Mixed-model home care's iffy politics

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This article was published 21/10/2017 (673 days ago), so information in it may no longer be current.

Manitoba is undergoing a major, rapid transformation of health and social services, including the closure of ERs, privatization of occupational and physiotherapy and the recent proposal to introduce "mixed-model home care." Many commentators have characterized these changes as part of a privatization and austerity agenda that is shifting health-care values in Manitoba.

On Sept. 20, Health Minister Kelvin Goertzen announced Priority Home service, which is set to launch in November. This service aims to provide short-term, intensive home care for up to 90 days in order to divert individuals from entering personal care homes or hospitals. This allows patients to be panelled for services at home, rather than undergoing this process in the hospital.

Currently, many aging people and their families do not initiate the home-care application process until they are in crisis, which doesn’t account for administrative time, home assessments or any waiting lists for services. Providing intensive "bridging" at times of crisis, with the aim of avoiding more costly and institutionalized care solutions, does indeed respond to urgent gaps in the health-care system.

However, the WRHA news release glosses over the "mixed-model" aspect of Priority Home. Two-thirds of the $15.7-million budget will go toward private companies providing these intensive services. While receiving intensive home care is often preferable, there are legitimate concerns about private companies providing these services.

Evidence shows that privatized health care geared toward finding greater "efficiencies" and cost savings means that social-health approaches are further removed from care delivery, and patients/clients often have little choice or autonomy when it comes to their care. Rather than striving for well-rounded care delivery, this mixed-model "fix" erodes hard-earned public infrastructure and may also exacerbate social inequalities that make care less accessible in the long run.

WRHA proposes Priority Home as "an intensive intermediary" until public infrastructure can reabsorb these services. This raises questions about the job security of care workers and how this might affect clients/patients. This privatized "fix" to a crisis of Canadian health care is a familiar refrain. Simon Enoch and Christine Saulnier of the Canadian Centre for Policy of Alternatives refer to a recent report from Privatization Nation, saying, "We thought this to be conclusive evidence that despite 30 years of experience, governments rarely seem to get privatization right, and more often get it wrong with astonishing regularity."

Experts on public-private health-care models, such as Heather Whiteside at the University of Waterloo, argue that these temporary "fixes" rarely (if ever) live up to their promises, and mostly represent politically motivated incentives not to seek out public solutions. Given this track record, it’s hard to imagine how the public sector will simply re-absorb the "private transitional care beds" after two years, as promised.

In many ways, policies and practices of care are a litmus test for how socially progressive a given society is. Disability activist Mia Mingus describes care as an essential part of valuing marginalized people — particularly older people and disabled people so often isolated in inadequate health-care systems. Mingus urges us to nurture alliances among workers and those who use services to reveal the urgent politics of care.

Donna Baines of the University of Sydney says care is part of an ethos of social justice that addresses poverty, class relations, sexism, heterosexism, ageism and ableism. What does Priority Home say about the politics of care in Manitoba? It tells us that disabled and older people are considered a "burden" on the health-care system, and that the "best" care is provided by the lowest bidder, regardless of how it might undermine public health-care infrastructure or care worker security.

Manitoba Health proudly reminds us that we have the "oldest comprehensive, provincewide universal (home care) service in Canada" — and we can continue to develop home-care policies that hold Manitoba up as a leader nationally and internationally. Amid stories about "budget cuts," "rising health-care costs" and the necessity to "overhaul" an outdated system, there is opportunity to approach care as a complex system, one that is interrelated with other social services and driven by a broader ethos of social wellbeing and even justice.

Rather than adhering to narrowly defined metrics of "quality of care," let’s use this juncture to develop publicly funded home care that is guided by the best research on the social, political and geographic dimensions of care and the experiences of the people on the front lines of care — workers, clients, families and patients.

Mary Jean Hande is a postdoctoral fellow in community health sciences at the University of Manitoba whose work examines the politics of care under austerity in Canada. Christine Kelly is an assistant professor in community health sciences at the University of Manitoba who is leading a national study on directly funded, or self-managed, home care.