Hospital discharge → home-care initiation
2daysMedian
14days90th percentile
From hospital discharge to initiation of home and community care.
Evidence & Research Library
The Evidence Behind the Regional Care Challenge
Understanding the gaps in care continuity and the fragmentation of Ontario’s healthcare workforce.
Care needs can change quickly after hospital discharge or a sudden disruption in the community. At the same time, practitioners work across organizations, employment arrangements and schedules. The regional demonstration asks whether shared coordination can help connect short-term stabilization with continuity of care.
01 / Care transitions & stabilization
When Care Is Needed Before Continuity Is Available
A timely start matters. So do reliable follow-up, clear information and the handoff to continuing support.
ONTARIO · DAYS
How long until home care begins?
Community application → first home-care service
7daysMedian
42days90th percentile
From community application to first service; excludes case management.
The median is the midpoint of reported waits. The 90th percentile marks the wait within which 90% of measured service starts occurred.
Ontario Health · Annual Report 2024–25, appendix p. 121 (opens in a new tab)
Definitions, limitations and data table
Published 2024/25 results for Ontario Health atHome service-initiation indicators. Cohort counts and full inclusion rules are not supplied in this table. These waits do not measure all unmet need or establish that someone received no other care. The report notes changes to accountability indicators in 2024/25.
| Pathway | Period | Median (days) | 90th percentile (days) |
|---|---|---|---|
| Hospital discharge → home-care initiation | 2023/24 | 2 | 13 |
| Hospital discharge → home-care initiation | 2024/25 | 2 | 14 |
| Community application → first home-care service | 2023/24 | 7 | 39 |
| Community application → first home-care service | 2024/25 | 7 | 42 |
Discharge readiness and community support are connected.
8% of acute-care patients admitted through the emergency department were designated alternate level of care in CIHI’s reported cohort.
ALC describes a different level of care being needed while a person remains in hospital. This national measure is not an Ontario post-discharge gap rate; cohort counts and full geographic coverage are not supplied in the narrative.
Canadian Institute for Health Information · opening findings, June 2026 (opens in a new tab)
Continuity involves more than the first visit.
Ontario patient and caregiver research points to reliability, information sharing and the work families take on during a transition.
Transitional-care studies describe different programs and outcomes. Their findings do not establish a Caredara effect on readmissions or recovery.
CMAJ Open · 2020 study (opens in a new tab)
02 / Workforce fragmentation & capacity
Healthcare Workforce Capacity Exists Across Fragmented Employment Arrangements
Employment data show how work is organized. Identifying additional capacity requires a separate conversation with practitioners.
Employment status is not a measure of spare capacity. Part-time employment, casual employment, or holding multiple positions does not necessarily indicate unused workforce capacity. Additional capacity must be established through practitioner-reported willingness, availability, qualifications, and actual participation.
Ontario · General Class registrations reporting nursing employment · Annual renewal snapshots · RN excludes nurse practitioners
Overall employment status · RN
Share of registrations, by highest working status
Full-timePart-timeCasual
Positions held · RN
Share with one or more than one nursing position
One positionMultiple positions
Select a year in either chart to explore the figures below. Both charts show employment arrangements, not hours available.
2026 renewal snapshot · RN
Registrations in these tables116,318+3.4% from 2025
Part-time or casual29.5%-0.1 percentage points from 2025
More than one position16.4%0.0 percentage points from 2025
In 2026, 81,972 RN registrations were classified full-time, 25,637 part-time and 8,709 casual. 19,019 reported multiple nursing positions in Ontario.
College of Nurses of Ontario · 2026 Appendix A, §§4.5–4.6 (opens in a new tab)
Charts adapted by Caredara from College of Nurses of Ontario data. Percentages and year-to-year changes are calculated by Caredara. This is not an official CNO presentation and does not imply CNO endorsement.
View accessible tables and methods
Overall status follows the highest status across nursing positions: full-time, then part-time, then casual. Multiple = two plus three-or-more positions. Percentages and year-over-year percentage-point changes are calculated from counts. Registration-level snapshots, not unique people across categories or hours available. RN excludes NPs. 2026 renewal: November 19, 2025–March 23, 2026. Earlier years reflect their own renewal periods. Rounding may produce totals of 99.9% or 100.1%.
