Establishing a Crown Agency Amid Multiple Service Providers
Bibliographic record
Abstract
Directly funded (DF) home care is a policy mechanism where individuals are given funds to arrange their own services by hiring people in their communities or by subcontracting to service provider organizations. In 2017, the Ontario Ministry of Health and Long-Term Care briefly established a crown agency called Self-Directed Personal Support Services Ontario (SDPSSO). The stated goal of the SDPSSO was to create a DF home care program to serve older people, expanding an existing Ontario program serving a small number of younger adults with disabilities. The development of SDPSSO was influenced by the then health minister's ideological belief, pressure to reform home care from multiple stakeholders, and positive (although sparse) international evidence of the efficacy of DF home care among older adults. Reaction to the policy shift included a judicial injunction brought forward by a coalition group of home care service providers, halting implementation. A SWOT analysis shows that the SDPSSO provided as many threats and unknowns as there were possible benefits. A change in provincial government resulted in the dissolution of the SDPSSO in 2018 and the introduction of a family-managed program that continues to exclude older people. It is unclear what future changes may be in store for home care in Ontario. Le programme de financement direct (FD) des soins à domicile consiste à transférer des fonds aux individus pour qu'ils mettent en oeuvre eux-mêmes les services dont ils ont besoin en recrutant au sein de leur communauté ou en sous-traitant à des organismes fournisseurs de services. En 2017, le Ministère de la Santé et des Soins de Long-Terme de l'Ontario a mis en place un éphémère organisme de la couronne appelé Services de Soutien à la Personne Autogérés de l'Ontario (SSPAO). L'objectif affiché de SSPAO était de créer un programme de FD pour les personnes âgées, par extension d'un programme déjà en place pour une population restreinte de jeunes adultes handicapés. Le développement de cet organisme peut s'expliquer par une préférence idéologique du ministre de l'époque, des pressions de multiples origines pour réformer le système des soins de long-terme à domicile et des éléments de preuve rares mais favorables sur l'efficacité des soins à domicile FD pour les personnes âgées. En réaction à ce changement de politique, une coalition de producteurs de services de soins à domicile a déposé une injonction en justice, freinant la mise en place de l'organisme. Une analyse FFOM (SWOT) montre que le SSPAO engendrait autant de menaces et d'inconnues que d'avantages possibles. Un changement de gouvernement provincial a conduit à la dissolution du SSPAO en 2018 et à l'introduction d'un programme de gestion familiale qui continue à exclure les personnes âgées. L'avenir des soins à domicile en Ontario est pour le moins incertain.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.015 | 0.006 |
| Scholarly communication | 0.007 | 0.004 |
| Open science | 0.002 | 0.009 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.021 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".