On February 25, 2020, Ontario’s Minster of Health tabled Bill 175 – Connecting People to Home and Community Care Act, 2020, which significantly changes home and community care. There has been little, if any, public consultation. Care Watch is concerned that when government’s regular business resumes, the Bill could be pushed through quickly without clear information about how services will actually be delivered. We developed a briefing note which summarizes our comments, concerns, and questions.

Read the briefing note and other materials on home and community care here.

(We will resume our analysis of the Canada Health Act principles in the next post – stay tuned!)

Care Watch has long supported the principles underlying the Canada Health Act (CHA). We also believe these principles are fundamental to any system for in-home and community support services.

We posted a detailed assessment on Applying CHA Principles to Home and Community Care Suppport Services and will share snippets each day.  Today, we address home care and community support services.

Historically, home care and community support services were provided on a voluntary basis by charitable organizations. Today, they are provided by a mix of for-profit and not-for-profit organizations and municipalities and funded through public funds, user co-payments and fees, and charitable donations.

The CHA does not mandate that in-home care or community support services be insured, but it does give each province and territory the discretion to insure medically-related “extended health care” services. Examples include nursing home intermediate services, adult residential care services, home care services, and ambulatory health care services. Provinces and territories may also provide “additional benefits,” which they fund and deliver according to their own terms and conditions.

In 1994, Ontario’s Home Care and Community Services Act (HCCSA), and associated regulations, established a legislative foundation for the province’s home and community care sector. HCCSA’s stated goals included: (a) providing a wide range of community services to people in their own homes and communities, thus offering alternatives to institutional care; (b) supporting family caregivers; (c) improving the quality of community services; and (d) promoting the health and well-being of those who need these services. It outlines administrative responsibilities, accountability, and oversight; sets rules and standards; and creates funding structures and requirements. It also includes a patient bill of rights along with requirements for complaints and appeal processes.

On February 25, 2020, Ontario’s government tabled Bill 175 – Connecting People to Home and Community Care Act, 2020, which is intended to modernize Ontario’s home and community care services system. If passed, the Bill will repeal and replace the HCCSA, formally transferring responsibility for planning, coordinating, and delivering home and community care (HCC) to the new Ontario Health Teams. Health teams are essentially not-for profit corporations or interlocking corporate partnerships, some of which may be for-profit service providers. Beyond this information, however, we know little about their structures, partnerships, governance, funding, and operating methods.

Some HCCSA provisions appeared to align with CHA principles, though the HCCSA had no clear statutory provisions for them. Bill 175, however, contains no reference to either the HCCSA‘s purposes or goals, and it includes no new public interest purposes or service goals. Home and community care services are thus unprotected and prey to erosion in the name of modernization and cost-cutting.

In the next post, we begin to examine the principles. Read the full backgrounder.

Care Watch has long supported the principles underlying the Canada Health Act (CHA). We also believe these principles are fundamental to any system for in-home and community support services. We posted a detailed assessment on Applying CHA Principles to Home and Community Care Suppport Services and will share snippets each day.

Constitutionally, our provincial/territorial governments are responsible for health services and programming. The federal government is responsible for leadership, coordination, funding, and maintaining nationwide equity. National frameworks such as the Canada Health Act provide a foundation and guidance for consistent and coordinated provincial/territorial action. This action creates public goods that benefit us all. Such frameworks can guide not only health care, but also other national initiatives and programmes.

As of this writing, Ontario is restructuring the delivery and funding of health services, including home care and community support services. The CHA’s five legislated principles (public administration, comprehensiveness, universality, portability, and accessibility), as well as the implicit principles of equity and solidarity, provide a lens for viewing and assessing current and pending changes.

The Canada Health Act

The Canada Health Act establishes a national policy framework for publicly funded health insurance plans (generally called Medicare), which cover (or insure) necessary medical, surgical dentistry, and hospital services by authorized providers. Medicare is not, however, a single unified programme; each province and territory establishes its own insurance plan, with its own terms and conditions. To qualify for federal funding (transfer payments), these plans must conform to the CHA’s legislated principles. Although most providers operate as private, for-profit businesses, their medically necessary services are publicly funded, so users don’t pay directly for them and don’t pay at the point of service. Some people, in Canada and elsewhere, think of Canada’s Medicare system as free. It is not, however, any more “free” than any other insurance system. Insured people pay (through their taxes) into a common pooled fund, from which they withdraw as needed.

Sect. 3 of the CHA states that Canadian health care policy’s primary objective “… is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.”

Health Canada also affirms that ‘‘framed by the Canada Health Act, the principles governing our health care system are symbols of the underlying Canadian values of equity and solidarity” based on the shared goals and interests of maintaining and improving individual health, population health, and the public health system.

Check back tomorrow, or read through the full backgrounder.