The Home Care Consolidation Debacle: Fred Horne’s Mission Impossible

Like Tom Cruise in Ghost Protocol, Health Minister Horne is tearing through the building trying to stay ahead of the explosives he’s set to detonate.  The big question is will he make it out in time.

So far Fred has successfully blown up the AHS board, slashed the number of RNs by 200 and jeopardized contract negotiations with the United Nurses of Alberta—all the while amassing a $100 million surplus at AHS.

But his decision to “consolidate” Alberta’s home care agencies from 72 to 13 (with the majority of these being large Ontario based for-profit corporations) has infuriated seniors, unions, public advocacy groups, home care residents, their families and care givers—and they’re fighting back.

Why consolidate?  

Home care is care given to the sick, the frail, the elderly and the disabled living at home, in lodges or supportive living facilities.  It includes help with dressing, bathing, meals and medication.  It is an intimate relationship that evolves over time between caregivers and their clients.  It’s not just a business.

So why is the government switching from the traditional non-profit home care model to for-profit corporate providers?  Premier Redford says the switch will “…reduce administration costs so we can continue to put resources into the system.”*   

I beg your pardon???  Transferring $371 million in taxpayer dollars to large Ontario-based corporations will save the province a mere $18 million in administration costs.

May I remind the Premier that her own Health Minister pooh-poohed the suggestion that the $100 million AHS surplus was worth getting excited about—it’s equal to three days of operating costs–that makes $18 million equal to a half a day of op costs, right?

Maybe it’s not about the $18 million…

Stephen Lockwood

At the June 6, AHS Board meeting, Stephen Lockwood, AHS Chair, said: “we will find more than $200 million in cost-savings this year…I’m not suggesting that this will be easy or that in some areas it will not have an impact on patient care.  We will closely monitor and make changes as needed…they are a necessary part of putting more resources into continuing care and other community care including home care, more dollars into new capacity while eliminating unnecessary costs…we will reduce overhead administration costs by at least $25 million over the next three years.”

With that the AHS Board approved two home care service contracts—one with CBI Home Health for $235,707,695 and the other with Bayshore Healthcare for $136,105,945—to provide home care services for Calgary and Edmonton for the next five years.

Just so we’re clear, I’m all for cost reduction, and I’m not assuming that the entire $200 million in cost savings this year and the additional $25 million reduction in administration costs will come from the consolidation of home care;  what I don’t understand is how the AHS will achieve any cost savings by entrusting home care to private companies whose raison d’etre is to increase profits?

Where are savings and who gets the benefit       

Calgary Family Services, a non-profit that’s provided home care for 68 years, lost its $8 million contract to Bayshore and Revera Home Health, even though it bid the AHS set price.  That means that Bayshore and Revera came in with low-ball bids.  Calgary Family Services CEO Sue Mallon says:  “Having managed this program for a long time, I know there isn’t a lot of money in it.  A reduction has to come out of somebody”* 

Care to guess who that “somebody” might be?  Let’s ask the City of Leduc.

Leduc has provided home care for 34 years.  It lost the AHS contract to We Care, Canada’s largest privately owned home care company.  Leduc’s 37 caregivers got the boot.  We Care said it would take some of them back if they took a 40% pay cut, lost their benefits and traveled from Leduc to Edmonton to pick up their cheques and medical supplies.**Oh, and We Care does not pay mileage.  Just think what they would have offered if We Didn’t Care! 

The only way a service company can maintain or increase profits is to decrease its costs.  This is achieved by paying sub-standard wages to employees who are directed to provide fewer services;  for example reducing the number of baths or the time spent in a home visit.  Sorry no time to chat, this is a business relationship. 

The Hue and Cry

Now this is where it gets interesting.  In a classic David and Goliath showdown home care residents, their families, caregivers, seniors and healthcare advocates of all stripes are fighting the consolidation through press conferences, demonstrations, letters to the editor and letters to their MLAs.  The opposition parties, particularly the NDP, rallied to the cause…and poor Minister Horne is becoming “increasingly frustrated.***

Janet Davidson

He threw Janet Davidson, the AHS Official Administrator, into the breach.  Ms Davidson (whose job title should be “The Fixer”) set up an independent appeal panel comprised of lord knows who, which reversed some of the contracts granted to the for-profits.  From a legal perspective this sounds like a breach of contract and a breach of tender law, but hey, it’s Fred. 

