Most older Ontarians say the same thing: if it’s possible, they want to grow old in their own homes. National polling consistently shows ~9 in 10 Canadians 45+ prefer in-home care over moving to long-term care, and 95% agree aging in place preserves independence, comfort, and dignity.^[1]

This concluding post pulls together the themes from Parts 1 to 3 of my Mature Matters Blog Series – system reforms, tenants’ rights, and COVID-era accountability – into the less visible terrain of home and community care: who can get it, under what terms, what protections exist, and where the gaps remain.

While Ontario legislation does not promise that every person will receive home care, it legally defines what “home and community care services” are; protects clients through a Bill of Rights; provides recourse through complaints and tribunal appeals; and empowers the government to enforce compliance.

Ontario’s Home & Community Care Law: The Short Version

For decades, home care ran under the Home Care and Community Services Act, 1994, S.O. 1994, c. 26, and was delivered regionally first by Community Care Access Centres^[2], then Local Health Integration Networks^[3]. Under this structure, most service standards and eligibility criteria were set by policy rather than statute, resulting in significant regional variation and limited legal recourse for clients.

In 2020, Ontario passed Bill 175, Connecting People to Home and Community Care Act, 2020, S.O. 2020, c.13 to modernize the framework by building home-care rules into the Connecting Care Act, 2019, S.O. 2019, c. 5, Sched. 1 (“CCA”).

On May 1, 2022, the 1994 statute and its regulations were repealed and the new regime within the CCA came into force, supported by O. Reg. 187/22, Home and Community Care Services (“O. Reg. 187/22”). The rules formerly set out under the 1994 statute have been consolidated within the CCA and O. Reg. 187/22, creating a single, province-wide legislative framework that replaces region-by-region policy with uniform, rights-based standards and centralized oversight.

The New Model

Home-care standards and client rights are now defined in statute and regulation, creating a consistent, enforceable system governed by Ontario Health rather than 14 separate regional bodies.

Key elements of the new model include:

• Defined Service Categories – The law now expressly defines which services fall within Ontario’s publicly funded home- and community-care system.^[4] They are:

1. 1. Professional services – Including nursing, physiotherapy, occupational therapy, speech-language pathology, dietetics, and social work.
   2. Personal support services – Assistance with personal hygiene, dressing, ambulation, toileting, feeding, and routine activities of daily living.
   3. Homemaking services – Meal preparation, light cleaning, laundry, and other domestic tasks necessary to maintain a safe home environment.
   4. Community support services – Programs such as adult day services, meal delivery, transportation, respite and caregiver relief, palliative and bereavement supports.
   5. Indigenous services – Indigenous healing and wellness programs designed and delivered by or in partnership with Indigenous communities, ensuring culturally safe and community-driven care.
   6. Care co-ordination services – The assessment of client needs, development of individualized care plans, and ongoing monitoring, case management, and system navigation.
   7. Home and community care services that include residential accommodation – Supportive living or congregate care settings (for example, assisted living programs) where both accommodation and care are integrated.

By explicitly enumerating these categories, the regulation provides a clear baseline of what services clients may request and what providers are funded and obligated to deliver, reducing discretionary or regional differences.

• Client Bill of Rights – O. Reg. 187/22 codifies a Home and Community Care Bill of Rights that applies to every person receiving services under the Act.^[5]  It guarantees, among other things, the right:

• • To be treated with dignity and respect;
  • To receive care free from abuse or discrimination;
  • To participate in assessments and in the development, evaluation, and revision of their plan of care;
  • To receive information about their home and community care services; and
  • To give or refuse consent to any service.

These provisions align with the Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A and the Human Rights Code, R.S.O. 1990, c. H.19, embedding person-centred and consent-based values directly into the home-care regime. Providers must post the Bill of Rights prominently and ensure all staff and contractors are trained on its content.

• Complaints & Appeals – Every funded provider and Ontario Health Team must maintain a documented, transparent complaints process. Clients may file complaints about any aspect of service delivery, quality, or staff conduct, and providers must respond within defined timelines.^[6]

Where a client is found ineligible, has services reduced or discontinued, or disagrees with an assessment or plan of care, they may escalate the matter to the Health Services Appeal and Review Board (HSARB). The HSARB, an independent adjudicative tribunal established under the Health Insurance Act and empowered by the CCA, can confirm, vary, or rescind the service decision and may direct that services be provided, continued, or increased. This creates a meaningful, quasi-judicial avenue of review that did not previously exist under the policy-based framework.^[7]

• Accountability & Oversight – Responsibility for system-wide performance now rests with Ontario Health, which integrates home care within the broader continuum of hospitals, primary care, and community agencies. Ontario Health:

• • Allocates funding and enters into accountability agreements with Ontario Health Teams and service providers^[8];
  • Monitors compliance with the CCA and regulations through investigators and audits^[9]; and
  • Can issue compliance orders or recommend ministerial directives or supervision where client safety or systemic failure is at risk^[10].

Investigators appointed under the CCA have statutory authority to enter premises, examine records, and interview staff or clients to ensure compliance.^[11] This framework gives the home-care system real enforcement power, something notably absent under the earlier regional model.

