Feature Article April 16, 2003
LAND O' LAKES NewsWeb HomeHomecare in rural areas dealt a blow with VON closureby Jeff Green
On Wednesday April 9, the Victorian Order of Nurses in Kingston, Sharbot Lake and Northbrook stopped taking new referrals. The VON has been losing money on home visits by its nurses since signing a four-year contract with the Community Care Access Centre - Kingston (CCAC), a provincial government agency which administers homecare services in the region. The VON, a 106-year-old not-for-profit health care enterprise, has provided the bulk of the service under its contract, with privately run Paramed and All-Care also providing service. In early April, VON Kingston approached the CCAC and requested an increase over the $37 they are paid under contract for each home visit, in order to be able to maintain the service. When that request was denied by the CCAC on April 8, the VON began taking the steps which will see it pulling out of providing home nursing services in Kingston and the rural areas it serves by mid-June.There is widespread concern that services traditionally delivered by the VON to residents in the Frontenac and Addington regions from its offices in Sharbot Lake and Northbrook will be severely diminished as a result of the VON pullout. The Sharbot Lake and Northbrook offices cover a vast area, including Bedford district of South Frontenac, the whole of Central and North Frontenac and Addington Highlands. Alen Prowse, the Executive Director of the CCAC in Kingston bristled at any suggestion the CCAC should have opened up the VON contract and increased payments. What was being asked for was a significant increase from a provider that was already the highest cost one. They had a contract with us and they wanted us to voluntarily increase their payments. It would be unethical to open up a contract with one provider while holding the other two providers we contract with to the terms of their contract. The VON should have thought about the consequences when they bid for the contract in the first place, he told the News. Prowse also said the other companies are taking up the new cases that come forward. He admitted, however, that they are not compelled to take on the clientele in the Sharbot Lake and Northbrook catchment areas. I might have to contract with another provider, he said, although he cautioned that we are not there yet. I am assuming that ALL-Care and Paramed will take the work, until I learn differently. Whatever happens, we will ensure that the service is provided. Dawn Peterkin RN, the senior VON staff at the Northbrook office doesnt think the other providers will be particularly tempted by some of the realities of rural care that she deals with. I recently had one patient that needed dialysis each day, which involved an evening visit, and a follow up the next morning. It involved a 45-minute drive each way, and a visit of over an hour in the evening, and a shorter one in the morning. At my wage, and with a mileage rate of 25 cents per kilometer, the visits were costing the VON $100, and they were only receiving $37 from the CCAC. While Peterkin understands that the private companies pay about $5 an hour less than the VON, and pay only 20 cents per kilometer for mileage, those visits will still be money losers for them. Why would a profit making company take on a money losing referral? A worker at the Community Care Access Centre Office in Northbrook shares some of Peterkins concerns. As of now almost all the referrals to the Northbrook and Sharbot Lake areas choose to be served by the VON, but in the few cases that have chosen differently, the Northbrook office has received calls from nurses in Kingston who were preparing to start out for the north with questions about road conditions and weather. This is not something that has ever happened with VON nurses, who already live in the area and know the roads to begin with, the worker said. Cathy Fox, the senior staff member of the Sharbot Lake office, says she could not, morally, work for a for-profit health care institution, and will be looking for a job in a hospital if there is no intervention by the Ministry of Health and Long Term Care before the rural VON offices are closed. Ross Sutherland, chair of the Kingston Health Coalition, wrote a letter to Health Minister Tony Clement on behalf of the VON. In it he said currently Kingston agencies receive less money per visit than many communities throughout the province. This is an inequity that needs to be addressed.
The average Ontario VON branch receives $42-$44 per visit, while the Kingston VON only receives $37. Sutherland said that over half of the VONs throughout the province have gone out the home nursing business, so the Kingston case is by no means unique. A hospital nurse himself, Sutherland said he didnt see why, even with the VON, homecare nurses make $8 an hour less than hospital nurses. In the rural areas, the nurses are out there working with no backup, doing palliative care, and diagnostic work. And they never know when they go into a house what they are going to be faced with. Hospital nursing has its challenges, but hospitals are a controlled environment. Nurses doing home visits should be paid the same as nurses in hospital. MPPs Leona Dombrowsky of Kingston, Frontenac, Lennox & Addington, and John Gerretson of Kingston and the Islands, both Liberals, have called for Minister Clement to intervene and providing funding so the VON can continue serving Kingston and the region with nursing services. Cathy Fox describes her role as a VON nurse as that of a community resource. I am from the community I serve, and with the VON I can spend the time with each patient to help them through some difficult times. We are paid by the hour, so if it turns out that I need to spend an hour and a half with a patient because thats how long it takes to provide care, I am paid for that time. With the other providers, the nurses are paid a flat rate per visit. After 45 minutes, they are no longer paid. I could never work like that. Cathy Fox and Donna Peterkin are the only full-time Registered Nurses working in the Northbrook and Sharbot Lake regions, and both have said they will not work for a private nursing company. When told of this, Larry Prouse of the Kingston CCAC said People say a lot of things when they are speaking from their hearts, but it remains to be seen if there will be nurses who are unwilling to work for private companies.
In their press release announcing their decision, the VON said they are hoping to restructure and will be bidding on the nursing contract when the new contract is being negotiated after 2004. This may be cold comfort for those patients in this region who have always seen the VON as a part of the community, and will be left holding their breath and hoping that All-Care, Paramed or some other heretofore unknown outfit will be able to send qualified nurses to their homes.
