How to Arrange Home Care in Canada and the US
Getting the right home care in place is one of the most important and most overwhelming tasks a caregiver faces. This guide covers every publicly funded option in both countries, how to apply, what to do when funded care runs out, and exactly what to ask before hiring any private agency.
In both the US and Canada, publicly funded home care programs have assessment processes and — in many cases — waiting periods. The time to apply is before a crisis, not after. If your loved one is currently in hospital, ask to speak with the social worker or discharge planner on the first day of admission to begin the home care referral process immediately.
4 Types of Home Care — and What Each One Covers
Home care is not a single service — it is a spectrum. Understanding what level of care your loved one needs is the first step to finding the right combination of funded and private support.
Skilled nursing and medical care
Provided by registered nurses, physiotherapists, occupational therapists, or other regulated healthcare professionals. Requires a physician order in most cases.
Wound care · IV medication · Post-surgical monitoring · Physical therapy · Catheter carePersonal support / home health aide
Assistance with activities of daily living (ADLs) — bathing, dressing, grooming, toileting, and mobility. Provided by personal support workers or home health aides, not regulated healthcare professionals.
Bathing · Dressing · Meal preparation · Medication reminders · Mobility assistanceHomemaking and companion care
Non-medical support with household tasks and social engagement. Typically not covered by public programs but available through private agencies and some community organizations.
Light housekeeping · Grocery shopping · Laundry · Companionship · TransportationRespite care at home
Temporary relief for the primary caregiver — a trained worker comes to the home so the caregiver can rest, work, or attend to their own needs. May be funded through separate respite programs.
Scheduled relief hours · Overnight care · Emergency respite · Caregiver breaksPublicly Funded Home Care in the US — Medicare, Medicaid, and VA
The US has three major publicly funded home care pathways. Understanding which one your loved one qualifies for — and what each covers — is the foundation of your home care plan.
Medicare Part A and Part B cover home health services when four conditions are met: your loved one is under the care of a physician, is homebound (leaving home requires considerable effort), needs skilled nursing or therapy services on an intermittent basis, and the home health agency is Medicare-certified.
- What is covered: Skilled nursing care, physical therapy, occupational therapy, speech-language pathology, medical social work, and limited home health aide services when a skilled service is also being received
- What is NOT covered: 24-hour care, meal delivery, homemaking, personal care alone (without skilled services), or custodial care
- How to access: Ask the discharging physician or hospital social worker for a home health referral. The physician must certify homebound status and order the services. Only Medicare-certified agencies can bill Medicare.
- Duration: No set limit — services continue as long as the patient remains homebound and needs skilled care. Re-certification required every 60 days.
"Homebound" under Medicare does not mean bedridden. It means that leaving home requires a taxing effort — due to illness, injury, or a condition such that leaving is medically contraindicated. Patients can leave home for medical appointments, adult day care, or occasional non-medical outings and still qualify. If the physician believes your loved one qualifies, ask them to document homebound status clearly in the medical record.
Medicaid HCBS waivers provide a much broader range of home care services than Medicare — including personal care, homemaking, respite care, and adult day services — for people who meet the income and functional eligibility requirements. Coverage varies significantly by state.
- What is covered: Varies by state waiver — can include personal care, homemaking, meal delivery, respite care, adult day services, home modifications, transportation, and more
- How to apply: Contact your state's Medicaid office or the Area Agency on Aging (AAA) for your region. Eldercare Locator at eldercare.acl.gov can find your local AAA.
- Wait lists: Many states have waiting lists for HCBS waivers — sometimes years long. Apply as early as possible.
- Consumer-directed care: Many states allow Medicaid recipients to hire and direct their own personal care workers — including family members in some states
The VA offers several home-based care programs for eligible veterans, including the Home Based Primary Care (HBPC) program, Skilled Home Health Care, Homemaker and Home Health Aide Program, and the Caregiver Support Program — which provides support specifically to the veteran's caregiver.
- Caregiver Support Program: Provides training, mental health services, and financial stipends to caregivers of eligible post-9/11 veterans under the Program of Comprehensive Assistance for Family Caregivers (PCAFC)
- How to access: Contact the veteran's VA primary care team or call the VA Caregiver Support Line at 1-855-260-3274
- Eligibility: Varies by program — generally requires the veteran to be enrolled in VA healthcare and to have a service-connected or non-service-connected condition requiring home-based care
Publicly Funded Home Care in Canada — Provincial Programs
In Canada, home care is a provincial responsibility — meaning every province runs its own program with its own eligibility criteria, covered services, application process, and wait times. There is no single national home care program.
