Advancing Care Beyond Boundaries: Home and Community-Based Care for the Region of Waterloo - News

Published on Apr 3, 2025


Apr 2, 2025

St. Joseph’s Health System unveils transformation plan for continued care in the community

Building on a legacy of care, St. Joseph’s Health System (SJHS) is launching St. Mary’s Health and St. Mary’s Health @ Home to renew Catholic care in the Region of Waterloo and meet the changing health and social needs of the community for generations to come.

SJHS launched a series of community engagements last summer to gather perspectives on how to advance Catholic care to meet the Region of Waterloo’s growing healthcare needs. This work was in preparation for the merger of St. Mary’s General Hospital and Grand River Hospital to form Waterloo Regional Health Network (WRHN), supported by the St. Joseph’s Health System’s Board of Directors. The existing St. Mary’s General Hospital site, now WRHN, will continue to be an acute care hospital for the next several years.

"For 100 years, St. Mary’s General Hospital has been at the heart of care in the Region of Waterloo, founded by the Sisters of St. Joseph to meet community need,” said Roger Fulton, Chair of the St. Joseph’s Health System Board of Directors. "Today, we renew our commitment to that mission, shaping the future of health and social care through community-driven solutions that emphasize access, equity, and integrated services that go beyond the walls of traditional hospital care.”

Rapid population growth in the Region of Waterloo has increased demand for health care services, resulting in longer wait times and limited access to primary and specialty care services. Additional support is also needed for seniors as the region’s senior population is expected to double in the next 20 years.

St. Joseph’s Health System is one of the largest Catholic corporations in Canada, serving more than two million Canadians. With an integrated care model that includes acute care, long-term care, home and community care, rehabilitation, and hospice services, SJHS provides high-quality, compassionate care to people throughout their lives.

"Our vision is to transform home and community care services, expand primary and specialty care access, and combine services across the lifespan to advance the legacy and honour the contributions of St. Mary’s in the community,” said Mike Heenan, Interim President and CEO of St. Joseph’s Health System and President of St. Joseph’s Healthcare Hamilton.

Strengthening Home and Community Care to Meet the Needs of People at Home

Home care services are essential to help seniors age safely at home and meet the needs of the region’s fast-growing senior population. St. Mary’s Health @ Home is the first service provided by St. Mary’s Health. It will continue serving people who no longer require hospitalization — but still need medical and personal support — by safely discharging them from hospital so they can continue recovering at home with support. Care at home is best for people while also alleviating pressure on hospitals.

"‘Caring for the Dear Neighbour’ has always been at the heart of our mission,” said Heenan. "Home care professionals are in the homes of our neighbours every day, delivering high-quality, compassionate care that enhances recovery in a familiar, safe and healing environment.”

St. Mary’s Health @ Home builds on the St. Joseph’s Hospital-to-Home Program that provides preventative care to seniors and patients with complex health conditions as they are discharged from the hospital. These transitions can be challenging for patients. For example, frail elderly patients as well as those who are transitioning back home after a long hospital stay need proactive care to reduce complications or hospital re-admission. Caregivers need support too so they can confidently look after their loved one.

Supported by an interdisciplinary team including nurses, personal support workers, occupational therapists, physiotherapists, rehab assistants, and social workers, St. Mary’s Health @ Homeprovides ongoing, personalized care that supports both clients and their caregivers, helping individuals regain independence and continue their healing journey.

"Our goal is to ensure that every patient receives the care they need, when they need it, and where they need it along their entire healing journey,” said Nadia Surani, VP of Post-Acute Care at St. Joseph’s Healthcare Hamilton and Executive Director of St. Joseph’s Home Care. "Together with our hospital and community partners, we’re expanding our home care services to enhance access to urgent in-home supports for people in the Region of Waterloo.”

A Bold Vision for the Future: Removing Barriers and Enhancing Access to Care Across the Lifespan

In addition to recognizing the growing need for home care support, SJHS community engagements identified a critical gap in primary care access – 13 per cent of residents don’t have a family doctor. To help address this gap, St. Mary’s Health will look to strengthen partnerships with primary and specialty care providers and the Ontario Government’s primary care action team to ensure more people in the community can access the care that they need.

"Traditionally, healthcare is provided in a hospital or institutional setting, but healthcare environments are changing to meet the needs of diverse populations through team-based care,” said Heenan. "Our vision for the future of care combines a variety of primary, home and long-term care services so it’s easier for everyone — particularly seniors, people with complex conditions, and underserved populations — to receive care outside of the hospital.”

Continuing the Legacy of Mission-Based Care in the Region of Waterloo

Guided by the legacy of the Sisters of St. Joseph, SJHS will continue its mission by collaborating with community partners to adapt, innovate, and create a healthcare system that prioritizes compassionate, equitable, and sustainable care for generations to come.

"As we embark on this transformation, St. Joseph’s Health System is building upon a century of excellence in healthcare, under the St. Mary’s Health name in the Region of Waterloo,” said Fulton. "We are grateful for the community’s trust and support as we take this next step toward a stronger, more connected healthcare future for all.”

Media Contact: Nicole Vaillancourt, St. Joseph's Health System