Home Care Reform

Written on November 20, 2015 – 6:00 am | by Jasmine Sweatman

Being a provincial jurisdictional issue, health care reform was not a hot button topic during the media’s election coverage. But health care issues and reform are fundamental to the current issues facing our governments, be that at the municipal, provincial or federal level.

“Home Care,” that is, support services for those living in their home, is a particular area in need of attention given our aging population. Home care appears to be delivered through three main branches of service providers: (1) Community Care Access Centres (CCACs) which is the network of agencies that arranges all government-funded services for seniors living at home, (2) private personal support service providers, and (3) informal caregivers who take it upon themselves to look after their family members or friends.

The Auditor General Bonnie Lysk’s produced a special report reviewing Ontario’s CCACs system in September of this year. This review reported CCACs deliver home care services to more than 600,000 Ontarians each year.

One area the report scrutinizes is the budget and expenditures of these CCACs. It reports that CCACs cost $2.4 billion annually (less than 5% of Ontario’s $50 billion health care budget) but about $1.5 billion goes to outside contractors, ranging from large corporations to not-for-profit agencies, which are providing the bulk of the hands-on care and about $75 million of the $1.5 billion becomes profit. In addition, the report notes that CCACs spend about $930 million on administrative activities as opposed to direct patient contact which means that approximately 39% of the overall budget goes purely towards administration costs. Moreover, CCAC executives have received bonuses and raises each year despite provincial wage freezes and the average CCAC CEO salary was $249,000 in the fiscal year ending March 31, 2014. As a stark comparison, the average personal support-worker employed by third party companies within the CCAC system earns about $14.50 per hour.

The report also scrutinized the quality of service provided by CCACs. The report found that, as there is no standard treatment guidelines for these home and community care providers, service experiences can vary dramatically between the 14 CCAC regions. High-need patients can have to wait days or even weeks for their care and because the CCAC does not provide staff on the weekends, this exacerbates the waiting times for individuals to receive care.

And what fills in the gaps for home care between CCAC services? For those who have the funds to afford it, the answer is private providers. For those who cannot afford this, the answer is likely informal caregivers.


According to the Statistics Canada 2012 Report on Caregiving, 8 million Canadians are caregivers for loved ones (i.e. family or friends) and 2 million of these informal caregivers are “sandwiched” between caring for their parents and their children. These people are unpaid caregivers who take it upon themselves to care for their loved ones. As a result of taking on this role, informal caregivers can drain of their own funds, miss time at work, and experience negative effects on their physical and mental health.


Health Quality Ontario’s annual report “Measuring Up” evaluates the health care system in Ontario and the health of people in Ontario. Based on this survey, 33% of informal caregivers (family or friends) looking after loved ones at home reported feeling distressed. In the same survey taken four years ago, only 16% of caregivers reported this. The report quotes one family caregiver as saying, “Family caregivers are the largest invisible population in the health system.” This caregiver pointed to how our health system is dismissive of the informal caregiver’s role and does not adequately support them.

It seems that at both ends of the spectrum our system is falling short on supporting home care in the right ways.

Until next time,



Private Foundation Continuity

Written on November 19, 2015 – 6:30 am | by Malcolm Burrows

The combination of “private foundation and perpetuity” is a bit like “Fred and Ginger”, always linked in the public mind. Since 2000, however, the charitable status of 1,750 Canadian private foundations has been revoked. Of that number, 1,088 private foundations deregistered on a voluntary basis at the request of trustees or directors.

To put these numbers in context, the number of new private foundations registered since 2000 is 2,983. In other words, the establishment rate is 1.7 times the revocation rate. In 2011, private foundations overtook public foundations as the second largest category of Canadian registered charities. The private foundation total is currently 5,436, while there are now 5,084 public foundations.

This data from Canada Revenue Agency helps to underscore the challenge associated with private foundations continuity. Private foundations are established with optimism and funded by some kinds of major event, such as a business sale of gift by will. Registration is the easy part. The hard work is creating a durable entity that will survive and thrive in providing public benefit.

Assuming the foundation has adequate funding, and frankly many do not, the key to the future health of a foundation is good governance. Does the foundation function as an independent entity and does it have a strong board that will renew itself, either through family or recruiting qualified volunteers? More prosaically, are there support systems in place to ensure sound administration, granting and compliance?

Establishing and funding a private foundation during life is a prudent step to addressing governance and continuity. Governance capacity can be developed and succession planned. There is often a major influx of funding at death. Preparing the capacity of the foundation in advanced is just plain prudent.

Succession plans should be articulated through by-laws, trust deeds and other written instructions. Next generation governance could involve family, trusted colleagues or professional support providers, such as a trust company. If there is a lack of clarity about succession of a private foundation, it may often makes more sense to establish a donor advised fund within a public foundation that has existing support systems and strong governance to implement the charitable purposes. Or a foundation could deregister as a separate entity but continue as a donor advised fund within a public foundation.

At the creation of private foundations, legal and tax advisors have a responsibility to ask clients about their long-term goals. While this may seem like asking about a child’s post-secondary education during sex, it is a helpful step in reminding clients that longevity, if desired, must be planned.

Tags: , , , ,