Ontario Launches New Home Care Initiative to Alleviate Hospital Crowding

Ontario has officially announced the launch of a new home care initiative aimed at addressing hospital overcrowding across the province. The program, known as High-Intensity Bundled Home Care, is designed to facilitate quicker transitions for patients moving out of hospitals while ensuring they receive the support they need at home. This initiative comes in response to the increasing pressure on Ontario’s healthcare system, where many patients, particularly seniors, occupy hospital beds despite no longer requiring acute medical treatment.

As part of this program, home care providers will be tasked with delivering hospital-level care directly in patients’ homes. The initiative primarily targets those who are waiting for long-term care placements, allowing them to move out of hospitals that are often at capacity. According to internal documents obtained by CTV News, the request for proposals from home care agencies was issued on November 7, 2023, with the program expected to take effect on December 8, 2023, in select regions of Ontario.

Program Details and Support Structure

Under the new model, home care agencies will receive a flat fee payment for each patient discharged from hospital. Each patient’s care will be overseen by a registered nurse, who will coordinate a team of personal support workers, physiotherapists, and occupational therapists. Included in the care plan are essential services such as 24-hour on-call medical coverage, assistance with hospital bed arrangements, home medication delivery, virtual monitoring, and meal programs like Meals on Wheels.

Lisa Burden, Chief Patient Services Officer for Ontario Health atHome, emphasized the initiative’s goals: to help patients remain safely at home, avoid unnecessary emergency department visits, and alleviate the pressures on hospital capacity. The program represents an expansion of the existing home and community care framework to address the needs of three priority patient groups in the coming weeks.

Challenges and Concerns

The introduction of the High-Intensity Bundled Home Care program presents significant logistical challenges, particularly given its rapid rollout. The initial phase aims to assist approximately 570 seniors requiring extensive care and supervision, many of whom suffer from severe dementia or mobility limitations. The documents outline an ambitious goal of transitioning all these patients back into their homes by the end of December.

A healthcare worker, who spoke anonymously, expressed skepticism about the feasibility of such a swift implementation, stating, “They’re talking about the heaviest of heavy-care clients. It’s ambitious—maybe too ambitious—to launch this quickly.” Concerns have also been raised regarding the flat-rate funding model, with front-line staff warning that this could jeopardize the quality of care provided. One worker noted, “Not every visit can be rushed,” highlighting the need for adequate time to ensure proper care.

Additionally, staffing shortages in personal support and other home care roles have emerged as a potential barrier to successful implementation. Dr. Alan Drummond, an emergency physician in Perth, Ontario, remarked on the challenges of sourcing quality workers, given that staffing shortages are affecting all areas of the healthcare system.

If the program successfully transitions all 570 patients into high-intensity home care, the initiative could cost approximately $11.4 million each month. The documents do not indicate any specific time limit for the intensive care being provided.

Ontario’s hospitals continue to face significant pressure, with many emergency rooms overwhelmed by patients waiting for admission. Surveys indicate that between 15 and 20 percent of inpatients are classified as “alternate level of care” (ALC), meaning they no longer need acute hospital treatment but lack other placement options. These patients, sometimes referred to as “bed blockers,” exacerbate overcrowding and contribute to longer wait times for surgeries and acute care services.

As the province braced for a peak in hospital occupancy projected for early to mid-January, when cases of influenza, COVID-19, and RSV typically surge, the urgency for solutions like the High-Intensity Bundled Home Care initiative has become increasingly evident. The initial phase of the program will focus on regions with the highest ALC rates, with the potential for expansion to additional areas.

Currently, Ontario has around 650 accredited home care organizations capable of providing care, though only a few, including Bayshore Home Health, Care Partners, and Paramed, possess the infrastructure necessary to deliver services across the province. Agencies have until November 20, 2023, to submit their proposals, with contracts expected to be awarded shortly thereafter on November 27, 2023.

This initiative reflects Ontario’s commitment to improving patient care while addressing the critical issue of hospital overcrowding. As the program unfolds, its success will depend on careful coordination, adequate staffing, and a focus on maintaining high standards of care for vulnerable populations.