Grant: DRA : Canada Graduate Research Scholarship - Doctoral Program (CGRS D)

As Canada's population ages, more seniors rely on home care services to help them live at home, avoid unnecessary hospital visits, and delay moving into long-term care. In British Columbia (BC), publicly funded home care is provided based on need, but services are capped, and extra care must be paid for out-of-pocket. This creates concerns about affordability and fairness, especially for people with complex and changing health needs. Although governments have invested more in home care, there is still little evidence to guide decisions about how much to fund, who benefits most, and what combinations of services work best. Most research treats home care as a simple "yes or no" measure, without capturing how people move between different types of care-formal care from paid providers, informal care from family or friends, or a mix-over time. We also know little about how these changing patterns affect later outcomes like hospital use, long-term care entry, and costs. This study will use data from the Canadian Longitudinal Study on Aging (CLSA), linked with provincial health records, to follow British Columbians aged 65 and older with physical or cognitive limitations over time. Study objectives are (1) to identify patterns in home care use and how people transition between them; (2) to estimate how these patterns affect future hospital visits, long-term care use, and costs; and (3) to test "what if" funding scenarios, such as increasing services for high-need groups, to assess which strategies give the best results for cost and care. By understanding which mixes and patterns of home care services deliver the greatest benefit to individuals and the system, this work will provide evidence to help BC target home care funding where it will have the greatest impact, improving care for seniors while making better use of health system resources.