Grant: Project Grant

The organization and delivery of quality home care services for long-term care needs associated with aging and disability is one of today's greatest health policy challenges. Directly-funded (DF) home care provides government funds to individuals to arrange assistance with the activities of daily living. DF, also referred to as 'self-managed' home care, may relieve the strain on home care systems and is expanding across Canada. While promising, emerging evidence suggests DF home care may exacerbate health inequities when scaled up. Our research team proposes the question: How can DF home care programs be designed to enhance social and health outcomes for diverse home care clients, informal supports, and care workers in Canadian contexts? We hone in on three perennial policy issues - that is, areas in which consensus has not been reached and that present challenges to equitable service delivery. First, we consider the role of home care agencies in DF service delivery. The role of non-profit and for-profit home care agencies is unclear and there may be health equity implications compared to a 'hire-your-neighbour' approach historically endorsed in DF programs. Secondly, we consider the implications of expanding DF to a larger portion of home care users in contrast to focusing on specific groups of people. Finally, we explore how to best adapt DF for rural contexts. Framed with the concepts of intersectionality and health equity, our 5-year study will take place in four provinces (Alberta, Manitoba, Ontario and Newfoundland & Labrador). We will use a variety of qualitative methods, including an environmental scan, focus groups, key informant and lived-experience interviews, and content and discourse analysis. Our study aims to generate insights about how DF can most equitably serve users, their families and supports, and workers.