Scaling Home Care in Canada: Lessons From Leading $225M+ Portfolios

Scaling Home Care in Canada: Lessons From Leading $225M+ Portfolios

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Hello and welcome to Caresmartz360 On Air. I’m Erin Cahill, Senior Account Executive at CareSmartz360. Home care in Canada is at an interesting point. Demand is at its peak, the workforce is under pressure, and care providers are being asked to do more than their daily bandwidth allows. Plus, both agencies and agency owners are navigating complex terrains. Our guest for this podcast has spent more than 20 years working through those challenges. Devon Mymko is an enterprise healthcare builder with

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experience across care, community, and broader healthcare systems. He has led large-scale portfolios within multibillion-dollar organizations as well as worked with smaller providers who need to stabilize, power, or rethink the systems they are currently operating in. A big part of Devon’s system has been turning ideas into systems that can function at scale. He has led care transformation projects, supported provincial-level redesign, built new models of care, and worked closely with the government to move those initiatives

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forward. This experience gives him practical, hands-on expertise in where home care is headed and how well it will fare in the near future. In this episode of the CareSmartz360 podcast, we talk about the changes Devon has seen across the care sector, the challenges care providers need to address, and what it will take to build and retain a strong workforce. The podcast also discusses technology, the role of AI in home care, and the impact of policies on Canadian home care systems. Welcome to the podcast, Devon.

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>> Thank you for having me. >> So, we’ll jump right into the first question that I have for you, you’ve worked across provider operations, provincial health and systems, workforce strategy, and healthcare transformation. What are the biggest changes you’ve seen in Canadian home and community care over the past 20 years? I think 20 years ago, home care was much more focused on personal support, basic nursing, chronic care, task like housekeeping, bulk meal prep. Today we are delivering much more complex care at

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home. So wound care, IV therapy, palliative care, rehab, post-acute care, remote monitoring, complex chronic disease management. uh think of a recent example in Ontario is home hemodialysis. So patients who historically would have needed repeated trips to a hospital or a dialysis center can now you know when it’s clinically appropriate receive hemodialysis or peritoneal dialysis at home. So I think to me that really illustrates one of the biggest changes in the last 20 years is the clinical complexity of what we can

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safely deliver in somebody’s home. uh that that’s increased dramatically. Um the structure on the government side has also changed dramatically. I think about provinces like Ontario probably the clearest example. Um I think of the government structures we’ve gone from CCAC’s to HCCSS but now we have what’s called Ontario Health at home. So we’ve kind of broken up the province into you know 30 40 plus uh regions and at the same time Ontario health teams are trying to integrate

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hospitals primary care home care and community services around the patient rather than having every sector operate separately. So there’s been enormous structural change in how home care is organized and integrated and I think hospital to home is a recent example where we’re discharging patients essentially straight from hospital uh to home and they’re retaining hospital-like services in the home as opposed to traditional um home supports. So that can be, you know, a bundled program of

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therapy and rehab, nursing, uh, home support with a primary care physician, uh, closely integrated to that. So funding has evolved, not necessarily as far as I would have expected to be honest. So I talked about the move toward bundled care. So we were expecting that years ago and that that has happened. So again, bundled care means instead of, you know, each individual provider being funded separately for an individual piece, um it’s more around like a broader episode of care with the providers actually

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coordinating across the home setting. So Ontario was piloting bundled hospital and home care models back in 2015. Um we also expected back then uh was a move to fairly quickly to outcome based funding. Um now there are some outcome based pathways today but we still spend a lot of time paying for and measuring visits, hours, service volumes, fill rates and efficiency. So, you know, as a leader in the field, I definitely thought we’d be much further along paying for what actually happened to the patient

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by now. So, you know, have they remained independent? Um, did their function improve? Have they avoided ED visits or hospitalizations? You know, did we delay or prevent an unnecessary LTC placement? So, I I really did expect bundled care to be the bridge toward true outcome based funding. uh we we haven’t quite gotten there yet today. >> Right. And what are the most urgent challenges facing Canadian home care providers today that you think and which of them are not getting enough attention?

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>> We don’t have enough capacity at home for sure. So governments want shorter hospital stays, fewer ALC patients, fewer unnecessary ED visits, and more people remaining independent at the home. But none of that works if nursing, PSW, and HCA rehabilitation, community supports aren’t actually available when a patient needs them. So, if we truly want people to age at home, um, you know, we need enough funded capacity to actually make that possible. >> Yeah, absolutely. And as demand for care

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at home continues to grow, as we know it will, how can providers scale services without compromising quality, continuity, or the client experience? >> So, can you pause it for a sec? >> Yeah, of course. >> Right. Um, >> sorry. Sorry. >> So, what are the most urgent challenges facing Canadian home care providers today and which of them are not getting enough attention? Uh well, we don’t have enough capacity in the home. So, governments want shorter hospital stays,