By a strange coincidence all the contract reversals are in Edmonton which picked up 2 new NDP MLAs in the last election.

Mission Impossible?

Dumping Alberta’s elderly, sick, frail and disabled into the arms of for-profit corporations in order to save $18 to 200 (?) million is a heartless short term trade-off which guarantees higher costs in the long run because residents who receive sub-standard home care will quickly move into more expensive auxiliary and long term care facilities.

Public outcry has forced Mr Horne to partially reverse this ill-conceived initiative.  In order to ensure Mr Horne’s consolidation mission becomes mission impossible, please attend the Public Interest Alberta rally to be held on Sunday September 8th at 1:00 on the steps of the Legislature (assuming it’s still standing) and other locations around Alberta.  Check out the PIA website for more information.

Tom Cruise can escape an exploding building because Ghost Protocol is a movie.  But in real life no one can outrun public fury, not even Fred Horne.

Cue the Mission Impossible theme song…da, da, da-da…

Many thanks to Carol Wodak for her assistance in providing background information for this blog.

* Calgary Herald Online, June 8, 2013 

**, July 11, 2013

***Edmonton Journal July 9, 2013 

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29 Responses to The Home Care Consolidation Debacle: Fred Horne’s Mission Impossible

  1. Baldwin Reichwein says:

    So it is told that Phaedrus was confronted with the horns of a dilemma, i.e. two premises, not unlike the front end of an angry, charging bull customarily in possession of ‘two’ horns. Fortunately, in Alberta’s home care debacle there is only ‘one’ Horne and his actions defy logic. Over to Phaedrus (or better Redford) for a solution!

    • Baldwin, thank you for the learned comment (I have to admit I googled Phaedrus!) Thank goodness there is only “one” Horne. I don’t think our healthcare system could survive under two. Unfortunately I’m convinced that Redford is very aware of what Horne is doing and supports it as necessary under her austerity budget. I’m still waiting to hear her explain why she’s pushing the government deeper into debt now that the differential between Alberta oil prices and the WTI etc has narrowed. This makes the “bitumen bubble” excuse utterly meaningless.

  2. Jill Browne says:

    I keep trying and failing to see and grasp some consistency of guiding principles in the government’s actions. Thanks for this information, Susan.

    • Jill, you’ve put your finger on the problem. The government does not have a guiding principle or larger strategy. A medical friend tells me that there is still a lot of waste in the hospitals, but it’s overlooked because departments do their budgeting in silos. This fellow had a minor surgery which required a brief stay in hospital. He was told he’d be treated with medicine X. He knew medicine X was harder on the body than medicine Y and asked for medicine Y instead. He was told that he was getting X because it was $2 cheaper than Y. When he pointed out that X would force him to stay in hospital for 2 extra days at $1000/day he was told that the extra days were in someone else’s budget so it wasn’t an issue (at least not for this department). Bizarre.

  3. danikloo says:

    So, to follow commenter Baldwin’s analogy, let’s take the Horne by the “Bull” and get this guy out of there (of course, we do all know he’s not acting independently, right??)

    • Great idea. We’ll start with Horne and take the others out as well. In all seriousness, this home care mess has the potential to blow up big time. Public outcry has forced Horne to reverse some of the contracts. By rights, he should reverse them all, however if he does that would be tantamount to admitting that public pressure and demonstrations on the steps of the Legislature have an impact. I think the PCs will do everything they can to make it look like the reversals were “their” idea and not a response to public outcry. But we know better, don’t we!

  4. mare donly says:

    Excellent article, Susan. Thank you for keeping us informed!

    I had a moment of optimism (but still vigilant 🙂 when I’d gotten an email about some of the contracts being rescinded, but the information was very vague. I didn’t realize it was only Edmonton. Just sick about Calgary Family Services, for one … so wrong.

    Thanks again, Mare “If you’re going to be passionate about something, be passionate about learning. If you’re going to fight something, fight for those in need. If you’re going to question something, question authority. If you’re going to lose something, lose your inhibitions. If you’re going to gain something, gain respect and confidence. And if you’re going to hate something, hate the false idea that you are not capable of your dreams.”

