Homecare That Actually Works: Key Insights from Dr. Charles Wong on Medically-Supervised Homecare

As hospitals across Canada face worsening capacity constraints, many physicians are encountering the same recurring challenge: patients who no longer require acute medical care, yet cannot be safely managed at home under existing support models. These patients often remain hospitalized, or are admitted unnecessarily, not because of medical instability, but due to gaps in functional, social, and caregiver support.

In a recent Alethea Learning Session, Dr. Charles Wong, Emergency Physician at Rockyview General Hospital and Medical Director of HomeFree Homecare, examined why traditional homecare models fail medically complex seniors, and how Medically-Supervised Homecare™ offers a viable, physician-led alternative that keeps patients thriving at home while reducing pressure on hospitals and long-term care facilities.

Why Seniors End Up in Hospital and Long-Term Care

Dr. Wong framed the issue around a common but underrecognized syndrome driving admissions and prolonged hospital stays: the convergence of frailty, falls, dementia, chronic disease, and caregiver burnout. In many cases, these patients are medically stable but lack the functional and social supports needed to remain safely at home.

Hospitals, as Dr. Wong emphasized, are frequently used as default holding environments for patients who actually need:

• Consistent caregivers
• Flexible scheduling
• Daily mobilization and exercise
• Physician oversight
• Extended supports such as meals, transportation, and companionship

These needs are poorly addressed by conventional homecare, leading to repeated emergency visits, deconditioning, and loss of independence.

A Critical Reframing: Public Long-Term Care Is Not Free

One of the most impactful takeaways from the session was the reframing of long-term care (LTC) costs. In Alberta, publicly funded LTC and ALC beds carry significant patient costs—often exceeding $2,000 per month, even for shared accommodation.

When compared against this true baseline, Dr. Wong argued that intensive, medically supervised homecare can deliver higher-touch, more personalized care at a comparable or lower out-of-pocket cost, while preserving patient autonomy and quality of life.

The Three Homecare Models Physicians Should Understand

Dr. Wong outlined three distinct homecare models currently available to patients:

1. Traditional AHS Homecare

• Task-based and rigid
• Inconsistent caregivers
• No physician oversight
• Limited flexibility or accountability

2. Standard Private Homecare

• Fully patient-paid
• Flexible scheduling
• Unregulated and variable quality
• No clinical integration

3. Medically-Supervised Homecare™

• Physician-led oversight integrated with primary and specialty care
• Consistent, trained caregivers
• Accountability to patients and families
• Comprehensive medical, functional, and social support

The defining difference, Dr. Wong emphasized, is not the number of hours provided, but medical accountability and human continuity.

CDHCI: An Underused Clinical Tool

A key practical insight for physicians was the role of Client-Directed Home Care Invoicing (CDHCI), a provincially funded program that allows eligible patients to direct public funding toward private homecare providers.

CDHCI can fund anywhere from 0 to 40+ hours per week, but access is highly subjective and often poorly navigated without physician and caregiver advocacy. Dr. Wong highlighted that outcomes improve substantially when:

• The most responsible family member leads the assessment process
• Physicians help contextualize medical complexity
• Patients are coached to describe worst-day function rather than best-day function

For many patients, even partial CDHCI funding can be the difference between remaining at home and institutionalization.

What Medically-Supervised Homecare™ Actually Delivers

Using HomeFree as a case example, Dr. Wong outlined how medically supervised homecare differs operationally from traditional models. Key elements include:

• Physician oversight integrated with the patient’s GP and specialists
• Consistent, language-matched caregivers
• Regular family communication and updates
• Extended services beyond ADLs
• Navigation of public funding programs

Patients typically receive 12+ physician touchpoints per month, including regular clinical rounds, chart reviews, and home visits, levels of medical engagement comparable to or exceeding many long-term care facilities.

Human Resourcing as the Clinical Engine

Dr. Wong emphasized that outcomes are driven not by policy, but by people. Medically supervised homecare relies on:

• Competitive wages and retention-focused staffing
• Client-specific training
• Stable care teams rather than shift-based labour
• Physician and RN backup

Each patient undergoes an intensive onboarding process involving family meetings, medical review, and home safety assessment—creating the stability necessary to detect deterioration early and prevent admissions.

System-Level Impact

Despite being a relatively young program, HomeFree has already demonstrated measurable system impact, including:

• Thousands of hospital and LTC bed-days offloaded
• Significant public funding redirected to home-based care
• Strong referral growth from primary care clinics
• Formal recognition as a Top Innovation by the Alberta College of Family Physicians

Dr. Wong emphasized that medically supervised homecare is not an alternative to the health system, but a way for the system to finally work for aging patients at home.

What This Means for Physicians

For clinicians navigating increasingly complex discharge planning and outpatient care, the session highlighted several key takeaways:

• Many “LTC-dependent” patients are actually care-dependent
• CDHCI is a powerful but underutilized funding mechanism
• Physician involvement materially changes patient outcomes
• Medically supervised homecare offers both better medicine and better economics

Click here to read the full learning session notes
Alethea users can request a copy of the session recording by emailing sales@aletheamedical.com

Not registered on Alethea? Sign up for free here to access learning sessions, eConsults, and specialist collaboration tools.