Home Health 101: Understanding how publicly-subsidized home care works in BC

With the controversy swirling around the BC government’s planned expropriation of home care staff into 3 health authorities in just over a year’s time, we have had a lot of questions about how publicly-subsidized home health works here today. The following provides a quick overview on this topic.

What is home health care?

Home health care is a term used to refer to the services which seniors (and other people needing support) receive to help them live well at home. Home health care refers to two components 1) home care and 2) home support. However, these terms are sometimes used interchangeably.

Home Care: Professional services such as nursing care, physiotherapy, occupational therapy, speech therapy, respiratory therapy, nutrition, counseling, and social services.

Home Support: Unregulated services such as bathing, personal care, and meal preparation.

Who pays for care?

Home health care can either be arranged through the government (publicly-subsidized care), or purchased privately (private pay care). Seniors who can afford it sometimes prefer to arrange for care privately, because it allows for more flexibility. For example, private pay care may include things like light housekeeping, companionship, or even dog walking, while publicly subsidized care does not include those services.


If a senior is looking to access publicly-subsidized care (which is the focus of this post), how much they will pay depends on their “pay rate.” A person’s pay rate is determined by their income or a fee schedule, depending on the service they need. Depending on the rate, a senior may receive a service at no cost, or they may share the cost with government.[1]

Who delivers publicly subsidized care?

In some cases, staff are directly employed by the health authority to deliver home care and home support services. In other cases, the government has a contract with a non-government organization which manages the delivery of some or all home health services in a specific area.

In other words, while the government may pay for some or all the cost, another organization may arrange, deliver and be accountable for the care a senior receives.

Who are the contracted providers delivering care?

Six large organizations hold primary contracts with BC health authorities. Several others hold smaller contracts and are sometimes referred to as “surge” providers.

Contracted providers must meet very high standards. For example, they must be accredited by an approved third-party, such as Accreditation Canada or CARF; they must participate in regular audits; and they are required to adhere to all policies and guidelines within the B.C.’s Home and Community Care Policy Manual.

Contracted providers can either be for-profit or non-profit organizations.

How do seniors think publicly-subsidized care can be improved?

Seniors would like to see visit times improved. Currently visits can be as short as 15 minutes. They would also like to see more kinds of services available to them, including things like light housekeeping, and more help with meal preparation.

What actions are being taken by government?

The NDP government recently announced that they will not be renewing contracts with the organizations who are currently caring for B.C.’s seniors. At least 4,000 workers will be transitioned from their organization to the health authorities.

What will it mean for seniors when services are “brought in-house”?

This could mean less access to care and more costs for taxpayers. It is not supposed to affect the kinds of services seniors receive, nor is it supposed to increase the length of time home support workers are able to spend with these clients.

What is BC Care Providers Association recommending?

The BC Care Providers Association (BCCPA) is recommending that the government take the time to properly consult with seniors and the sector before they move forward with what will be a major and disruptive change for seniors and for workers.

Jim Mann asks the BC government to hit the ‘pause button’ and consult with seniors

[1] Who pays for care? Government of British Columbia. Accessed at: https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/who-pays-for-care

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