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Ontario considers asking wealthy seniors to chip in for home care

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TORONTO - Ontario seniors with higher incomes could be asked to chip in for their home care as the province looks for ways to sustain health-care reforms meant to meet the needs of its aging population.

A report officials said will pave the way for the province's strategy on seniors care recommends exploring the possibility of an "income-based system."

It's one of 169 recommendations laid out in the report titled "Living Longer, Living Well," the highlights of which were released Tuesday.

Health Minister Deb Matthews said the province has already moved to an income-based system when it comes to drug co-pays, and it may be time to do so for home care.

"If we can ask people to contribute so that more can get care, that's a conversation we need to have," she said in a news conference at Toronto's Mount Sinai Hospital.

But Matthews stressed the province will ensure everyone has access to the health care they need, regardless of their financial situation.

Some services included in the home care umbrella — such as meal preparation, snow shovelling and other non-medical assistance — are already subject to co-pays.

But so far, at-home medical services for seniors have been fully subsidized by the health-care system.

The recommendation relates to home care funded by community care access centres, which can include medical services but also personal support such as dressing and bathing.

Several other provinces, including British Columbia, Alberta and Nova Scotia, impose co-pays for home care on a sliding scale.

Still, the proposal raised red flags for some opposition members, who said it could keep seniors from receiving the help they need.

"I think the investigation will quickly show it becomes a barrier to access, it becomes very bureaucratic and basically it adds complexity to a system that already has a tough time with the level of complexity that it has," said France Gelinas, the NDP's health critic.

And while the province clearly needs to bring health-care spending under control, co-pays aren't the only way to achieve savings, said Christine Elliott, the Conservative critic.

"Rather than going first to taxpayers, I think that we need to take a look at all of the alternatives and we need to take a look at our entire health-care system," she said, adding the party is preparing to announce specifics of its proposals.

As it is, wealthy seniors are set to start paying a greater share of their drug costs next year.

A provision in the 2012 budget amended the Ontario Drug Benefit so that single seniors earning more than $100,000 will pay a deductible of $100, plus three per cent of net income over $100,000.

The deductible for senior couples with a combined income of more than $160,000 is $200, plus three per cent of their net family income over $160,000.

The province has said the move will save $30 million in the 2014-15 budget, funds that will be poured into the seniors care strategy.

A key commitment in the governing Liberals' health care plan, the strategy inched ahead Tuesday with the release of the recommendations and the minister's promise to act on them swiftly.

Matthews took the opportunity to highlight initiatives to link seniors with primary care providers and boost personal support worker services — both of which were in the works before they were included in the recommendations.

Seniors and health advocates lauded the document, which was penned by Dr. Samir Sinha, director of geriatrics at Mount Sinai, following widespread consultations this summer.

More than 5,000 seniors and thousands of caregivers, health and social workers and officials in 19 communities weighed in on the issue.

"This report comes at a critical time," Candace Chartier, CEO of the Ontario Long Term Care Association, said in a statement.

"Action must be taken if Ontario is going to be ready to deliver the full range of care and services to the growing number of frail, chronically ill Ontario citizens."

Susan Eng of the Canadian Association of Retired Persons — one of the groups consulted for the report — said the recommendations showed promise and pushed for "immediate implementation.”

While praising the plan and its potential to position the province as a leader in seniors care, the NDP's Gelinas questioned whether it would ever come to fruition.

She said the health minister's decision to "reannounce" existing programs Tuesday rather than act on the new recommendations was "a clear signal that nothing is going to come of this," adding it "would be a real shame."

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