'Common sense' healthcare policy is social murder

Next time you go to the polls remember #fordiskillingus through common sense policies that promote #socialmurder and we need to vote in a government that will #stopprivatizinghealthcare.

Credit: Ontario Health Coalition

There is no such thing as common sense. Defined as, knowledge and judgement that is universal in nature and that is commonly held and shared by the majority of people, that assumes that everyone has mutual lived experiences and interactions that leads to a shared view. That’s not possible given the intersectionality of some lives and the lack of that experience by, well, let’s say, patriarchal, libertarian white supremacist males.

Until you experience something for yourself and cement it in memory, it is not common sense.

Take the nightmare many Ontarians refer to as the Harris years (1995 – 2002) when conservative Premier Mike Harris destroyed essential services and social safety nets with his ‘Common Sense Revolution.’

Harris cut provincial income taxes by 30 per cent so other common sense cuts had to be implemented to offset the lost revenue.

Harris immediately cut social assistance rates by 21. 6 per cent arguing that too many folks were taking advantage of the Ontario Disability Support Program (ODSP).

That cut meant folks living with disabilities that made it impossible for them to work received up to $930 per month to cover rent and all living expenses.  Harris called that common sense policy. I, on the other hand, call it social murder.

Harris also introduced Ontario Works (OW) for folks deemed able to work which provided $520 per month for rent and all living expenses. The thing is, many people receiving OW are actually unable to work and are waiting for approval to move onto ODSP.

Under the Ford government ODSP maxes out at about $1,300 and OW at about $733 per month. Canada Emergency Relief Benefit (CERB) proved a minimum of $2,000 per month was needed to provide a basic standard of living during the pandemic. That standard of living benchmark has only increased thanks to skyrocketing rents and the cost of living.

Harris made additional cost savings by cutting health care spending, although some cuts were made to counter $30 billion in transfer payments no longer coming from the federal Liberals.

Several hundred nurses were laid off, hospitals were closed or amalgamated and Telehealth Ontario was launched.  

The largest cuts imposed by the Harris government targeted cutting 3,506 chronic care beds from hospitals. Between 1990 and 2010, Ontario lost half of its chronic care beds and one-third of its acute care beds.

These cuts impacted elders waiting for long-term care (LTC) admission as well as those living with acquired immunodeficiency syndrome (AIDS), Multiple Sclerosis (MS) and Huntington’s Disease.

Under Harris, chronic care was renamed ‘complex continuing care.’  This created two categories of patients – those dependent on technological interventions and those who are not.

As chronic care beds closed, the conservatives substituted less specialized LTC beds funded at $90 per day that offered limited care as opposed to chronic care beds funded at $200 per day offering much higher levels of medical, therapeutic and nursing care.

That’s when new co-payments for patients were introduced for elders waiting in hospital for a LTC bed.  

The Ontario Health Coalition (OHC) condemned the plan to move chronic care patients into LTC beds as ‘warehousing’ that would result in a continuous downward spiral towards cheaper care for chronic care, hospitals, nursing homes, homes for the aged, supportive housing, long-term in-home care as well as community support services like adult day programs.

However, many elders have very complex, often co-existing medical problems and disabilities requiring intensive nursing care, therapy and medical interventions combined with high levels of personal care.

Chronic care bed closings, slated for completion by the end of 1999, meant that elders living with Multiple Sclerosis, Parkinson’s Disease, Amyotrophic lateral sclerosis (ALS), HIV/AIDS, severe dementias and multi-systems failures were downloaded to nursing homes and homes for the aged because over 18,000 folks were on the wait list for LTC at the time.

Even when an elder was moved to a LTC facility, the level of care was inappropriate and the time spent with each elder did not meet their individual needs thereby putting lives at risk. That’s because residents with heavy care demands placed impossible burdens on workers and staffing levels were not increased because required staffing ratios were eliminated by the Harris government.

Harris’ common sense LTC agenda also included awarding 6,700 new, cheaper LTC beds to major corporations like Extendicare (965 beds/14.4 per cent) and Versa-Care/Central Care Corp (1,385 beds/20.7 per cent), Leisureworld Inc. (512 beds/ 7.5 per cent) among other private, for-profit corporations who often sub-contract out daily operations.

Privatization also takes place when patients are moved out of public hospitals and no longer have the protection of the Public Hospitals Act and the Medical Insurance Act. That’s when chronic care patients are hit with new charges for drugs, therapy, dental and foot care that they have to pay out of their own pockets.

In 2000, OHC summarized the changes implemented by the Harris government in Public Pain, Private Gain: The Privatization of Health Care in Ontario. The OHC report was based on a comprehensive study conducted by Paul Leduc Browne that was published by the Canadian Centre for Policy Alternatives (CCPA).

Page 11 of the report references Bill 26, Savings and Restructurings Act, which was in fact, an omnibus bill containing over 200 pages detailing changes to existing laws, healthcare and municipal services. Bill 26 eventually became better known as the ‘Bully Bill.’

