Minister of Health Announces a New Direction for Home and Community Care in Ontario

On February 25, 2020, Ontario’s Minister of Health, Christine Elliott, announced she will be introducing the Bill 175, Connecting People to Home and Community Care Act, 2020, which will establish a new direction for community and home care in the province.

The Minister explained that Ontarians seeking home care face multiple assessments and long wait times. The current outdated and rigid legislation also creates barriers to care and to innovation. To help ensure that patients get the connected and responsive home care they need, the government plans to integrate home care with the rest of the health care system, moving the home care sector closer to the “point of care” and to where other care decisions are already being made.

The changes

Legislative changes

If passed, the Act, officially titled “An Act to amend and repeal various Acts respecting

home care and community services” would repeal past legislation and add regulations under several existing acts. The primary home and community care provisions would be included in the Connecting Care Act, 2019, the Act that formed Ontario Health and Ontario Health Teams (OHTs).

The Home and Community Services Act, 1994 would be repealed. Many elements of that Act would be maintained, either through additions to the Connecting Care Act, 2019 or new regulations of that Act. Additions to the regulations include the definition of community services, the settings of care, eligibility for services, an updated version of the Bill of Rights and requirements for handling complaints.

Other legislative updates in Bill 175 include:

The term “Integrated Care Delivery Systems” (the original term used for Ontario Health Teams) will be official replaced with “Ontario Health Teams”.
Only OHTs who have been designated as such by the Minister or who have received permission may use the term.

What is not changing

During the Ministry’s webinar, they reiterated that the changes will not change what services clients are receiving but that it may change how they are receiving these services. The Ministry also indicated that they expect the contracted model of hiring service provider organizations to remain in place, though that is not included in the legislation.

The current Local Health Integration Network (LHIN) structure is being maintained, with 14 corporations, though they will be renamed Home and Community Care Support Services.

Long-term care placement will continue to be managed by the LHINs, though the Ministry of Health and the Ministry of Long-Term Care are working together to determine how best to manage long-term care placement in the OHT model.

What is changing

Eventually, the delivery of home and community care should move from the Home and Community Care Support Services organizations (former LHINs) to the OHT. During the Ministry webinar, they indicated that they anticipate this transition will take at least a few years to complete.

The legislation and regulations establish that home care services could be delivered by a Health Service Provider (HSP) or OHT, allowing for organizations who are not yet designated OHTs to preform that function.

Organizations who would receive direct funding from Ontario Health to provide home and community care services would be required to be not-for-profit organizations. Organizations contracted to provide services could be not-for-profit or for-profit organizations. Community support services would continue to be delivered by not-for-profit providers, though any existing contracts with for-profit organizations would be exempt.

Home and community care HSPs – including the LHINs in the interim – would be required to ensure certain care coordination functions are performed. They would have the option of assigning these functions to contracted providers or to partner organizations. These functions include assessing patient need and eligibility, developing a care plan that includes outcomes (not just hours or number of visits), coordinate care between providers, and provide the patient with navigation services. The Ministry also suggested that the care coordinator role could continue to evolve, including relying more on virtual care.

The proposed regulations allow for Ontario Health to fund HSPs or OHTs to provide funding to patients for self-directed care. The Regulation consultation document does note that eligible cohorts covered by self-directed care would be determined through policy and they are not currently seeking feedback on these policies.

The changes also allow for greater use of and greater oversight of transitional care settings, including residential congregate care, providing an option for patients who are not able to return home but who do not require the intensity of care provided by a hospital or by long-term care.

What the changes mean

What does the Act mean for LHINs?

The 14 LHINs will maintain their home and community care staff, while other staff transition to the regional offices of Ontario Health. This move will essentially return the LHINs to their role as Community Care Access Centres (CCACs). They are expected to continue to function in this role for the next few years at a minimum.

What does the Act mean for Ontario Health Teams?

The new structure is being positioned as providing more flexibility for OHTs to develop and deliver innovative models of home and community care. While this may be true, this change will require each OHT to determine how they will handle care coordination, which may not follow the same pattern across OHTs. In the future, it may also require each OHT to either deliver home care themselves or to hold their own contracts with service providers.

What does the Act mean for Service Provider Organizations?

Current service providers will continue to provide services under their existing LHIN contracts for the foreseeable future. Eventually, they may be required to participate in a new procurement process, but any new procurement or partnership models appear to be left to the OHTs following the transition of home and community care to these groups.