Pre-Budget Recommendations

January 16, 2025

Care Watch Ontario is pleased to submit its recommendations for the 2025 Ontario budget. Care Watch recommends that in 2025, Ontario’s government invest an additional $385 million:

• $241 million for home and community care
• $144 million to increase and equalize compensation for the people who deliver this care

These investments will make home and community care more accessible to older adults by positioning services to meet current and future needs and providing enough people to deliver these services.

Setting priorities: Making home and community care accessible for older Ontarians

Government says that the budget is the “province’s roadmap for the year” and that it sets priorities for spending. Care Watch community members have told us that a priority is making home and community services available and accessible so that older adults can have what they need when they need it. We therefore use availability and accessibility as the context for our recommendations.

Making home and community care accessible: Providing enough service

Ontario’s government has made large investments in home and community services, including its 2024 commitment of more than $2 billion over three years. Wages and benefits have been increased,  and programs such as Meals on Wheels, adult day programs, and assisted living have expanded. We welcome these investments. Yet people can’t always get what they need, and home and community services still struggle. This year, some waitlists for personal support services have increased as much as eightfold. Some organizations have waitlists that far exceed their funded programs. Current investments can’t keep up with either the needs of today or the demands of the future.

The Home First Operational Direction – that every effort be made to provide resources to support people to remain home as long as possible – is a laudable effort. However, it risks becoming meaningless if there aren’t enough services and enough people to deliver them.

Care Watch supports the recommendation of the Ontario Community Support Association that in its 2025 budget the Ontario government: Invest an additional 5% (or $241 million) in home and community care. This additional funding can:

• Make services available to more people
• Help home and community service providers prepare for future needs
• Develop the infrastructure and digital capabilities to support team-based care and operate more efficiently

Making home and community care accessible: Supporting the people who provide it

Personal support workers deliver most home and community services. It’s a unique profession because the work doesn’t overlap the work of medical or rehabilitation professionals. Instead, it’s an extension of activities that clients would do for themselves if they could. It’s essential, but also demanding.

Personal support workers in homes and communities are the lowest paid workers in health care, earning less (and with fewer, if any, benefits) than those who do the same work in hospitals and long-term care homes. The province’s $3/hour increase applies only to hours of direct care, so personal support workers often aren’t compensated for the time it takes to travel to clients’ homes. They also aren’t given full wages for the time they spend assessing clients or managing and documenting care – critical activities for which other health care workers are paid. Taking into account the Bill 124 retroactive increases for other health care workers, the $3/hour increase still leaves personal support workers well behind.

Care Watch supports the recommendation of the Ontario Community Support Association to: Invest in a 3% ($144 million) compensation increase for the home and community care workforce and to include this increase in a strategy for the entire community health sector.

This additional funding could:

• Narrow the gap and give personal support workers in the community equal wages to those in hospitals and long-term care
• Retain the 20% of personal support workers who leave home and community care each year
• Create an additional 23.5 million hours of care each year
• Prevent unnecessary long-term care home admissions and lower the number of hospital alternative level of care patients
• Reduce overall health expenditures by 26%

Care Watch also recommends that the Ontario government: Establish a working group to develop and carry out a fair and workable approach to building and maintaining a home and community care workforce.

This workforce strategy must include the many unpaid caregivers and volunteers who provide at least 70% of care in the community. They contribute almost $10 billion each year in unpaid labour to Canada’s health system. Though sometimes referred to as “informal” caregivers, the care they provide is far from informal. Working as a volunteer for a community agency or simply taking a family member to regular appointments is a formal, though unpaid, commitment.

The Ontario Caregiver Organization’s latest Spotlight Report tells us that, in comparison with 2019, caregivers are feeling more depressed (43% vs. 37%) and experiencing more financial hardship (45% vs. 36%), and 73% (vs. 65% just last year) don’t know whether they can handle all their caregiving duties in the future. Losing their contributions would harm both the older adults who rely on them and the health care system.

Making home and community care accessible: Looking beyond the numbers

Care Watch recommends: 

• That province-wide standards for home and community care be established, monitored, and enforced, with consistent consequences and penalties for failing to meet those standards.
• That the results of consistent indicators and the performance of Ontario Health atHome be regularly and publicly reported.

• In addition to overall structures, home and community services depend on individual providers and agencies. We need to know how and why those providers are chosen.

Care Watch recommends that the process for selecting home and community service providers be: Based on clear selection criteria, and transparent and publicly accountable.

When contracts are awarded, non-profit providers deserve priority. They know the people in their communities and can provide sensitive and linguistically and culturally appropriate services. Their boards, which often include local officials and councillors, hold open meetings and issue public reports. These agencies, however, are currently under-represented in home and community care. Before 1995, for-profit corporations delivered only 18% of home and community services across Ontario. They now deliver nearly two-thirds of these services.

Care Watch recommends encouraging non-profit providers to bid on home and community care contracts by:

• Specifying that priority will be given to applicants that demonstrate they can meet high and measurable standards for quality of care and equitable staff compensation and benefits.
• Opening bidding first to non-profits, with for-profits eligible only if non-profits decline to bid.

Making home and community care accessible: Taking steps

In its announcement of the pre-budget consultations, government says it wants to hear from Ontarians on “the most pressing challenges of today.” The need for home and community services for an expanding population of older adults fits this description.

Care Watch has recommended that Ontario’s government add two investments to its 2025 budget: $241 million for home and community care and $144 million to increase and equalize compensation for the people who deliver this care.

The $385 million total – as a proportion of the total provincial budget – is relatively modest. However, what this investment can do – expanding services, compensating workers fairly, and choosing providers thoughtfully – can have large results for older Ontarians.