Public, Private, and Informal Home Care in Canada: What are the Determinants of Utilization and the Interrelationship among Different Types of Services?

In Canada and internationally, increases in Home Care (HC) services for the elderly have been a policy priority in recent decades. HC services include Home Health Care (HHC) and Homemaking/Personal Support (HM). The primary objectives of this study were to explore the interrelationship among publicly funded, privately funded, and informal HC services in terms of potential for substitution, and between publicly funded HHC and HM services; and the determinants of the receipt of each type of HC services. Stabile, Laporte, and Coyte’s family home care decision model (2006) was extended, to develop an understanding of the demand for HHC and HM services separately and to include different household arrangements. The consequential hypotheses were tested in two empirical studies. Individual panel data for those aged 65 and over were derived from 8 biannual waves of the Canadian National Population Health Survey (1994-95 to 2008-09). A Panel Two-Stage Residual Inclusion method was used to estimate the likelihood of the receipt of HC services, adjusting for socio-demographic, health status, disability, dependence on help with Activities of Daily Living (ADLs), and regional characteristics. The results showed that receipt of publicly funded HM is complementary with receipt of publicly funded HHC services after adjusting for functional and health status. Receipt of publicly funded and privately funded HM services did not show an effect on each other. Receipt of publicly funded HM did not affect the receipt of informal HM services. The availability of informal care from a partner or other adult sharing the household reduced the likelihood of publicly funded HM receipt. Age, dependence on help with ADLs, health status and income are determinants of the propensity to receive publicly funded HHC and HM services as well as privately funded and informal HM. Findings in this study suggest that changes in the availability of publicly funded HC services may not greatly affect the provision of informal care in Canada. The complementary effect between publicly funded HHC and HM services and the income effect in the receipt of publicly and privately funded HC services may raise concerns about equitable access to HC services in Canadian jurisdictions.Ph