In order to gain a greater breadth of understanding medical geographical issues, such as medically underserviced regions, medical geographers are paying more attention to health policy. Using existing evaluations, an historical analysis of home care programs in Canada's largest and most populous province informs how developments in long-term health care policy have contributed to the geographical inequalities that exist in home care services throughout the province. The geographical bias in the testing, planning and implementation of home care programs has influenced their availability, accessibility and quality in the underserviced region of northern Ontario. Exploring the history of long-term care policy in Ontario also sheds light on the contemporary politics of welfare reform taking place in much of the western world. In many western countries, home health care has moved from being a complementary or alternative form of long-term care, to the favored form of long-term care. The most recent long-term care policy reform in Ontario points to the decentralization of long-term care, a strategy that has already been in affect in some western countries.