West CCAC’s partnership with Manitouwadge General Hospital, which delivers home care services for the isolated community, are cited as possibilities for more efficient service delivery in the northeast.

An improvement plan outlining how the report’s recommendations will be implemented will be presented to the North East LHIN on September 23rd.

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