First step in privatizing healthcare? | Page 6 | GTAMotorcycle.com

First step in privatizing healthcare?

MacDoc said:
ask the seniors how they did/are doing under "private care' with the watchful eye of Fnord.

saugeentimes.com

Record in long term care homes is dismal says reader | Saugeen Times

saugeentimes.com saugeentimes.com
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2 things. First, I think you will be very surprised how much improved LTC is under the current Ford regime. Still struggling, but in much better shape with respect to regulatory compliance and outcomes. Been in one lately? I've been balls-deep in LTC for the last year.

Second, don't come to an argument unarmed.

Ford inherited a lot of broken stuff, among the worst was LTC. PC Harris started overhauling the public sector, however, McGinty and Wynne carried forward his privatization and cost-cutting agenda at WOT. Their reforms were a bit more sinister as they focussed on displacing gov't costs onto workers, the elderly, and the poor while preserving votes from the masses through hollow election promises.

Liberals' aggressive privatization and P3 reforms to LTC included massive subsidies for-profit nursing and LTC ($10B+ in cash transfers over 10 years). Despite fully understanding the tension for $$$ between 'profit’ and ‘care’, they turned a blind eye with respect to transparency, financial accountability, and regulation. Whether they did this for expediency or votes, the public's money hit shareholders and executives instead of serving the needs of residents. 15 years later Ford inherited a poorly regulated, financially unbalanced system that was raping the public purse at the expense of residents and workers.

Libs knew the problems, they campaigned with specific promises to fix, but never fulfilled a single promise.

McGuinty came to power in 03 with LTC reform as a campaign promise. He failed to deliver on promises of minimum staffing levels of 4hrs/day, care standards, and competitive bidding. It was later determined that Elinor Caplan recommended no action as it would jeopardize votes and party donations.

Over the liberal's tenure, they celebrated adding 20,000 beds to LTC! Horray -- we need beds! Sadly they added 2,500 PSWs and 900 nurses - care - so each of those new beds got 1.1 hours of care / day. Their failure to keep staffing levels in pace with the growth of complex needs has created alarming scenarios in care homes. One of the most egregious was turning to antipsychotic drugs as chemical restraints -- at it's peak 70% of dementia patients and 40% of all patients were continuously drug restrained.

What has Ford done?

  • Doubled the number of inspectors across the province and is doubling fines for individuals and corporations in long-term care that violate care standards. Wanna see staff jump in a LTC home today? Whisper 'look at that droplet on the floor, someone could slip".
  • Use of antipsychotic drugs as chemical restraints has dropped by half to it's lowest point ever, <20%.
  • 90 facilities had no AC and substandard HVAC, they will all have all been brought into compliance by this summer.
  • Building 40% more bed inventory is well underway -- by 2028 that will be done. MAny of the 28,000 beds that were out of compliance when PCs took office now meet provincial standards.
  • Increased transparency. Annual inspections, compliance audits, incident reports, and wait times for every private and public LTC facility in Ontario are now publicly available on-line.
It's not perfect. But it's no longer headed backwards.




​

 
You finished with your political polemic tract... :rolleyes:
Non-profits had an average of 2.8 deaths per 100 beds while municipal homes averaged 1.4. The average death rate in for-profit homes is 5.2.

Pat Armstrong, a professor at York University in Toronto who studies best practices in long-term care, said her research shows consistent differences among ownership types when it comes to other quality-of-care indicators.

"Certainly ownership is a factor and we've known that for a long time," she said. "It doesn't mean that all of the for-profits are terrible or that all of the government-owned ones are wonderful, but the pattern has been pretty consistent for quite a while now."

Long before COVID-19 arrived, there were more transfers to hospitals, more deaths and more bed ulcers in for-profit homes, Armstrong said.
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nursing-home-covid-19-death-rates.jpg

Why did the "oh so efficient" for profits fare so badly ? 🍿
 
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My posting that the author is NDP has nothing to do with my opinion on the topic of LTC homes or political views. The letter was obviously, to me, written by someone with a bias..

Has David McLaren always been an advocate for better LTC home conditions.. or just now using it to take a shot at Ford?
 
MacDoc said:
You finished with your political polemic tract... :rolleyes:

nursing-home-covid-19-death-rates.jpg

Why did the "oh so efficient" for profits fare so badly ? 🍿
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There are a variety of reasons, some related to profits, some not so much. **Occasionally** charts like the one above are 'fun with statistics', if I had a spare week to review the chart, I'm sure I could blast some nice holes in a proofing of that data.

