Understanding Home Care: Public & Private
This is a comprehensive educational article on the continuum of home care; both public-subsidized and private-pay, from the hospital or when the need arises at home.
There is an assumption that public home care services are free and they will be adequate, allowing the adult to live at home as long as possible. It comes as a major shock to most families how much pubic-subsidized home care costs and how little is provided. Private home care is much more comprehensive but costs can be astronomical.
Understanding the options for home care now will reduce stress later – especially in the case of a sudden decline.
Community Publicly-Subsidized Home Care
Home Care is ‘non-medical’ assistance for activities of daily living: bathing, dressing, transferring, and eating.
Bathing is usually ‘bird-baths’ with a shower once or twice a week.
It does not include housekeeping, laundry, meal preparation (caregivers will heat prepared meals and serve it), or shopping. (‘Better at Home’ and other services can fill the gaps, but waitlists are long.)
The usual time is 2 to 4 visits per day, divided into 2 to 4 time slots.
There will likely be different caregivers every visit – and this is a significant issue for those with cognitive decline.
Referrals to home care
If nursing care is needed for medical reasons, or if physiotherapy or occupational therapy is required, they are provided at no cost. They are arranged separately by your community case manager.’ See listings in Sources and Resources.
If the adult is at home at the time of need:
Anyone, including family or the adult, can request home care. It does not need to be ordered by a physician or social worker.
Call your local community health branch and ask for “Intake.” Leave a message with the person’s name, Personal Health Number, a quick summary of the situation, and the urgency.
If you have not heard back in a week, or if the situation worsens, call back and keep following up.
The adult must ‘be known’ to community health and require support of some sort to be put on the list for public-subsidized long-term care.
A final important note: If the adult is experiencing physical or cognitive decline and the need for long-term care is projected, it is important to bring in community supports as early as possible.
If the adult is in hospital:
An unplanned hospital admission is the reason most adults will suddenly require home care – even if they were independent before the hospitalization.
Because of an extreme shortage of long-term care beds and months or years-long waitlists, the Ministry of Health has a ‘Home first’ mandate where care at home must be attempted before long-term care will be considered (except in the most extreme cases where it can be proven that the home is unsuitable or the adult would be unsafe).
The attempt at home must ‘fail’ before long-term care is considered.
If home care is required, a social worker or community liaison will make a referral.
Be aware:
It may be several days or weeks after discharge before a community case manager assesses the adult. The time between discharge and care coming in may need to be filled by family, friends, or private home care.
Public home care is too often unreliable as caregivers fail to show up or cancel at the last minute. If the adult can’t manage at home and private home care is not a financially viable option, keep taking them back to the hospital — and assertively ask for an urgent or emergent placement in long-term care. (See Understanding Long Term Care.)
Home Palliative Care and Hospice:
This is provided through the same community health agency as regular home health. Anyone can put through a referral, but the adult must have been deemed ‘palliative’ or end-of-life by their primary care provider.
When this designation is in place, the adult’s condition and needs are supervised by a special nurse case worker and team.
Home care, home equipment (such as a hospital bed, commode, and lift), and medications are free.
If the adult wants to die at home, 24/7 support is supposed to be available for the last 72 hours of life, but this might be limited due to staffing issues.
Read more, Understanding Palliative Care and Hospice.
Public-Subsidized Home Care generally has a cost
For non-caregiving supports such as housekeeping and shopping:
Call or visit the BC 211 website (dial 211).
Call your local seniors’ centre.
Home Care services are based on the income (not assets) of the adult, and if they are a married couple, their spouse’s income is added – even if only one person is receiving services.
Home Care can be a significant expense when adults live on a fixed income.
You are expected to use savings and draw against the value of your home.
“Choices in Supports for Independent Living” (CSIL) is an option for disabled adults to receive more care at a lower cost:
If the adult is capable or has someone who can act as a financial administrator and case manager (hiring, firing, coordinating caregivers). In that case, an application might be considered in which the adult hires caregivers, stretching the allotted dollars and allowing for more consistent care.
Funding is provided only for those likely to live at home long-term, not for those expected to need long-term care in the foreseeable future.
A final important note: If the adult is experiencing physical or cognitive decline and the need for residential care (assisted living or long-term care) is projected, it is important to bring in community supports as early as possible.
Private-Pay Home Care
More and more adults and their loved ones are turning to private home care agencies to fill the gaps in public home care.
