Direct Funded Home Care for Older People in Canada.

About the Project

Project term: 2016-2021

Most people want the choice to “age in place” at home and in their community, and home care is key to supporting this choice. A growing alternative to government-organized home care is “directly-funded” (DF) or self-managed home care, which provides individuals with cash to arrange their own home care services. Using feminist and disability care frameworks, this project involved a national environmental scan, 13 key informant interviews with government experts across the country, a survey of 95 workers, and 47 lived experience interviews with clients, caregivers, and workers. This project asked a variety of questions including: What are the features of DF programs across Canada? What are the emerging issues related to program design and policy development? Who are the workers in DF home care, and what are the working conditions? How does DF home care support and/or place demands upon family caregivers? Does DF have theoretical implications for social movements among older and disabled people in need of home-based support?

What we learned

Policy Trends

DF home care is growing across Canada particularly among older clients and their families. The evidence suggests that DF programs may provide a short-term solution for inequitable access to services in rural areas, and can improve social outcomes for some client groups such as people from sexual, linguistic, and ethnic minorities. However, the evidence also suggests that clients who use DF programs are disproportionately represented by people from higher socio-economic backgrounds and with well developed problem-solving and decision-making skills.

Client and family experiences

DF enhances choice and flexibility of home care services, particularly in terms of what gets done and when it gets done, leading to greater satisfaction and a sense of improved care quality among both clients and caregivers. DF can also reduce caregiver burden, although there are areas where caregiver support still needs improvement.

Worker experiences

Workers in DF are frequently involved in the work of keeping households running and supporting social and community interactions. Workers are also occasionally, and uniquely, involved in helping with the administration of DF home care services and finding new workers. We refer to this increased emphasis on work that is not related to body care as ‘social task shifting.’ At the same time, relationships with clients can become extremely complex, which some experience as exploitation. For many, however, work in DF results in rewarding and meaningful personal relationships.

Publications and information materials

National Report (coming soon)

Fact Sheets (coming soon)

Infographics (coming soon)

Research Team Members

Principal Investigator: Christine Kelly, University of Manitoba
Katie Aubrecht, St. Francis Xavier University
Amanda Grenier, McMaster University
Mary-Jean Hande, Mount Saint Vincent University
Anne Martin-Matthews, University of British Columbia
Maggie Fizgerald Murphy, Carleton University
Allison Williams, McMaster University

Research associate

Yuns Oh, PhD

Research assistants and students

Hiwot Amare, Kevin Balkaran, Lisette Dansereau, Aliya Jamal, Elizabeth Tingey,
Zena van de Poel

This research was supported by the Canadian Institutes of Health Research, project grant number 148856