Together, these measures move home care from a discretionary, policy-based program to a rights-based, legislated service model governed by uniform duties, transparent processes, and centralized accountability.

The Stakes: Demand, Risk & Unmet Need

Ontario’s population is aging faster than any point in its history. The proportion of residents aged 65 and over will nearly double by 2046, while the number of those 75+ – the group most reliant on home care – will more than double by 2051.^[12]

Yet more than 475,000 Canadians currently report unmet home-care needs, and Ontario’s system remains constrained by workforce shortages and regional inequities.
The challenge is clear: without robust legal and operational enforcement, the promise of “aging in place” risks becoming aspirational rather than attainable.^[13]

What It Takes to Age at Home: Legally & Practically

Aging at home isn’t just about passing new laws. It’s about whether those laws translate into real, reliable care. Ontario’s new framework puts the pieces in place, but making it work depends on how they come together in practice.

1. Comprehensive, appropriate services

Real “aging in place” means the full mix: personal support hours that actually meet daily needs, nursing and rehab care that prevent hospital readmissions, and community supports like meals, transportation, and culturally safe or Indigenous programs. The legal categories now exist, the challenge is resourcing them so people can build real care plans, not patchwork schedules.

2. Continuity and responsiveness

Home care must evolve as people do. When needs change, the system should adapt, not stop, wait, or reset. True continuity means clients and families co-creating care plans that shift naturally with health, mobility, and circumstance, rather than restarting from scratch after every reassessment.

3. Rights with recourse

A Bill of Rights only matters if people can use it. The promise of complaints and appeals isn’t about bureaucracy; it’s about fairness and accountability when services are cut or delayed. For older adults, the ability to challenge a decision can make the difference between staying home safely and entering care prematurely.

4. Public accountability

Oversight isn’t punitive, it’s protective. When inspectors, compliance orders, and sanctions exist, they remind everyone in the system that home care is a public responsibility, not a favour. Legal “teeth” reinforce trust: that care standards mean something, and that failure has consequences.

5. Awareness and equity

Rights are only as strong as people’s ability to claim them. Even with modernized rules, success depends on outreach, staffing, and equitable access, especially in rural, northern, and underserved communities. For many families, navigating the system still requires persistence, advocacy, and sometimes, luck. Awareness, not just legislation, is what makes home care real.

Final Thoughts

Aging at home is more than a preference, it’s a structural challenge that law must underwrite. Ontario’s modernized framework, the CCA and O. Reg. 187/22, now names the services, protects client rights, mandates complaints/appeals, and backs it all with enforcement. The remaining work is about capacity and clarity: making sure every senior and caregiver knows these rights, that providers meet them consistently, and that oversight bodies act when they don’t. If Ontario gets that right, “aging in place” moves from aspiration to lived, lawful reality.

Closing the Circle — From Institutions to Independence

Over this series, we have traced Ontario’s evolving elder-care landscape:

• Part 1 examined the Support for Seniors and Caregivers Act, 2025 and the modernization of care governance;
• Part 2 clarified the housing and tenancy rights of seniors in care homes;
• Part 3 analyzed the post-COVID accountability regime; and
• Part 4, here, anchors the discussion in the right to care at home, where most Ontarians wish to remain.

Together, these developments reveal a common thread: a move toward dignity, autonomy, and legal enforceability across every setting of aging. Ontario’s new home-care framework extends that promise beyond institutions and into the community, affirming that safety, respect, and recourse belong wherever a person calls home.

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[1] Ipsos, “Nearly All Canadians 45+ Years Want to Age at Home, But Only 1 in 10 (12%) Say They Can Afford the Cost of a Personal Support Worker” (19 May 2022) online: <Nearly All Canadians 45+ Years Want to Age at Home, But Only 1 in 10 (12%) Say They Can Afford the Cost of a Personal Support Worker | Ipsos>.

[2] Regional agencies established under the Home Care and Community Services Act, 1994 to coordinate and deliver publicly funded home and community care and long-term care placement services.

[3] Crown agencies that replaced Community Care Access Centres in 2017 under the Patients First Act, 2016, S.O. 2016, c. 30 – Bill 41, assuming responsibility for planning and coordinating home and community care services until their functions were transitioned to Ontario Health in 2021 under the new regime.

[4] O. Reg. 187/22, at s. 1.

[5] Ibid at s. 9(1).

[6] CCA, at s. 43.10.

[7] O. Reg. 187/22, at ss. 30, 31.

[8] CCA, at s. 22.

[9] Ibid at ss. 24, 26.

[10] Ibid at ss. 20, 43(5).

[11] Ibid at s. 26(6).

[12] Ontario, “Ontario population projections” (updated 01 August 2025) online: <https://www.ontario.ca/page/ontario-population-projections>; Ontario, “Ontario’s Long-Term Report on the Economy” (2020) online: <https://eapon.ca/wp-content/uploads/2021/09/Ontario-long-term-report-book-2020-06-03-en.pdf>.

[13] Arthur Sweetman, PhD, “The Impact of Ontario’s Aging Population on the Home Care Sector” (February 2024) online: <KraljSweetman-Home-Care-Ontario-Report-06Feb2024.pdf>.