Home care in Canada is the part of the health system that is not covered by the Canada Health Act. Hospitals and doctors are insured nationally; nursing, personal support and therapy delivered at home are provincial programmes with different eligibility, co-payments and waiting lists in each province. Around 2000 that gap produced a wave of reports commissioned by governments and by the associations of home care providers.
What the reports said
The synthesis and technical reports of the period agreed on a few points. Home care was the fastest-growing part of health spending but received a small share of it. Provinces were shifting care from hospitals to homes without shifting money. Family caregivers, mostly women, were providing the bulk of the care unpaid and were burning out. Data were so inconsistent between provinces that national comparison was barely possible. The reports called for a national minimum basket of home care services, standard data, support for family caregivers and integration of home care with primary care and hospitals.
Romanow and the 2004 accord
The 2002 Romanow Commission recommended that the Canada Health Act be extended to cover home care for mental health, post-acute care after hospital discharge and palliative care at home. The 2004 First Ministers’ health accord adopted a narrower version: provinces agreed to provide short-term acute home care, acute mental health home care and end-of-life care from 2006. The federal Compassionate Care Benefit, giving employment insurance to people caring for a dying relative, dates from the same period.
Where it stands
Two decades later the pattern repeats. The 2017 federal-provincial agreements sent 6 billion dollars over ten years to home and community care; the COVID-19 pandemic exposed long-term care homes and renewed the argument for ageing at home; and in 2023 the federal government tied new health transfers to data-sharing commitments. Waiting lists for publicly funded home care remain long, private agencies fill the gap for those who can pay, and the Canadian Institute for Health Information now publishes comparable indicators that the early reports could only ask for.
This site is an independent reference on community and home care. It does not represent any Canadian association and does not hold their reports.