Home Support Fees: Who Pays, and a Better Way

Home support is help at home with washing, dressing, meals and medicines. In BC around 35% of seniors receiving home support pay part of the cost, based on their after tax income. This is a direct corollary to the 70% to 80% of income paid by those moving into Assisted Living and Long-Term Care.

Right now the home care fee rule hits lower income seniors in BC very hard taking up to 36% of their after tax income. This absolutely needs to change. BC also has a $300 CAP rule that allows seniors with earned income to pay no more than $300 per month. Low income seniors need relief but this rule has been abused for decades by creative accounting and should be removed.

Recently, a new campaign "Health Care Needs Home Care" wants to make home support free for every senior. We disagree with their approach of removing all fees for home care services. Claims that seniors are pushed into LTC early because of cost have not been demonstrated by any study, and they do not match the experience of the writer. We would rather see a softer graduated approach that protects low-income seniors and preserves half of gov revenues from home care fees levied under the Continuing Care Act. This page explains all three, and the calculator lets you check the numbers for yourself.

How the rule works today

The health authority looks at your income after tax, takes off $10,284 for a single person ($16,752 for a couple), and divides what is left by 720. That is your daily rate. You pay up to that amount on every day you get care. Your daily rate is a ceiling: you are charged the health authority's hourly cost for the care you actually get, up to that ceiling. A half-hour visit at about $40 an hour costs $20 even if your daily rate is $55; the ceiling only matters once a visit costs more than your rate. If you get the Guaranteed Income Supplement or income assistance, you pay nothing.

• A single senior with $33,000 after tax pays about $960 a month for one hour of care a day. That is a third of everything they have.
• A senior with $45,000 pays about $1,213 a month for one hour a day. So does a senior with $150,000. The rule stops rising once it reaches what the care actually costs, about $40 an hour.
• If you or your spouse has any earned income, even $500, your bill is capped at $300 a month. A wealthy retiree with a little consulting work pays less than a pensioner with none.
• The $10,284 deduction has not changed since 1997. Back then it was about 60% of what a typical senior earned. Now it is about 30%.

You can check your own rate with our Government Care Cost Calculator.

The campaign plan: free for everyone

The Health Care Needs Home Care campaign asks the province to drop all home support fees for seniors. Its example is right: a $31,000 senior can pay close to $10,000 a year for daily care. But the campaign leaves three things out.

• Two out of three people who get home support already pay nothing. The lowest-income seniors would gain nothing directly.
• Everyone who pays today would save the same amount, whether they earn $40,000 or $250,000.
• Making care free brings in many more clients. The province is short of care workers already. With no price and no new workers, the people who cannot buy private care would be the ones waiting longest.

What the evidence actually shows. The Canadian Institute for Health Information found that about 1 in 9 people admitted to long-term care across Canada in 2018-19, and 14.5% in BC, had a health profile that could have been managed at home. When CIHI asked why, it ran two focus groups with 15 people, including two residents. They named four barriers: not knowing how to get services, out-of-pocket costs for care that public home care did not cover, unreliable and inflexible workers, and missing social and cultural supports. CIHI published no percentages, because 15 people cannot give one, and the money problem they described was paying privately for care the public system did not provide, not the daily rate on public home support. Nobody has linked BC's admission records to what those people were assessed to pay, how many hours they were offered, or whether they turned service down. That linkage is the data this debate needs. The Ministry already holds every piece of it: the care assessment, the daily rate, the hours delivered and the reason a client stopped service.

Our plan: a sliding scale that protects low incomes

• Pay nothing if your income after tax is under about $30,000. That is the GIS line, so it moves every year on its own.
• Pay the full cost of each hour if your income is above $62,139. That is the income where BC already charges the most for a care-home bed, so it moves every year too.
• Pay a share in between. The share rises in a straight line from 0% to 100%.
• Reasonable for everyone Care fee costs rise from 2% to 6% for low income seniors. Nobody pays more at home than a care-home bed would cost them.
• Close the earned-income loophole. The $300 cap goes. Working households are still protected, because the first $25,000 of each person's earned income is ignored.

