While there was little policy debate during the recent Provincial Conservative leadership campaign, what little there was left health-care advocates concerned we’re going to see more privatization of health and other public services in the coming years.
Jim Prentice told the Edmonton Journal in August that he would overhaul the Alberta Supportive Living Initiative (ASLI), which, according to the Alberta Health Services (AHS) website, pays for construction of about 800 new continuing-care units each year.
“We need to proceed at almost twice that speed, just to keep pace,” our newly minted Premier-designate said. “We would partner not only with the private sector, but we would also partner with faith communities.”
His comments have Friends of Medicare executive director Sandra Azocar worried.
“Any time the government takes steps to further privatize the system or further download delivery of services to the non-profit sector, we’re concerned,” she says. “The PC government knows they would face a huge public backlash if they did a wholesale privatization of health care, so they are doing it by stealth, in pieces.”
Azocar says that whether service delivery is carried out by a private corporation or a non-profit, it serves the government’s purpose in two ways: it obscures financial transparency and removes accountability when something goes wrong.
She points to the consolidation of homecare delivery last year, where AHS forced the consolidation of 74 service delivery agencies into 18.
“They forced these agencies—whether for profit or not—to compete with each other for these contracts,” argues Azocar. “And the agencies that survived created a new class of workers: under-paid, under-valued and under-trained.”
Azocar complains that the changes left homecare recipients with less one-on-one time with their caregivers, the caregivers forced to cover the travel time and mileage to go between clients and private, for-profit companies gaining great control over the “market.”
Research published last week by the Centre for Research on Work and Society at York University in Toronto indicates Azocar’s concerns have merit. The paper, “Not Profiting From Precarity: The Work Of The Nonprofit Service Delivery And The Creation Of Precariousness” found that the dominance of precarious workers in the non-profit sector had negative impacts that went beyond the workers themselves. And while more than half of employees in the nonprofit service sector (NPSS) were classified as something other than full-time, even those with full-time employment in the sector were subject to high levels of job insecurity because of their reliance on short-term and unstable contract funding.
“By observing the workings of precarity in this sector, precarity is revealed to be far more than an employment-based phenomenon but also a force that negatively impacts organizational structures as well as vulnerable communities,” the authors wrote. “As a contract dependent sector, the very nonprofit organizations themselves exist under a continuous threat of defunding, placing their on-going operation on a kind of temporariness footing.”
Marie Renaud, executive director of the Lo-Se-Ca Foundation, a non-profit organization that provides residential and day supports to adults with developmental disabilities, concurs.
“Because of the nature of the funding, many smaller non-profit organizations are unable to offer any long-term assurance to their workers about how long they might be employed,” she says. “We hire on a permanent basis on the assumption that the financing will continue but there’s really no guarantees.”
Renaud points out that non-profits have to compete for potential employees with Alberta Health Services which pays its workers far more than it funds non-profits to pay theirs.
This didn’t come about by accident. The York research study recounts how the downloading of service provision to non-profits was accompanied by profound changes to the way governments funded those organizations. This started in the 1980s as governments across Canada adopted neoliberal approaches to government and public administration. The Keynesian approach which they abandoned, and which had been followed by most governments in the decades following the Second World War, took a different approach in that it saw a direct role for government to provide public services.
It was not seen as anathema that public-sector workers made good wages because they would spend their money in their communities and promote further economic growth.
“Not only was there a movement away from direct state provision of services to alternative and discounted third-sector service delivery,” the study notes, “but the funding structure that supported nonprofit providers shifted from core/base to project-based contract financing.”
The authors describe a “flexible just-in-time” system of provision of stripped-down public services. The problem is that while a just-in-time production strategy might work well for manufacturing cars or consumer electronics, it’s not optimum for delivering services to vulnerable people who are relying on those services for their very well-being.
Azocar says not knowing if their job is going to be there from one week to the next isn’t just a problem for homecare workers, it’s a very real problem for their clients.
“You would hope this government would want the most vulnerable people in our society to be cared for by people who are happy in their job,” she says.
In an open letter to Prentice, the Friends of Medicare called on the government to reverse its privatization of the system in all areas. The letter, which can be found on the group’s website, paid particular attention to elder care in long-term care facilities and home care provision.
The York researchers found that one of the biggest labour force retention challenges facing the NPSS are the noncompetitive wages they offer and lack of career mobility paths in the sector. This presents particular problems in a bust-and-boom economy like ours.
Renaud recalls that during the last economic boom, her staff turnover rate was seventy-three percent.
“You can’t blame anyone for moving on to something that will help them to better provide for themselves and their families,” she says. “But it’s really hard on the clients.”
The researchers point to other problems. While governments (and our new Premier) like to use the term “partnership” to describe the relationship between them and non-profit service providers, it is a partnership in name only. The government dictates the terms and delivers the funding along “with top down reporting mechanisms that are tightly linked to narrow market-based efficiency measures.”
Azocar says the result is that there is no direct accountability.
“The delivery of these services is the government’s responsibility,” she contends, “yet they have divested themselves of both financial transparency and accountability because when something goes wrong, they just blame the company or agency. If taxpayers want to know how the money is being spent, to ensure that it’s going to provide the best patient care, too bad—it’s private information.”
On Tuesday, Statistics Canada released an article based on the 2012 General Social Survey. In “Canadians with unmet homecare needs” the agency reports that 792 000 of the 2 692 000 Canadians receiving homecare services for a long-term illness, aging or disability condition reported that their needs were only partly met or not met at all.
Home care is an important tool to keep people out of institutional care which is better for the person and saves the government money. Azocar says there’s much that could be done to improve the situation for these care recipients and that should start with reversing the trend towards privatization. Albertans will have to wait and see. Azocar’s advice?
“I wouldn’t hold my breath.”