Canadian Medical Association Journal: For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths peer reviewed study concluded that the risk of an outbreak of COVID-19 at an LTC home was related to a) the COVID-19 incidence rate in the public health unit surrounding the home, 2) its total number of beds, and 3) the era of the homes' design, rather than for-profit status.

The study did determine for-profit LTC homes had larger COVID-19 outbreaks and more deaths than nonprofit and municipal LTC homes, however they concluded a higher number of for-profit homes operate with dated designs. Why? Between 2005 and 2013 McGinty pawned off every out-of-date public LTC facility to private operators under the conditions they run them and do not close beds -- about 1/3rd of Ontario LTC beds. Those facilities have dorm-style accommodation (4 to a room), residential-style hallways, dining, and gathering areas that restrict social distancing. A higher percentage of those homes are also in urban areas where the likelihood of community outbreaks was high.

An interesting side note, in my city (Markham), the numbers look like this.
TypeCovid DeathsBedsRate
Non Profit (3 homes)*334248%
Profit (1 home)161928%
 
I get sun damage lesions on my face that could turn cancerous if ignored. Actinic Keretosis, AK for short. It is very common in the 50+ group, especially if you're into boating, skiing, fishing and non ATGATT riding.

The old system:

Every six months I go to a dermatologist and in five minutes a qualified MD singles out the spots and freezes them with liquid nitrogen. There is no prep work and it stings for a minute or two. Over the next week the frozen skin falls off. and you become normal again. Your down graded appearance is less than a mild abrasion. No drugs and the associated after effects.

The new system

You get a lifetime prescription for Actikerall at $66 a bottle. The bottle has a shelf life of about a year but only three months after you open it. Two per year = $132

An unqualified person applies it or you can do it yourself using a pair of mirrors.

If you miss a spot it can go cancerous.

The Actikerall leaves a white film over the area. This can be for up to twelve weeks. Healing can be up to eight weeks after stopping treatment. A physician can tell you how long to keep applying the liquid but that require a visit unless he shoots from the hip.

There are numerous side effects including months of explaining the bird poop look on you forehead or cheek.

Dermatologists make on average $165 an hour and could see 10 patients an hour so the fee per patient (In simple terms) would be under $20 per visit with work being done by a professional that could recognize other conditions.

I assume a dermatologist could make a lot more doing non OHIP approved treatments such as spider veins, Botox, non malignant warts etc.

If the patient misses something or does something wrong, resulting in a cancer, the costs go silly high.

Does the new system seem like a good idea.

Food for thought: A retired dermatologist had a system where she only treated plantar warts one evening a week. It's a similar procedure. Mass production.

How about a nurse or nurse practitioner doing the work?

To the original question about privatization, could other disciplines go the same way?

When things go wrong has anyone ever seen the government correct anything in a timely fashion?
 
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Hearing how public school system is degrading while education ministers have their kids in private school makes me question how good private healthcare will be. For public anything to work there needs to be some common stake. Crime and theft is rampant. Police and the the justice system are not doing anything about it. Next on the list will be a private police force? Society is nose diving towards a wild west culture while we're told to keep calm.
 
Spoke to a doctor friend of mine the other day. He casually mentioned to me there seems to be a lot of contractor activity around healthcare right now, but not in a way you'd expect to notice any changes. The impression was a lot of money is being spent but not actually benefiting the system or the people it serves.

I guess the vultures are circling the money carcass of healthcare. Let's see how that Fed arrangement to the provinces actually changes anything or just makes a select group of people rich.
 
putting the shoe on the other foot, your a doctor making your 300K in a hospital setting , you do your shifts in ER on saturday night while your friends are enjoying YOUR cottage. Somebody says lets open a critical care clinic , a 'private' version of triage. Forward people to ER if required. And you stand to make 500K.
Makes Statuday night without your friends seem ok.
 
crankcall said:
putting the shoe on the other foot, your a doctor making your 300K in a hospital setting , you do your shifts in ER on saturday night while your friends are enjoying YOUR cottage. Somebody says lets open a critical care clinic , a 'private' version of triage. Forward people to ER if required. And you stand to make 500K.
Makes Statuday night without your friends seem ok.
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Huronia Urgent Care Clinic in Barrie has been operating like that for decades. They do stitches, casts and imaging in house. A decent number of ambulance calls to there for people that should have gone to ER to start with. Founding doc is a nice guy and really humble.
 
sburns said:
Spoke to a doctor friend of mine the other day. He casually mentioned to me there seems to be a lot of contractor activity around healthcare right now, but not in a way you'd expect to notice any changes. The impression was a lot of money is being spent but not actually benefiting the system or the people it serves.

