As a longtime clinician and administrator, I’ve had the privilege of both observing and participating in the transformation of healthcare systems in Canada and the U.S. It has been exciting to witness the evolution of healthcare in Ontario in recent years through Ontario Health Teams, primary care, home and community care, and integrated care models. Seeing the various players collaborate to advance the goal of seamless transitions and person-centred care has been inspiring. Despite, and in some ways due to, the pandemic, Ontario’s healthcare system has made significant strides toward modernization.

The term "home care modernization" is frequently used in reference to various transformation activities across the healthcare sector. It suggests that home care has not kept up with recent healthcare innovations, which is far from the case. Home care providers and funders have embraced virtual care, artificial intelligence, remote monitoring, and research- and data-informed decision-making. Moreover, they have partnered with other healthcare organizations to integrate care and build capacity within the system.

What truly requires modernization, and what I believe was the original intent of the term, is the way home care is organized, accessed, and contracted in Ontario. This is about modernizing the healthcare system in Ontario, with a particular focus on home and community care.

Increased access to home care is vital for keeping Ontarians well and achieving the province’s vision for a modern, integrated healthcare system. With proper funding and coordination among healthcare providers, clients can receive personalized, high-quality care in the right place—the comfort of their homes and communities. Research shows that this not only improves patient outcomes but also reduces hospital readmissions and generates cost savings for the healthcare system.

To realize these improvements, we should focus on modernizing four key areas:

1. Home Care Expertise in Program Design and Decision-Making 

Home care providers possess deep expertise, critical capabilities, and unique insights into the client and caregiver experience outside institutional settings. Including the home care perspective as an equal partner in the design of integrated programs can improve patient outcomes, enhance the practicality of care models, reduce complexity, and ensure clients and caregivers remain the true focus of healthcare modernization efforts.

This proposal is complicated by the fact that home care is often a contracted service, and our system includes both not-for-profit organizations, like VHA, and for-profit providers. While it may feel unconventional to invite a "vendor" to the program-design table, this collaboration helps avoid challenges and unintended consequences that arise when home care is underrepresented in early planning stages. All voices—contracted or otherwise—should be at the table to drive meaningful healthcare modernization. 

2. Direct Access to Home Care for Primary Care Providers 

Currently, primary care providers do not have direct access to home care services. As a result, early signs of client decline, which could be mitigated by timely home care intervention, often lead to more urgent care needs and potential emergency department visits.

Allowing primary care providers to directly order home care services would ensure more appropriate, timely, and compassionate responses to patients’ non-emergent needs. Additionally, primary care providers have deep knowledge of their patients' health status, social determinants of health, and some insight into their home environments. With the ability to directly order home care, they could tailor services to meet each patient's specific needs and circumstances—fundamental to person- and family-centred care. As Dr. Jane Philpott notes in Health for All: A Doctor’s Prescription for a Healthier Canada, home care should be one of the services integrated into primary care to provide a one-stop shop for patients to receive necessary care and stay in their homes. 

3. Expanding the Scope of Practice for Home Care Providers 

Modernizing Ontario’s healthcare system requires that all frontline clinicians, including home care providers, work to the full extent of their training and expertise. Home care providers play a vital role in supporting clients’ recovery and independence outside hospital settings. Expanding the scope of practice for home care clinicians—such as nurses, pharmacists, and physiotherapists—would unlock new efficiencies and make home care a more attractive career path for talented clinicians.
Allowing home care providers to order diagnostic tests, adjust medications, and make certain treatment decisions as part of the integrated healthcare team would enable faster, more responsive care for clients, while reducing unnecessary emergency department visits and hospital readmissions. 

4. Addressing Funding and Wage Disparities 

To build a truly integrated healthcare system, we must address the longstanding disparities in funding and compensation across care settings. Currently, acute care, primary care, home care, and community care providers operate under different financial models, leading to stark wage and resource disparities. This perpetuates the preference for working in institutional settings over home and community-based care.

If we want Ontarians to live safely and independently at home and in their communities, home and community care agencies must be able to attract and retain qualified staff. Ensuring wage parity across settings would help achieve this goal. Research shows that equalizing wages for personal support workers in home and community care could result in significant cost savings for Ontario’s healthcare system by reducing the need for more expensive institutional long-term care. Eliminating funding silos would also create more equitable employment opportunities, where all healthcare workers are fairly compensated for their contributions. 

Conclusion 

Together, these four changes would significantly enhance the integration and efficiency of Ontario’s healthcare system, improving health outcomes and ensuring high-quality, responsive care at the right time and in the right place. Home care professionals are proud to play an integral role in this transformation and look forward to contributing at the decision-making table.
As home care is seen as a critical part of the system and continues to innovate and evolve, the term "home care modernization" does not capture the full scope of the necessary changes. True modernization must occur at the healthcare system level, focusing on the integration of home and community care within a reimagined, patient-centered model.

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