Health system integration update: modernizing the delivery of home and community care while maintaining stability of services

Today, consistent with the government’s plan to build a better, more connected health care system centered around the needs of patients, the Honourable Christine Elliott, Deputy Premier and Minister of Health, issued transfer orders under the Connecting Care Act, 2019, transferring the Trillium Gift of Life Network (TGLN) and non-patient care functions from the Local Health Integration Networks (LHINs) to Ontario Health. The transfers will take effect on April 1, 2021.

The government has committed to building an integrated, connected health care system centred around the needs of patients and improve overall health outcomes. A key part of this is the integration of multiple provincial health agencies and organizations into a single agency – Ontario Health – providing a central point of accountability and oversight for the health care system. Ontario Health has a critical role in working with health service providers who provide health services to Ontarians. Five provincial health agencies and one transfer payment organization have already transferred into Ontario Health.

Over the past year, we have seen more than ever how important it is for health service providers to work together as one integrated team to deliver high-quality care to patients all across our province. This is especially true of home and community care providers, whose tireless efforts not only support patients at home or in the community but also help to reduce the burden on our hospitals. Home and community care services have also played a critical role in supporting Ontario’s COVID-19 response. As we continue to move forward with these thoughtful, incremental changes to modernize home and community care, there will be no disruptions to patient care.

It is an important time to be working together to deliver better connected care for patients and families and improve home and community care as part of a fully integrated health care system.

Home and Community Care modernization and the role of Home and Community Care Support Services to ensure no disruption to patient care

On February 25, 2020, the government announced its plan to modernize the delivery of home and community care as part of an integrated health care system, through Ontario Health Teams. Ontario Health Teams will work together to understand a patient’s full health care history, directly connect them to the different types of care they need and help patients 24/7 in navigating the health care system. The strong partnerships and integrated care established by Ontario Health Teams and Ontario Health have helped Ontario’s health care system to quickly and effectively respond to COVID-19. This includes supporting long-term care homes, simplifying the purchase of personal protective equipment, helping establish assessment centres, launching virtual urgent care initiatives, and expanding remote patient monitoring programs to support COVID-19 patients and other vulnerable populations.

At the onset of the pandemic, the province paused the planned transfer of non-patient care LHIN functions to Ontario Health to ensure the stability of the health care system and to focus health care resources on responding to COVID-19. Ontario is now resuming this process in order to break down long-standing barriers and allow for the seamless coordination of services for patients.

Following the transfer, to ensure the ongoing stability of services while home and community care transitions into Ontario Health Teams, on April 1, 2021, LHINs will begin operating under a new business name, Home and Community Care Support Services, to reflect a singular mandate to deliver patient care. During the transition, patients and caregivers will continue to access home and community care services in the same way and use the same contacts.

Home and Community Care Support Services will provide a stable foundation for the modernization and transformation of home care and will support the gradual transition of home care services to Ontario Health Teams and other points of care over the coming years. Home and Community Care Support Services’ focus on direct service delivery will be separate from the role of Ontario Health, which will be assuming the LHINs’ non-patient care functions involving health system planning and funding.

LHIN employees who provide patient care will continue their important work within their respective LHIN organizations under the new business name. Home and Community Care Support Services organizations will continue to be Crown agencies funded through accountability agreements with the Ministry of Health. Home care contracts with service provider organizations will continue to be held and administered by the Home and Community Care Support Services organizations.

There will be no changes to how patients access home and community care or long-term care home placement services nor will there be changes to their contacts. Patients and caregivers can continue to access the home and community care services they need in the same way using the same contacts. To help promote continued patient familiarity with these services, Home and Community Care Support Services will maintain the same regional identifiers as existing LHINs (e.g., Erie St. Clair, Central, Champlain and North Simcoe Muskoka).

To promote a common approach to home and community care modernization across Ontario, Home and Community Care Support Services organizations will be governed by a common set of cross-appointed board members with a streamlined leadership team starting in Summer 2021. The membership of these boards will eventually be distinct from the board membership of Ontario Health.

To support a smooth transition and ensure operational continuity, in the immediate term after the April 1, 2021 transfer, the 14 LHIN boards will remain in place including their directors who are cross appointed to Ontario Health to provide governance and oversight for the interim home care organizations. It is anticipated that a new board will be established on July 1, 2021, and cross appointed to all 14 Home and Community Care Support Services corporations. Additional details about the leadership and governance for Home and Community Care Support Services will be provided at a later date.

Home and community care delivery through Ontario Health Teams will be built on the legislative infrastructure of the Connecting People to Home and Community Care Act, 2020. Once proclaimed into force, this legislation will break down long-standing barriers that have separated home care from primary care and other parts of the system and lay the groundwork for integrating home and community care delivery into Ontario Health Teams and other points of care. The government’s intention is that the new legislation will come into force once home and community care regulations are also ready.

Planning for the transition to Ontario Health Teams is a process that will unfold over the coming years. The Ministry of Health is working with Ontario Health Teams, Ontario Health and LHINs to support this transition. This work will be gradual and with the common goal of maintaining stability in care and in the sector while enabling more flexible, patient-centred models of care. Ontario will be winding down LHINs in a phased way as home and community care services are transitioned to Ontario Health Teams over time.

Ontario Health Teams (OHTs)

Currently, there are 42 Minister-approved Ontario Health Teams which, at maturity, will provide coverage to over 86% of Ontario’s population. The Ministry of Health has adjusted its intake and assessment process and is now focusing on supporting providers to come together in areas of the province that do not already have approved OHTs in place. Additionally, work is underway to help OHTs support underserved populations, including Francophone and Indigenous communities and providers. Eventually home and community care placement services will fall under the responsibility of the OHTs.

Trillium Gift of Life Network (TGLN)

Given the complexity of Ontario’s organ and tissue donation system, the transfer of TGLN was previously paused at the onset of the COVID-19 pandemic to ensure there would be no disruption to patients and families involved with organ and tissue donation and transplantation. TGLN will now be transferred in whole to Ontario Health on April 1, 2021. The objective is to support further integration, to enable greater cross-functional collaboration and to maintain clinical operating functions.

On April 1, 2021, after its transfer into Ontario Health, TGLN corporation will be dissolved, but services to patients and families involved with organ and tissue donation will continue uninterrupted. Continuity of executive leadership will support local health system response to the COVID-19 pandemic.

One health agency with one strategy and one set of priorities means that more resources can be invested into frontline care; patients will have more convenience and choice in accessing health results and information, and health care providers will be better supported with tools and information to deliver the right treatment at the right time and in the right setting. This is a 21st century approach to integrated health care that puts patients at the centre of Ontario’s health care system.