Because most CCACs no longer directly employed rehabilitation professionals, initial client assessments were now frequently conducted by CCAC case managers, the majority of whom were nurses.
Specifically, the separation of purchaser and provider left the purchaser (the CCACs) in the position of wanting to be more involved in determining course of treatment.
Moreover, regardless of assessed clinical need, most CCACs now placed administrative limits on the number of client visits that would be funded.
The first of these consequences concerns the ethical dilemmas home-care rehabilitation professionals often faced in attempting to reconcile their judgments about client needs with administrative constraints placed by the CCACs on services actually provided to clients.
We also get complaints from funders." In fact, she noted that over fifty per cent of the inquiries the regulatory college receives are "related to those kinds of [ethical] dilemmas at the moment." In describing the conflict a rehabilitation professional faces when told to discontinue what he or she believes to be required client care, the manager of a for-profit provider agency noted that "those two situations to me are in extreme tension if they're carried to their fullest extent." The manager of a provider agency directed her concerns at the CCACs, noting that "there are huge issues around.., how many visits that professional will be allotted to achieve their goals." She further noted that her rehabilitation staff "were feeling terribly compromised.
Almost two-thirds of CCAC and provider-agency interview respondents (eighteen of twenty-eight) suggested that as "divested" independent entrepreneurs, rehabilitation professionals experienced an erosion of their economic autonomy in competitive home-care markets.
Such effects became more pronounced as the provincial government froze CCAC funding in 2001, even as demand for home-care services continued to grow (Randall and Williams 2006).
Respondents agreed that, prior to Ontario's managed competition reform, rehabilitation professionals (both those who were CCAC employees and those working for private provider agencies) had had almost complete control over work scheduling.