Three developments are shaking Ontario’s home care model which rests on a decades old design from a different era. A lumbering model that is described as insufficient by family members, rigid and complicated by providers, and out of step with a society which wants homecare redesigned and delivery transformed.
These developments are changing the homecare paradigm. The growing ageing population, non-stop clinical discoveries, and the arrival of virtual care. First, we all know about the growing tsunami of elders and their prominent health needs. The pandemic changed their minds about where they wanted to spend their elder days and where they wanted to receive health service; and that is in their own homes. Which sounds good. However, I don’t think the current $36 per diem that Ontario allocates for homecare service to clients is going to cut it with our moxie older adults. And it shouldn’t have to. A shift in long term care strategic spending that emphasizes enhanced homecare allocations would grow that $36 into what looks more like an investment category than strictly an expense entry on the Ontario Government’s balance sheet.
The second factor that is shaking things up is the impressive clinical discoveries that are regularly being announced for homecare results. Research findings that demonstrate higher quality outcomes in areas such as post stroke care; palliative care for heart failure patients; home service for youth mental health and eating disorders; post hip fracture surgery homecare; and even post transplant care in the home….are all having their impact. And I doubt that these clinical discoveries are going to come to an abrupt halt. In fact just the opposite with A.I. coming. So let’s design our home care to accelerate the transfer of research into comprehensive care results for our community. This is where the hospitals come in. If hospitals get their act together as Dr. Danielle Martin explains: “New buildings and fancy technology aren’t needed. What’s needed is a willingness on the part of hospitals to organize their care differently, supporting primary care and home care and home care workers who need back up.” In the 20th century Stratford General Hospital, like hospitals across Canada, transformed from poor house to powerhouse based on science, clinical knowledge, and as Dean Robinson reminded us – The Women’s Hospital Auxiliary. For the 21st century hospitals need to solidify their partnerships with primary care providers and a unified home care entity in order to meet the public’s expectations. The hospitals commitment and action to transformative home care should not be negotiable.
Thirdly and perhaps most significantly is the impact that virtual care is having on home care. Accelerated as a disruptive innovation by the pandemic, virtual care has gone from an occasional opportunity to a potential game changer for home care … if we pay attention. And paying attention means the Ontario Government has to promptly arrive at imaginative ways to include the growing array of virtual care services in our Ontario medicare payment systems to hospitals and primary care providers such as family health teams. (Feel free to read Katherine Fierlbeck and Gregory P. Marchildon’s 2023 eye-opener, The Boundaries Of Medicare.) Or will government leave virtual care outside of our medicare coverage and thus let medicare fall into the hands of private for-profit providers within a buckling health system.
Where is Stratford homecare headed; entrenched in the past or transformative for the future?