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{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}

==Overview of Home Care==

Sometimes informal care from family, friends and local community organizations is unavailable or unable to meet a person’s needs and keep them safe. In that case, home care can provide supplemental personal care and health care in the person’s home. Home care can be through the publicly funded home care in [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care each health authority],([[{{PAGENAME}}#References|1]]) or purchased privately.

Home care for older adults includes personal care and health care. It may be provided over a short term to support rehabilitation or to provide respite for caregivers. It can also be provided over a longer term to prevent hospitalization or admission to long-term care or assisted living.

Personal care includes help with activities of daily living such as bathing, dressing, eating and meal planning, mobility, transfers and using lifts, personal grooming and toileting, task reminders, and ensuring that a person takes their medication. Personal care may also include activities such as tidying, laundry, and meal preparation.

Most personal care is provided by health care assistants (HCAs), commonly referred to as community health workers or care aides.

Health care includes assessment of health care needs, care planning, management of medications, treatments, wound care, chronic disease management, post-surgical care, occupational therapy, physical therapy, palliative care, and assigning and supervising the work of HCAs. Health professionals also devote time to educating and supporting family caregivers.

Health care is usually provided by Licensed Practical Nurses (LPN) or Registered Nurses (RNs), in consultation with a doctor or nurse practitioner. Physical therapists and occupational therapists also provide home care.

This section will discuss eligibility for subsidized home care, how to apply, private home care services, palliative care, and concerns with home care.

==Eligibility for Subsidized Home Care==

The province sets out the requirements for subsidized home care. A person must:

* Be 19 years of age or older;
* Be a citizen or permanent resident;
* Have lived in BC for at least 90 days;
* Be eligible based on health care need;
* Be eligible based on financial need;
* Have their level of urgency assessed;
* Be living in a home that is safe for home care workers; and
* Have family caregivers be willing to take on some caregiving tasks, if the person has family caregivers.

The [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care home health office] will assess a person’s health care needs. To be eligible, the adult must be unable to function independently because of chronic health-related issues, or require care due to one or more of the following circumstances:

* care is required to prevent or reduce the need for emergency services, hospitalization or admission to a long-term care home (chronic care);
* the person is recently discharged from an acute care hospital (rehabilitation care);
* the person has time-limited acute nursing care needs (acute care); or
* the person has a life-limiting illness (palliative care).

To assess a person’s health care needs, the home care staff will use a standard assessment tool called the Resident Assessment Instrument. This assessment tool examines a person’s quality of life and functional abilities. The assessment looks at a variety of areas, including capacity, health conditions, changes to a person’s health, depression, level of pain, how well a person can perform daily activities, falls, the availability of caregivers, and caregiver distress.

Provincial legislation sets out the financial eligibility for home care and the associated client fees. Health authorities assess applicants for subsidized home care based on their annual income, or joint annual income if the person lives with a spouse.

If a person is eligible, they must agree to pay the assessed client rate to access services. Some services are free for financially eligible adults, but the adult may be required to pay for supplies in some circumstances.([[{{PAGENAME}}#References|2]])

If an adult is receiving any of the following income benefits, they can get a fee waiver or pay a reduced fee:

* the Guaranteed Income Supplement or associated spousal allowances;
* support or shelter allowance under the provincial income assistance program; or
* a War Veterans Allowance.

If paying the assessed fee would cause serious financial hardship for a person, they can apply to the health authority for a [https://connect.health.gov.bc.ca/system/files/files/forms/hcc/3992fil.pdf temporary fee reduction].

There are some exceptions available to the eligibility requirements. If you want more information about exceptions, contact your local home health office in your health authority.([[{{PAGENAME}}#References|3]])

==Applying for Subsidized Home Care==

To apply for subsidized home care, you can contact your local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] yourself, or get a referral from a doctor, social worker, or other health care professional.

When you apply for home care, the office will conduct an assessment to see if you are eligible and what your care needs are. See the province’s website for information on how to [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care prepare for an assessment].([[{{PAGENAME}}#References|4]])

If you are eligible, a health care worker will create a care plan. The care plan will be shared with you, your health care team, representatives, and family members you want involved.