Under our plan a $33,000 senior pays about $60 a month instead of $960. A $45,000 senior pays about $310 instead of $1,213. A $75,000 senior pays what they pay today. The $150,000 retiree with $500 of consulting income pays $1,213 instead of $300.

People waiting for a care-home bed

Home support is normally capped at about four hours a day. People who are approved for a care home but are waiting for a bed can get more, sometimes around the clock. Under our plan, hours above four are charged at lower rates (half price for hours five to eight, a quarter for hours nine to sixteen, nothing after that), the yearly cap still applies, and the bill can never be more than the bed would cost. The bill can only go up as hours go up, never down.

A bigger problem than the fee: care you can count on

Money is not the main reason seniors give up on home support. In our experience it is the stream of different faces. Visits come at different times from different workers, and each new person has to be shown the same things again. Many seniors, especially those with dementia, will not let a stranger help them bathe. So they cancel the visit, or refuse the service, and the help stops. That is when the falls, missed medicines, poor eating and hospital visits start, and a care-home bed becomes the only option left.

The evidence backs this up:

• When the Seniors Advocate surveyed 17,500 home support clients, the first problem they named was continuity: rotating workers erode continuity of care.
• A study of 59,854 home care patients found that seeing the same care staff lowered the chance of a hospital admission or emergency visit and raised the chance of getting better at daily tasks.
• A 2024 study of 3,864 long-term home care clients found that keeping the same worker meant fewer falls, better function and fewer signs of depression, and that continuity gets worse as care hours go up, so the people who need it most get it least.
• When care needs go unmet, hospital admissions double and emergency visits rise by about a third. Unmet needs for help with daily living are linked to nursing-home admission and early death.
• Of long-term care residents surveyed by the Seniors Advocate in 2023, 60 per cent of those newly admitted said they would have stayed home if they had support services. The barriers residents name nationally include reliability and flexibility of home care, not just cost.

Cutting the fee does nothing about any of this. We would put the effort into making public home support reliable and consistent: the same small team, at the same times, with enough hours to matter. That would keep more seniors at home than free care they cannot count on.

What the government collects

Fees bring in about $31 million a year today, out of $693 million spent on home support. Under the campaign plan that drops to zero. Under our plan it drops to about $14 million, and almost all of the difference is relief for people earning between $30,000 and $62,000. People above $75,000 pay the same as today, and the earned-income group pays more. Each senior kept out of a care home saves the province about $45,800 a year, so about 370 avoided admissions would cover the whole change.

Sources

• BC Reg 330/97, Continuing Care Fees Regulation
• Home and Community Care Policy Manual, Chapter 7 (client rates, effective January 1, 2026)
• Office of the Seniors Advocate, We Must Do Better: Home Support Services for B.C. Seniors (2023)
• Office of the Seniors Advocate, BC Seniors: Falling Further Behind (2022)
• Office of the Seniors Advocate, Home Support Survey of 17,500 clients (2015-16), and Every Voice Counts: Long-Term Care Resident and Visitor Survey (2023)
• Canadian Institute for Health Information, Common Challenges, Shared Priorities, Volume 2 (2020): the 1-in-9 indicator and the focus-group barriers
• Russell D. et al., Continuity in home health care: is consistency in nursing personnel associated with better patient outcomes? Journal for Healthcare Quality (2011)
• Reckrey J. et al., Home care worker continuity in home-based long-term care, Innovation in Aging (2024)
• Huang J. et al., The consequences of unmet needs for assistance with daily life activities among older adults: a systematic review (2024); and Unmet needs and healthcare service utilization among older adults: a systematic review (2024)
• Island Health, Home and community care rates: "you will never pay more than the actual cost of service"