The Harris government’s omnibus bill initiated hospital restructuring and introduced co-pays for elders waiting in hospital for LTC. Thousands of hospital patients waiting for beds in nursing homes paid a daily charge for room and board.

Harris introduced co-payment fees of $65.32 per diem for alternate level of care (ALC) patients waiting to be discharged to LTC. The montly maximum was $1,986.82. Find the Ministry of Health fact sheet on co-payments here.

This payment matches the LTC co-payment contribution towards accommodation and meals of $65.32 for a basic long-stay.

However, in August 2022, the Ford government passed Bill 7, More Beds, Better Care Act, that could be used to force hospital patients waiting for LTC into homes not of their choosing on a ‘temporary’ basis.

The bill, that was passed hastily without going to committee, allows hospitals to send ALC patients who are discharged up to 70 kilometers away from family and friends to the first LTC bed that opens up. That distance increases to 150 kilomters for elders living in northern Ontario.

To date, over 400 Ontarians have been put into nursing homes not of their own choosing. Common sense, and the law, recognizes this does not constitute informed consent.

Elders refusing to move could be charged a daily fee of $400 to remain in hospital care although the maximum uninsured hospital rate of $1,800 per day looms large over these folks.

Elders are refusing to go to LTC homes that are not on their list of preferred homes for excellent reasons. LTC homes with space, like Orchard Villa, generally have the worst death rates resulting from malnutrition, dehydration, neglect, chronic understaffing and human right violations. In the case of Orchard Villa, the army had to be sent in during COVID lock down and once inside, described horrific conditions that have left some soldiers with post-traumatic stress disorder (PTSD).

Yet, Ford thought it was common sense to issue Orchard Villa an 87-bed extension along with a new 30-year license.

A class-action lawsuit is proceeding against the minister of long-term care, Natalie Kusendova-Bashta, for alleged negligence regarding the government's response to COVID-19.

Homes with vacancies are most often private for-profit and older facilities — some slated for demolition — that are unable to fill enough beds to meet the occupancy targets required to get full funding from the province. Coercing elders to take a bed at these facilities means these corporations continue to profit while elders receive less than optimal care potentially in cities far from family and friends.

The question remains how is it common sense that the libertarian Ford government continues designating more acute patients as ALC and ALC awaiting discharge to LTC and charging them a daily fee? Especially when the alternative is being warehoused in a sub-par private for-profit LTC home simply so that corporation can meet its quota and maximize provincial payments.

Keep in mind, hospital physicians do not necessarily know anything about LTC facilities in general nor what services LTC homes actually provide folks with multiple chronic conditions. That makes sending elders to the first LTC home with space – without considering patient need, the state of the facility and widespread, chronic staffing shortages -- inhumane and, quite frankly, immoral.

Currently, 40,000 folks are on the provincial wait list for LTC. There are also insufficient hospital beds for folks needing rehabilitation; mental health supports; psychogeriatric, medical, surgical, ICU and palliative care. And, there in lies the impetus to fast-track patients into ALC and ALC awaiting LTC where they can be charged a daily fee and bullied to move to the first available LTC spot.

“Chronic care is neglected and largely ignored. Patients are not given adequate access to rehab and there is a lot of ageist discrimination against the elderly and people with dementia. So, they don’t get the falls prevention, they don’t get stimulation,” Natalie Mehra, executive director OHC told Small Change via email.

“Chronic care/complex continuing care needs to be totally reformed and modernized to actually support the elderly who have no choice but need ongoing hospital care and deserve to be supported to live to their best potential in it. ALC has become a catch all and a way to force ever more acute elderly people out to cheaper beds and ultimately out of hospital, whether or not the care is safe, appropriate or even humane,” Mehra added.

So, was it really common sense to cut $1 billion out of annual hospital funding to pay for the 30 per cent corporate and individual tax cuts that benefitted Ontario’s wealthy? 

Mehra says, it was not!

“They cut $800 million from hospitals, but they spent more than $3 billion on restructuring to close down services, merging hospitals, moving services around and laying off nurses. They were then forced into a sea of change because the entire system was thrown into crisis and they re-funded the hospitals starting in 1999.”

But that failed to help because the damage was done and Harris moved on to receive millions in cash and shares serving as Chair of the Board for Chartwell Retirement Residences while starting the for-profit home-care franchise, Nurse-Next-Door in 2012 with his third wife, Laura.

And, you can be sure that Ford is following the same play book deregulating and privatizing the remaining vestiges of universal healthcare so that he has a nice little position to move into which will benefit him in his political retirement because self-interest and greed is innate corporate fascist common sense.

Next time you go to the polls remember #fordiskillingus through common sense policies that promote #socialmurder and we need to vote in a government that will reverse course and #stopprivatizinghealthcare.

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