Senior Toronto blog

As we become older and need more support, most of us hope that we can age in place. That probably means that we are likely to need home care. It’s what most of us want, and it helps ease the pressure on hospitals and long term care. But years of underfunding and political tinkering have left home care in tatters. Denial of service, missed home visits, insufficient staff, poorly paid staff, service reductions and cancellations, lack of transparency about who qualifies for what service and for how long, unequal availability of and access to services from one region to another, lack of public reporting about quality of care, care outcomes and system performance – the list goes on and on. Bill 135, the Convenient Care at Home Act, which went into force on June 28, 2024, is the Ontario government’s latest effort to restructure home care. Will it fix this ailing service?

Home care used to be coordinated by 14 organizations called Home and Community Care Support Services, formerly Community Care Access Centres, formerly Local Health Integration Networks. Under the new legislation, these have all been dissolved and replaced by a single corporation, a crown agency called Ontario Health atHome that is responsible for all home care services across the province. They will do this through new entities called Ontario Health Teams, 58 groups comprising for-profit and not-for-profit health care providers including hospitals, doctors, and home and community care agencies. The teams will be responsible for coordinating and providing home care services to people in their local communities. These teams are still being formed. Once they are all up and running, the role of Ontario Health atHome will focus on providing designated Ontario Health Teams and/or other client providers with back-office and care coordination supports, including by assigning care coordinators to work under the direction of client providers. Under this new structure, patients should be able to move seamlessly from one form of service to another, and from one region to another.

But dig around a little, and you start to spot some red flags. Ontario Health atHome is governed by a Board of Directors, all appointed by the Minister of Health. There are no provisions for public meetings of the Board, public notice, public access to Minutes and documents nor any other democratic provisions. There are provisions for audits and reporting to Ontario Health, but not to the public. There is no legally required process for the internal governance, oversight, operations and legal liabilities or other responsibilities of Ontario Health Teams. Bill 135 does not require any standards of transparency, oversight and public accountability for Ontario Health Teams, other than reporting to Ontario Health atHome which itself is also not subject to any such standards. The key functions of care coordination and patient placement, which have always been administered publicly, are now contracted out to the provider agencies. Bill 135 repeals significant clauses in existing legislation that protected clients’ and the public’s interests in home and community care, including the Bill of Rights and complaint processes. These have been replaced by a Patient, Family and Caregiver Declaration of Values for Ontario, an aspirational document with no force in law.

With so little accountability and oversight, the new system primarily creates an environment hospitable to for-profit companies. But here's the problem with privatization in home care: the need to generate profit creates a huge new expense. In a service sector like home care, there aren't many ways to generate that profit. It has to come from cutting back on service and keeping wages low. For-profit service providers will be tempted to cherry-pick patients with simple, short-term needs, and limit access to care for patients with more complex, longer-term problems. There is a conflict between the need of private companies to produce a profit, and the need for patients to receive appropriate, quality care.

So who benefits from this restructuring of home care? Here’s a hint: it’s not us.

I’ve been working out regularly for years. Every morning before breakfast, I followed a twenty-to-thirty minute aerobics video for seniors, doing a different one every day. And in the afternoon, I would do a twenty-minute walk. I thought I was meeting the standard guidelines: 150 minutes of at least moderate activity per week, or 30 minutes five times a week. So I was a bit surprised when I got diagnosed with a heart condition not long ago. I was even more surprised when the cardiologist reviewed my stress test results and told me my cardiac fitness was weak. He whisked me off to cardiac rehab, where I soon learned that my exercise routine was all wrong. Really, I was just being an idiot, it’s all there if you look for detailed guidelines and read them carefully. But hardly any of the seniors I know are getting it right either, so I’m going to lay it all out for you.

What kind of exercise builds heart strength and endurance? It’s an activity that boosts your heart rate above resting level and keeps it there the whole time you’re exercising. You can’t stop, slow down, or change to a different exercise. Activities you could choose include brisk walking, cycling, swimming, or using an exercise bike or elliptical. To do this, you could go to a gym, invest in some home equipment, or, like me, just do the bargain-basement version: brisk walking in small circuits in the house: living room, dining room, hall, a thousand times over. How long do you do it? Ideally, you work your way up to twenty minutes at a time, plus five minutes to warm up and five to cool down, at least five times a week. How hard should you work? On a perceived exertion scale of 1 to 20, you want to feel you’ve reached 12 to 13, a bit hard to somewhat hard; you’re breathing deeply and starting to sweat. But if you’re like me and find it easy to lie to yourself about how hard you’re working, you need a more objective measure. Calculate your maximum heart rate: 220 minus your age. Your target heart rate should be 50% - 80% of your maximum heart rate for a moderate intensity workout, or 70% - 85% for a vigorous intensity workout. Ranges vary by age, so you might want to check this chart. Then get an inexpensive activity tracker that captures your heart rate and wear it on your wrist while you exercise. Of course, if you have a heart condition, don’t figure out your target heart rate on your own; consult your doctor. And to round out your exercise routine, add in some resistance training two or three times a week.

So what about fitness videos? Most of them aren’t ideal for building endurance. They keep changing movements, so it’s hard to keep your heart rate in the target zone. I still do them, but I see them as serving a different purpose now. They help me get going in the morning. They warm me up, loosen my muscles and bones, and get my heart going a bit. That’s all fine, but don’t depend on fitness videos to strengthen your heart. Follow those guidelines. Your heart will thank you.