Recently, someone asked me about the role of CCACs. Specifically, they wanted to know “why, particularly in a time of limited resources, the world needs another overblown bureaucracy.” Why couldn’t “all that money” go to “frontline” care?
It’s not a surprise, given the recent inaccuracies in the media. There’s little doubt that our sector has been misrepresented of late, and Ontarians have every right to demand answers about the quality of care they receive and the value generated for the taxpayer’s dollar.
Responding starts with busting the myths – and pushing back on the blatant misinformation being reported by those who clearly don’t understand how CCACs contribute to the healthcare system.
Here are three of the more common myths associated with what CCACs do, how we do it, and where, as well as the facts of each. As always, I welcome your comments.
Myth #1: Case Managers / Care Coordinators are “administrators,” not providers of “frontline” care
To address this myth, it’s important to understand what CCACs do.
CCACs deliver care directly to clients. This is different from planning, which is what Local Health Integration Networks (LHINs) do. CCACs employ nurses, physiotherapists, speech pathologists and other regulated health care professionals who have additional, specialized training in home, community, and long-term care. These case managers (also called “care coordinators”) provide essential health care services to clients, and play the vital role of helping them navigate the health system to get the care they need.
Could this work be done by administrative staff rather than healthcare professionals? Sure – if it were administrative work. But to serve clients effectively, case managers require a strong understanding of diagnoses, interventions, and best-practice care. For an illustration of a case manager at work, please see my previous post called “Integration, Not Duplication: How Case Managers Add Value.”
Myth #2: CCACs are bureaucracies that siphon money away from direct client care
Another myth currently circulating is that CCACs are nothing more than administrative bureaucracies that are thriving to the detriment of frontline care.
In actual fact, CCACs have reduced overall spending on administration from 8.6% to 8.2% over the past three years. In Central West, each year our administrative spending decreases even as our client list continues to grow.
CCACs don’t direct money away from frontline care; they help people access it. Over the past two years CCACs have actually reduced wait times for our services by 21 percent for 9/10 clients, helping them get the care they need, faster. We also monitor our clients’ care to ensure we are investing only in the interventions that are making a difference. The downstream effect is better clinical outcomes, more people supported in their communities and fewer hospitalizations. Ultimately, we save the system money – and we redirect every dollar directly back into client care.
Myth #3: Care Coordination belongs in hospital hubs or primary care offices
I must admit, these suggestions boggle me. Hospitals and primary care are already the most overburdened parts of the healthcare system, and neither have structure, capacity, or, in my understanding, the desire to take on an enhanced role in care coordination, system navigation, long-term care placement, home care provision and monitoring, or the countless other functions for which CCACs are responsible.
The truth is, CCACs currently work with primary care providers on a number of fronts, including as valued members of many family health teams; we also connect unattached patients with care providers through the provincial Health Care Connect program. We alleviate our hospitals’ burden through programs that help support people at home instead; between June 2011 and July 2012 alone the CW CCAC served 520 people through our Home First programs, saving our three hospital sites approximately 11,799 days of care at a cost of approximately $6,867,018. Effectively cancelling these programs while asking hospitals or primary care facilities to take on the CCAC’s role would create tremendous – and unnecessary – upheaval in the system, and would be to the detriment of patients / clients.
CCACs bring care into people’s homes and connect them with resources in a coordinated, effective and efficient manner. Collectively, we care for hundreds of thousands of people annually, and have the infrastructure, health professionals, electronic health records and quality measures to ensure successful health outcomes for our clients. Any proposals to eliminate CCACs as the single point of access to home care, community care and long-term care and replace them with services scattered through either Ontario’s 151 hospitals or thousands of primary care practices smacks of political posturing and self-interest at a time when our system – and our clients – need neither and deserve more.