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fewer ALC patients, fewer unnecessary trips to the emergency department, and more people remaining independent at home. None of that really works if nursing, you know, personal support workers, home care attendants, uh rehab and community supports aren’t actually available when the patient needs them. So if we truly want people to age at home, we need enough funding capacity to make that happen. Uh you know, we spend enormous amounts of money once somebody is already in the hospital. So I really

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firmly believe that we need to put more emphasis on preventing people from getting there unnecessarily in the first place. So that means you know investing in home care, chronic disease management, rehab, falls prevention, caregiver support, remote monitoring, and other community based services. Um I think home care is also a lot less visible than institutional care. So hospitals and LTC facilities are very visible. You know, a new hospital wing or LTC is something that people can see, get celebrated. Um the success of home

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care is of often something that you know didn’t happen. So the hospitalization didn’t happen. The remission was avoided. Fall was prevented. You know LTC placements been delayed. So that makes the value of home care harder to see politically. Um, you know, even though it can create enormous value for the client, the broader health system, for sure the taxpayer, uh, nobody cuts a ribbon for hospitalizations that didn’t happen. Um, you know, recruitment obviously a major issue, but so are

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things like scheduling, geography, travel, continuity, and predictable hours, and retention of staff. So, you can have caregivers saying they want more hours. the organization is simultaneously struggling to fill visits. Um particularly it can be a challenge in rural and remote communities where geography like fundamentally changes the economics of home care but doesn’t typically change the funding model uh which can be a real strain for providers and I think family caregivers don’t get

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enough attention. So family members are providing enormous amount of unpaid care across Canada today. Um when that caregiver burns out, the formal health system often ends up picking up that care. Um and PEI, for example, has a home caregiver benefit. It’s a really interesting example of formally recognizing and financially supporting unpaid caregivers where the person, you know, has significant needs at home with a loved one. >> And as demand for care at home continues to grow, how can providers scale

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services without compromising quality, continuity, or the client experience? >> Yeah. Well, for me, I’ve always said don’t grow faster than your operating model. So, before taking on, you know, that new contract or significant new volume, you know, organizations can be obsessed with uh, you know, client acquisition and revenue growth. But before taking on new volume, I want to know, can we recruit for it? Can we schedule it? Can we supervise it? Can we maintain continuity, which is arguably

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the most important metric in home care? Um, can we respond when something goes wrong? Can we measure the quality of what we’re delivering? So, growth is good. All for it, but operational capacity has to grow with it. Otherwise, clients really do feel the strain. uh sub centralized when it creates efficiency, but I think it’s important to keep your care and your leadership local. So it can make sense to centralize areas like finance, payroll, HR, crediting, technology and IT support, quality systems analytics, but

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I really stress to keep things like clinical leadership, scheduling, caregiver relationships, client relationships, and any escalation as close to the community and that client as possible. um and measuring uh the client sorry measuring the experience that the client actually received. So it’s not enough to say well every authorized visit was technically delivered you know we’re all good 100%. But I’d also look at continuity, the caregiver, missed and late visits, um referral to start time

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of care, um the number of complaints that come in and and why, and are we seeing improvement in those areas, client and family satisfaction, as well as, you know, going back to outcome based funding, but clinical outcomes. So, if somebody receives every scheduled visit but sees 10 different caregivers in a week, that may meet contract requirements, but it’s still a poor client experience. It’s certainly like not something that I would be happy with on my end. >> Absolutely. And caregiver shortages of

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course remain a major concern. Beyond recruitment, what should organizations be doing to build and retain a stronger home care workforce? Well, retention has to be part of the strategy. You can’t recruit your way out of a retention problem. So, you know, constant recruitment will never solve things like poor schedules, inadequate hours, excessive travel, weak coaching and management, or burnout, or lack of career opportunities and career progression. So I think providers really need to take the time

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and understand why people leave and not just, you know, how do I replace them? So giving caregivers better jobs with predictable schedules, enough hours, you know, to pay their bills, uh, make a living, better geographic density, um, less unnecessary travel and downtime. So, you know, maximize the time that your caregivers are actually spending with clients, not driving from client to client. >> Again, better continuity uh of care with clients. So reasonable workloads and in home care, you know, a job that looks

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attractive on paper can become much less attractive once things like travel gaps between visits and unpredictable scheduling are factored in compared to say um you know a position in long-term care, retirement homes or hospital. I think it’s important to invest in the leadership, the front line. So for a frontline caregiver, their experience of the organization is often their scheduler or coordinator and clinical supervisor. Um maybe a peer out in the community if they’re working in a a cluster site like a condominium or