There may be a wait for services to begin. Home care services are based on the urgency of the health need, the availability of health care workers, and how long the person has been on the waiting list.

For specific information about publicly funded services in your area, visit your local health authority website. They are listed in Appendix A of this guide. The listings include links to Aboriginal Patient Liaison workers who can help Indigenous patients find the services they need.

The next section will discuss hiring private home care.

==Private Home Care==

People can hire private pay home care services. A person may do this if they do not qualify for government subsidized services or if they wish to access extra services. Private pay service providers may be individuals or businesses. You access these services by contacting a service provider directly.

Private pay services are mostly unregulated. Exercise caution when using these services. For example, ask about the company’s screening and training practices, the insurance they carry, and their complaint processes. When hiring an individual, ask about their credentials and check their references. Read the service contract carefully and make sure it clearly spells out fees and what services they include.

Some tips for hiring a private service provider:

* Interview each candidate in depth. Screen applicants on the phone but always follow up with an in-person interview.
* Be specific about all the tasks, skills, languages, and schedules involved and be sure that the person you are considering is comfortable with all of them.
•	If there is a particular situation that you are concerned about, such as a family member living with dementia sending the care provider away upon arrival, then be up front about this with the agency.
* Discuss compensation and payment schedules. Do not pay for services in advance.
* Request several work and personal references and check them carefully. Verify the information provided, and ask all references about reliability, trustworthiness, punctuality, and the care provider’s ability to handle stress.
* Perform background checks. If you are hiring through an agency, background checks are usually done in advance, but it is helpful to ask exactly what they cover. There are also online agencies that offer inexpensive waitlist background checks to help identify potentially serious problems.
* If the person is not the right fit, keep looking. It is important that you feel comfortable with the individual delivering services in your home.
* If you are not satisfied with a service, try talking to the company or individual care provider to see if the issue can be resolved. If not, start looking for other options soon.
* When hiring an individual person to provide care, rather than through a company, consult with your home insurance provider to see if you’ll need additional insurance to cover risks such as theft or in-home accidents by the caregiver.

[[Rout65.ca]] offers a network of credible home care agencies, as well as further resources for choosing a quality service provider, including downloadable checklists on their [https://route65.ca/assurity-info/ Assurity page] that people can use to screen a home care and independent living providers.

==Palliative Care==

A person with a life-limiting illness may receive [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care palliative care]. Palliative care focuses on maintaining a person’s quality of life through pain management and other services. It can be provided alongside treatment for an illness. Once a patient is designated as palliative, the Medical Services Plan will pay for certain services, medications and supplies that are specific to palliative care. It also pays a fee to physicians providing palliative care supervision.

Palliative care can be provided in a number of settings, including in the home through home care services. The eligibility and application for home-based palliative care is the same as other home care services.

Route65.ca lists various operators of palliative care services. Users can find a current list using the palliative care search filter [https://route65.ca/search/?type=place&healthcare-services=Palliative%2BCare,Palliative%2BCare%2B%2528%2524%2529&sort=random here].

==Concerns, Complaints, and Accountability==

If you have concerns or complaints about public or private home care, you have several avenues to get accountability. This includes complaints through a:

* health authority;
* Patient Care Quality Office; or
* health profession regulator.

''Health Authorities''

Health authorities are required to have clear procedures in place for dealing with complaints about home and community care. Health authorities must also ensure that clients have access to information about how to express concerns about home and community care services. This includes concerns a person may have about:

* eligibility and access;
* the type, quality, and frequency of services allocated; and
* fees and fee waivers.

For example, if a person disagrees with the results of an assessment they can appeal directly through their local health authority. A person can appeal a range of decisions, including the services authorized, assessed rates, and general eligibility.

''Patient Care Quality Office''

Through the Patient Care Quality office, a person can make a complaint about the quality of the care they received within that health authority. The office may facilitate a resolution. If a person does not believe that their complaint was resolved in a satisfactory way, the person can request a review from the [https://www.patientcarequalityreviewboard.ca/makecomplaint.html Patient Care Quality Review Board].([[{{PAGENAME}}#References|5]]) The review board will review any outstanding concerns, including the way the Patient Care Quality Office responded to the complaint. See Appendix A for a list of PCQOs.

