Leaving Hospital in Ontario: What "Home First" Means for Your Parent

Ontario hospitals now plan every older patient's discharge around one goal: getting them home. Under Home First, a direction from Ontario Health, the agency that oversees health care in Ontario, a hospital should assess a patient 65 or older within 48 hours of admission, assign a discharge planner, set an estimated discharge date, and give the family a written transition plan 2 days before discharge. Long-term care is considered only once every home and community option has been ruled out.

That's the system working as designed. For a family, it can feel sudden. One day your parent is admitted after a fall; a few days later the team is talking about a discharge date and what help they'll need at home.

This guide explains what the hospital is doing, why, and the decisions that are yours to make. You're not expected to know any of this in advance. Most families learn it in a hospital hallway, and the ones who cope best simply learn it a few days earlier.

Who's who: Ontario Health, Ontario Health atHome and your hospital

Three names come up again and again, and they're easy to mix up:

• Ontario Health is the provincial agency that plans and oversees the Ontario health care system, including hospitals. It issued the Home First direction.
• Ontario Health atHome arranges publicly funded home care and long-term care placement. Its care coordinators are the people your family will deal with about home supports and long-term care applications.
• Your hospital's discharge planner coordinates your parent's transition plan with both.

Neither is the same as OHIP, which pays for doctor and hospital visits. If you're searching "Ontario Health" for your health card or an OHIP question, ServiceOntario handles those.

What is Ontario's Home First approach?

Home First is how Ontario hospitals, Ontario Health atHome and community agencies are told to plan care for older patients. In the words of Ontario Health's Operational Direction: Home First (August 14, 2024), it's "an approach whereby every effort is made to ensure adequate resources are in place to support patients to remain at home whenever possible, and ultimately return home upon discharge."

The direction applies to all bedded hospital care: acute, rehab, complex continuing care and mental health. Its guiding principles include:

• Patients have the right to choose to live at risk in their own home, with the right level of support.
• Major decisions, like moving to long-term care, should be made from home, where people are most comfortable and best able to decide.
• Long-term care is not a substitute for affordable housing, and shouldn't be used to speed up a discharge.

Why don't hospitals want older patients to stay longer?

Because a hospital bed is hard on an older body. Ontario Health notes that 50% of older adults experience functional decline and increased dependency during a prolonged hospital stay: weaker muscles, delirium, infections, lost confidence.

There's a system reason too. When it issued the direction, Ontario had more than 5,000 people in hospital with an ALC designation, about 46% of them waiting for long-term care. Every one of those beds is unavailable for someone in the emergency department.

So when the team pushes gently toward home, it usually isn't about rushing your parent out. Staying longer than needed carries real risks of its own.

What happens in the first 48 hours?

A lot, mostly behind the scenes. Under Home First, for patients 65 and older (or frail) who are flagged as at risk, the hospital should:

If you haven't been told the estimated discharge date or met the discharge planner after a couple of days, ask for them by name. It's a reasonable request, and it's in the plan.

What does ALC mean?

ALC stands for alternate level of care. A patient is designated ALC when they no longer need hospital-level care but can't yet go home safely, or are waiting for another setting such as rehab or long-term care.

Under Home First, a patient should not be designated ALC to long-term care unless all community resources have been exhausted and they can't safely return home. Hospital leadership and Ontario Health atHome review each long-term care referral first, using an escalation template that asks whether home care, a retirement home or assisted living, or a transitional care bed would work instead.

Hospitals also review every patient waiting for long-term care weekly, looking for a safe path home while they wait.

Can my parent be sent to a long-term care home we didn't choose?

Yes, in some cases. Under the More Beds, Better Care Act passed in 2022, a placement coordinator can arrange admission for an ALC patient to a long-term care home within 70 km in southern Ontario or 150 km in northern Ontario, and a patient who refuses can be charged $400 a day to stay in hospital, as CBC News reported when the rules took effect.

This is the scenario families fear most, and it's the strongest reason to plan early. Two things help:

• Have a home plan ready. Under Home First, a patient who can wait at home applies for long-term care from home, with their own choices, once they're settled.
• Look at private options now. A retirement home with care, or a short private stay, can be the bridge that keeps your parent's choice in your family's hands.

What can the family arrange before discharge?

More than most people realize. The hospital and Ontario Health atHome will arrange publicly funded supports, which can include:

• Home care from Ontario Health atHome: personal support, nursing and therapy
• Community support services, like Meals on Wheels, transportation and adult day programs
• Hospital to Home programs, with extra support for the first weeks
• Transitional or convalescent care beds, for a short recovery stay
• Behavioural supports and remote monitoring, where available

Ask the care coordinator for a list of local Ontario health services and community programs your parent qualifies for. Many families never hear about half of them.

Public hours are set by assessed need and local capacity, and they often stop short of evenings, nights and weekends. That's where families add private help. Our home care after hospital discharge guide covers what to set up, and our private home care in Ontario guide explains what an agency costs, typically about $28 to $40 an hour for a personal support worker.

When does a retirement home make sense after a hospital stay?

When your parent can't manage safely alone at home, but doesn't need nursing care around the clock. A retirement home offers meals, medication help, staff on site day and night, and care packages that can increase as needs change.

Many Ontario retirement homes also offer short-term or respite stays, a few weeks of recovery with care included. It's a practical middle step: your parent leaves hospital, recovers in a supported setting, and your family decides about the longer term from a calm place, which is exactly what Home First recommends.

Starting rents in Ontario have a median of about $4,041 a month in our directory (October 2026), with care packages on top; full-service and premium residences start around $5,000 and up. See our Ontario retirement home cost guide, or compare retirement homes in Toronto, Ottawa and Hamilton side by side. Every Ontario retirement home must be licensed by the RHRA, and our listings link to each home's licence.

How do you choose between home, a retirement home and long-term care?

Start with what your parent needs every day, not with what's available this week.

Our long-term care cost guide explains the co-payment, and the Ontario Seniors Care at Home Tax Credit can help with some home care costs.

What should you bring to the hospital?

A small folder saves hours of back-and-forth, and the discharge and long-term care paperwork asks for most of it:

• Your parent's Ontario health number (the number on their health card) and the card itself
• A full medication list, including over-the-counter pills and supplements
• Power of attorney for personal care and property documents, or the name of their substitute decision-maker
• The family doctor's name and contact, so the discharge summary reaches them
• Details of any home care already in place, including private agency hours

What should you ask the hospital team?

Bring this list to the first family meeting. Write the answers down.

1. Who is our discharge planner, and how do we reach them?
2. What is the estimated discharge date?
3. Has a referral gone to Ontario Health atHome, and who is the care coordinator?
4. What will my parent need help with at home, and how many hours of public home care are likely?
5. Is a Hospital to Home program, transitional bed or convalescent stay available here?
6. If long-term care is being discussed, which home and community options were ruled out, and why?
7. When will we get the written transition plan?

You're entitled to ask every one of these. Good discharge planners welcome them, and you'll find most of them are on your side.

You don't have to sort this out alone

Leaving hospital is one of the most stressful moments in caring for a parent, and the decisions come quickly. Start with the discharge planner, take every hour of public support offered, and fill the gaps with private help you've vetted.

If you'd like a hand comparing home care agencies or retirement homes near your parent, our advisors are here, free and with no pressure.