Current Government initiatives promote the provision of health care in the community rather than in medical institutions. Over the last decade there has been a growth in the number of early discharge hospital-at-home initiatives which provide a level of nursing and rehabilitation care in the home that previously would have been provided in an acute hospital. Simultaneously, there has been a move away from medical to client-centred models of health care delivery. These new client-centred models of health care emphasise collaboration between client and professional and encourage users of health care services to take greater control over and responsibility for their health care. Some occupational therapists may question whether the principles of client-centred care are compatible with the policy of discharging patients early from hospital while they remain in need of health care. This paper briefly reviews some of the principles of the Canadian Model of Occupational Performance; discusses some of the barriers to providing client-centred services in the early discharge hospital-at-home setting; and reflects upon whether the principles of client-centredness are consistent with early discharge from hospital policies.

While the need to realign the continuum and change the delivery system is one of the many factors driving health care reform, it is clear that a major transformation of the delivery system is already under way and that ambulatory care and home care are at the forefront of that movement. This trend is likely to continue regardless of the pace of health reform.