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 hours 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 are required, they are provided at no cost. They are arranged separately by your community ‘case manager.’
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 residential care.
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.
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 residential care beds and months or years-long waitlist, the Ministry of Health has a ‘Home first’ mandate where care at home must be attempted before residential 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 residential care is considered.
If home care is required, a social worker or community liaison will put through a referral.
Be aware:
It may be several days after discharge before a community case manager comes to assess the adult, and then there may be more time before care is put in place. The time between discharge and care coming in needs 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 Residential 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 family practitioner.
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 supports are 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 website for BC 211 (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.
There is a process to reduce the fee when it is a burden: talk to the case manager about doing an expense report to reduce your income.
CSIL – an option for disabled adults to receive more care at a lower cost:
Suppose 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 for “Choices in Supports for Independent Living” (CSIL) might be of consideration so that caregivers are hired by the adult, stretching the dollars allotted and allowing more consistency in care.
Funding is only provided for those likely to live at home long-term and not for those expected to need residential 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-one’s 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 up to the agency 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 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 minimums of 3 to 4 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.