    -Daniel Golston

    • I have a friend who works with an agency that provides home care here in Calgary. It’s clear the government gave no thought to the impact of its hurried decision on the caregivers or their clients. Her agency worked very hard under extremely difficult circumstances to ensure that throughout the transition their clients were well cared for. She and her team deserve great praise for working through this situation with professionalism and dignity. I question whether the for-profit home care provider that grinds down its staff by offering a 40% wage cut and no benefits (which equates to another 15% to 20% in compensation) would demonstrate such courtesy.

  5. I am trying to stay away from media, political and ahs releases, making me ill. I am a poor old senior in my 80’s and I feel so helpless by what is transpiring. Anyway thanks Susan for throwing some light on the goings on.

    • Tom, the one ray of hope in this tawdry situation is that Horne actually reversed some of the contracts. That tells me that the public outcry had an impact. Groups like PIA and Whitemud Citizens for Public Health organized protests and letter writing campaigns which I believe raised public awareness and showed the government that the people were NOT going to take this lying down. Even simple things like commenting on this blog, attract the attention of the powers that be. Thank you Tom for staying connected to the issues. I appreciate it.

  6. Carol Wodak says:

    In my current state of not-able-to-do-muchness, I’ve been rereading series of books from our collection of mystery novels. I’m currently almost through Edith Pargeter/Ellis Peters tales of politics, intrigue, war and mayhem in 12th century Britain, and most days I think that may well have been the Klein/Stelmach/Redford model for public policy. Certainly the strategy and tactics of the succession of health ministers and AHS mandarins resemble the English strategy and tactics against the Welsh…seems that may well have been where Fred Horne learned dispute resolution.
    Thanks, Susan, for the reference to the Leduc situation. An interesting side note there is that in addition to providing home care services, the FCSS home care staff were “available to arrange medical and support services and to coordinate care in the home”, and FCSS was also the local authorizer for AADL special equipment and supplies [ ].
    Also, from , Home Care Case Manager-Physician Realignment :
    “The Leduc Beaumont Devon Primary Care Network has partnered with Alberta Health Services, Edmonton and area, to realign Home Care Case Managers with specific PCN Physicians.
    In the past, Home Care Case Managers were aligned with a specific geographical region where all of their patients lived. This resulted in Home Care Case Managers having to work with a number of different physicians whose patients lived in this designated area. Under the current PCN-Home Care partnership, Home Care Case Managers are now realigned to provide services only to patients under the care of specific PCN physicians. This results in physicians having to work with only 1 or 2 Home Care Case Managers for all of their patients. Regular meetings between PCN physicians who have a large number of their patients on Home Care are encouraged to improve communication and foster a team approach to managing patients with complex medical needs.”
    Can’t see We Care staff at any level having the inclination, time or skills to do any of these things, which were the closest we’ve been to an integrated and comprehensive community care system.

    • Carol, thanks for this information. Looks like the decision to jettison the Leduc home care team will have an even broader impact. I wasn’t aware of FCSS’s role with the PCN physicians. I checked out the We Care website and saw nothing comparable, but they do provide “remote health monitoring” starting at $199.00/month (this does not include “activation fees”). This service remotely connects seniors to an RN who monitors their vital signs and “encourages medication compliance”. It’s available, get this, only in Ontario and only during regular business hours. So residents had better not plan on having a medical incident on the weekend.

      Your comment about the Edith Pargeter series having the same level of political intrigue as the Klein/Stelmach/Redford troika reminded me of something I read about President Woodrow Wilson. He pushed through what was considered the most progressive political agenda the US had ever seen at a time when the nation’s richest 1% owned half of its wealth.

      Like you said Carol, some things never change and the battle continues.

  7. Thank You!! Michael Moore “Sicko” was the preview to what comes next! The PCN is Albertan for HMO in the United States. Welcome to the 51st State * aka ALBERTA!!

    • Exactly! The PCs are steadily shifting our publicly funded and publicly provided healthcare to the private sector which gets the best of both worlds–guaranteed payment from the government and control over how the service is provided. This last point troubles me greatly. Fred Horne listed two reasons for shifting home care to the private sector. One was to save $18 million, the other was to standardize the delivery of home care across the province. His “standardization” rationale is shocking given that his government has enacted legislation, regulations, standards and guidelines setting out the minimum levels of care and employs inspectors who fan out across the province to ensure that the standards are being complied with. Is Mr Horne admitting that his department has failed to carry out its legally mandated obligation to protect home care clients and why does he think an Ontario-based private company will do it any better?

