By Jonathan Sher, The London Free Press

Ontario’s auditor general has slammed the massive bureaucracy that handles home care after finding problems so glaring it could doom the $2.4-billion system.

Auditor General Bonnie Lysyk investigated community care access centres (CCACs) after The Free Press showed how the London-based Southwest CCAC more than doubled the pay of its chief executive and exaggerated its spending on patients by counting the 20% of its budget it gave to agency gatekeepers who limit how much care is provided.

In a critical report Wednesday, Lysyk showed such problems are provincewide and asked the government to consider scrapping CCACs.

“Now is a good time to start making significant changes,” she said in an interview.

The gauntlet thrown at his feet, Ontario Health Minister Eric Hoskins vowed within months he’d lay out “bold and transformative change.”

“I see (Lysyk’s) report as a catalyst,” he said.

Asked if he’ll scrap the 14 CCACs, Hoskins said he hasn’t decided but hasn’t ruled it out. Before he makes that call, he’ll seek feedback from patients and others with a stake in home care, including the head of the Registered Nurses’ Association of Ontario, Doris Grinspun.

For years, Grinspun asked the Liberal government to scrap CCACS so home care can be co-ordinated by primary care teams.

“When will the government have the courage to do what’s right and not just tinker?” she asked.

Patients suffer when money that should be used for their care is swallowed by bureaucracy and gatekeeping of a sort found nowhere else in the health system, she said.

“Instead of layers of administration, there (should) be more hours of patient care,” Grinspun said.

Her pitch gets a boost from Lysyk’s report, which found too many patients don’t get the care they need.

She also found CCACs overstate how much they spend on patients. While the agencies say they spend 92 per cent of money on direct patient care, the amount spent on face-to-face treatment is just 61 per cent, she wrote. The rest goes to care co-ordinators who decide who gets access to services, to administration at CCACs and to hired home care agencies that direct about 20 per cent of what they get to pay for overhead and to turn a profit.

“This is an opportune time to assess whether the current delivery model (could) be streamlined for the benefit of patients,” Lysyk wrote.

The CCACs pay different rates to service providers for the same services, with a hodgepodge of 14,000 distinct contracted rates for 94 service categories. The access centres also pay their own registered nurses far more an hour than do service providers they contract with.

“In the two decades since the inception of the CCACs, there has never been a thorough review to determine whether the current delivery model is providing consistent, equitable and cost effective care,” Lysyk wrote.

In response, the CCACs said care should be modernized — and the CCACs are just the ones to do it.

“CCACs are well positioned and committed to deliver the best possible service and outcomes for patients and their caregivers and provide the greatest value for public funds,” Catherine Brown, chief executive of the Ontario Association of Community Care Access Centres, said in a release.

“Care co-ordinators carry out many different kinds of activities for patients — all of which ensure patients receive the right care and support, where and when they need it,” she wrote.

But that claim rings hollow to some in the face of the failings found by the auditor general, who cited a program that gave tax dollars to CCACs to hire nurses to make sure patients with especially complex needs would be seen at their homes within 24 hours of being discharged from hospital.

Of thousands of patients who were to get home visits that first day, just 53 per cent did. And it wasn’t just their care that fell by the wayside: CCACs didn’t check if those who received home visits were less apt to wind up back in hospital within 30 days — data hospitals track and are readily available.

It turns out the home visit program had little, if any, value, said Lysyk, who did legwork the multibillion-dollar system did not.

Her report isn’t the first to wave a home-care red flag — it’s the fifth by the auditor’s office showing a bureaucracy that treats clients inequitably, their care varying with where they live.

Change is overdue, Progressive Conservative health critic Jeff Yurek said.

“The home care system is dysfunctional,” said the Elgin-Middlesex-London MPP.

The drive for scrutiny intensified last year after The Free Press showed the chief executives of Ontario’s CCACs were given massive raises while some patients had to fight for basic needs, like access to support workers to take more than one bath a week.

It also turns out CCACs gave out raises to CEOs far exceeding that which home care agencies gave to their own upper brass, Lysyk found.

In her year-end 2015 annual report, Lysyk plans two related audit reports, one on personal support services in homes and the other on the performance of Ontario’s 14 Local Health Integration Networks that fund CCACs, hospitals and other community health services.