The denominator for each percentage is that year’s total in the selected category. Dual registrants may appear in both RN and RPN tables; do not sum them as unique people.
| Renewal year | Full-time | Part-time | Casual | Total |
|---|---|---|---|---|
| 2021 | 68,578 (69.1%) | 24,413 (24.6%) | 6,254 (6.3%) | 99,245 |
| 2022 | 70,747 (70.6%) | 22,608 (22.6%) | 6,875 (6.9%) | 100,230 |
| 2023 | 72,099 (70.6%) | 21,739 (21.3%) | 8,302 (8.1%) | 102,140 |
| 2024 | 75,236 (70.3%) | 22,640 (21.2%) | 9,096 (8.5%) | 106,972 |
| 2025 | 79,223 (70.4%) | 24,405 (21.7%) | 8,889 (7.9%) | 112,517 |
| 2026 | 81,972 (70.5%) | 25,637 (22.0%) | 8,709 (7.5%) | 116,318 |
| Renewal year | One | Two | Three or more | Multiple (%) |
|---|---|---|---|---|
| 2021 | 83,737 | 13,401 | 2,107 | 15.6% |
| 2022 | 82,916 | 14,706 | 2,608 | 17.3% |
| 2023 | 84,948 | 14,611 | 2,581 | 16.8% |
| 2024 | 89,234 | 15,012 | 2,726 | 16.6% |
| 2025 | 94,104 | 15,635 | 2,778 | 16.4% |
| 2026 | 97,299 | 16,157 | 2,862 | 16.4% |
A distinct workforce
Personal support workers deserve a separate lens.
PSWs work across different employers and care settings. Their research and data cannot simply be merged with nursing registration figures.
Ontario research examines preparation, supervision, irregular schedules, travel and retention. These conditions matter when asking what additional work is feasible. CIHI’s recent work also explains why more consistent PSW data are needed.
University of Waterloo · 2021 thesis (opens in a new tab)
Canadian Journal on Aging · 2021 policy and practice note (opens in a new tab)
Journal of Applied Gerontology · 2025 scheduling study (opens in a new tab)
Canadian Institute for Health Information · 2026 report (opens in a new tab)
PSW-related job vacancy rates
2021
7.8%
2022
8.5%
2023
8.2%
2024
6.7%
Vacant positions indicate unmet demand. They do not measure spare practitioner capacity. This national occupational grouping is not a count of all Ontario PSWs.
Statistics Canada · Chart 3 (opens in a new tab)
Scope, methods and full data
NOC 33102 (nurse aides, orderlies and patient service associates) plus NOC 44101 (home support workers, caregivers and related occupations) in health-industry subsectors 621, 622 and 623. Rates use vacancies divided by vacancies plus adjusted employment. JVWS and LFS coverage differs; 2020 includes only Q1 and Q4.
| Year | Rate |
|---|---|
| 2016 | 2.6% |
| 2017 | 3.3% |
| 2018 | 4.2% |
| 2019 | 4.8% |
| 2020 | 7.2% |
| 2021 | 7.8% |
| 2022 | 8.5% |
| 2023 | 8.2% |
| 2024 | 6.7% |
Adapted from Statistics Canada, Regional dynamics of vacancies in health-related occupations in Canada, 2024 (2016–2024 data). This does not constitute an endorsement by Statistics Canada of this product. Open licence (opens in a new tab)
Keeping the distinction clear
What the evidence shows. What we still need to learn.
Published research informs the demonstration. It does not stand in for evaluating it.
| Published evidence | Remaining question | Demonstration opportunity |
|---|---|---|
| Care initiation can be delayed. | Where do short-term gaps remain unresolved, and how often? | Document stabilization requests, unmet needs and time to care start. |
| Nursing employment arrangements vary. College of Nurses of Ontario · §§4.5–4.6 (opens in a new tab) | How many additional hours are willingly offered and feasible? | Measure declared availability, verified hours and hours actually delivered. |
| Transitions cross organizations and care relationships. | Can coordination improve access without displacing existing care? | Measure successful activations, completed handoffs and unresolved gaps. |
| Transitional-care models and reported outcomes differ. | Which stabilization episodes succeed, for whom, and under what conditions? | Evaluate a defined local model and operational outcomes in context. |
A curated, traceable collection
Explore the research.