  8. Elaine Fleming says:

    Yes, I agree with Bruce that our health care is trending more to the U.S. “system” than most people realize. Something here, a little more there …. more players, and health care becoming more and more a marketplace. I have been watching the movement of PCN’s (Primary Care Networks) that are funded with taxpayers’ dollars by the way, setting up private “concierge” clinics within them. Some have other little businesses selling their own brand of vitamins, massage therapy and what have you. I can see the potential for these to be handed to HMO’s (Health Management Organizations) who will also bring in private health insurance “options” so people can buy the extras- which in many instances will be necessities, like long term care.

    Look at the example of the Medicentres having been purchased by Darryl Katz. You see them now placed at the back of the Rexall drug stores, so patients have to walk throught the merchandise to get to the doctor, and there of course, is a pharmacy right there when you leave to fill your prescription. Now what would stop a businessman from buying PCN’s? Like for-profit long term care and home care providers, there is a steady stream of taxpayers’ money coming in with government contracts, not to mention a slew of aging baby boomers coming down the pipe.
    The doctors might want to watch these developments a little more closely. They are worried about losing their autonomy working in Family Care Clinics, but I don’t think they would like working for corporations, HMO’s or insurance companies much either.

    And as a patient/taxpayer, where does that leave me? Having to pay twice or three times for health care: taxes, extra charges and insurance. No thanks.

    • Elaine very good point re: Family Care Clinics. Both Premier Redford and Health Minister Horne are on record as saying that FCCs can be owned by doctors or “the community”. They don’t tell you what a “community” is but I haven’t heard a logical explanation for why an FCC should be owned by a town or city and it’s pretty obvious that a community association wouldn’t have the capital to finance an FCC (they cost about about $5 million) so I assume “community” is simply code for a Katz-like corporation. As you point out, these PCNs and FCCs are financed by the taxpayers. I’m okay with this if they are operated by doctors who don’t use them to push “concierge” services and products, but if taxpayers’ money is going to a Katz-corp then this is just another example of the government providing corporate welfare to its friends.

      All of this nonsense would be avoided if the government simply delivered on its promise to publicly fund and publicly deliver healthcare, or at the very least was more transparent about where the taxpayers money was going. Then citizens could decide whether they’ll continue to support the government/corporate healthcare provider model. Why is this so difficult?

  9. Baldwin Reichwein says:

    People around the world admire how Calgary’s Mayor Nenshi and municipal employees responded to the flood disaster and “hell or high water” could not stop Calgarians in staging a great Stampede. Hurrah! Yet, around the same time Calgary Family Services lost its home care program, which is going to an out-of-province for -profit corporation. The first example typifies what subsidiarity and proportionality (worthy principles of democracy) can do, while the second example shows how local involvement is allowed to erode.

    Do we want municipalities to be handmaidens of the provincial government anymore than is good for them? Privatization of home care diminishes the autonomy and scope of municipal governance. To cite examples in historical context. Calgary Family Services provided home care ever since the early 1950s. Lethbridge Family Services evolved from the Nursing Mission that opened its door in 1910 to provide socio-medical home care on a non-profit basis. Family and Community Support Services (FCSS) and predecessor organization (PSS) under unique provincial legislation encouraged ever since 1966 program development at the local level. FCSS is a precedent-setting balance of local initiatives under federal/provincial/municipal cost sharing arrangements. It is a genuine Alberta advantage that should not be lost.

    Whenever the existence of FCSS was threatened by provincial politicians, municipal councils and their municipal organizations fought back, resisted provincial intrusion and won. FCSS has a commendable record of achievement. Read Leslie Bella (1978) on The History of PSS. Erosion of he foundation of FCSS should concern all of us. If home care goes for profit, so can other community services, i.e. day care, services for families, children and seniors etc. Campaigning for municipal elections has begun. Privatization of home care is a blow to local autonomy and it should be an election issue for municipal candidates. We need more “hell or high water” t-shirts to save home care and local decision making. Ironically, local authorities in European member states gained instead of lost prominence and value in delivering services. Let’s keep the dialogue going!

    • “Do we want municipalities to be handmaidens of the provincial government…?” Very insightful and timely question Baldwin, especially given the province’s propensity for double talk. The government is advocating for more community based healthcare, and yet it sees nothing wrong with awarding massive contracts to Ontario-based mega-corporations in the interests of reducing costs. The irony is that there’s no evidence (or they haven’t provided any) to indicate that costs will go down in the long term. If we don’t speak up long and loud about this sort of hypocrisy other community services will start to fall like dominoes. Thanks for the reference to Dr Leslie Bella and thanks for all your hard work with PIA and other advocacy groups to hold the PCs accountable!

