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Excellent Care for All

Home at Last (HAL) – Back to the Basics

Health Care Challenge

Across Ontario, nearly one in five seniors stay in the acute care ward of a hospital because they do not have access to the appropriate care necessary to return home. These people are no longer in need of the care provided at a hospital and could be more appropriately served in the community. However, these patients lack the appropriate supports to transport them home safely with the care they need.

“Given the right supports, most of our elderly and frail clients would choose to be at home,” said Brent Farr, Executive Director, Community Care Durham and Sponsor of the Central East LHIN’s Home at Last Program. “The hospital is not the right place for these patients – we know from the evidence that elderly and frail patients lose five per cent of their functioning for each day they spend in a hospital bed and our hospital partners need those beds to treat people with more acute health needs.”

Real Change In Action

Home at Last, a model now in place across the province, is an innovative partnership between hospitals and community support service agencies. It is a time limited service to transition hospital patients home safely, smoothly, and comfortably following an emergency department visit or hospital stay. The main focus is to get the patients home on discharge day and settled in; then to make the connections, if requested, to other community services to link the client permanently to longer term supports. The program ensures that patients need not feel vulnerable and alone after their hospital stay, but instead have the support they need.

When the patient is discharged, transportation arrives along with a Home At Last worker, who rides home with the patient or meets the patient at home, then gets the client settled in, makes a meal or snack, and stays until family arrives or until a set time. The worker may fill the necessary prescriptions, and buy groceries. To ensure that clients are safe and thriving in the home environment, the Home at Last care coordinator will follow-up the next day to see how the client is and discuss if longer-term support services can be set up.

Better Quality Care

“With the implementation of Home at Last programs, seniors can be supported to return home in a timely manner and, in turn, this helps to free up beds for the people who need hospital care  more urgently,” said Farr. “It’s safer for the clients and it’s a more efficient use of hospital resources.”

The Home at Last Program is an excellent example of patient-centred and integrated care for our growing senior population. There are 13 Home At Last programs now in place across Ontario, and more than 16,127 seniors have been served by the program.

Learn more about Home at Last.

For More Information

Call ServiceOntario, Infoline at 1-866-532-3161
In Toronto, 416-314-5518
TTY 1-800-387-5559
In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm