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Investigating cutbacks in Ontario's home care system Date: 06/27/16

By Kelly Grant

The Globe and Mail's award-winning home care investigation began after I read local newspaper stories about home-care clients in two different Ontario cities having their care cut off or reduced because of funding shortages. My hunch was that if it was happening in two places, chances were it was happening across the province.

At the time, I was the paper's health news reporter. I wanted to dig deeper into the potential problems with home care, but my time was limited. It was already the spring of 2015 and I was due to have my third baby at the end of July. 

Fortunately, The Globe's editors liked my pitch and paired me up with senior reporter Elizabeth Church, a veteran scoop machine with whom I had covered Toronto City Hall during the Rob Ford era. We began to dig. 

My hunch led to a three-month pursuit involving dozens of interviews – some with elderly clients who were afraid to talk to the media, and indeed had been warned not to – and the difficult and often Byzantine task of getting documents from the government's 14 regional home-care agencies. 

Our first step was a round of off-the-record interviews that helped us direct our reporting. Next, we set out to get our hands on the agendas, minutes and reports of the supposedly public boards of each of the region's home-care agencies, known as Community Care Access Centres (CCAC.) 

Some of the boards posted useful materials online; most did not. Others claimed key documents were simply not public. We needled the communications folks at each CCAC until they pulled the material together and turned it over to us. We also developed sources who leaked us some key internal memos, including one that provided a three-step process for how CCAC staff were supposed to keep upset clients from calling the media about losing their service.

The documents we did get were so laden with bureaucratese that it took weeks of reading and interviewing to make any sense of them. (One of my favourites was a memo we obtained from a man who had fought the CCAC's efforts to reduce the number of baths his mother received per week. It was titled: "Community Independence Clients Efficiency Strategy: Focus on PSW for Maple 1 and 2 clients," which, loosely translated, was about kicking lower-needs seniors off the agency's roster.) 

One of the major challenges of the investigation was finding clients who were willing to publicly share their home-care experience. Many feared speaking out would make them a target for retaliation. 

We found our subjects in three main ways: 

  • First, we published a few early stories on troubles with home care in Ontario (including an A1 investigation of how the provincial government's efforts to give in-home personal support workers a raise had gone awry) in which we asked readers who had encountered problems with publicly funded home care to contact us. We put our email addresses at the end of the stories. 

  • Next, we approached a health-care advocacy organization that had conducted consultations across the province to put us in touch with clients they had heard from.

  • Finally, we approached opposition MPPs and local councillors to see if they would pass on the names of constituents who had asked for their help dealing with the CCACs. That's how we found the Oshawa mother and son in our lede.

One of the trickiest parts of writing this series was zooming out to make sure the big picture wasn't lost in the local and individual details. Canada's health-care system is relying on home care more and more each year as a cheaper alternative to expensive nursing homes and hospitals. Politicians across Canada – not just in Ontario – often talk about home care as though it were some sort of panacea for a cash-strapped public health-care system. Our investigation found that was most definitely not the case. 

Kelly Grant (@kellygrant1) is a health news reporter for The Globe and Mail in Ontario.