  10. Roy Wright says:

    Penny wise…pound foolish. That seems to capture the financial strategies of our provincial government. You accurately point out the savings of $18 million is barely a drop in the bucket. We often hear of stories when one department or group saves some money, but another department has to pick up the slack caused by the downloading, often resulting in even higher costs than what was originally saved. The $471 million contracts that are going to non Alberta companies may result in savings from one part of the pie, but may cost Albertans far more than the initial savings indicate. I would presume these “for profit” companies will lift their profit margins right out of Alberta, which means we won’t see corporate tax benefits, won’t see the benefit of those monies being spent in Alberta towns. A modest 10% return on capital ($47million) equates to almost three times the supposed savings. The notion of “shop local” is the mantra of many sustainable communities, in large part because the benefits remain in the area. So by attempting to save $18 million, the government has endangered our seniors, reduced the standard of living of staff who used to work at these places, destroyed community based non-profits and lost the multiplier effect of retaining more money in the province. Guess we have moved from the bitumum bubble style of fiscal management to the bozo bubble style…brilliant move!

  11. Roy, I love the “bozo bubble” comment! How appropriate for this government. It’s focus is the election cycle and not on developing a strategy that’s good for the province in the long term. A disgruntled ex-PCer told me that Ms Redford is following the time honored Klein/Stelmach formula–clobber the people in the first 18 months, ease up for the next 18, and throw around a little money and make outrageous promises for the last 12 and presto, you’re re-elected (again). It worked like a charm in the past, but not this time. We’re going to fight this one to our dying breath, and then we’ll fight the next one and the one after that. I’m so glad you’re along for the ride Mr Soapbox!

  12. Carol Wodak says:

    SEE AHS Awarding AHS home care contracts July 24, 2013 available on July 24, 2013
    Note the missing attachment and RFP terms. Note yet another reason for the “transition”: apparently being like Calgary is a worthy goal, no matter the cost. In fact, there’s been no evidence to show that works in Calgary is the best way for Edmonton. (and anyway, that doesn’t account for the changes we’ve seen in Calgary, at the Calgary Family Services and the Wing Kei Care Centre and the Wheatland Lodge in Strathmore… and possibly others we don’t know about yet. Which reminds me, they still haven’t told what HAS happened.
    In my opinion, this is NOT just a communication problem.
    Ms. Davidson’s E-mail: official.administrator@albertahealthservices
    Fred Horne’s Email:
    Alison Redford Email:

    • Carol, as you astutely point out this “explanation” about the decision to go with for-profit home care providers explains nothing. The fact that the link fails to include the RFP, which can’t possibly be confidential, is damning. If Redford and Horne really believed in transparency they would have disclosed the RFP and the winning contracts. All they had to do was “redact” or black out the contract price. I really want to know whether the government included a contractual obligation requiring the for-profit home care provider to comply with the standards of care set out in the regulations, and more importantly, a provision stating that AHS inspectors were free to pop in anytime unannounced to ensure that the standards were being complied with.

      I see that Janet Davidson said the government has “learned some lessons” from this mess. Well so has the public. It’s learned to speak up loud and often when the government does something awful. The public had a small victory here. If we keep up the pressure we can turn this into a big victory in the future.

  13. goinfawr says:

    “…what I don’t understand is how the AHS will achieve any cost savings by entrusting home care to private companies whose raison d’etre is to increase profits?”

    Oh, but rest assured that ‘business’ understands it. Which is why privatization of lucrative public works for pennies on the dollar is always always always the answer to every manufactured crisis.

    It’s carpet bagging 101: First, unecessarily indebt the mark. Thus enslaved, lobby your pocketed politicians to create a funding emergency (or promote the perception of one) and employ your privately owned media cheerleaders to lure the hoi poloi on board with a (real or imagined) one time budget surplus, short term deficit reduction, and/or immediate marginal cost rollback. Once the monopoly/essential service/revenue generating infrastructure is securely in private hands (and effectively opaque to the public eye) begin the process of surreptitiously raising prices to satisfy shareholders’ insatiable profit growth requirements.

    And voila! In no time the public is unwittingly paying more for less services and vastly reduced accountability.