I guess the vultures are circling the money carcass of healthcare. Let's see how that Fed arrangement to the provinces actually changes anything or just makes a select group of people rich.
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That us true. My sons GF is a resident nurse in the North. She makes $35/hr plus regular govt worker benefits. Contract nurses in he hospital earn $100 hr, no benefits but the get $50/day for food, and $2000 tax free accommodation. allowances.

Privateers shouldn't be able to profit off the public this way.

Many are nurses recruited to the private network after gaining 2 years if hospital experience.
 
Mad Mike said:
That us true. My sons GF is a resident nurse in the North. She makes $35/hr plus regular govt worker benefits. Contract nurses in he hospital earn $100 hr, no benefits but the get $50/day for food, and $2000 tax free accommodation. allowances.

Privateers shouldn't be able to profit off the public this way.

Many are nurses recruited to the private network after gaining 2 years if hospital experience.
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They shouldn't but I think it's a lot harder to get people up to the Northern communities otherwise. This is the incentive to help out and get experience. My same friend does this he rotates between a few northern communities and then when he's back, works at a local GTA hospital. But he's not doing this to make himself better off. He was established in a NWT city for a long time and had to come back to TO for family reasons. Now he still wants to help out those Northern communities because he knows what it's like up there and still feels connected to them. Plus he doesn't agree with all the policies of having his own practice when certain agendas are pushed instead of actual care (more billing hours, and writing scripts). So he's kinda stuck, but I'm sure others are taking advantage of the perks to only better themselves.
 
Hearing that DoFo has fixed healthcare gives the inside of my butt a warm smoky feeling.
 
We now have two friends doing northern duty remote nursing. They don’t make $100 an hour but it better than hospital wage . They work two weeks , off three . They could care less about “ helping out” , they are there for the lifestyle and cash contract nursing provides .


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crankcall said:
We now have two friends doing northern duty remote nursing. They don’t make $100 an hour but it better than hospital wage . They work two weeks , off three . They could care less about “ helping out” , they are there for the lifestyle and cash contract nursing provides .


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Northern nursing pay structure varies by specialization and experience. Contract Community, mental health, & clinic nurses make $60 hr, ICU and surgical nurses $100, PICU nurses are pulling $170hr. VS $35 to $50 depending only on tenure in the public system
 
Why is OHIP incapable of paying the nurses the market wage directly? Do they only speak contractor and intermediary above $50? What's that $100 nurse billed at?
 
daught said:
Why is OHIP incapable of paying the nurses the market wage directly? Do they only speak contractor and intermediary above $50? What's that $100 nurse billed at?
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Market wage is interesting in a monopoly. It is literally whatever government is willing to pay. If they pick a number far too low, nurses move to other jurisdictions. I don't think we are there. Huge issues in the system but I don't think critically low pay is one of them. Inserting agencies in the center really messes with the program. Drives costs to the moon while providing very little benefit (other than the piles of gold heaped upon the owners of the agencies for doing almost nothing). I don't think market rate for a nurse is $100 as the system would collapse if all were at that number. Putting in controls that limited agency roles (maybe by time or percentage of hours in a facility) would result in better working conditions (and possibly increased pay) for staff nurses as there would be a mandate to keep a high percentage on staff. Easy to fund that when you stop paying agency triple for the same person.
 
Ontario hospitals usually pay nurses a wage based on the ONA contract. Salary ranges from $34.02 to $49.02 for FT staff. PT staff make the same wage, but get a premium of 9% - 13% in lieu of benefits.


If you are a PT nurse in a hospital with 10 years experience you are making $48.17 or $54.43 / hour with the 13% premium. PT nurses often have a fair amount of flexibility in scheduling, but you still have to meet the staffing requirements of the unit in the hospital where you are going to work. Agencies offer more scheduling flexibility and a higher per hour wage. If the agency is paying the nurse $75 / hour they are billing the hospital 2 - 3 times the hours rate or $150 - $225 per hour.

