Humber River Hospital. Photo by Jason Zhang.

They Took Home Care, Now Surgeries Are on the Privatization Block

The privatization of surgeries follows the playbook we saw with home care starting in the 1990s. Cost-cutting, deterioration of service, union-busting, and more

Doug Nesbitt 

Home care is what it sounds like: care in the home. The large majority of home care work is conducted by Personal Support Workers (PSWs). PSWs deliver about three quarters of all home care. The people they help are usually referred to as “clients.” These clients are often outpatients from hospitals and long-term care homes.

Home care work is hard work. PSWs do non-medical work. Many clients need help getting out of bed or off a couch. They need help bathing, moving around, getting dressed and much more. PSWs routinely conduct heavy lifts, expose themselves to disease and face a wide range of emotional and physical responses from clients, some of which can be violent. Injuries are common.

In the 1980s, healthcare and patients’ rights advocates argued that home care was a safer and more humane form of care. Institutionalizing people in hospitals when they could easily be at home was viewed as unnecessary and even dangerous in terms of exposure to other illnesses.

Home care advocates also argued that there were major cost savings. Researchers demonstrated how home care was far cheaper per patient and could free up hospital beds.

In the early 1990s, Bob Rae’s NDP government took the ideas to heart and set about expanding home care in Ontario. Opposed to healthcare privatization, Rae’s government excluded for-profit home care companies from receiving public home care contracts.

But a public home care agency was not established as it had been in Manitoba under a 1970s NDP government.

Home care in Ontario was delivered by non-profits, such as the Victorian Order of Nurses (VON), Canadian Red Cross, and St. Elizabeth. Unionization within the workforce was quite common.

The NDP cut the number of hospital beds, a move they blamed in part on a deep economic crash and cuts to federal funding transfers by conservative Prime Minister Brian Mulroney and Liberal Jean Chretien.

In 1995, the NDP was turfed and Mike Harris and the Ontario PC Party formed the new government.

Harris expanded home care in order to reduce hospital beds. However, Harris also opened the doors to massive privatization of home care delivery. (This was also when he handed tens of millions of taxpayer money to build private, for-profit long-term care — but that is another story).

Harris would often point out that he had cut fewer hospital beds than Bob Rae’s NDP. He was correct, but the difference was very slim.

Between Rae’s election in 1990 and the defeat of the Ontario PC Party in 2003, the number of Ontario hospital beds had been slashed from 33,400 to 18,800 beds. That number has stayed low. Ontario had only 21,000 hospital beds in January 2021. Since 1990, Ontario grew from 10 million to 15 million people.

Under Harris, not only could for-profits now bid for public home care contracts, but the Harris government’s new rules required public home care contracts to be awarded to the lowest bidder.

Clients began suffering as lowest-bid contracts led to widespread cost cutting. Wages and benefits were held down, workloads increased, and care time decreased.

With most PSWs driving their own vehicles between clients’ homes, compensation for mileage was reduced or even eliminated. “Flexible hours” became a common way of denying workers full-time hours and keeping PSWs begging for hours.

Union busting became pervasive as unionized non-profits lost contracts to nonunion for-profits. New home care union drives were opposed by both non-profits and for-profits.

As working and care conditions plummeted, the lowest-bid law was finally scrapped in 2008 by Premier Dalton McGuinty’s Liberals.

But the damage had been done. A powerful for-profit lobby, Home Care Ontario, had grown and become quite close with both the ruling Liberals and opposition PCs. The Liberals had no intention of rolling back home care privatization.

Fast forward to 2023. After Doug Ford’s PC government deliberately held down wages in the healthcare sector between 2019 and 2022 and oversaw a staffing crisis, Doug Ford’s Ontario PCs are now privatizing day surgeries once performed in hospitals.

Like private home care operators filling the gaps of hospital bed closures, the private surgery clinics are another government-protected corporate welfare scheme. By allowing the expansion and public bankrolling of these clinics, for-profit healthcare companies and their lobby groups become increasingly powerful political players in Ontario.

Their goal is to maximize profits. This means holding down labour costs and undermining the quality of care. The private medical industry’s power will continue to grow until it is contested,

contained, and shut down. The only known antidote to organized money remains organized people.

This article appears in the February - March 2023 Issue.