Jones Aaron, Lee James, Schumacher Connie, Sultan Heebah, Mayhew Alexandra, Watt Jennifer, McArthur Caitlin, Tannahill-Wade Margaret, Holyoke Paul, Bronskill Susan, Costa Andrew
Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
ICES, Toronto, ON, Canada.
BMC Health Serv Res. 2025 Jul 3;25(1):912. doi: 10.1186/s12913-025-12975-4.
Home care supports older adults living in the community by providing medical, rehabilitative, and personal care at home. Across Canada there is wide variability in public funding models for home care, which may also be paid for privately. Our objective was to compare individual characteristics across different home care payment groups and examine associations between sociodemographic factors, health status, and private payment for care.
We included formal home care users from the Canadian Longitudinal Study on Aging (CLSA) between 2015 and 2021 and classified them into three groups based on how much of their home care was paid for out-of-pocket: none, part, or all. We used descriptive statistics to compare the individual and home care characteristics of the three groups. We used unadjusted and adjusted multinomial logistic regression models to examine associations with the home care payment groups.
Of 44,817 participants in the CLSA, 3,580 were formal home care users. Using weighted proportions, 6.8% of the CLSA were home care users, and of these 46.2% reported paying nothing out-of-pocket, 12.7% paid partially, and 41.0% paid all costs. Individuals who paid all costs reported the best health, whereas those who paid partially reported the worst. Meal preparation/homemaking and housework/maintenance services were more commonly paid for privately, while medical care was more likely to be publicly funded. Higher-income individuals were more likely to pay entirely out-of-pocket and large provincial variations were noted across payment groups.
Private home care is common in Canada, particularly for non-medical services. Income-related disparities may limit access for those unable to pay, contributing to inequities in aging. Policies ensuring equitable access to essential services will be critical as demand for home care grows.
The online version contains supplementary material available at 10.1186/s12913-025-12975-4.
居家护理通过在家中提供医疗、康复和个人护理来支持居住在社区中的老年人。在加拿大，居家护理的公共资金模式存在很大差异，也可以由私人支付费用。我们的目标是比较不同居家护理支付群体的个体特征，并研究社会人口因素、健康状况与护理私人支付之间的关联。
我们纳入了2015年至2021年加拿大老龄化纵向研究（CLSA）中的正式居家护理使用者，并根据其居家护理自付费用的多少将他们分为三组：无、部分或全部。我们使用描述性统计来比较三组的个体和居家护理特征。我们使用未调整和调整后的多项逻辑回归模型来研究与居家护理支付群体的关联。
在CLSA的44,817名参与者中，有3,580名是正式居家护理使用者。使用加权比例，CLSA中有6.8%是居家护理使用者，其中46.2%报告没有自付费用，12.7%部分自付，41.0%支付了全部费用。支付全部费用的个体健康状况最好，而部分自付的个体健康状况最差。膳食准备/家务管理和家务/维护服务更常由私人支付，而医疗护理更可能由公共资金提供。高收入个体更有可能完全自付费用，并且在支付群体之间发现了较大的省级差异。
私人居家护理在加拿大很常见，特别是对于非医疗服务。与收入相关的差距可能会限制无法支付者获得护理的机会，导致老龄化方面的不平等。随着对居家护理需求的增长，确保公平获得基本服务的政策将至关重要。
在线版本包含可在10.1186/s12913-025-12975-4获取的补充材料。