''Health profession regulator''

Regulated health professionals are governed by colleges, which set out practice and ethics standards. A person can make a complaint about an individual regulated health professional to that person’s college. Regulated health professionals include doctors,([[{{PAGENAME}}#References|6]]) nurses,([[{{PAGENAME}}#References|7]]) occupational therapists,([[{{PAGENAME}}#References|8]]) physical therapists,([[{{PAGENAME}}#References|9]]) speech and language pathologists,([[{{PAGENAME}}#References|10]]) dentists,([[{{PAGENAME}}#References|11]]) pharmacists,([[{{PAGENAME}}#References|12]]) and some mental health professionals.([[{{PAGENAME}}#References|13]])

A member of the public can make a complaint about a regulated professional, and the college must investigate. If the health professional has engaged in professional misconduct, they can face disciplinary action. A complaint to the college will not lead to compensation but may trigger outcomes for the health professional and improve health care practices.

''Care Aide and Community Health Worker Registry''

In BC, there is a [https://www.cachwr.bc.ca/ Care Aide and Community Health Worker Registry].([[{{PAGENAME}}#References|14]]) Any health care assistant (HCA) who is working at a publicly funded facility must be registered with the Registry. However, the oversight of care aides is minimal. An HCA is eligible to be registered if they have completed an approved BC training program or an equivalent program. If an employer suspends or fires an HCA because they are suspected of abusing or neglecting a patient or client, this must be reported to the registry. The registry will investigate. If the allegations are found to be true, the HCA is removed from the registry.([[{{PAGENAME}}#References|15]])

The registry is very limited in terms of the public. The public cannot make a complaint about an HCA. This can only be made by an employer. The results of an investigation are not made public, even if they are found to be true. Additionally, the public does not have access to the registry. The public cannot check if the HCA is registered, and therefore has taken an approved education program. Only publicly funded employers can access the registry.([[{{PAGENAME}}#References|16]])

If an HCA works for a company that does not receive public funding, or works privately on their own, the HCA does not have to be registered, or complete any training programs.([[{{PAGENAME}}#References|17]])

If you are thinking of hiring an HCA yourself, you should carefully check the care aide’s education and work record. If you are using a home care agency, check their hiring and training policies, and their insurance coverage. A private home care agency may be listed in the Better Business Bureau.

==References==
# British Columbia “Home & Community Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at chs 2.B 4.B & 7B online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at ch 2.B 7.D online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia “How to Arrange for Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care>.
# British Columbia Patient Care Quality Review Boards “Clear. Consistent. Timely. Transparent. “Request a Review” (last visited 30 August 2023) online: <https://www.patientcarequalityreviewboard.ca>.
# College of Physicians and Surgeons of British Columbia “Home” online: <[http://www.cpsbc.ca www.cpsbc.ca]>.
# British Columbia College of Nurses & Midwives “Home” online: <[http://www.bccnm.ca www.bccnm.ca]>.
# College of Occupational Therapists of British Columbia “Home” online: <[http://www.cotbc.org www.cotbc.org]>.
# College of Physical Therapists of British Columbia “Home” online: <[http://www.cptbc.org www.cptbc.org]>.
# College of Speech and Hearing Health Professionals of British Columbia “Home” online: <[http://www.cshbc.ca www.cshbc.ca]>.
# British Columbia College of Oral Health Professionals “Home” online: <[http://www.oralhealthbc.ca www.oralhealthbc.ca]>.
# College of Pharmacists of British Columbia “Home” online: <[http://www.bcpharmacists.org www.bcpharmacists.org]>.
# College of Psychologists of British Columbia “Home” online: <[http://www.collegeofpsychologists.bc.ca www.collegeofpsychologists.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “Home” online: <[http://www.cachwr.bc.ca www.cachwr.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.
# Krista James & Sara Pon ''Strengthening BC’s Health Care Backbone: Oversight of the Work of Health Care Assistants CCEL Study Paper 11'' (October 2022: British Columbia Law Institute) at pg 124 to 130 online: ''British Columbia Law Institute'' online: <[http://www.bcli.org/project/hca-oversight-in-bc www.bcli.org/project/hca-oversight-in-bc]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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