Operational Direction: Home First

Ensuring patients across Ontario receive the right care, in the right place at the right time remains of paramount importance. We thank you and your teams for the work you do every day to support Ontarians by providing compassionate and dignified care to thousands of people across our provincial health care system every day.

It is critical that we continue to focus effort on reducing the number of patients in hospital designated as alternate level of care (ALC), particularly given rising demand for long-term care (LTC) and the seasonal surge in respiratory illnesses anticipated this fall. As such, we are leading a province-wide effort to enhance ALC throughput and reduce ALC volumes by 10% by the end of September 2024.

Across the province there are more than 5,000 people with an ALC designation waiting in hospital beds, with approximately 46% waiting for LTC. Fifty percent of older adults experience functional decline and increased dependency during prolonged hospitalization. To optimize patient outcomes and system capacity it is imperative that we shift away from an “LTC-first approach.”

Home First is an approach whereby every effort is made to ensure adequate resources are in place to support patients to remain at home whenever possible, and ultimately return home upon discharge from all bedded levels of care (i.e., acute, rehab, complex continuing care, mental health).

This operational direction is intended to provide sectors with specific actions and approaches that will support patient flow and overall system efficiency, with a focus on supporting patients at home and returning patients home with the appropriate supports. This direction highlights and builds on key elements from The Transitions Between Hospital and Home Quality Standards ^(QS) and The Alternate Level of Care (ALC) Leading Practices Guide: Preventing Hospitalization and Extended Stays for Older Adults ^{(ALC LP)} that support and reinforce the implementation of the Home First approach.

Ontario Health regional teams will continue to work closely with your teams to identify strategies to address gaps based on your local context and support you with the implementation of these directives in advance of the anticipated fall/winter surge and respiratory season.

Thank you for all that you are doing to provide care for the people of Ontario.

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