There are two basic models of public home care delivery: a provider model in which services are arranged for and provided through staff hired by home care agencies, and a self-managed home care model in which clients are given cash or service to vouchers manage and arrange for all aspects of service provision including, hiring, tasks provided and quality of care (MacAdam, 2004). While all provinces and territories offer the provider model, only eight offer both models (Québec, British Columbia, Alberta, Ontario, Manitoba, New Brunswick, Newfoundland, and the Northwest Territories). Further, the self-managed care model is usually only available to younger adults with disabilities but not to the elderly, although Veteran Affairs offers a self-management home care program to Veterans. Currently there are no known national statistics on the utilization or cost of self-managed care. If they are not eligible for publicly funded home care, Canadians are able to purchase home health services privately. It is estimated that about 20% of total home care expenditures are paid for privately (MacAdam, 2004:395).

In Canada, there are four different models used for the procurement of home care services:

1. Public provider model. Professional and home support services are delivered by public employees, for example: Manitoba, Saskatchewan, Québec, Prince Edward Island, Yukon, Northwest Territories and Nunavut.
2. Public professional and private home support model. Public employees provide professional care and home support care is contracted to private agencies, for example, in New Brunswick, Newfoundland, and British Columbia.
3. Mixed public and private model. Public employees provide case management and professional services are provided by either private or public employees. Home support services are contracted out to for-profit or not-for profit agencies, for example, in Nova Scotia and Alberta.
4. Contractual model. Public employees provide case management and co-coordinating services through a Community Care Access Centres (CCACs). Professional and home support services are contracted out to a mix of for-profit and not-for-profit agencies who are chosen to deliver service through a quasi-market “managed competition” model , for example in Ontario. (Caplan 2005; Home Care Sector Study Corporation, 2003a)

Utilization

Data from the 2003 Canadian Community Health Survey indicates that the rate of publicly funded home care users is 25 per 1,000 population or 1.2 million Canadians aged 18 and over (CIHI, 2007). Using these data, Carriere (2006) reports that 5% of Canadians aged 18 or older had received home care in 2003. The proportion receiving home care increases with age: 6% of those aged 65 to 74, 15% of those aged 75-84 and 32% of those aged 85. Women were more likely than men to receive home care. Those most likely to receive home care were lived alone, were admitted to hospital in the past year, had one or more chronic conditions and reported social assistance as their main source of income. The most frequent types of care provided included housework followed by nursing care, personal care and meal preparation (Carriere, 2006). In 2003-2004, provincial and territorial government spending on home care averaged $105 per person. Of this, $57 was spent on home health care, including professional and nursing care and $60 for home support, such as personal care, housework, meals, shopping and respite care (CIHI, 2007).

The CHCHRS (Canada Home Care Sector Study Corporation, 2003a) estimated the number of potential home care consumers in 2046, taking into consideration changing demographic structure of the population would increase. They estimated that home care clients would grow from 539,597 in 1996 to 1,460,088 in 2046, an increase of almost three times as many home care recipients.