If you are a FT nurse in a hospital with 10 years experience you are making $48.17 / hour. FT nurses have very limited flexibility in scheduling and often work a rotating schedule of days, evening and nights, weekdays and weekends. Some units offer compressed work weeks where you might work 2 on and 2 off etc...... over a 2 week pay period. but you still have to meet the staffing requirements of the unit in the hospital where you are going to work. These RN's have full benefits and a DB pension with HOOPP. In spite of this, burnout is resulting in these FT nurses leaving and working for Agencies on their terms, not the hospitals.

Agencies offer more scheduling flexibility and a higher per hour wage. If the agency is paying the nurse $75 / hour they are billing the hospital 2 - 3 times the hours rate or $150 - $225 per hour. In the above example the hospital pays the FT nurse $48.17 / hour + about 40% in benefit cost + pension or $about $75 in round numbers. Clearly, paying 2 - 3 times this amount to an agency nurse is not sustainable.

Many hospital nurses will tell you that staffing shortages, higher patient acuity, 3 years of COVID and the grind of shift work have negatively impacted their ability to provide care to their patients and they go home feeling very unsatisfied about the work they do. So they quit, join an agency and work on their terms.
 
ReSTored said:
Ontario hospitals usually pay nurses a wage based on the ONA contract. Salary ranges from $34.02 to $49.02 for FT staff. PT staff make the same wage, but get a premium of 9% - 13% in lieu of benefits.


If you are a PT nurse in a hospital with 10 years experience you are making $48.17 or $54.43 / hour with the 13% premium. PT nurses often have a fair amount of flexibility in scheduling, but you still have to meet the staffing requirements of the unit in the hospital where you are going to work. Agencies offer more scheduling flexibility and a higher per hour wage. If the agency is paying the nurse $75 / hour they are billing the hospital 2 - 3 times the hours rate or $150 - $225 per hour.

If you are a FT nurse in a hospital with 10 years experience you are making $48.17 / hour. FT nurses have very limited flexibility in scheduling and often work a rotating schedule of days, evening and nights, weekdays and weekends. Some units offer compressed work weeks where you might work 2 on and 2 off etc...... over a 2 week pay period. but you still have to meet the staffing requirements of the unit in the hospital where you are going to work. These RN's have full benefits and a DB pension with HOOPP. In spite of this, burnout is resulting in these FT nurses leaving and working for Agencies on their terms, not the hospitals.

Agencies offer more scheduling flexibility and a higher per hour wage. If the agency is paying the nurse $75 / hour they are billing the hospital 2 - 3 times the hours rate or $150 - $225 per hour. In the above example the hospital pays the FT nurse $48.17 / hour + about 40% in benefit cost + pension or $about $75 in round numbers. Clearly, paying 2 - 3 times this amount to an agency nurse is not sustainable.

Many hospital nurses will tell you that staffing shortages, higher patient acuity, 3 years of COVID and the grind of shift work have negatively impacted their ability to provide care to their patients and they go home feeling very unsatisfied about the work they do. So they quit, join an agency and work on their terms.
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Is this a real number.. or a guess?
 
raginduck said:
Is this a real number.. or a guess?
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I think the agency number is closer to 3x the salary nurse number. Not 3x the contract nurse number. The nurse gets about 2x and the agency keeps 1x.

ottawacitizen.com

'It's corrosive. They're price gouging:' Agency staffing is costing hospitals, LTC homes, critics say

"It's corrosive. They're price-gouging."
ottawacitizen.com ottawacitizen.com
In a Twitter video, Dr. Michael Warner, an ICU physician at Michael Garron Hospital in Toronto, said that, prior to COVID, agencies charged hospitals $65 an hour. They now charge $110 an hour, he said.

“I think this is exploitative and predatory. There’s one company that even offers surge pricing, whereby, if the shift is booked just prior to when the shift starts, the price goes up to $140 an hour,” he said.

The nurse doesn’t keep it all. But the amount they keep is far higher than than they would get with a unionized wage, even when other factors such as vacation pay and pension are factored in, Warner said.

Last year agencies were charging twice what staff were earning. It’s more than that now, said Lisa Levin, CEO of AdvantAge Ontario, which represents over 200 municipal and not-for-profit homes.
 
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