    Next up: carpet bagging 220- Selling your gutted essential service back to the public for dollars on the penny.

    • Well said Goinfawr. Especially the last bit which kicks in when no amount of cutting corners will produce sufficient profits to satisfy the shareholders. Then the service is rolled back into government hands in worse shape than ever.

  14. Carlos Beca says:

    I could not say it better than Goinfawr and yes that last bit is the one many people do not realize because they return the destroyed services as if it is our fault that the government did not deregulate enough to allow them to make whatever profits they think they deserve.
    I have said enough about this issue in previous posts. This government is simply incompetent. Fortunately they took Lukaszuk out of the limelight and next is Fred Horne that just discovered that it was a bad idea to privatize Home Care. Too late now he says, with a victorious smile.
    In the meantime Alison Redford is totally disgusted with Allen’s prostitute hunting in the US. That is her biggest disgust in her petty life. I have a message for her – I am extremelly disgusted with her political prostitution with the elites and the oil companies. She is fully representing this people for whatever benefit, either in some bank account or only for political ambition but either way that is the principle of mental prostitution. She can obviously get disgusted with other’s sexual atitudes but does not seem to be inteligent enough to understand her own similar ones.

    • Right, even the Republicans (if you can believe it) recognize the need to be more than the “fend for yourself” party. But like the Alberta PCs I doubt they’ll be able to get there. Lip service is not enough. Thanks for the input Carlos.

  15. Carol Wodak says:

    We still don’t know who had contracts and now doesn’t or now does. ParaMed, for instance, has not been identified as an approved contractor – except that ParaMed is a division of Extendicare (Canada) Inc. and may well continue to provide on-site care in its Red Deer and Lethbridge supportive living facilities, and build/convert other facilities to this model. Public care providers have long been denied capital funding for supportive living facilities; recently, the Minister has made clear that there will be no more public funding for any LTC facilities, preferring the all-things-to-all-folks model.

    Ms. Davidson’s “review” decision does not identify the Review Panel or its report, the RFP requirements or “quality standards”, the Community Provider award criteria, or the contract provisions for a “congregate living provider” – proving yet again the glaring misnomer of “accountability and transparency”. To say nothing of public consultation about public policy…

    What it does do, perhaps inadvertently, is establish the basis for funding for providers for services with “unique population needs”. That’s as neat a synonym for the Victorian “deserving poor” who may be entitled to charity as I’ve seen. These approvals went to 3 agencies providing services in communities which clearly are not a profitable market.
    o Sisters of Providence Father Lacombe Care Centre is a 110-bed continuing care facility founded by the Sisters of Providence in 1910… many of the Sisters volunteer their time for everything from palliative care to feeding and otherwise caring for the residents…
    o Placid Foundation operated by the Missionary Oblates of Mary Immaculate, Foyer Lacombe is a bilingual (French and English) 41-bed supportive living centre for Oblate priests and brothers who are retired and/or need supportive care…
    o Operation Friendship provides services for Edmonton inner city homeless seniors who have mental illness, addiction issues and minimal family support…

    The earlier exception for West Country Hearth facility in Sturgeon County seems to be a belated acknowledgement that rural Alberta is a different environment than Edmonton or Calgary…

    Judging by the results, the purpose of this initiative is to further limit the provision of publicly provided home care services – it’s really just another step in the 2008 Continuing Care Strategy. Of course, in the context indicated in point 9, it’s also a step toward creating market opportunities for enhanced core health services.

    • Carol, your comments remind me of something I’d recently read about Dickensian Economics: Dickensian Economics extends far beyond the idea of avarice and meanness towards a fellow human being. It is today’s reality; the reality of predatory capitalism whose aim is to have the poor pay for the needs of the poor.” We’re seeing it unfold here in Alberta under Redford’s government. It’s shameful.

  16. Carol Wodak says:

    I agree. I still think the most pertinent presentation I’ve done on seniors issues was a take-off of A Christmas Carol, with which I temporarily spoiled the cheer of an FSNA Christmas party. There is only a question mark about the ghost of Christmas yet to come, although it doesn’t look good.
    I apologize for the orphan reference to “point 9” in my last comment; I adapted that from a briefing document I’m working on which records available information about this home care consolidation. Point 9 included headlines about home care staff and service cuts in the last several months prior to this initiative – setting the stage, so to speak. If anyone wants a copy of that, let me know.

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