The pros:
Consistency.
If caregivers can’t attend, it is the agency's responsibility to fill that shift. (Ask about their policy!)
Caregivers can do whatever needs to be done: physical care, meal preparation, housekeeping, shopping and errand running, and companionship
Hours can be increased as the need increases
24/7 care can be provided.
The cons:
It’s expensive! Rates are generally $35 to $55 per hour (depending on the city and the agency – cheaper is not always the best option). Most agencies have a minimum of 3 hours per shift and at least three weekly shifts. This can add up to tens of thousands per month.
Not all private care agencies are created equal. You must do your homework.
Sources and Resources
BC Ministry of Health: Home and Community Care
Care Options and Cost
Eligibility
How to Arrange for Care
Who Pays for Care
Managing Your Care
Accountability
Concerns and Complaints
Vancouver Coastal Health (VCH) Main Information Website
Intake Listings (Community Access Lines): Like Northern Health, VCH breaks its home health intake lines down by specific geographic communities. No doctor referral is required to call.
Vancouver: 604-263-7377 (Palliative Specific Access Line: 604-263-7255)
Richmond: 604-675-3644
North Shore (North Vancouver, West Vancouver): 604-983-6700
Sea-to-Sky (Squamish, Whistler, Pemberton): 604-892-2293
Sunshine Coast (Sechelt, Gibsons): 604-741-0726
qathet / Powell River (including Texada Island): 604-485-3310
Bella Coola: 250-799-5311
Bella Bella: 250-957-2314
Listing of Services:
Case Management: Community Care Clinicians serve as case managers to assess eligibility, build personalized care strategies, coordinate community resources, and assist families with care logistics.
Home Support: Practical assistance with standard daily activities (bathing, dressing, basic meal heating, toileting, transfers, and medication support) alongside built-in caregiver relief.
Community & Ambulatory Nursing: Professional acute, chronic, and post-surgical medical interventions. This includes wound care, intravenous (IV) therapy, and illness management, provided either in the home or at a local community health center.
Rehabilitation Therapy: Assessment and treatment plans provided by Physical Therapists (PTs) and Occupational Therapists (OTs) focused on fall prevention, safe movement, and ordering adaptive medical equipment.
Professional Support Services: In-home access to Registered Dietitians (community nutrition advice), Social Workers (counselling and resource navigation), and Speech-Language Pathologists (swallowing and communication therapies).
Adult Day Programs: Structured group activities, socialization, and monitoring for older adults or individuals with cognitive decline to help them stay active while giving family caregivers a break.
Specialized Subsidized Programs: Health Services for Community Living (HSCL) for adults with developmental disabilities, Acquired Brain Injury services, and the Choice in Supports for Independent Living (CSIL) self-managed funding model.
Palliative & End-of-Life Care: Specialized medical, nursing, and emotional comfort support delivered at home or via local hospices for individuals dealing with a terminal illness.
Assisted Living & Long-Term Care Placements: Structural assessments to transition individuals into supportive housing or 24-hour complex care facilities when they can no longer live at home safely.
Island Health Main Information Website
Intake Listings (Community Access Line): You do not need a doctor’s referral to call. Lines are open 7 days a week, 365 days a year.
South Island: 250-388-2273 or toll-free 1-888-533-2273 (8:30 a.m. – 10:30 p.m.)
Centre Island: 250-739-5749 or toll-free 1-877-734-4101 (8:30 a.m. – 8:00 p.m.)
North Island: 250-331-8570 or toll-free 1-866-928-4988 (8:30 a.m. – 6:00 p.m.)
Listing of Services:
Home Support: Help with daily living activities (bathing, dressing, grooming, simple meal heating, and blister-pack medication administration).
Nursing Care at Home/Clinics: Skin and wound care, IV care, post-hospital care, and chronic disease/medicine management.
Community Rehabilitation: Physical Therapy (PT) and Occupational Therapy (OT) for mobility, falls prevention, and home safety/equipment adaptations.
Caregiver Support & Respite: Temporary relief and short-term breaks for primary unpaid caregivers.
Community Virtual Care: Remote health monitoring by phone or video for specific chronic medical conditions.
Specialized Care: End-of-life/palliative care, brain injury support, and developmental disability support (Health Services for Community Living).
Assisted Living & Long-Term Care: Assessments and transitions into subsidized community facilities.