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retirement home, but their primary points of contact throughout their career are going to be that scheduler and supervisor. So strong frontline managers uh make people feel supported. >> They solve problems quickly, communicate well and recognize good work. Um I think poor frontline management can really undermine everything else the organization is trying to do around culture and retention. Um it’s important also to give people somewhere to go. So create visible career paths. um you know

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uh personal support worker, a home care attendant, um enabling them to be able to progress into a lead position or a coordinator coordinator or supervisor role. Um an LPN or RPN providing them with opportunities to know upgrade their their training and education to an RN clinical leadership role. So really supporting education, mentorship, certifications, career advancement and make the job easier to do. So reduce duplicate documentation, do you know implement uh improved scheduling technology, make

00:15:26 – 00:16:33 communication easier. you know, a nurse out in the field shouldn’t have to make seven phone calls to connect with a coordinator and let them know that, you know, there’s an emergency out in the field. Um, give caregivers quick access um to the information that they need. Um, and the more administrative friction that we can remove, the more time people can spend actually caring for clients, just just like the travel piece. So we talk constantly about the client experience but it’s always been huge

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priority for me uh is the employee experience. I think that’s actually what directly affects the client experience. One of my most important if not the most important metric uh for me is always employee engagement. I know that my career carvers you know love what they do who they work for. They’re going to provide an exceptional experience to our clients out in the field. Yeah, absolutely. That’s really helpful for all agencies to keep in mind. And technology is playing a larger role in

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Home care operations. Where can it create the greatest impact and where do organizations often get the implementation wrong? >> I think coordination is where it can have a massive impact. So scheduling is probably the biggest opportunity. So I think about things like better route optimization, geographic matching to reduce again that unnecessary travel, maximizing the time that our caregivers are actually with patients, not driving. So technology can match caregivers based on things like availability skills,

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geography, and continuity with the client infinitely faster than a coordinator can. I say that as a former coordinator. Uh, real-time staffing tools can help organizations identify gaps, respond before a visit is missed. Um, coaching and clinical support. So, caregivers are often working independently at somebody’s home. Technology uh like say Lip and Cot app can provide on the-fly access to clinical protocols, policies, decision support, escalation. Um, you know, AI can potentially reduce documentation burden and help frontline

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staff find the information that they need quickly again without having to contact the office. >> Clients and family communication. So, clients and families increasingly expect the same visibility they receive in other industries in home care. And you know, back in the past, we used to print out a calendar for clients a few weeks in advance to the start of the month, and by the time the month starts, they could have an entirely different schedule with different care providers. So things like portals today can provide

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scheduling visibility in real time, information on who their caregiver is, care plan updates, notifications, um easier, quicker communication with the care team. Um so we should really be able to reduce the number of routine phone calls and emails families need to make um just to understand what’s happening. And that also dramatically reduces the burden on the coordinators and allows them to focus on enhancing that relationship with their front line and scheduling which is obviously the primary objective of the role. Um the

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remote monitoring and clinical care. So remote monitoring can help identify deterioration in clients easier and earlier. um falls, medication adherence, vital signs, chronic disease indicators can be, you know, increasingly monitored outside of traditional healthcare settings. The goal is not collect more data. It’s identifying risks early to actually intervene. Um leaders should really start with the problem. I think um not the technology. So often leaders see, you know, something that’s bright and shiny like

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how can we implement this? But I think it’s important to, you know, look at the problem that you’re trying to solve. You know, does it save frontline time? Does it improve the client or family experience? Does it integrate with the systems that we already have today or might be looking to move to? And will our staff actually use it is a big one. So don’t just digitize a broken process and call it transformation. But uh for me the best technology should do at least one of three things. So give back time to the

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caregiver, improve the client or family experience or help us uh and our clinicians identify risk earlier. >> That’s a great thing to keep in mind. And of course, you’ve led organizations through growth and transformation. What separates homecare organizations that adapt successfully from those that struggle with the change? >> Yeah, those that respond to reality quickly. I think labor market changes, government priorities change, funding models change, contracts change,

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technology changes, client expectations change. So successful organizations don’t become overly attached to the way that they have always operated. Um senior leadership understands the front line. Um so me myself I started off as a coordinator scheduling um home care attendants out in the field. I accompanied them on hundreds of visits and really got to see what a day in the life of a you know home care attendant or personal support worker is like and I think the leaders really need good data

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dashboards they also need to understand how the service is actually being delivered. So a strategy has to work when somebody calls them sick. Um know a client deteriorates, a visit gets missed or you know the hospital suddenly increases referrals at 4 p.m. on a Friday. So transformation has to work operationally but not just look good in a presentation or in the boardroom. So you know problems have to surface early. uh missed visits, turnover, complaints, scheduling problems, uh poor clinical outcomes, any financial