Read the original evidence, understand its limits and explore how it informs the two areas of focus.
Ontario Policy and Health System Context
Official standards, workforce datasets, policy guidance and accountability reports are included in the same library.
16 of 16 sources
Ontario Health Annual Report 2024–25
The Ontario Health atHome appendix reports home-care initiation waits and system performance. Hospital-discharge and community-application measures have different starting points.
Findings, relevance & limitations
What it contributes
The reported medians are shorter than the 90th-percentile waits for both pathways.
Why it matters here
Supports measuring time to care start separately from continuity and care sufficiency.
Limits of the evidence
Page 121 supplies aggregate percentiles, not individual records or a cohort size. The appendix covers the atHome organizational period June 28, 2024–March 31, 2025; the table labels its results 2024/25. SAA indicators replaced earlier accountability indicators. Delayed initiation does not establish that no other care was available.
Source location: Appendix, pp. 117, 121
Source checked · 22 October 2026
Nursing Statistics Report 2026: Appendix A
Renewal data describe nursing registrations and employment arrangements. The charts below use the RN and RPN tables for work in Ontario.
Findings, relevance & limitations
What it contributes
Full-time, part-time, casual and multiple-position arrangements are all reported.
Why it matters here
Provides a baseline for asking practitioners about additional availability.
Limits of the evidence
This is registration-level self-report, not available hours. RN here means General Class; NPs are separate. Dual registrants can appear in both categories, so they must not be added as unique people.
Source location: Appendix A §§2.1–2.4, 4.5.1–4.5.2, 4.6.1–4.6.2
Source checked · 22 October 2026
Nursing Statistics Report 2025: Appendix A
The previous renewal release provides a historical comparison for Ontario nursing employment. Its overlapping overall-working-status counts were checked against the 2026 appendix.
Findings, relevance & limitations
What it contributes
The 2021–2025 RN and RPN status counts agree across the two releases.
Why it matters here
Supports reproducible comparisons without mixing incompatible series.
Limits of the evidence
The current charts consistently use the 2026 release. Annual renewal snapshots do not track an individual’s hours or movement between jobs.
Source location: Appendix A §4.5
Source checked · 22 October 2026
Transitional care programs for older adults moving from hospital to home in Canada: A systematic review of text and opinion
A systematic review maps Canadian transitional-care programs described in grey literature. It compares their settings, services and reported outcomes.
Findings, relevance & limitations
What it contributes
Programs differed considerably, and outcome reporting was limited.
Why it matters here
Supports defining a local model and collecting consistent outcomes rather than promising a borrowed effect size.
Limits of the evidence
This is a review of text and opinion, not a pooled trial-effect estimate. Program reports cannot establish a common readmission benefit or predict Caredara outcomes.
Source location: Abstract; Results; Tables 1–4
DOI: 10.1371/journal.pone.0307306
Source checked · 22 October 2026
Patient and caregiver experience in the transition from hospital to home — brainstorming results from group concept mapping: a patient-oriented study
Ontario patients and caregivers described what shaped their hospital-to-home experience. Responses addressed discharge, follow-up, medicines, education and home-care access.
Findings, relevance & limitations
What it contributes
Participants identified problems with the timeliness, sufficiency, reliability and consistency of home care.
Why it matters here
Informs questions about missed support and the quality of handoffs.
Limits of the evidence
Qualitative brainstorming in 2018 identified priorities; it did not estimate population prevalence or test an intervention.
Source location: Abstract; Methods; Results
DOI: 10.9778/cmajo.20190009
Source checked · 22 October 2026
Exploring Patient and Caregiver Work and Continuity of Care During Hospital-to-Home Transitions of Care in the Canadian Context
Interviews explore the practical and cognitive work patients and caregivers undertake during hospital-to-home transitions. The study examines how continuity affects this work.
