Directly Funded Home Care Programs in Canada: A National Inventory

One effort to relieve the pressure on home care infrastructure is directly-funded programs, a model expanding throughout Canada and the developed world. Direct Funding (DF) programs provide individuals or families with cash to hire and manage workers for home care or respite. Most often, this means locating and hiring people from the community, with or without training. DF is also known as self-managed or self-directed care, consumer-directed care, individualized or personalized budgets, and/or direct payments. DF is associated with feelings of empowerment and high levels of user satisfaction, and is at least cost-neutral as a policy mechanism. DF can engender tension with labour perspectives, and be at odds with feminist scholarship on care. DF is an evolving policy approach that highlights the complex politics of care.

In this presentation, we share findings of a comprehensive inventory of Canadian DF programs, gathered through qualitative interviews and questionnaires conducted with program administrators. We outline key program elements that characterize the Canadian policy landscape, and emphasize the implications for older clientele. We consider two themes that emerged across the country. The first theme considers the lack of information on the workers employed through DF home care. Care workers in a variety of settings can be an under-documented population. This issue is exacerbated by the informal hiring practices and low entry requirements of DF, paradoxically two of the programmatic features lauded by clients. Finally, we consider the increasing role of agency care providers within DF schemes, considering the advantages and the ways that these organizations can conflict with some of the DF policy aims. In doing so, we demonstrate the diversity, and at times, inequity, in available DF options in Canada.