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deterioration in the business. So, strong organizations will create an environment where problems move upward really quickly instead of being hidden until they become a crisis. I talked earlier about an engaged workforce. Sometimes the best escalation comes from the staff in the field escalating the problem right away. that helps management um you know adapt and make change quickly. >> Yeah, absolutely. And looking ahead, what do you believe Canadian home and community care will look like over the

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next 5 to 10 years? And what should leaders start preparing for right now? >> Well, I think we started off the podcast and I talked about more complex care in the home. I do think that that’s going to continue. Um so more complex care continuing to move home. We’re going to see more complex nursing, rehab, palliative care, chronic disease management uh delivered in the home like home hemodialysis. So the question is going to increasingly become does this patient actually need to be

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um you know in a healthcare institution for this care or can we safely bring the care to them. Um, unfortunately for us, you you can’t just pop up a new hospital in, you know, 3 to six months if you need that capacity. So, we’re going to need to increase the capacity in the home. >> That’s where patients want to be. So, more capability is going to be brought to the person. I think actually out in New Brunswick, um, they have a nursing home without walls pilot going on right now. It’s an interesting example. It

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uses expertise and resources of nursing homes to support seniors who are still living within their own home communities. I think we’re going to see a lot more of that type of concept rather than automatically moving the person to an institution and ask what services and capabilities can we bring to the home. Um I also think there’s going to be a lot more client and family direction. So programs like self and family managed care I expect to continue to grow exponentially. Um you know Manitoba and

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Alberta I know that those programs are growing today and I do think other provinces are going to soon follow. Saskatchewan has individualized funding for home care patients. PEI is investing in self-managed and caregiver model supports. So I do expect more clients and families to have greater control over who provides their care and how that care is arranged. That’s something the providers will have to prepare for. U more integration around the patient. So Ontario health teams are one example

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of the direction. So we need home care to be better connected today with primary care hospitals, you know, rehabilitation teams, pharmacy, community supports and family caregivers. So patients and clients shouldn’t have to understand which organization owns which part of the system. We do really need to operate as an integrated team. Mhm. >> Still um expect much more outcome based funding in the future. So instead of asking how many visits do we provide, how many hours do we fill the service? I

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think we’re going to find ourselves increasingly asking did the person remain safely at home? Did their function improve? Did we prevent an avoidable uh visit to the emergency department? Do we prevent hospitalization? Did we delay LTC? Uh what was the total cost to the health system? So bundled care for sure was an important step because it encouraged providers to think across the broader episode of care. But I do still expect us uh to move further toward paying for actual outcomes. I think Canada doesn’t

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lack innovative home care ideas or pilots today. They’re everywhere. The bigger challenge is actually taking those models that work and implementing them consistently at scale across the provinces. It’s almost like today every province has one one great idea, but I do think we need to work uh together better and think of the Canadian health care system. >> Yeah. And uh one last question here for you Devon. Um, Canada relies heavily on internationally trained health care professionals. How will evolving

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immigration policies impact the home care workforce and what should agencies do to prepare for this? >> Yeah, sure. Immigration policy has a direct workforce impact. I mean, today in Canada, homecare relies significantly on internationally educated, internationally recruited healthcare workers. So, you know, if and when federal immigration programs or eligibility rules change, employers can feel that impact like very quickly. >> So, I think it’s important for agencies to never assume that the immigration

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pathway available today is, you know, necessarily going to remain five years from now. Um, so to me, the obvious solution is, you know, don’t depend on one source of labor. uh you know sustainable workforce strategy. You need multiple challenges sorry channels. Uh you need domestic recruitment, >> internationally educated professionals that already live in Canada. Um international recruitment students and new graduates upscaling your existing employees. So I talked about promoting those say community health worker to a

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personal support worker to an LPN or RN to an RN. I have seen that for sure in the past and now even seeing some of those individuals leading you know significant uh operations um retention strategies and provincial and federal uh immigration pathways. So immigration and credential recognition to me are two separate issues. So getting somebody into Canada doesn’t automatically mean that they can practice at the level that they were trained for. Um licensing and registration happen provincially. So employers can

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help internationally educated professionals with their credential assessment bridging uh registration mentorship and coaching Canadian health care orientation and potentially language support where it’s required. So should really be trying to get internationally educated professionals working as close as possible to the level where they were trained for rather than leaving the skill these skilled people coming to our country underemployed. And I think retention after arrival really matters too. So potential

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settlement support, housing, transportation, integration into their community when they come over from abroad, career progression and permanent resident support uh you know where it’s appropriate. So international recruitment can absolutely be part of the workforce solution, but I think it’s really important that uh should not compensate for jobs that people don’t want to stay in. >> Absolutely. Um Devon, thank you so much for your time. These were really actionable takeaways that I think any

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Canadian agency can work with. We really appreciate your time. And for everyone tuning in, I am Erin Cahill CareSmartz360 On Air and we will see you soon. Goodbye.