Bringing health care home
About the Association Members
Home Care Ontario is a non-profit membership association representing providers of quality home care services from across Ontario. The Association is dedicated to promoting the growth and development of the home and community health care sector by helping to shape health care policy, supporting members to excel, and being a leading source of information on home and community care. (www.homecareontario.ca)
Collectively, Home Care Ontario members employ about 25,000 staff, and serve approximately 500,000 Ontarians yearly. Home Care Ontario members work with families as integral partners in the delivery of home care services touching the lives of an estimated 1.4 million Ontarians every year.
Service provider organizations that are members of Home Care Ontario comply with the Association’s high standards of excellence, are accredited through provincially approved accrediting organizations and complete a self-assessment annually as part of membership renewal in order to provide the community with evidence of the high practice principles to which they subscribe.
Home care is defined as an “array of services, provided in the home and community setting, that encompass health promotion and teaching, curative intervention, end-of-life care, rehabilitation, support and maintenance, social adaptation, and integration and support for the family caregiver.”
Services within home care include nursing, personal support/homemaker, therapy (including physiotherapy, occupational therapy, speech language pathology, social work, nutrition/dietetics), medical supplies, and equipment in the home. Home care services are intensely personal and provided at a time when individuals are most vulnerable. As such, Home Care Ontario members carefully recruit, educate and support their staff emphasizing a strong customer service orientation.
Home care programs work closely with community support services such as day programs, respite care facilities, volunteer services, meal delivery programs and transportation services. Clients’ needs are met in a comprehensive way when a strong linkage exists between the delivery system, which provides both physical and social support.
There is a synergistic relationship between home care and community services which is further supported and described as “the provision of health care, community and social support programs that enable individuals to receive care at home and/or live as independently as possible in the community.”
Why Home Care?
Most, if not all, people wish to remain independent at home in their community during their older years. Successful aging requires a holistic approach – avoiding disease and disability; maintaining cognitive ability; and engaging with life. One of the most significant and least desirable outcomes for a community dwelling senior is to be prematurely institutionalized because of the lack of home and community care- based health and social support options.
Home care is critical to supporting individual health needs, managing chronic illness and system sustainability. A robust system incorporating both publicly and privately funded home care services can give Ontarians flexibility and independence as they age and can help them to maintain their valuable contribution to communities and families. For the overwhelming majority who prefer to remain in their community, home care service is more desirable, as well as more cost and health effective.
History of Government Funded Home Care
Home care is a publicly funded, not a publicly insured, service. In Ontario, publicly funded home care falls under the jurisdiction of the Ministry of Health and Long-Term Care (MOHLTC), which has steadily increased its investment in order to meet the increasing demand. Notwithstanding, the mandate of the publicly funded system is to support families to provide care at home. Families provide the majority of care at home, and to manage, many choose to use private funds to retain home care service provider organizations.
Government funded home care was formally established in Ontario in 1970 and has grown and evolved as a sector over the past 45 years. As has been the case ever since the inception of the publicly funded home care system in Ontario, service provision is based on a private sector delivery model where the corporate status of service provider agencies is varied. There have been many successes and today the government funded home care system is responsible for providing almost 38 million visit/hours of high quality care at home to close to 700,000 Ontarians per year. As the largest home care program in Canada, Ontario leads the way in building a system driven by quality and evaluated on several dimensions.
In Ontario, the publicly funded home care program is locally administered by 14 Community Care Access Centres (CCACs) across the province. CCACs are accountable to the Local Health Integrated Networks (LHINs), regional organizations responsible for local health system planning, community engagement and funding a wide range of health service providers. CCACs serve to provide a simplified service access point and are responsible for determining eligibility for, and buying on behalf of consumers, the highest quality, and best priced visiting professional and homemaker services provided at home and in publicly-funded schools. CCACs also provide information and referral to the public on community-related services and authorize admissions to long-term care homes.
Publicly funded home care services are designed to complement and supplement, but not replace, the efforts of individuals to care for themselves with the assistance of family, friends and community. A fundamental component of home care is that family and/or friends will provide care to supplement the publicly funded service.
Home Care Ontario estimates that 150,000 Ontarians purchase an additional 20 million visit/hours of home care services annually in order to remain at home. The purchase of private home care services allows individuals to remain at home surrounded by family and friends, and helps them to continue to contribute to their community. These individuals may be “on the fringe” of admission to a facility, or may not be eligible or entitled to additional publicly funded care. Privately purchased home care service often provides the vital few hours of care and respite that enables families to continue their care giving responsibilities – which many are fulfilling while raising their children and holding a job. Home care service providers are often contracted to deliver additional hours that supplement publicly funded care. Frequently, this care is paid by privately‐insured employment plans and/or government programs (such as respite programs) and/or direct private purchase.
The growing senior population in Ontario is a testament to our success as a society. Seniors, as a group, are healthier and more active, and the seniors of the future are predicted to be amongst the healthiest in history. However, a consequence of aging is that the likelihood of developing chronic conditions and long term illness increases and can compromise the prospect of independence.
The health system has already begun to plan for the shifting demographic and associated health care needs. Recognizing the different drivers for care, the Ministry of Health & Long-Term Care (MOHLTC) has undertaken initiatives that will transform the health system from one that is reactive and focused on cure to one that is proactive and driven to support individuals to live independently and to self-manage their conditions as well as possible.
As the home care sector grows and evolves to respond to the demands of the system, there is a need for legislative and regulatory change to support the emerging practice. Leadership within government is essential to driving the change that is required. Much is written about the impact of our aging population and technology as two key trends that will change society. Within home care, the Association anticipates a system that fully utilizes members of the health care team and focuses on outcomes that are cost-effective and generated by each person’s values and preferences in the context of fully informed choices.
An efficient and effective publicly funded home care system appropriately includes and integrates all members of the team to achieve value and to assist Ontarians to remain independent at home. Safe, reliable, privately funded home care services can offer additional capacity to the system and provide even more choice to Ontarians. The full array of home care services, including access to case management, family physicians, nursing, therapies, community pharmacists, and personal and community support are essential to support good health outcomes.
Home Care Ontario will continue to serve as the voice for home care in Ontario advocating for “more nights at home” for all Ontarians. On behalf of all Ontarians, the Association will continue to champion excellence in home and community care, working collaboratively with health system stakeholders to create seamless transitions within and across publicly and privately funded providers of health care.