Home care: Canada should take inspiration from Germany and the Netherlands

Montreal, November 7, 2022 – Provincial governments in Canada should implement cash-for-care systems to encourage home care, while respecting taxpayers’ ability to pay, according to a new brief from the Montreal Economic Institute (MEI) published this morning.

“The cash-for-care model would completely change our approach to long-term care,” says Krystle Wittevrongel, Senior Policy Analyst at the MEI and co-author of the study. “Instead of focusing on providers, these models are based on the interests and decisions of the patients.”

Cash-for-care models involve giving patients a choice between receiving care in specialized institutions (like CHSLDs and other long-term care homes) or receiving periodic cash payments to spend on care options as they see fit, including to help them age at home.

These cash payments can be used to cover the costs of informal caregivers, compensate family caregivers, and pay for the equipment necessary for patients to live comfortably in their own homes.

Germany and the Netherlands adopted such systems in the 1990s. In the Netherlands, 23% of long-term care spending goes to cover home care, while in Germany, the proportion reaches 57%. In Canada, only 11% of long-term care spending is directed toward home care.

A 2021 survey indicates that seven out of 10 Quebecers want to age in their homes past the age of 75. Only one per cent indicated wanting to live out their golden years in a CHSLD.

“It’s no surprise that Quebecers prefer to age in their own homes rather than in government-operated long-term care institutions, especially when one sees the state of the province’s CHSLDs,” said Ms. Wittevrongel. “Instead of continuing to focus almost exclusively on institutionalized care, Quebec should listen to Quebecers and work to improve access to home care.

“Implementing a cash-for-care system would be a big step in the right direction.”

The complete MEI publication is available here.

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The Montreal Economic Institute is an independent public policy think tank. Through its publications, media appearances, and advisory services to policy-makers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship.

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