Inequities in access to directly-funded home care in Canada: a privilege only afforded to some

Abstract

Background Directly-funded home care (DF) provides government funds to people who need assistance with the activities of daily living, allowing them to arrange their own services. As programs expand globally, many allow DF clients to hire home care agencies to organize their services rather than finding their own workers. In Canada, half of the DF home care programs allow users to purchase agency services. The goal of this research is to describe the role of agency providers in DF home care in Canada and consider potential equity implications for service access from the perspectives of clients and families. Methods Framed with intersectionality, the study included online focus groups with families and clients (n = 56) in the two Canadian provinces of Alberta and Manitoba between June 2021-April 2022. All transcripts underwent qualitative thematic analysis using open and axial coding techniques. Each transcript was analyzed by two of three possible independent coders using Dedoose qualitative analysis software. Results The article presents five thematic findings. First, the focus groups document high rates of satisfaction with the care regardless of whether the client uses agency providers. Second, agency providers mediate some of the administrative barriers and emotional strain of using DF home care, and this is especially important for family caregivers who are working or have additional care responsibilities. Third, there are out-of-pocket expenses reported by most participants, with agency clients describing administrative fees despite lower pay for the frontline care workers. Fourth, agencies are not generally effective for linguistic and/or cultural matching between workers and families. Finally, we find that DF care programs cannot compensate for a limited informal support network. Conclusions Clients and families often intentionally choose DF home care after negative experiences with other public service options, yet the results suggest that in some Canadian contexts, DF home care is a privilege only afforded to some. Given the growing inequalities that exist in Canadian society, all public home care options must be open to all who need it, irrespective of ability to pay, degree of social support, or competence in the English language.

Combattre la toxicité financière associée aux soins contre le cancer au Canada

“…Le financement des services à domicile est laissé à la discrétion des autorités sanitaires provinciales, ce qui fait que bien des coûts sont assumés par la patientèle atteinte de cancer et sa famille 3 . Il existe une variation considérable entre les provinces quant à l’admissibilité aux soins à domicile et à l’équipement médical et à leur subventionnement 8 . Bien que les régimes d’assurance privés puissent couvrir ces services, la plupart des personnes au Canada n’ont accès à ces régimes que par l’emploi; or, les personnes atteintes de cancer qui réduisent leurs heures de travail ou quittent leur emploi sont à risque de perdre cette couverture 6 .…”

“…• Dans les systèmes de santé du Canada, bien des coûts directs liés au traitement du cancer -comme les médicaments pris à la maison et les soins à domicile -ne sont pas financés par l'État, avec des variations considérables d'une province à l'autre. l'équipement médical et à leur subventionnement 8 . Bien que les régimes d'assurance privés puissent couvrir ces services, la plupart des personnes au Canada n'ont accès à ces régimes que par l'emploi; or, les personnes atteintes de cancer qui réduisent leurs heures de travail ou quittent leur emploi sont à risque de perdre cette couverture 6 .…”

Tackling financial toxicity related to cancer care in Canada

“… 3 Considerable variation exists between provinces on the eligibility and subsidization of home care services and medical equipment. 8 Although private insurance plans may fund these services, most people in Canada have access to private insurance only through employment; patients with cancer who reduce their working hours or leave their job are vulnerable to losing such coverage. 6 …”

“…3 Considerable variation exists between provinces on the eligibility and subsidization of home care services and medical equipment. 8 Although private insurance plans may fund these services, most people in Canada have access to private insurance only through employment; patients with cancer who reduce their working hours or leave their job are vulnerable to losing such coverage. 6 Alongside potential drug, equipment, and home care costs, a cancer diagnosis may be accompanied by loss of employment or reduction in income, as well as increased costs related to travel and accommodation for treatment, home modifications, and child care.…”