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The care deficit.

The community
care deficit.

“Community care” is a catch-all term for a complex and fragmented network of health-care services. Some are delivered by public health, some by community health centres, and others by not-for-profit and for-profit providers. More and more services are being moved from hospitals into the community, even though this sector is already full of gaps and inefficiencies.

Because the system is so complex, one of the most important roles is the coordination of care. Care coordinators are usually registered nurses, but may also be occupational therapists, social workers, or other health-care professionals. Right now they’re struggling to do their jobs. It’s been that way for years, and it’s getting worse.

Chronic underfunding means that many care coordinators are dealing with caseloads that are impossibly high. This staffing issue is a care deficit that affects patients directly. For example, most assessments have to be done over the phone instead in the patient’s home, where care needs are best evaluated. Heavy caseloads also mean that care coordinators have less time to follow up with patients directly in person. In fact, face-to-face follow-ups are now very rare. At the same time, the needs of patients are becoming more complex. It’s a double bind.

The number of home care patients with unstable health conditions is rising.

Health Quality Ontario

The fragmentation of care presents another significant burden. Care is farmed out to a wide variety of provider agencies. But they don’t always supply the feedback they’re expected to. As a result, care coordinators spend a lot of time chasing down information to ensure that patients are really receiving the care they’ve been promised and that patient well-being is improving.

The constant contracting-out of care leads to another inefficiency – the bureaucracy required to manage the large network of providers. Funding that could be paying for direct care by skilled health-care professionals disappears into a top-heavy bureaucracy instead.

Over 20% of informal caregivers (spouses, family members) experience distress. They need more support.

Canadian Institute of Health Information

The Ontario Nurses’ Association is a leader in advocating for more direct care for patients. There are many solutions that could make community care a more effective contributor to patient well-being.

  • Dedicate more funding specifically to front-line care in our communities. Hire more registered nurses and other skilled professionals who assess needs and deliver care. And close the wage gap that makes it hard to recruit nurses and others to this sector.
  • Keep home care truly public. Stop offloading public home-care services to for-profit business that squeeze the amount of care they provide and refuse to disclose their profits.
  • Fund the community care sector to ensure that everyone in Ontario has the same access to services, no matter what their geographic location.
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