Academic journal article Canadian Review of Social Policy

Canada's Complex and Fractionalized Home Care Context: Perspectives of Workers, Elderly Clients, Family Carers, and Home Care Managers1

Academic journal article Canadian Review of Social Policy

Canada's Complex and Fractionalized Home Care Context: Perspectives of Workers, Elderly Clients, Family Carers, and Home Care Managers1

Article excerpt


In Canada, home care provides health and social services to an estimated one million people, most of them older adults. In the absence of national policy directives, services vary considerably from one jurisdiction to the next, in what has been called a "checkerboard" of policy and practice. This paper examines policy-relevant issues in the provision of home care services, focusing specifically on "home support" services delivered by unregulated workers. We examine findings from our seven-year program of research, and highlight three policy issues that emerged from our study of workers, older clients, family carers, and managers. These are: scope of services, scheduling of services, and the presumption of availability of family/friend carers. For each issue, we give examples of policy or practice initiatives being undertaken and current challenges. We then examine these issues in relation to guiding principles for services, as identified by the Canadian Home Care Association.


Au Canada, des services de santé et des services sociaux à domicile sont fournis à environ un million de personnes, pour la plupart des personnes âgées. En l'absence de directives politiques nationales, les services varient considérablement d'un territoire à l'autre, dans ce qui a été appelé une « mosaïque » de politiques et de pratiques. Ce document examine les questions liées aux orientations politiques en matière de prestation de services de soins à domicile, et plus particulièrement les services de « soutien à domicile » proposés par des travailleurs non réglementés. Nous analysons les conclusions de notre programme de recherche mené à bien sur six années, et mettons en avant trois problèmes de politique qui ont émergé de notre étude sur les travailleurs, les clients âgés, les aidants familiaux et les gestionnaires. Ces trois problèmes sont : la portée des services, les horaires des services et la disponibilité présumée des aidants familiaux ou amicaux. Pour chaque point, nous présentons des exemples d'initiatives entreprises en matière d'orientation politique ou de pratiques, ainsi que les défis rencontrés. Nous considérons ensuite ces questions à la lumière des principes directeurs de ces services, identifiés par l'Association canadienne de soins et services à domicile.


The Final Report of Canada's Special Senate Committee on Aging described home care as "what Canadians want when their health makes it difficult for them to manage the activities of daily life... an essential part of providing integrated care to Canadians" (Carstairs & Keon, 2009). However, beyond recognizing home care's general desirability, one can say little else about it in a pan-Canadian context. Because home care services are not included in the Canada Health Act, service goals and program delivery vary not only across provincial jurisdictions but also between regions within a province, and sometimes even within health authorities.2 For most of the one million people who receive home care services (the majority of whom are older persons)3, the reality is that "where Canadians live, rather than what they need, determines access to services, residency requirements, the payment of user fees, and the continuity of service providers" (Shapiro, 2002, p.18).

This paper examines the perspectives of public sector home care managers, "unregulated" workers who provide the bulk of home care services, and older people who are clients of these services and their family carers in British Columbia (BC). Their experiences of home care are framed and interpreted through the lens of policy statements of the guiding principles of home care service delivery, with a particular focus on home care's place within an integrated Canadian health care system.

The Policy Context of Home Care in Canada

Over a decade ago Leduc Browne concluded that, in Ontario "the balance in home care is tipping from public to private payers, from non-profit to for-profit providers, but also from paid to unpaid workers" (2000, p. …

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