Innovation in Northern Ontario Hospital is Supporting Safer Transitions Home for Older Adults
With support from Ontario Health and regional partners, Timmins and District Hospital developed a made‑in‑the‑North Home First approach – helping older adults return home sooner, with the right supports in place for a safer transition.
When Claudette Chartier, 79, fell in her home in Timmins, she spent seven weeks in inpatient rehabilitation. Her goal was clear: to recover safely and return home with the right supports in place.
“I was determined to get back to my own home,” says Chartier. “The team made sure I had everything in place so I could recover safely and keep living independently.”
For older adults, the path out of hospital can be complex, especially when the next stage of care isn’t immediately available.
Timmins and District Hospital’s Home First philosophy is designed to help people transition to the right setting sooner, improving the patient experience while freeing hospital capacity for those who need urgent care.
Coordinating Care With a Home First Philosophy
Chartier’s experience shows how this new approach helps reduce the number of patients in alternate level of care (ALC). ALC refers to people who no longer need acute hospital care but remain in a hospital bed while they wait to move to a more appropriate setting like rehabilitation, long-term care or home with supports.
Discharge planning begins early. To proactively identify patients who may face more complex discharge needs, Timmins and District Hospital completes a risk assessment within 48 hours for patients over 65. This helps care teams plan for the right supports, as early as possible.
As the highest referral hospital for acute services across more than 11 communities – an area comparable in size to Atlantic Canada – Timmins and District Hospital face realities unique to Northern Ontario. These range from barriers in transportation, limited community resources and challenging climate.
To respond to these realities, applying a Home First philosophy involves identifying discharge barriers early, coordinating services before someone leaves the hospital and, when home isn’t immediately possible, creating transitional options outside of acute beds.
For older adult patients like Chartier, this approach can mean the difference between waiting in hospital and recovering in the right setting with the right supports.
Starting Discharge Planning Early For Safer Transitions
A dedicated patient flow team works seven days a week to identify barriers early and support discharge planning from day one. This work is reinforced through close collaboration with physicians and social workers, who help to coordinate safe discharges and connect people with community supports.
To better support older adults, the hospital also draws on geriatric-focused expertise, including comprehensive geriatric assessments and supports aimed at helping seniors recover in the right setting.
Partnering to Ease Pressures on Hospital Resources
As part of the broader Home First philosophy, to help reduce pressures in alternate level of care, Timmins and District Hospital also formed a partnership with St. Mary’s Gardens Retirement Residence to create a 38‑bed transitional care unit. The unit operates as an extension of the hospital for people who are medically stable and awaiting a long‑term care bed.
The people transferred to St. Mary’s are medically stable but still require restorative support. Having those 38 transitional beds allows us to move people to the right environment while freeing acute beds for urgent care. It’s been instrumental in reducing alternate level of care at the main hospital.”
Hospitalist, St. Mary’s Gardens
Our coordinated approach, grounded in Home First, has transformed how we manage patient flow. By identifying discharge barriers early and supporting people to return home safely, we have significantly reduced alternate level of care pressures and improved timely access for patients with acute care needs.”
Director of Clinical Services, Emergency Department, Timmins and District Hospital
Aligning with the Hospital to Home Program
Timmins and District Hospital also work closely with Ontario Health atHome, which coordinates publicly funded home and community care services, to help ensure supports are arranged before a person leaves the hospital. For people who need short‑term rehabilitation or additional assistance, the Hospital to Home program provides intensive, time‑limited support to help people recover safely at home after discharge.
Chartier benefited from the Hospital to Home program, which helped ease her transition by ensuring the right services and supports were in place when she returned home. For her, the outcome was simple: she could recover safely at home and continue living independently. She credits the team’s planning and home supports for helping her feel confident about going home.
I felt supported every step of the way. Going home felt possible again.”
patient who benefited from the Home First approach at Timmins and District Hospital
Improving Access to Emergency and Inpatient Care
Altogether, these coordinated strategies strengthened patient flow across the hospital and improved access to emergency and inpatient care, which supports shorter emergency department wait times and faster access to inpatient beds.
In April 2025, the hospital’s emergency department ranked 14th in the province for length of stay for people who were not admitted. By December 2025, it ranked fourth, reducing wait times from 22.4 hours to 7.3 hours – representing a 67 per cent decrease.
Results like this demonstrate the importance of health innovations that address the unique challenges and opportunities in a given community.
The solutions that worked for this Northern Ontario hospital can offer learnings and insights that go on to benefit patients in regions across the province.
Last Updated: June 16, 2026
