Policy and Political Action

Policy & Political Action

Home and Community Care Review Expert Group


The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses (RNs), nurse practitioners (NPs) and nursing students in all roles and sectors within Ontario. Our mandate is to foster knowledge-based nursing practice, promote quality work environments, deliver excellence in professional development, and advance healthy public policy. We promote the full participation of present and future RNs and NPs in improving health, and shaping and delivering health-care services. With this mandate in mind, we are pleased to provide this submission to the Ministry of Health and Long-Term Care’s Home and Community Care Review Expert Group.

There is general agreement that Ontario’s health system is not being optimized in its present form. Although planners may have had the best intentions, too much emphasis has been placed on hospital care. The outcomes of these policy decisions include soaring health-care costs and sub-optimal patient outcomes. RNAO believes in the sustainability of a single-tiered publicly-funded and not-for-profit delivery system. To optimize our health system and improve its outcomes, especially in the face of a growing and aging population, we must shift the emphasis from the institutional setting to the community. Moreover, it is the view of RNAO that the future strength of Ontario’s health-care system depends on how primary care is positioned. We believe that primary care must serve as the anchor of the system.

Recognizing the need for transformative change in Ontario’s health-care system, RNAO developed and launched its Enhancing Community Care for Ontarians (ECCO) model. The model was first introduced in 2012 and updated in 2014 with an expanded white paper that includes more operational details. From its origin, ECCO has included the contributions of stakeholders and was recognized by health policy experts as a “health-care innovation whose time has come.”

RNAO has chosen to apply a systems approach in responding to this consultation, as it is impossible to achieve substantial change in the community sector in isolation of broader system reform. RNAO recognizes that the panel has posed several questions to stakeholders to facilitate consultation. Our submission is an attempt to answer these questions in a comprehensive manner, however, a summary of the submission can be found in Appendix A.

Topics covered

Limitations of Current Health-Care System
Opportunities for Innovation

Proposed Outcomes:

The proposed outcomes of the solutions being brought forward are plenty. Key evidence-informed outcomes include:

  • Decreased prevalence of illness and delay of chronic conditions and their complications
  • Improved access to timely and evidence-informed care
  • Effective and comprehensive care co-ordination
  • Improved health outcomes
  • Controlled health-care costs, including the reinvestment of nearly $200M CCAC administrative expenditures into direct hours of home health-care delivery
  • System integration

The extent to which these outcomes are achieved depends on bold and visionary leadership, along with agreement of the need for health-care system transformation. Government commitment and leadership are critical and must be expressed through the Legislature of Ontario, Ministry of Health and Long-Term and Local Health Integration Networks. Secondly, health-care system stakeholders must attempt to set aside politics and view the system objectively from a person-centred perspective. Finally, the success of any transformation strategies will be based upon the degree to which primary care is embraced as the foundation of the health-care system. Efforts to make these needed improvements will be stalled unless there is a shift from an institutional and illness focus, to a community and health focus.


RNAO is pleased to offer the following recommendations to the Home and Community Care Review Expert Group:

  1. Adopt solutions that expand a single-tiered, publicly-funded and not-for-profit health-care system, including the rejection of proposals for co-payments, user-fees, income-based means testing and increased presence of for-profit delivery in home health-care.
  2. Develop a health system that is rooted in primary care and places a high focus on health promotion, illness prevention, chronic disease prevention and management, and mental health.
  3. Enable person-centred care through transparent and evidence-based population health planning and funding across sectors led by LHINs.
  4. Ensure the Excellent Care for All Act applies to all sectors and health professionals, thus creating an expectation for evidence-informed care.
  5. Devolve the functions of CCACs to existing areas of this health system. This includes transitioning the care co-ordination functions and workforce (with their salary and benefits intact) to primary care.
  6. Remove CCAC as a structural entity following the devolution of its functions to the LHINs and to primary care.
  7. Enable the primary care regulated workforce to embrace their full scope of practice, including providing comprehensive care co-ordination and RN prescribing, as well as full utilization of NPs in all primary care models and sectors.
  8. Stabilize funding models within home health-care by adopting sufficiently resourced pathways that are: evidence and outcome-based, support front-line clinical autonomy and developed in consultation with home health-care providers.
  9. Secure compensation and benefit equity between the acute care sector and the primary care/home health-care sectors for RNs, NPs and Registered Practical Nurses (RPNs).

Get the full submission with appendices and references below.

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