Association for Public Policy Analysis & Management

The targeted federal homecare transfer launched in 2017-18 and will transfer $6B to provincial and territorial governments over ten years. Coming fifteen years after the Romanow Commission’s homecare recommendations, this transfer represents an historic use of federal spending power to address gaps and inequities in access to homecare services. Three years into implementation of this federal reform, this study assesses progress to date and identifies key challenges and opportunities going forward. This policy case study analyses the ideas, interests and institutional factors that have influenced the development of the targeted homecare reform, and how these same factors are influencing the implementation and future prospects. Data to support this analysis is drawn from bilateral transfer agreements that are now in place between the federal government and all thirteen provinces and territories, the Canadian Institute for Health Information reports on six common indicators agreed to by all jurisdictions, and three cycles of government budget documents. Anticipated factors include ideas regarding inequities in access and aging at home, the interests of an aging population and Personal Support Workers, and institutional factors related to federalism. Progress to date includes an overall elevation of homecare as a provincial and territorial priority, but a diffusion of impact through variable provincial and territorial implementation and relatively weak accountability mechanisms. Reporting on six common indicators across jurisdictions will bring some accountability for the federal homecare transfers. Nevertheless, momentum for homecare transfers will be difficult to sustain without continued advocacy from key interest groups such as baby boomers.