Photo caption: The Osler@Home program team at Etobicoke General Hospital (EGH).
It’s no secret that most older adults want to live safely in their own homes for as long as possible. Aligning with Ontario Health’s Home First approach, William Osler Health System (Osler) is helping make that possible through Osler@Home – a program designed to support eligible older adults as they recover and regain independence at home, rather than remain in hospital or transition to retirement or long-term care. Since launching three years ago, the program has helped more frail older adults return home safely, surrounded by loved ones and connected to their communities.
Delivered in partnership with Bayshore HealthCare’s Integrated Health Solutions division (Bayshore), Osler@Home is one of the largest ‘hospital at home’ programs in Ontario, having served close to 700 people over the past fiscal year. Today, most patients enrolled in the program remain at home following their care. In 2025/26, this included 77.6 per cent of patients in the program’s 16-week program and 84.3 per cent of those in its eight-week program.
“Patients in our program are often frail seniors at risk of becoming alternate level of care (ALC) patients once their acute medical needs have been met by the hospital,” said Terri Lynn Hansen, Clinical Services Director, Acute General Medicine, Critical Care, Respiratory Therapy and Transitions, William Osler Health System. She also notes that the program supports an efficient transition time for patients going from hospital to home, with 100 per cent of first visits completed within 24 hours of discharge in 2025/26.
“As a result of strategies, including Osler@Home, we’ve seen a steady decline of ALC rates from 14.3 per cent in 2023/24 to 10.6 per cent in 2025/26 and this is welcome news for patients, families and throughout the hospital.”
Photo caption: The Osler@Home team at Brampton Civic Hospital.
What differentiates Osler@Home from traditional task-oriented home care models is its two-stream, integrated, people-centred approach: an eight-week program designed to avoid unnecessary hospital admissions, and a longer 16-week program that focuses on rehabilitation and restoring independence after discharge. Eligible patients are identified early in their hospital stay, ensuring the program is offered to those most likely to benefit from the level of care and support provided.
Bayshore and Osler work together with patients and their families to develop personalized care plans prior to discharge and get the necessary supports and equipment in place so services can start as soon as possible once a patient returns home. Depending on their needs, a patient’s care plan may include coordinated supports from a range of health care professionals including nurses, personal support workers, occupational therapists, physiotherapists, dieticians, and social workers.
Lara MacNeil, Manager, Transitions, William Osler Health System, believes the true strength of Osler’s program lies in its person-centred approach. It goes beyond supporting patients through their recovery, the team works closely with patients to understand their unique needs, goals and daily routines. This helps patients maintain living independently and safely in their own homes long after their clinical care has ended.
“Before patients are discharged from the program, we connect them with community supports that impact daily living such as ordering groceries, meal preparation, housekeeping and personal care. These are all vital to their ongoing health, well-being and independence, and help them thrive at home.”
Most rewarding for Bayshore and Osler’s teams has been the response from patients and families. In 2025/26, 90 per cent of clients surveyed rated the overall service as excellent or good, with 91 per cent strongly agreeing or agreeing that they would recommend the program to others.
For Hansen, Osler@Home is so much more than delivering care outside hospital walls. As Osler’s communities continue to grow and age, she sees the partnership with Bayshore as an incredible way to help older adults remain living safely in their homes as long as possible and provides peace of mind for families and caregivers.
“For every senior we successfully discharge home with supports, a bed opens up for a patient in one of our hospitals who needs acute care, whether that’s another senior, an adult or a child, making this program a win-win for seniors, the communities Osler serves, and the broader health system.”