Home and community care has been heralded as a large part of the solution to allow people age at home and bring cost savings to the overall health system, but the current state of home and community care has yet to fully realize it’s acclaimed benefits.

Two reports were recently released identifying the major systemic problems of Ontario’s home and community care as well as recommendations: “Bring Care Home” written by an Ontario convened expert group led by chair Dr. Gail Donner and included other health care practitioners Cathy Fooks, Joe McReynolds, Dr. Samir Sinha, Dr. Kevin Smith, and patient advocate Donna Thompson, and “The Care We Need” written by the Ontario Health Coalition, which represents over 400 member organizations, a network of Local health Coalitions, and individual members. Despite bringing well-needed attention to the problems, the reports’ recommendations were lackluster – neither offering large-impact solutions that will bring about the system-wide change that Ontarians urgently need.

Problems deeply entrenched in the system

The problems identified by the two recent reports were alarming but unfortunately, not a surprise to those who have come into contact with the home and community care sector:

• lack of standards and consistency across geographic locations and lack of measures or indicators to track performance;
• lack of coordination and communication between service providers and the administrators with the patients and their families;
• lack of accountability to ensure health outcomes and cost-effectiveness of services;
• lack of access to services;
• a fragmented, overly-bureaucratic system.

Not much seemed to have changed since the Ontario Auditor General ‘s 2010 report on home care. The Auditor General’s 2010 report had found similar problems such as major funding inequities across the province that led to inequitable access to service as well as the level of service, in which people with similar conditions received different levels of service. This led to wide variances in wait times between the different regions – average wait times ranged from 8 days to 262 days. The assessment wait times also ranged from 4 days to 15 months. The Auditor General also found a lack of standards and consistency that led to large variances in frequency, duration, and level of service. In addition, the Auditor General found that the best value for both cost and service from service providers were not being obtained.

Lacklustre Recommendations

With any set of recommendations, most Ontarians want to see concrete ideas that will directly address the identified problems and, ultimately, help people access the services they need within a reasonable expected time and value for money. However, with the exception of a few, the two reports’ recommendations fell short of this expectation.

A few of the exert group’s “Bring Care Home” recommendations are welcome, such as the recommendations for more resources and services to support family caregivers, greater transparency of information for patients and their families, such as a clear definition of the publically covered home care and community services and their eligibility criteria, improve communications strategies for primary care providers and home and community care providers, and capacity planning to address identify and address gaps and needs.

However, many recommendations fail to directly address the identified problems, lacking teeth to bring about any meaningful change to patients and their families, such as the recommendations to incorporate a principle-based Home and Community Care Charter into the system’s policies, to develop a plan to define and deliver a “coordinated needs-based statement of benefits” that is provided by all relevant Ministries, and for each of the Local Health Integrated Networks to select and fund a lead agency to coordinate home and community care, which would add another layer of administration to an already heavily bureaucratic system.

In contrast, the Ontario Health Coalition’s “The Care We Need” report had a few more notable recommendations that address the underlying systemic problems around lack of standards, coordination and accountability. For example, it recommends the establishment of an enforceable, standards-based continuum of care provided on a universal and equitable basis so that every applicant has the right to an assessment of his or her care needs and if assessed as having a need for home care, they receive the service. This particular recommendation addresses the government’s boasts of fulfilling its promise to reduce wait times for home care to within 5 days after the assessment while being silent about the long wait time to receive the initial prerequisite assessment.

The Ontario Health Coalition also recommends system structural reform to reduce the duplicate layers of administration and cost by specifically reforming the Community Care Access Centres (CCACs), which are responsible for providing home care services in Ontario. Instead of contracting out the services, as it is done currently, they recommend to have the CCACs directly provide the care and ensure that they are accountable for the delivery of care in the public’s interest.

Without Greater Access, Better Standards and Coordination is Meaningless

Most people would welcome recommendations for enforced standards, more accountability, and better coordination, but unless they are able to receive the service they need, the recommendations are meaningless. Neither report addressed the need for greater funding in home and community care to expand access nor how the system would be able to meet the increasing demand for more home and community care. Most Ontarians feel that the health care system spends enough money but in that its current resources can be used more cost effectively, such as reallocating existing funds to home care from hospitals.

CARP has been calling for transformative change of the healthcare system so that the system is no longer designed around the priorities of the service providers but the people who they are supposed to serve. CARP’s call demands that Canadians not be treated as health consumers or merely patients but rather as “health citizens” who pay for the system and expect it to serve the values set out in the Canada Health Act – universality, accessibility and comprehensiveness. This means the system should ensure that home care should be there when people need it.

Read the expert report “Bring Care Home”.

Read the Ontario Health Coalition report “The Care We Need”

Read CARP’s submission to the federal Advisory Panel on Health Innovation that calls for system re-design around the healthcare citizen.