An elderly woman receives a visit from a personal support worker who helps her bathe, dress, and prepare for the day. This assistance allows her to remain in her own home rather than move to a nursing home - a preference so strong she will accept significant discomfort to maintain it. A man recovering from hip surgery receives home physiotherapy, the exercises rebuilding strength so he can manage independently again. A palliative patient spends final weeks at home, surrounded by family, home care nurses managing symptoms that would otherwise require hospitalization. A caregiver daughter takes unpaid leave to supplement the few hours of home care her mother receives, the public hours insufficient for actual need. A home care agency struggles to staff its contracts, workers leaving for better-paying retail jobs, the wages for intimate personal care lower than for stocking shelves. Home care services, providing health and personal care in people's homes, enable independence and preference for millions of Canadians. How these services are funded, staffed, and delivered shapes whether aging and illness can be managed at home.
The Case for Home Care Investment
Advocates argue that home care requires significant expansion. From this view, home care is both preferred and efficient.
Home care is what people want. Most Canadians prefer to receive care at home rather than in institutions. Respecting patient preference means expanding home care capacity.
Home care can be cost-effective. For many patients, home care costs less than hospital or nursing home care. Investment in home care may reduce more expensive institutional care.
Current home care is inadequate. Hours are limited, services are inconsistent, and waitlists exist. People who could stay home are forced into institutions because home care is unavailable. Expansion is needed.
From this perspective, home care should be treated as essential healthcare: adequately funded, universally accessible, and staffed by well-compensated workers.
The Case for Appropriate Limits
Others argue that home care has limitations that must be acknowledged. From this view, home care is not always appropriate or efficient.
Not everyone can be cared for at home. Some conditions require institutional care. Homes may not be suitable. Family may not be available. Home care has limits.
Home care efficiency depends on circumstances. For some patients, concentrated institutional care may be more efficient than distributed home visits. Case-by-case assessment should guide placement.
Caregiver expectations should be managed. Home care supplements but does not replace family and self-care. Expecting public home care to meet all needs is unrealistic. Shared responsibility is appropriate.
From this perspective, home care should be available for appropriate patients while recognizing that institutional care remains necessary for others.
The Workforce Crisis
Home care faces severe workforce challenges.
From one view, home care workers are shamefully underpaid. Personal support workers doing intimate, demanding work earn poverty wages. No amount of home care expansion will succeed without addressing compensation.
From another view, home care work conditions - isolated, physically demanding, variable schedules - create challenges beyond pay. Comprehensive workforce strategy is needed, not just wage increases.
How home care workforce is supported shapes service capacity.
The Coordination Challenge
Home care requires coordination with other services.
From one perspective, home care should be integrated with healthcare system. Hospital discharge planning, primary care, and home care should be connected. Fragmented systems harm patients.
From another perspective, home care coordination is complex. Multiple providers, funding streams, and governance create integration challenges. Progress requires sustained effort.
How coordination works shapes care transitions.
The Family Caregiver Role
Home care often depends on family caregiving.
From one view, family caregivers need support. They provide enormous amounts of unpaid care. Respite, financial support, and recognition for family caregivers are needed.
From another view, public home care should not assume family availability. Some people have no family. Others' family cannot provide care. Home care must be available regardless of family situation.
How family caregiving is understood shapes home care expectations.
The Private vs Public
Home care can be publicly or privately funded.
From one perspective, home care should be publicly funded and universally accessible. Like hospital care, home care is healthcare. It should be covered by medicare principles.
From another perspective, private home care provides choice and supplements public services. Mixed models may serve well. Not all home care need be publicly funded.
How funding is structured shapes access and equity.
The Canadian Context
Canadian home care is provincially funded with significant variation. Hours provided vary by province and individual assessment. Waitlists exist in many areas. Workforce shortages affect most regions. Private home care supplements public services for those who can afford it. Federal funding has targeted home care expansion. Coordination with hospitals and primary care is variable. Family caregivers provide most home-based care. Home care policy attention has increased. Implementation lags aspiration.
From one perspective, Canada should dramatically expand home care as essential healthcare.
From another perspective, home care expansion should be targeted and recognize home care's limitations.
How Canada develops home care shapes where Canadians receive care.
The Question
If home care is what people want, if it can be cost-effective, if current services are inadequate, if workers are underpaid - what level of investment is appropriate? When someone enters a nursing home because home care isn't available, what choice was denied? When home care workers earn less than retail workers, what value are we placing on their work? When family caregivers sacrifice careers and health to fill gaps, what burden are we imposing? When we speak of aging at home, what support does that actually require? When institutional and home costs are compared, what factors should be included? And when someone's preference is to stay home, what should the system provide?