Governance and Structure of Home Care in Canada

Canada has a complicated structure that supports the planning, funding and delivery of home care services across Canada. There is no central body of government that regulates home care, and in 12 of 13 provinces and territories, home care services fall under the jurisdiction of the Ministries of Health. The exception is New Brunswick where professional health care services or the ‘Extra-Mural Program’ is under the jurisdiction of the NB Department of Health and Wellness. Long-term home support services are administered by the NB Department of Social Development.

The provincial / territorial ministries provide  overall direction for home care through provincial legislation and policies, as well as funding. They also set and ensure compliance with policies and guidelines for their health care system. The organization responsible for the direct planning, management and delivery of home care services is different in each province / territory.

According to Canadian Home Care Association, the following government bodies regulate home care in different jurisdictions:

In British Columbia, Alberta, Saskatchewan, Manitoba, New Brunswick, Newfoundland, the Northwest Territories, and Nunavut, the Regional Health Authorities (or similar entities) , which are the governing bodies of the health regions, are provided with global funding from the province and are responsible for setting priorities for health services in the region and planning, managing and delivering home care services.

• In Ontario, the 14 Local Health Integration Networks (LHINs) who are responsible for the planning, integrating and funding of local health services, including home care services, work in partnership with the 14 Community Care Access Centres who are accountable for the planning, delivery and ongoing operational management of home care services.

• In Quebec, at a regional level, 18 Regional Authorities (agences de la santé et des services sociaux) have responsibility for strategic planning and organization for their respective jurisdictions and the allocation of resources between the institutions and communities in their region. In collaboration with their respective Regional Authority, 95 Health and Social Services Centres (CSSS) are responsible for the delivery and operational management of home care services.

• In Nova Scotia, Prince Edward Island (PEI) and the Yukon, home care services are delivered and managed through the provincial / territorial government (although services are in the process of being devolved in Nova Scotia). In PEI, home care services are managed, coordinated and delivered through the provincial program reporting to the health minister through the Director of Community Hospitals & Continuing Care. In the Yukon, the Department of Health and Social Service, Continuing Care Branch of the Yukon Territorial Government administers the home care program.

There is no specific legislation throughout the country,  and all provincial / territorial programs are different. Home care is not an insured health service in Canada, because The Canada Health Act recognizes home care as an element in the category of “extended health services”. Currently, eight (8) provinces and one (1) territory have different legislation that impacts public home care through various legislation Acts. Other provinces and territories have Orders- in-Council, guidelines or other policies that direct the delivery of their home care services.   This lack of a specific legislative framework for home care in Canada contributes to the wide variation in access and availability of services across the country.

There is one nationally funded home care program that is legislated by the health services for the Canadian Forces and RCMP and that impacts overall home care -  the Veterans Independence Program. There is no legislation governing the First Nations Inuit Health Commuity Care (FNIHCC) program, even though the program received Cabinet approval in 1999.

 

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