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.