Navigating Ontario’s Homecare System
For over three months since we returned home from the hospital we have been learning about the homecare services Ontario offers. We have been completely floored by the variety of services available, and by the number of people you deal with in order to access these services. It’s like we’ve discovered an unknown world behind the scenes, a world you’re not aware of until you need help.
There are 5 parts to the services the health care system provides. First, there is a coordinator, who arrives about day two for a general conversation about your needs. My top priority need is for assistance getting in and out of bed, since I am paralyzed from the chest down.
For the actual services we have an occupational therapist who comes to consult with us about the mechanical lift I use, and my wheelchair. We also had a physiotherapist and her assistant, who came to the house for about six weeks. This is intended to give you time to find your own professional physiotherapy, which you will have to pay for. Extended health care insurance often covers the cost of this physiotherapy.
What I think of as the fourth level is the Nursing Team. They will visit once a week, and fill out a record of how we’re doing. If needed, they will come more often, in the middle of the night if necessary. Accessing all these professional services at home as needed seems quite remarkable to me, and very helpful for my continued recovery. But it has left most of our fall a hectic schedule of appointments and visits - 19 in one week! We've never been so busy.
The last level is the one we’re struggling with now, the provision of PSWs (Personal Support Workers). These are the people who do the actual work at your bedside, getting you washed and dressed and overseeing any other personal care needed, and then using the lift to get you into your wheelchair. Once I’m in my chair, I’m fine for the day, but I do need that personal help to get there.
Two days before coming home we were told we would be getting help for two hours a day – great! The next day we were told ‘oops, there are none available in your area, so you won’t be getting any help’ – not so great, in fact it’s terrible! We realized in the very first week that we would need help with this, and in the first two weeks our only alternative was to hire a private ‘PSW’ who comes 6 days a week in the mornings. She is both very competent and very pleasant. She has saved our butt!
Only a month ago we started getting some evening support, at first just two nights, but a start. Then we were told we’d be getting 6 nights a week. That was encouraging, but so far the most help we’ve had is 3 nights, and over the holidays I think we only got support 3 nights in 12. It would be very easy to rant and rave about the shortage of staff in this particular service program. Finding more support to help us get me in and out of bed is our top priority right now.
There are also lots of scheduling issues with the PSWs too. We often only hear the day before whether any help is available. We’ve had offers of help at all hours of the day, but medically, my need is for a reasonable hour of help in the morning and evening. Some days that is not available.
But before I mislead you, let me say that everyone who has come to the door, or been reached on the end of the phone, (about 25 people over 3 months) has been pleasant and as helpful as they can be. They know the limitations of the system as well as we now do. They just cannot fix the system any more than we can.
Out of this 3+ months of learning the system, I’ve reached a few conclusions.
-It’s amazing that these services exist at all, especially at no cost to us (there are others you do need to pay for).
Given the $25.00 - $50.00 cost of keeping someone in their own home and the $500 - $1000.00 cost to keep someone in a hospital, it’s easy to see what’s economically sensible.
The people we deal with have been uniformly pleasant and helpful.
But the PSW portion of the program faces a serious shortage of staff and funding.
Tomorrow the services that you have to pay for.