Interior Health Main Information Website
Intake Listings (Home Health Central Intake):
Public/Self-Referral Line: 1-800-707-8550 (Call this number for families, self-referrals, and general public intake).
Note: Physicians and Nurse Practitioners utilize a separate external Home Health referral form available online.
Listing of Services:
Care Management: Dedicated care managers who coordinate care planning, consult with families, and assist with transitions between care settings.
Home Support: Personal care assistance managed by Community Health Workers (bathing, dressing, special exercises, and medication administration) alongside caregiver rest and relief.
Community Care Nursing: Clinical interventions delivered at home or clinic including wound care, IV antibiotic treatment, pain and ostomy management, and self-care teaching.
Rehabilitation Therapy: Subsidized occupational and physical therapy assessments.
Health Services for Community Living (HSCL): Targeted health care assessments and planning for youth and adults with developmental disabilities.
Specialized Facilities: Oversight for Convalescent Care, Assisted Living, and Long-Term Care placements.
Fraser Health Main Information Website
Intake Listings (Fraser Health Access Line):
Phone Intake: 1-855-412-2121 (Open 7 days a week, 7:00 a.m. – 9:00 p.m., 365 days a year).
Online Intake: You can also request a callback by booking a telephone appointment via their online form on the Fraser Health website.
Note: Current clients can bypass the central line and contact their local community Home Health office directly (e.g., Burnaby, Surrey, Abbotsford, Tri-Cities, etc.).
Listing of Services:
Community Health Nursing: Professional nursing clinics or in-home care evaluating wound care, medication, and post-surgical health.
Home Support Services: Personal care support and assistance with day-to-day home activities.
Medication Management Program: Structured home visits conducted specifically by pharmacists to review and manage complex drug regimens.
Rehabilitation Therapy: Physical and occupational therapy focused on enhancing mobility, safety, and coordinating home-use equipment.
Caregiver & Family Support: Specialized education, connection to community resources, and advocacy tools for families.
Social Work, Nutrition & Dietitian Services: Professional advice regarding nutritional plans, navigating isolation, and community aid connections.
Palliative & End-of-Life Care: Specialized comfort care for individuals facing life-limiting illnesses.
Seniors Community Connector & Advance Care Planning: Programs focused on socialization, healthy aging, and outlining long-term healthcare directives.
Northern Health Main Information Website
Intake Listings (Local Community Offices): Unlike health authorities with a single region-wide hotline, Northern Health routes home health intake directly through localized community offices. Referrals can be made via self-referral, by a family member, or by a healthcare provider.
Prince George (Northern Interior): 250-645-8963
Smithers (Bulkley Valley): 250-847-6234
Terrace (Pacific Northwest): 250-631-4272
Fort Nelson (Northeast): 250-774-8100
How to find your local office number: Because Northern Health covers a vast geographic footprint, you can look up your town's intake number in the community directory on the Northern Health Official Website.
Listing of Services:
Case Management: Designated case managers coordinate care planning, determine program eligibility, monitor evolving needs, and guide transitions between care settings.
Home Support Services: Personal care assistance delivered by community health workers to help individuals maintain independent living (assistance with bathing, grooming, dressing, and simple medication administration).
Home Care Nursing: Non-emergency professional nursing care delivered either in-home or at local community clinics. Services include wound care and dressing changes, intravenous (IV) therapy, ostomy care, pain monitoring, and post-operative management.
Community Rehabilitation: Specialized Physical Therapy (PT) and Occupational Therapy (OT) home assessments to maximize safety, prevent falls, and arrange for adaptive medical equipment/supplies.
Health Services for Community Living (HSCL): Specialized, non-emergency clinical consulting (nursing, dietary, dental hygiene, rehabilitation) for adults with developmental disabilities who live in the community.
Choice in Supports for Independent Living (CSIL): A self-managed model of care where eligible individuals receive direct funding to independently recruit, hire, schedule, and manage their own home support workers.
Hospice Palliative Care & Caregiver Respite: Compassionate end-of-life care for individuals with life-limiting illnesses, paired with short-term residential or in-home relief options to grant unpaid family caregivers a temporary break.
Assisted Living & Long-Term Care Placements: Professional assessments to guide adults into subsidized, semi-independent housing or 24-hour complex care facilities when living at home is no longer safely manageable.