In Canada, publicly funded home care requires a formal application, an assessment of needs, and — in most provinces — a waiting period before services begin. Do not assume that a physician's recommendation or a hospital discharge order will automatically trigger home care services. You must initiate the application yourself, or ask the hospital social worker to do it on your behalf before discharge.
| Province | Program name | How to apply | What is covered |
|---|---|---|---|
| Quebec 🔴 | Soutien à domicile (SAD) via CLSC | Contact your local CLSC directly or ask your physician or hospital social worker to refer | Nursing care, personal care, physiotherapy, occupational therapy, nutrition services, homemaking (limited) |
| Ontario | Home and Community Care Support Services (formerly CCAC) | Self-referral online at ontario.ca/homecare or physician/hospital referral | Nursing, personal support, physiotherapy, OT, social work, nutrition |
| British Columbia | Home Health / Home and Community Care | Physician referral or self-referral to local Health Authority | Nursing, home support, physiotherapy, OT, palliative care |
| Alberta | Home Living / Community Care — Alberta Health Services | AHS Home Care intake line: 1-888-342-2471 or physician referral | Nursing, personal care, therapy, palliative care, telehealth monitoring |
| Manitoba | Home Care Program — Manitoba Health | Contact your Regional Health Authority or ask a physician for referral | Nursing, home support, day programs, respite |
| Saskatchewan | Home Care — Saskatchewan Health Authority | SHA Home Care intake or physician/hospital referral | Nursing, home support, OT, physiotherapy, palliative |
| Nova Scotia | Home Care Nova Scotia | Nova Scotia Health intake line: 1-800-225-7225 | Nursing, personal care, homemaking, therapy services |
| New Brunswick | Extra-Mural Program (EMP) / Home First | Physician referral or self-referral to Horizon/Vitalité health network | Nursing, rehabilitation, respiratory therapy, social work, palliative |
| PEI | Home Care PEI | Health PEI intake or physician referral | Nursing, personal care, homemaking, OT, physiotherapy |
| Newfoundland | Personal Care Home / Home Support — Eastern Health | Eastern Health intake or physician/hospital referral | Personal care, nursing, therapy, homemaking |
How Soutien à domicile (SAD) works in Quebec
In Quebec, home care is delivered through the Soutien à domicile (SAD) program at your local CLSC. Here is how the process works from referral to service delivery:
- Step 1 — Contact your CLSC: Call your local CLSC or ask your médecin de famille, specialist, or hospital social worker to send a referral. You can also self-refer by calling your CLSC directly — no physician referral is required to start the process.
- Step 2 — Needs assessment: A CLSC coordinator (usually a nurse or social worker) visits your home to assess your loved one's needs using the standardized OEMC assessment tool. This determines what services and how many hours you qualify for.
- Step 3 — Service plan: A personalized service plan is created based on the assessment. Services may include nursing care, personal hygiene assistance, physiotherapy, occupational therapy, nutrition support, and limited homemaking.
- Chèque emploi-service (CES): If you qualify, you may be eligible for the CES program — which allows you to hire your own home care workers (including family members) and have RAMQ administer payroll. Ask your CLSC coordinator about eligibility.
- Wait times: SAD wait times vary significantly by region and level of care needed. Post-hospitalization cases are typically prioritized. Ask the CLSC coordinator for a specific timeline when the assessment is completed.
How to Apply for Home Care — 5 Steps That Work in Both Countries
The application process differs by program and province — but the same strategic steps apply everywhere.
Start the application during — not after — any hospital stay
The hospital social worker or discharge planner is your most powerful ally for initiating home care. They can make referrals directly to home care programs, expedite assessments, and ensure a care plan is in place before discharge. Ask to speak with them within the first 24–48 hours of any admission.
Request a comprehensive needs assessment — and be present for it
Every public home care program begins with a needs assessment. The assessor visits your loved one at home (or in hospital) to determine what services they qualify for. Be present for this assessment. Your observations as a caregiver — about daily functioning, safety concerns, and what tasks your loved one struggles with — directly affect the level of service approved.
If the funded hours are not enough — ask immediately what your options are
Public home care programs frequently provide fewer hours than a family actually needs. When you receive the service plan, ask the coordinator directly: "If this level of support is not enough, what are our options?" Ask about additional funded options, subsidized programs, community organizations, and private pay options in your area.
Request a reassessment if your loved one's needs increase
Home care service levels are based on an assessment at a point in time. If your loved one's condition worsens significantly, you can request a reassessment — which may result in increased funded hours or additional services. Do not wait for the scheduled review period if there has been a material change in needs.
Supplement with private home care when funded services are not enough
Most families who rely entirely on publicly funded home care find that the hours provided are insufficient — particularly for personal care and homemaking. Private home care agencies can fill the gap, but require careful vetting. The questions in the next section will help you evaluate any agency before hiring.
12 Questions to Ask Before Hiring Any Home Care Agency
Not all home care agencies are equal. Ask every prospective agency these questions before signing any contract. A reputable agency will answer all of them clearly and without hesitation.
Red Flags — Signs of a Poor Quality Home Care Agency
Walk away from any agency that shows these warning signs — regardless of price or availability.
Pressure to sign immediately or offers that expire quickly
Reputable agencies do not use high-pressure sales tactics. Any agency that pressures you to sign a contract at the first meeting or offers a "limited-time discount" should be avoided.
Cannot answer basic questions about training, insurance, or background checks
If an agency cannot clearly explain their worker training requirements, insurance coverage, or background check process, they may be cutting corners on safety. This is non-negotiable.
Frequent worker changes with no explanation
High staff turnover is a major quality concern. Ask directly about their average worker retention rate. Consistent workers are essential for quality care — especially for clients with dementia or complex needs.
Workers arrive late, leave early, or miss shifts without notice
Reliability is the foundation of good home care. Even a single incident of an unexplained missed shift at the start of services signals a systemic reliability problem.
Workers asking for personal financial information, gifts, or loans
Any worker who asks for money, gifts, banking information, or access to financial accounts should be reported to the agency immediately. This is elder financial abuse — a serious and common crime.
✓ Home care setup checklist
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