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Home Care in Ontario - Overview

Home Health Care Providers
Individuals requiring skilled home care services usually receive their care from a home health care provider. Services provided by these providers are highly supervised and controlled. Some providers deliver a variety of home care services through nurses, therapists, social workers, homemakers and personal support workers, durable medical equipment and supply dealers. Other home health providers limit their services to nursing and one or two other specialties. For cases in which an individual requires care from more than one specialist, home health providers coordinate a caregiving team to administer services that are comprehensive and efficient. Personnel are assigned according to the needs of each patient. Home health providers recruit and supervise their personnel; as a result, they assume liability for all care.

Homemaking Providers
Homemaking providers employ homemakers, personal support workers and companions who support individuals through meal preparation, bathing, dressing, and housekeeping. Personnel are assigned according to the needs and wishes of each client. Homemaking providers recruit, train, and supervise their personnel and thus are responsible for the care rendered.

Home Support Providers
Community Support providers generally are not-for-profit organizations who receive funding from the government and are comprised of paid and volunteer staff. Services include adult day programs; Alzheimer/dementia overnight care; friendly visiting; intergenerational programs, social and recreation; and transportation. Some community support providers also employ nurses and personal support workers and have contracts with CCACs.

Institutional and Private-duty Providers
Staffing and private-duty providers generally are nursing providers that provide individuals with nursing, homemaker, personal support worker, and companion services. Some staffing and private-duty providers assign nurses to assess their clients' needs to ensure that personnel are properly assigned and provide ongoing supervision. These providers recruit their own personnel. Again, responsibility for patient care rests with each provider.

Pharmaceutical and Infusion Therapy Companies
Pharmaceutical and infusion therapy companies specialize in the delivery of drugs, equipment, and professional services for individuals receiving intravenous or nutritional therapies through specially placed tubes. These companies employ pharmacists who prepare solutions and arrange for delivery to patients. Nurses also are hired to teach self-administration in patients' homes. Each company assumes responsibility for personnel and the services rendered.

Durable Medical Equipment and Supply Dealers
Durable medical equipment and supply dealers provide home care patients with products ranging from respirators, wheelchairs, and walkers, to catheter and wound care supplies. These dealers employ staff who deliver and, when necessary, install these products as well as instruct patients on their proper in-home use. Durable medical equipment and supply dealers usually do not provide physical care for patients, but there are a few exceptions. Some dealers offer pharmacy and infusion services, where a nurse administers medication and nutritional formulas to patients and teaches them the proper techniques for self-administration. Some companies also provide respiratory therapy services to help individuals use breathing equipment. Each dealer is liable for its personnel and the services provided to patients.

The Ministry of Health and Long-Term Care (MOHLTC) is the department of the Ontario government that is responsible for administering the health care system and providing health care services to the public through such programs as health insurance (OHIP), drug benefits, assistive devices, care for the mentally ill, long-term care, home and community support services, public health, health promotion and disease prevention. The MOHLTC also funds and regulates hospitals and long-term care facilities, operates psychiatric hospitals and public health laboratories and co-ordinates emergency health services.

Community Care Access Centres (CCACS) are the provincially-funded organizations providing information about the care options available in designated geographic areas. In 1996, the Ministry of Health and Long-Term Care established 43 Community Care Access Centres covering all of Ontario. CCACs serve as a local point of contact and service co-ordination. CCACs also determine eligibility for government-funded home and community support services and admission to a long-term care facility.

Government or Publicly-Funded Services are the services that receive partial or 100% funding from the Ministry of Health and Long-Term Care (MOHLTC). In some cases the funding is administered via a CCAC, and other times the funding is administered directly by MOHLTC.

Provider Organizations are the corporations that deliver services to the client directly and/or operate a building where care is provided. These organizations are usually incorporated entities, and can be one of the following: a non-profit organization, a private corporation, a municipal government or an aboriginal organization.

Home care services are usually provided by provider organizations but may also be obtained from registries and independent providers. Home care organizations include home health providers; community support providers; staffing and private-duty providers; and companies specializing in medical equipment and supplies, pharmaceuticals, and drug infusion therapy.

Home care services generally are available 24 hours a day, seven days a week. Depending on the client's needs, these services may be provided by an individual or a team of staff working on a part-time, intermittent, hourly, or shift basis.

Registries serve as employment providers for home care nurses and homemakers by matching these providers with clients and collecting finder's fees. Clients select and supervise the work of a registry-referred provider. They also pay the provider directly and must comply with all applicable provincial and federal labour, health, and safety laws and regulations, including payroll tax and other withholding requirements.

Independent Providers
Independent providers are nurses, therapists, homemakers, personal support workers and companions who are privately employed by individuals who need such services. In this arrangement, the responsibility for recruiting, hiring, and supervising the provider rests with the client. Finding back-up care in the event that the provider fails to report to work or fulfill job requirements is the client's responsibility. Clients also pay the provider directly and must comply with all applicable provincial and federal labour, health, and safety requirements.