Community-Based Reform Efforts: The Case of the Aging at Home Strategy.

This paper considers one of Ontario's largest reform efforts: the Aging at Home Strategy (AHS). The AHS was initiated in 2007 to enable people to live independent lives in their own homes. A document review was conducted on relevant government materials to assess the goals and objectives of the AHS as it was rolled out over the course of three years. The findings identify that by the third year of the AHS, there was a reduction in the discretionary powers of the regional health authorities to allocate funds based on local priorities. These findings also highlight that the "mainstream" subsectors of the healthcare system - medical and hospital services - and those outside the mainstream (or the "marginal" subsectors) face different institutional boundaries, policy legacies, political actors and policy agendas. While interests within the mainstream subsector are organized and institutionalized, the marginal subsectors are fragmented, creating a power imbalance where the priorities of the mainstream subsector dominate.