An article in a Globe and Mail series on innovation in health care delivery highlighted the potential of home visits from family physicians to helping people live independently in their own homes. This can both reduce overall system costs through avoiding or delaying institutionalization and significantly improve the quality of people’s lives.
But let’s think a little bigger. It is not just a question of getting doctors out of their offices, and very few do home visits. What is really needed is building a full continuum of care: multi-disciplinary teams of nurse practitioners, interpreters, dieticians, social workers, and other support workers; providing customized, flexible, responsive and culturally appropriate services; well-coordinated through local bodies such as Local Health Integration Networks and Community Care Access Centres and through a solid infrastructure of information sharing and electronic health records; founded on the best evidence of what works and on engaging with communities on what people want and need — all to create a seamless continuum of care. In addition, there are already many innovative and effective providers delivering home and community-based care and support. One ‘big idea’ is being developed: community health centres and other ‘hub’ type models now provide one-stop access to a range of coordinated health and social services. Why not also provide services out of these hubs into homes and community settings? The challenge is to pull all of this together into an integrated system meeting the full range of diverse communities’ needs.
This idea of building a comprehensive continuum of care that will keep people well, in addition to treating them when ill, was envisioned by the original founders as the vital Second Stage of Medicare. They also emphasized that this full continuum of services must be publically funded and accessible; as soon as key types of care are only available by privately paying, then many who need these services most will be excluded.