Ontario quietly introduces $700-a-day home care to relieve hospital overcrowding

Ontario is launching an initiative to reduce hospital occupancy. (File image: Thirdman via Pexels)

Dr. Amina Jabbar sees the crisis every day in her seniors’ internal medicine unit just outside Toronto.

“You know, at the beginning of fall… we’ve got a 30 per cent rate of patients who just can’t go home, can’t leave the unit,” she said. In the Trillium Health Partners hospital where she works, that means there’s no room for incoming patients — a problem now replicated across Ontario hospitals.

Government figures show nearly 5,000 patients in Ontario are stuck in hospitals. Labelled ALC (alternate level of care) patients, half of them are waiting for long-term-care beds, rehab beds or mental care and addictions facility beds, that are not opening fast enough.

Against this backdrop, Ontario home-care agency Ontario Health at Home is quietly launching what it calls “High-Intensity Bundled Home Care,” an initiative that will offer home care agencies up to $700 per day -care agencies to deliver hospital-level services directly in a patient’s home. The program is targeting at least 570 seniors or patients waiting for long term care, along with others waiting for mental health or addiction support or rehabilitation.

In documents obtained by CTV News, the goal is to start moving them into the community by Dec. 8, freeing up beds before the winter season.

Program funding levels

Under the program, home-care agencies will receive a flat-fee payment to provide intensive services for each patient discharged from hospital:

• $1,500 per week for patients with at-home mental health or addictions support needs; and
• $5,000 per week (about $700 a day) for high-needs seniors or complex patients.

The budget is to co-ordinate and cover all services including personal support workers, occupational and physiotherapists, medications, medical supplies and equipment and meals. Twenty-four-hour on-call coverage is required along with transport to and from medical appointments.

Rapid rollout

Internal documents indicate Phase 1 targets about 570 high-needs seniors, many requiring two-person lifts, 24-hour supervision, or dementia support. The goal: move 100 per cent of them home in December and ensure they are well cared for, so that they don’t return to emergency departments or require hospital admissions.

“They’re talking about the heaviest of heavy-care clients,” said one health-care worker familiar with the proposal, who spoke to CTV News on condition of anonymity. “These are people who need two-person lifts, constant supervision, and 24-hour support. It’s ambitious — maybe too ambitious — to launch this quickly.”

Staffing remains the biggest question mark.

“It looks good on paper, and I wish them well,” said Dr. Alan Drummond, an emergency physician in Perth, Ont. “But knowing that staffing shortages are affecting every part of the health-care system, where are these quality workers going to come from?”

Vivian Stamatopoulos, a researcher and an advocate for better long-term care in Ontario, agrees that the sector is already stretched thin.

“I hear from home-care recipients all the time that it is very difficult to find workers, there are missed appointments… and of course the safety issues that come with that,” she said.

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The economics behind the plan

Dr. Samir Sinha, a geriatrician at Mount Sinai and Director of Health Policy Research for the National Institute on Ageing, says the province is offering what amounts to hospital-level funding to home-care agencies.

“If you offered me (over $700) a day as a service provider, I could almost provide 24-hour care. This is a lot of money — basically hospital rates — to keep a patient at home.”

According to the Ministry of Health, it costs Ontario taxpayers:

• $730 per day to house in-hospital ALC patients
• $201 per day to care for them in a LTC home.
• $103 per day to provide home care to clients with the most complex needs who have the equivalent needs of an LTC resident .

Moving all 570 high-needs LTC-waiting patients, as indicated in the report, into high-intensity home care would cost $11.4 million per month, with no specified time limit.

Sinha said the government’s plan should also be viewed against the backdrop of soaring infrastructure costs.

“We’re facing a massive cost to build new long-term-care homes. The plan is to redevelop 60,000 beds by 2028, but we’re still far from that goal,” he said.

He pointed CTV News to a proposal from 2020 from his institute that proposed similar intensive home care in 2020 at a cost of just under $200 a day.

“Right now, it’s more of a reactionary approach — and a very expensive one,” said Sinha. “If we made better investments overall in home care, we could avoid much of this high-cost solution.”

Hospital overcrowding nearing a breaking point

Ontario hospitals are heading into the winter surge of flu, RSV and COVID-19 with occupancy already stretched. Some hospitals report 15–20 per cent of beds are occupied by ALC patients; at some rural sites, it’s up to 40 per cent. This leads to new patients who need to be admitted waiting in the emergency units for hours, sometimes days.

Drummond admits that any measure that frees inpatient beds is urgently needed.

“Anything that clears up beds is a good thing,” he told CTV News.

To clinicians like Jabbar, the initiative is welcome, but she said she’s skeptical. Pointing to larger, long-term problems that have underfunded home care, she said, “It’s a band-aid on a gaping wound.”

Provincial NDP Opposition Leader Marit Stiles echoed those concerns at Queen’s Park.

“The province has tried versions of this before,“ Stiles said, referring to a novel contract for home care medical supplies in 2024 that led to a critical shortage of medical supplies.

“People went without catheters, we’ve all heard those nightmare stories. So I have some very deep concerns.”

The timeline to approve service providers is also tight – with submissions required by Nov. 20 and with contracts to be awarded Nov. 27 according to the documents obtained by CTV.

Regions with the highest ALC pressure, which will be the first to receive the program, are:

• Toronto Central;
• Mississauga Halton; and
• parts of central, eastern, and northern Ontario.

Ontario currently has about 650 accredited home care organizations that could provide care, though only a few – including Bayshore Home Health, Care Partners, and Paramed (owned by Extendicare) – have the infrastructure to deliver care province-wide.