Not enough home care top concern for Ontario patients, study finds

The three biggest problems for patients surveyed about their discharge from Ontario hospitals all concern publicly funded home care, according to new research published in an international medical journal.

The researchers hope the findings will encourage improvements in the hospital-to-home transition navigated by some one million patients every year in this province.

The study involved more than 700 patients who had been admitted to Ontario hospitals over the previous three years. The researchers aimed to find out what affected the patients' experience during their discharge and transition to home.

Among 52 factors considered in the study, the single greatest concern was "not enough publicly funded home care services to meet the need." That issue was ranked number one issue consistently across geographic, age, gender and ethnic groups, the researchers determined.

Participants ranked home care support not being in place when returning from hospital as their number two concern, and the third-ranked priority was "having to advocate to get enough home care."

"We know that when patients are discharged home from hospital it can be a really tricky time for them," said Dr. Tara Kiran, lead researcher of the study, in an interview with CBC News.

"Our goal was really to understand from patients and caregivers themselves where we need to prioritize our improvement efforts," Kiran said. "We asked them to rate the top gaps in the system that we needed to improve, and the top three gaps all related to home care."

Kiran is a family physician in Toronto and an associate scientist with St. Michael's MAP Centre for Urban Health Solutions. She says she didn't expect the strength of concern about home care nor its consistency.

"The number of comments that we got about home care was overwhelming," said Kiran. When patients were asked to rate their biggest concerns for action, "these three priorities around home care rose to the top very clearly," she said.

The study is published in BMJ Quality & Safety, an offshoot of the prestigious British Medical Journal. The research was conducted in conjunction with Health Quality Ontario, a provincial agency that is now folded into the government's centralized system known as Ontario Health.

Kiran hopes it will help prompt the provincial government to consider expanding and enhancing home care.

"Ultimately, I think we need more investment in publicly funded home care," she said.

"Right now, medicare covers doctors and hospitals 100 per cent. We've had some good public conversations about whether as a society we want to move toward including pharmacare. I think we need to have some of those same conversations regarding home care."

Ontario Health Minister Christine Elliott calls the research important and says it confirms things the health ministry already knows about how difficult transitions home can be for patients and how they sometimes don't receive adequate and effective home care.

"This is something that we take very seriously," Elliott said Monday in an interview with CBC News.

"Very often people feel that once they leave the hospital that they're disconnected from the entire health care system. It shouldn't be that way."

The Ford government increased annual home care funding by $155 million last year. It has also launched a reform of how the health system is organized, creating local Ontario Health Teams that bring hospitals and home care agencies together under a single umbrella.

Those teams "will know where the gaps in services are and will be able to fill them," said Elliott. "I feel very confident that we will see people's satisfaction in our home care services increase in the next year."

The creation of the Ontario Health Teams marks a big change from how home care was coordinated previously in this province, and provides an opportunity for addressing the issues raised by the study, said Kiran.

"I think they can use our findings to really prioritize what it is that they're working on," she said.

The research suggests hospitals can take actions to improve patients' experiences in recovering at home, including giving them a specific number to call when they have post-discharge issues.