New Plan to Modernize Home and Community Care in Ontario
Ontario is modernizing home and community care services to enable the introduction of integrated and innovative models of care. Since its initial introduction, the Home Care and Community Services Act, 1994 and the delivery model it supports have not kept pace with a number of changing dynamics, including:
- An aging population;
- Changing client expectations on the different types of care;
- Increasing opportunities for care at home; and
- Innovation in technology and delivery options.
At the same time, the act has created long-standing barriers that have restricted innovation in the delivery of home and community care, including:
- Rigid care coordination: Decisions about patient care are often made away from frontline care.
- Siloed care: Patients often interact with home care separately from primary and hospital care, which often includes multiple assessments leading to delays in care.
- Restrictive care plans: Patients have care plans with a set number of hours or visits with service maximums that can curtail care.
In response, Ontario is introducing the Connecting People to Home and Community Care Act and posting proposed new regulations under the Connecting Care Act, 2019 to bring an outdated system into the 21st century.
Requires all care coordination functions (intake, assessing and determining eligibility, care planning, service allocation and case management) to be performed by an approved agency.
Adaptable care coordination functions that can be embedded in frontline care within Ontario Health Teams, promoting integration between sectors, reducing duplication and ensuring care is more responsive to patient needs.
Places restrictions on changing care plans without formal re-assessments, limiting the ability to make changes to care plans that meet patient needs.
Flexibility in care planning requirements to support more responsive care delivery based on patient outcomes.
Reinforces a per hour/visit based approach to delivery of care.
More flexibility for innovative models of care by supporting care to be provided virtually and removing the emphasis on visit-based care.
Places restrictions on amount of services, reducing capacity to care for certain clients.
No service maximums, enabling provision of care to be based on identified needs and resources.
Provides limited clarity/oversight to enable new settings and methods of delivering care.
An oversight model for residential congregate services, which would support patients with needs too high to be met at home - but do not require the intensive level of care provided by a hospital or long-term care home.
At the same time, the new framework will maintain many elements, including the following:
- Definition of home and community care services and eligibility criteria.
- Ability to fund Indigenous organizations directly through the Ministry of Health and Long-Term Care Act. This will maintain the nation to nation relationship between the parties.
- Ability for approved organizations to deliver home care indirectly through contracts.
- Provisions regarding funding clients and families for self-directed care.
- Restrictions on client co-payments for services, to preserve the existing approach where only community services can have co-payments.
- Restrictions limiting the delivery of community services to non-profit corporations.
- Requirements for a complaints process.
- Right to appeal certain decisions to the Health Services Appeal and Review Board.
- Inclusion of home care in the jurisdiction of the Patient Ombudsman.
- The Bill of Rights for home and community care would continue in regulation, updated to reflect the realities of modern home and community care.
If passed, the new legislation will:
- Make it easier for people to access home and community care in hospital, primary care or community settings. Hospitals and primary care settings and others will be able to arrange home care directly for patients, instead of referring people to a separate home care organization. Doing so will reduce administration and transitions for patients.
- Help people connect with their care providers through secure video conferencing and remote monitoring devices. People with chronic conditions will be monitored at home, with a nurse checking in as needed. Nurses or therapists can use video conferencing to work with a personal support worker in the home to provide more specialized care.
- Provide more choice for people with high care needs to get care in new community settings. People will be discharged from hospital into a transitional care setting to gain strength and functionality to return home.
- Keep people healthier at home by empowering care teams to work together. Enabling frontline care providers to make more decisions about care, integrating home care into primary care and acute care, and breaking barriers to access to information will create teams that work together to support patients.
About Home and Community Care Support Services
To ensure the ongoing stability of services while home and community care transitions into Ontario Health Teams, Local Health Integration Networks (LHINs) are being refocused into interim and transitional organizations with a singular mandate of delivering home and community care, as well as long-term care home placement. To reflect this focused mandate, they are being rebranded as Home and Community Care Support Services.
The province expects the transition to Home and Community Care Support Services to occur on April 1, 2020 and exist for the next few years as home and community care transitions into Ontario Health Teams and other points of care. It is anticipated that the non-home and community care functions of the LHINs will transfer to Ontario Health in the near future.