Findings, relevance & limitations
What it contributes
Information, care-management relationships and consistent support shaped transition experiences.
Why it matters here
Supports measuring handoff quality and caregiver experience alongside response speed.
Limits of the evidence
A small purposive sample from two Southern Ontario hospital networks was interviewed in 2021. Findings are qualitative, not a regional rate or evidence of program effectiveness.
Source location: Abstract; §§2–3
DOI: 10.1111/hex.70727
Source checked · 22 October 2026
A critical examination of how Ontario’s home care system policy affects PSW-provided home care and client risk
This thesis examines how Ontario home-care policies affect PSW work and client risk. It considers training, hiring, complex care and supervision.
Findings, relevance & limitations
What it contributes
Policy and organizational conditions shape how PSWs can deliver care.
Why it matters here
Adds PSW-specific questions about preparation, support and safe deployment.
Limits of the evidence
Qualitative policy analysis and key-informant interviews; not a workforce census or a peer-reviewed journal article. Its regulatory context is historical.
Source location: Repository abstract; thesis
Source checked · 22 October 2026
Availability of LTC beds and community supports needed for smooth ED patient flow
CIHI connects emergency-department flow with inpatient discharge and access to continuing support. It describes acute-care stays among patients admitted through the ED.
Findings, relevance & limitations
What it contributes
Patients designated alternate level of care had longer median hospital stays.
Why it matters here
Explains why transitions must be studied across settings.
Limits of the evidence
National context, not an Ontario estimate. Total hospital stay includes acute and ALC time; it is not the length of a post-discharge care gap. The narrative does not provide cohort counts or a full jurisdictional coverage breakdown.
Source location: Opening findings; “ALC designation” table
Source checked · 22 October 2026
Using HR and payroll data to measure the personal support worker workforce
CIHI assesses whether employer HR and payroll records can improve PSW workforce measurement. The report compares data sources and governance arrangements.
Findings, relevance & limitations
What it contributes
Fragmented employer systems and incomplete registry coverage constrain workforce measurement.
Why it matters here
Supports keeping PSW evidence separate and verifying availability directly.
Limits of the evidence
The feasibility work uses pilot data from three Atlantic provinces. It does not supply a comparable Ontario RN/RPN/PSW employment-status series.
Source location: Report overview; feasibility assessment
Source checked · 22 October 2026
Regional dynamics of vacancies in health-related occupations in Canada, 2024
This analysis examines occupation and regional differences in health-related vacancies. It includes a defined grouping of personal-support occupations.
Findings, relevance & limitations
What it contributes
Vacancies indicate unmet employer demand, not practitioners’ spare time.
Why it matters here
Adds a separate labour-demand perspective without pooling unlike workforces.
Limits of the evidence
National estimates combine JVWS vacancies with adjusted LFS employment. The PSW grouping includes NOC 33102 plus NOC 44101 in selected health industries; it is not all Ontario PSWs. 2020 uses only Q1 and Q4.
Source location: Concepts and Methods; Chart 3 data table
Source checked · 22 October 2026
Transitions Between Hospital and Home: Care for People of All Ages
The quality standard describes expectations for planning and communication across hospital-to-home transitions. Its supporting resources include a patient guide and measurement guidance.
Findings, relevance & limitations
What it contributes
Assessment, information sharing and involvement of patients and care partners are part of a coordinated transition.
Why it matters here
Provides a reference for defining responsible handoffs.
Limits of the evidence
A quality standard describes expected care; it is not evidence that all services meet it or that Caredara has achieved its outcomes.
Source location: Quality statements and supporting documents; page updated June 26, 2026
Source checked · 22 October 2026
Ontario Health Teams: Guidance for Health Care Providers and Organizations
The guidance describes a coordinated continuum of care and a pathway for providers to develop Ontario Health Teams. It explains model expectations and readiness.
Findings, relevance & limitations
What it contributes
Collaboration across organizations is central to the model.
