HealthcarePapers 1(4) September 2000 : 5-6.doi:10.12927/hcpap..17346
In This Issue

Notes from the Editor-in-Chief

Peggy Leatt


Creating a meaningful profile for health services provided in the home has been on the agenda of federal and provincial governments alike for many years. The Health Care Forums established by Prime Minister Chrétien in 1997 set up an expectation that home care is, if not a "right," then certainly a service Canadians anticipate as part of the provision of health services. The fact that care-in-the-home versus care-inthe- hospital was not specified as part of the Canada Health Act seems a moot point, as does the requirement under the Act that services be deemed "medically necessary." Many of the services provided in the home that "heal" and improve health require basic helping services but not necessarily medical expertise.
It was reassuring to find that home care and community care are considered essential parts of the continuum of care by the First Ministers in their Communiqué on Health (September 2000). In fact, the Ministers committed to collaborate on a number of specific priorities that included home-care services. Clearly, effective delivery of home care requires the coordination of all levels of governments, including federal, provincial and municipal. But, as Michael Decter points out (Hospital Quarterly, Vol. 4 No. 1), the First Ministers simply pledge to strengthen investments in home and community care as critical components of a more integrated health system. There is no discussion of inequities in access or cost faced by Canadians in different parts of the country. There is no stated strategy to make home care adhere to national standards.

Hats off to Dr. Margaret MacAdam for starting the ball rolling in this issue with a thorough discussion of the state-of-the-art for home care in the Canadian context.We recognize that the task of defining the issue or problem for a publication such as HealthcarePapers is a challenging task. It often requires a "thick skin," as the commentators use the initial paper as a bouncing-off point for their analyses. MacAdam is to be congratulated not only for her thorough review of the relevant literature and research but also for her courage in outlining thoughts about a national program of home care for Canada that is developed at the local level within a framework of national principles and accountability mechanisms. True to form, the commentators rose to the task and provided some excellent ideas that complement and supplement MacAdam's lead paper.

Clearly, home care is not just an issue of policy but also an issue of politics. As noted in our last issue (HealthcarePapers Vol. 1 No. 3), there is no shortage of people with ideas about what needs to happen. The more difficult question is how to make change happen, i.e., what strategies can be used to move the agenda forward to ensure that health services are more accessible and are of higher quality.

Many of the issues raised by home-care respondents also relate directly to the challenge of integrating care and finding ways, as Duncan Sinclair put it (HealthcarePapers Vol. 1 No. 3), to "bridge the domains of policy making and politics to achieve the changes we all know are essential to meet the needs of Canadians into the 21st century."

The papers demonstrate significant differences in opinion; however, most agree that we need the following:

  • more and better data,
  • assessment and evaluation tools,
  • ongoing research and resource planning and
  • federal coordination.

On another note, Minister Witmer from Ontario demonstrates one government's response to home care.We welcome comments from her fellow ministers who are charged with the responsibility of leading and implementing new models of healthcare delivery.

Shirlee Sharkey raises the need to examine the impact of technology and information on the evolution of home care. Perhaps Michael Guerriere, editor of the new journal,, will address this in the near future?

As is our custom, the aim in this issue of HealthcarePapers is to stimulate discussion about critical health policy issues. Our keen interest is in publishing opinions from the many and varied geographic regions of Canada. Home care presents an ideal opportunity for examination and debate from a wide range of perspectives and from various provincial perspectives. Thus, we have provided viewpoints from Victoria, Saskatoon, Winnipeg, Toronto, Kingston, Ottawa and Montreal. The respondents represent the public sector, and also not-for-profit and private-sector providers. Our goal is not to provide an exhaustive perspective on this issue.We will feel satisfied if we have caught your attention and compelled you to think about provision of health services in the home in a new way.

It will be interesting to monitor the degree of attention that the newly re-elected federal government will direct to issues of adequate access and quality of services in the home. Perhaps it is now timely for the development of national standards for home care. The Liberal government should seize the opportunity to make a difference in this area.


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