That is, it would destroy the long-term chronic care function and it would ensure the preventive function is never developed. In the section on the contextual framework for home care in Canada, it is noted that over the last decade most provinces have strengthened their connections between continuing care and acute care by moving responsibility for continuing care services into the health sector from the social service sector. There is no dispute that this is, in fact, happening, but how it is happening requires critical examination. One of the real dangers of moving continuing care services from the social service sector to the health sector is that they become medicalized. They lose power as bit players competing for parts of the same pie with established interests, notably hospitals and, indirectly if not directly, physicians and pharmacare.
Integration is a catch word in current reform and a concept used without critical examination.
For example, when discussing home-care innovation in Canada, it is noted that one of the ongoing challenges is to stop the inappropriate vertical fragmentation of care. Integration, however, means that hospitals can turn to the home-care budget to cover their deficit unless there are strict and formal regulations in place, for example, that disallow transfer of funds from home care to the acute hospital sector. We are dealing here with powerful, established vested interests that can easily further disadvantage continuing care services unless protection is in place. The author argues, when talking about a national Canadian model, that finances are required from the federal government, but there must be assurances that the provinces will use the funding for home care. Similarly, as services are integrated, there must be assurances that established home-care monies can grow and that existing funds, small in comparison with other sectors, will not be used by other sectors.