An Introduction to Home Care

Home care has evolved by responding to changes that have occurred in the hospital sector (bed closures, increase in ambulatory care clinics, and day surgery) and in the long term care facilities sector (waiting lists for beds, limited availability). As a result, home care has emerged as an integral component of Canada's health care system and essential to its sustainability.

Home and community care comprises 4.25% of the overall spending on health care within provincial budgets. As Hollander suggests, "in integrated care delivery systems, home care has the potential to be a major force in increasing the cost-effectiveness of the overall health care system" (Synthesis Report: Final Report on the National Evaluation of the Cost-Effectiveness of Home Care, August 2002,pg. xii).

Maximizing individual health requires many inter-related services including illness prevention, health promotion and protection, diagnosis, treatment / cure, rehabilitation, support and maintenance, palliation, and social adaptation and integration. Home care programs provide components of all these services by integrating the provision of formalized health care delivery services in the home setting with community services (e.g. meals on wheels, respite care, volunteer services, etc).

Home care uniquely functions as a bridge between the various settings of care, including acute care hospitals, emergency rooms, supportive living, long term care facilities, hospices, and the physician's office. These close linkages enable home care programs to meet client's needs in an individualized and comprehensive manner, and go beyond physical and mental health care to engage social supports as well.

Home and community care goals include health promotion and teaching, curative intervention, end-of-life care, informal caregiver support, provision of service to support, independence and optimize functioning, and social adaptation and integration.

Currently home care programs across Canada are tasked with trying to stretch limited health care resources to provide both health and social support services to clients in need of assistance to remain at home.

In Ontario, publicly funded Home Care services are coordinated by Community Care Access Centres (CCACs) which are publicly funded agencies that provide information about care options. The CCACs were established by the Ministry of Health and Long-Term Care in 1996. As of January 1, 2007 there are 14 CCACs throughout Ontario.

In addition to government funded care, people wanting to stay at home may access services by purchasing services privately or accessing private insurance or benefit plans (e.g. private health insurance).
While it is generally accepted that home and community services enhance quality of life, are cost-effective and prevent unnecessary hospitalization, ER admissions and premature institutionalization, funding of the sector is not a priority. However, pressures to increase resources in this area will continue due to:

• Growing expenditures as a result of consumer preferences and acuity changes, growing reliance on the sector, an aging population and health care reform
• Changing profile of users in many provinces/territories
• Increasing acuity/complexity of client caseload as changes in delivery allow more treatment interventions at home versus in hospital
• Continued movement from facility-based to home and community-based care
• Changing public-private mix and increasing availability of private services
• Changing and growing human resource pressures
• Expanding use of in-home medical technology to improve service delivery
• Strengthening data and information systems for program planning an evaluation
  (Report to the Annual Premiers’Conference, “Strengthening home and community care across Canada: A collaborative strategy, August 2003)

Ontario Home Care Association engages in advocacy efforts directed at ensuring that the general public and the politicians understand the role and value of the home and community care system.