Report on the Manitoba Home Care Program

WINNIPEG – Auditor General of Manitoba Norm Ricard today published his report on the Manitoba Home Care Program. Home care services include health care, personal care and household services to people living at home and needing support. These services allow people to remain in their homes rather than staying in hospital or moving more quickly to personal care homes, both of which would be more costly. The audit examined the management and delivery of home care services by the Winnipeg Regional Health Authority (WRHA) and Southern Health – Santé Sud.

“The delivery and scheduling of Home Care services is a logistically complex undertaking, and many things can go wrong,” said Ricard. “We found that the regions need to pay more attention to the timeliness and reliability of services, to ensuring equal access to services and to their quality assurance processes. Left unaddressed, these and other issues discussed in our report may jeopardize the well-being of home care clients.”

Based on a sample of files, the audit found that clients waited on average 31 days in Southern Health-Santé Sud and 37 days in WRHA for personal care and household services to start after requesting assistance. Nursing services began promptly, following referral to the Program. “While related standards or targets are not in place to guide regions, an average timeframe to start services of greater than 3 weeks is worthy of follow-up,” said Ricard. The audit also found that some client assessments were incomplete. “We are concerned that incomplete assessments may lead to care plans that ignore or overlook required services,” said Ricard. “Also of concern is that 50% of clients in our sample were not reassessed within 18 months of their initial assessment, even though policies in both regions require annual reassessment.”

The audit found that there was a lack of guidance to help staff members determine whether family and community resources are available to provide the needed services (rather than the Home Care Program). “Because negotiation plays a large role in determining available family resources, we are concerned that this may lead to the unequal treatment of clients in similar circumstances,” said Ricard. In addition, over a selected 3-month period, the audit found that almost 40% of the clients reviewed had to use their back-up plans at least once, which usually meant additional reliance on family and friends. Individual use of back-up plans ranged from 1 to 13 times. “But neither region tracks the frequency with which clients must call upon family and friends to make up for home care service visits cancelled by the regions,” said Ricard.

The report notes that both regions encountered difficulties implementing a province-wide staffing initiative that provides some home care workers with guaranteed hours and set schedules. The initiative has resulted in significant wage payments for guaranteed hours that could not be matched to client assignments. “We estimated that, over a 1-year period, the 2 regions could have paid over $4 million for these unmatched hours, while at the same time cancelling an estimated 16,000 client visits because staff were unavailable when needed.” said Ricard.

The audit also found that the time allotted for staff to perform home care tasks was not always reasonable, potentially causing staff to rush through certain visits. And while client complaints were recorded in the client files, only certain complaints are centrally logged, limiting the amount of service quality information available to management. In addition, supervisors in the 2 regions conducted too few file reviews and home visits to assess whether standards, policies and procedures were being consistently met.

Oversight of the Program by the Department of Health, Healthy Living and Seniors was very limited. Standards are in place, but the Department does not ensure RHAs are complying with them. “Strong management processes are needed at the regions but the Department must also exercise effective oversight,” said Ricard. The audit found that the Department collected information on service volumes, but not on service timeliness or reliability or on client outcomes.

While the Department describes the Home Care Program as “comprehensive, province-wide, [and] universal”, it has not specified what direct services the RHAs are required to offer—resulting in some services (such as housekeeping) not being available in all regions.

“We are also concerned that the Department has not forecast the likely growth in demand for home care services,” said Ricard. “Given that Manitoba’s senior population is expected to grow rapidly between 2021 and 2036, this information is needed to understand how best to deal with the challenges of sustaining the Program over the long term.”

The report includes 28 recommendations.

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For more information contact:  Norm Ricard, Auditor General– 945-3790

NT3