"Can this care be provided at home?" This basic question is a powerful instrument for change in the healthcare system. The fundamental shift required for healthcare is from the current system, where home care is designed to accommodate and respond to pressures in acute care or long-term care, to a system where home care considerations actually drive practice. This article describes how a philosophical change accompanied by the measurement of "system shift indicators" can achieve the move to effective person-centred and home-based healthcare. By changing the approach and the measures for evaluating effectiveness, the health system changes sought by all jurisdictions across Canada and recommended by Drummond for Ontario will be sustainable.