March 24, 2025

TO: Matthew Anderson, President and CEO, Ontario Health

Dear Mr. Anderson:

In August 2024, Ontario Health issued its Operational Direction: Home First to the CEOs of Ontario hospitals, Ontario Health atHome, and community support and mental health service providers. The goal was to decrease the number of hospital alternative level of care (ALC) patients by establishing a system of assessment, care planning, and services for care at home. The timeline was ambitious – a 10% decrease in ALC volumes by the end of September.

Care Watch viewed this direction with great interest. We are a non-profit, non-partisan volunteer organization that promotes home and community care for older adults, so we welcomed an emphasis on non-institutional care. Now, seven months later, we are asking about results. Specifically:

• Has the Operational Direction: Home First been adopted and carried out?
• What funding was provided to implement it? How is this funding being used?
• By how much has the number of hospital ALC patients decreased? How many of these patients have returned to their homes rather than to institutions?
• How many of the patients who have been discharged home under ‘Home First’ policies continue to live safely at home with the level of supports they are receiving? How many have had to return to emergency rooms (either in the hospital from which they were discharged or in another hospital) after so-called “failed discharges”?
• Are hospital patients first in line for home care? Anecdotal reports indicate that people are being advised to go to an emergency department so they can gain priority for home care. How are hospitals, Ontario Heath, and Ontario Health atHome tracking and reporting these visits?
• Have the services of scarce personal support workers gone mainly to patients coming from hospitals at the expense of clients living in the community and waiting for home care?

We look forward to your response and would be happy to speak with you at any time.

Sincerely,

John Bagnall and Fiona Green, Co-chairs, Board of Directors

cc: Susan deRyk, Chief Regional Officer, Central and West Regions; Scott Ovenden, Chief Regional Officer, Toronto and East Regions; Brian Ktytor, Chief Regional Officer, North West and North East Regions; Anna Greenberg, Interim CEO, Ontario Health atHome