Why it matters here
Places a regional demonstration alongside existing coordination structures, without implying OHT designation or endorsement.
Limits of the evidence
Foundational guidance, not an evaluation of today’s implementation. The linked PDF does not state a publication date; its hosting-folder date is not treated as publication evidence.
Source location: Purpose; Part II; Appendix B
Source checked · 22 October 2026
Pan-Canadian Health Workforce Data Strategy
The strategy sets out shared priorities for improving health-workforce data across jurisdictions. It addresses completeness, timeliness, interoperability and collaborative governance.
Findings, relevance & limitations
What it contributes
Planning requires connected, comparable information and appropriate stewardship.
Why it matters here
Supports consistent definitions and a proportionate measurement plan.
Limits of the evidence
A strategy and recommendations, not an inventory of immediately available staff.
Source location: Executive summary; shared outcomes and recommendations
Source checked · 22 October 2026
Follow-Up on the 2023 Performance Audit: Emergency Departments
The follow-up examines actions taken on emergency-department recommendations. It includes workforce issues and the relationship between hospital capacity and community resources.
Findings, relevance & limitations
What it contributes
Progress on system recommendations was mixed at the follow-up date.
Why it matters here
Provides an independent system-accountability perspective.
Limits of the evidence
An implementation follow-up, not a trial of regional care coordination. Action status was assessed as of November 28, 2025.
Source location: Overall conclusion; status of actions
Source checked · 22 October 2026
Scheduling, Income, and School Closures: Unlocking the Key Drivers of Home Care Personal Support Unplanned Absences Through Time-to-Event Regression Analysis
Administrative records from an Ontario home-care organization were used to examine PSW unplanned absences. The study considers scheduling, income, travel distance and school closures.
Findings, relevance & limitations
What it contributes
Income and travel patterns were associated with absence risk, showing why operational conditions matter for care consistency.
Why it matters here
Supports asking about travel feasibility and scheduling constraints when verifying availability.
Limits of the evidence
Observational data from one large urban organization in 2019–2021. Pandemic conditions and local practices limit generalization; associations do not establish causal effects.
Source location: Abstract; Methods; Discussion
DOI: 10.1177/07334648251316973
Source checked · 22 October 2026
Policy and Practice Note: Policy, Safety, and Regulation with Regard to Ontario Home Care Clients and Personal Support Workers
This journal policy note examines home-care organization, PSW working conditions and safety. It discusses irregular schedules, part-time employment, travel costs and workforce retention.
Findings, relevance & limitations
What it contributes
The authors connect worker support and governance with the conditions needed to deliver safe home care.
Why it matters here
Informs questions about fair scheduling, supervision and respecting existing commitments.
Limits of the evidence
A policy analysis drawing on earlier studies, not a current workforce census. Published online in 2021 and in the September 2022 issue; regulatory descriptions are historical.
Source location: PSWs and Demand for Care; A Case for Regulation
DOI: 10.1017/S0714980821000209
Source checked · 22 October 2026
Selection is focused, not exhaustive. Sources are reviewed snapshots, last checked 22 October 2026. Original documents may be updated by their publishers. Inclusion does not imply endorsement of Caredara.
The regional demonstration research agenda
From Published Evidence to Regional Learning
The demonstration focuses on three questions, within an agreed regional scope.
- 01
Where and how frequently do short-term care disruptions occur?
- 02
How much additional practitioner capacity can be identified and responsibly activated?
- 03
Can shared regional coordination improve responsiveness and facilitate continuity of care?
Proposed future indicators · No demonstration results reported
A measurement plan to agree with regional partners.
- Declared additional monthly hours
- Verified available hours
- Actual hours activated
- Time to match
- Time to care start
- Successful stabilization episodes
- Completed continuity handoffs
Definitions, eligibility, baselines, safeguards and follow-up periods must be agreed before measurement. “Successful stabilization” requires an explicit, shared definition; a fast match alone is not evidence of safe or effective care.
Help shape the regional learning.
Organizations can contribute local knowledge, help define meaningful measures and explore participation.