During the transition, patients and caregivers will continue to access home and community care services in the same way and use the same contacts. To help promote continued patient familiarity with these services, Home and Community Care Support Services will maintain the same regional identifiers as existing LHINs (e.g., Erie St. Clair, Central, Champlain and North Simcoe Muskoka). Each of the Home and Community Care Support Services organizations will be governed by a common set of cross-appointed board members with a streamlined leadership team.
"Home Care Ontario welcomes the government's move to modernize home and community care. Today's changes will allow patients to better access the right care, at the right time, and in the right place. These changes will make the system work more efficiently, and ultimately will allow local health teams to better work together to keep people healthier at home." - Sue VanderBent, CEO of Home Care Ontario
"OCSA thanks the government for their collaborative approach towards modernizing home and community care legislation for all Ontarians. We look forward to seeing the details of the legislative and regulatory changes being proposed. We believe a system that works to ensure Ontarians can receive the services that they need with fewer barriers will successfully allow more people to live well at home." - Deborah Simon, CEO of Ontario Community Support Association
"The proposed changes announced for home and community care in Ontario will provide personal support workers (PSW), patients and clients a new opportunity to work together to make Ontario Health Teams a success. Streamlining and modernizing the scheduling and funding process will offer Ontarians greater access to supports while also promoting continuity of care. The OPSWA hopes that these changes will work to stabilize and modernize the PSW profession." - Miranda Ferrier, President of Ontario Personal Support Workers Association
"To deliver the care Ontario patients and their families deserve, providers from across the continuum need to work together seamlessly to provide the right care in the right place. Home and community care is a key part of the solution to hospital overcrowding and hallway medicine, especially as our population ages and grows. Modernizing the complex home and community care system requires increased flexibility and openness to innovation, and today's announcement is an important first step in that direction. We look forward to examining the legislation and its regulations in detail, and to working with the government and our health system partners to shape care as we evolve toward a better-integrated health care system in Ontario." - Anthony Dale, President and CEO of the Ontario Hospital Association
"Regardless of the comforts and programming we put in place in hospitals, we know that most patients don't want to be hospitalized; they want to recover at home with the right supports. Today's announcement will no doubt help make transition points safer, smoother and more coordinated for patients and families. I am looking forward to working in collaboration with Home and Community Care Support Services, our Ontario Health Team partners and patient and family representatives to coordinate home care services locally." - Sarah Downey, President and CEO of Michael Garron Hospital
"On behalf of VON Canada, Ontario's longest-serving home and community care provider, I'd like to thank the Government of Ontario for recognizing the need to modernize the rules governing this vital component of health care delivery. They have listened to feedback, including the imperative to ensure that gaps in home and community care are addressed. We look forward to participating in the consultation process, with a focus on strengthening capacity in the home and community care system to better enable the delivery of patient-focused health care in Ontario. This is an important next step toward achieving the vision of the government's Ontario Health Team transformation initiative." - Jo-Anne Poirier, President and CEO of VON Canada
"This is a really encouraging direction for home and community care in Ontario: the Guelph Family Health Team has advocated for a new model that better integrates home care with primary care. In our experience, people are better served when their care team members are enabled to work as a team. The coordination and delivery of home care needs to be better linked to the care provided by family doctors and other primary care providers. Modernization of Home and Community Care is foundational to enabling the Guelph and Area Ontario Health Team to deliver on our commitment to integrating health care in our community." - Ross Kirkconnell, Executive Director of Guelph Family Health Team and Diabetes Care Guelph
"As a physician works with frail older adults, who often rely on publicly-funded home care to stay at home, the legislative changes being introduced today are long overdue and welcomed. By ensuring that the home care that Ontarians need can be delivered in a more flexible and integrated way, will ensure that the hundreds of thousands of Ontario families who depend on it can be better supported by a more responsive system that puts their needs first." - Dr. Samir Sinha, Director of Geriatrics at Sinai Health System and University Health Network, Toronto