Are you trying to decide between home care and long-term care for yourself or someone you love? You're not alone. These choices can be overwhelming, emotional, and expensive, and the right decision isn’t always clear. We all want to age with comfort, dignity, autonomy, and safety. But in British Columbia, navigating the health care system and comparing real costs between in-home support and long-term residential care can feel like a maze. In this blog, we’ll break down the financial, emotional, and practical sides of each option, so you can make the most informed choice possible.
Home Health in BC is a publicly funded service that helps eligible individuals stay in their own homes for as long as possible by providing basic support with daily living. Services focus primarily on personal care, such as assistance with personal hygiene, medication reminders, and reheating meals. Care is delivered by community health workers under the regional health authority and access typically requires a referral from a medical professional. While additional services like physiotherapy, occupational therapy, and dietary support are technically available through Home Health, they are highly limited in practice due to high caseloads and staffing shortages. Most people receive short care aid visits ranging from 10 to 45 minutes, often just once per day.
Private in-home support in BC offers a more flexible and personalized level of care. These services are designed not only to support daily living, such as bathing, dressing, meals, mobility, medication reminders, etc., but also to help with light housecleaning, grocery shopping, outings, companionship and even light physiotherapy. This broader support can create a safer, more comfortable environment for aging in place. With consistent caregivers and more time to connect, many people receiving private home support are able to maintain a strong sense of dignity, independence and community, often continuing to live at home for an average of 10 years, surrounded by family and familiar routines.
Long-term care in BC provides 24/7 professional supervision in a residential setting for people with complex medical or cognitive needs who can no longer be safely cared for at home or in assisted living. Services include clinical support, personal care, meals, planned social activities, and specialized care such as dementia or palliative support, all in a protective environment designed to preserve dignity and quality of life. But in reality, long-term care often comes with trade-offs. Residents are placed wherever there’s an open bed, not necessarily near family or community. This can lead to isolation, mental health decline, and separation from spouses and support networks. The average life expectancy in public funded long-term care is just 2.3 years, and even in private long-term care, it’s about 5 years. This reflects not only the stage of life many residents choose long-term care, but also the reality that these environments aren’t always set up to fully support wellness, connection, and longevity. It’s a difficult reality that highlights the importance of understanding all options early, while choices are still available.
While long-term care includes nursing, meals, and basic personal care, many essential services, like help getting to the dining room, laundry, housekeeping, or extra body care, often come with additional costs. With that being said, when it comes down to it, the biggest factor families often wrestle with in this decision is cost.
If you're approved for publicly funded home care in BC, what you pay depends on your income. Most people contribute a small daily fee based on their after-tax income, some are assessed $9200 annually. Some individuals pay nothing at all, including those receiving:
Learn more about rates and exemptions here on Who Pays for Care.
If you're facing serious financial hardship, like struggling to afford food, rent, heat, or medications, you can apply for a Temporary Rate Reduction, though many families report that these reductions don’t always make a meaningful difference.
Here is where reality kicks in. Even small fees can add up. Some families have to choose between paying for care or covering other essentials like medication or rent. The Seniors Advocate of BC has found that the financial burden of home support can directly contribute to housing insecurity for low-income seniors, especially when the support given is limited or inconsistent.
And while home support can help people stay in the comfort of their own homes, wait times and service hours are stretched. Many people who have been placed on long-term care waitlists receive no home support at all in the several months leading up to their placement. Those waitlists are getting longer, averaging over 215 days in 2023 alone.
Still, for 92% of Canadians, home support is often the preferred option. It helps people stay connected to their communities and loved ones, preserves independence, and offers a level of personal comfort and control that can’t always be replicated in facilities. It also helps reduce pressure on family caregivers, even if only for a few hours a week.
If you or your loved one moves into a publicly funded long-term care home in BC, you'll have to pay a monthly fee. How much you pay depends on your income.
In 2025:
These amounts change a little every year.
In certain cases, if you receive government income support (e.g., under the Employment and Assistance Acts), you may qualify for a fixed, lower rate. Couples are assessed individually, but if they share a room, only one full monthly rate is charged, though this arrangement is increasingly rare, especially in rural communities where spouses are sometimes placed in separate facilities or even different cities.
But here's what isn’t always advertised: That monthly fee only covers the basics, housing, nursing care, meals, and basic hygiene. Many essential services come with extra charges. Families are often surprised to learn that many everyday needs are not included in the standard rate. These “chargeable items” can quickly add up to thousands of dollars per year, making long-term care financially out of reach for many moderate-income seniors who don’t qualify for full subsidies. Some examples of chargeable items include:
For a complete list of Allowable Charges check Chapter 6, Section F of the Home Community and Care Policy Manual.
While some costs may seem small (e.g. cable), others, like mobility equipment, personal care aides, or supplement costs, can easily exceed $9,000 a year, especially if a resident needs more one-on-one attention than the facility is funded to provide.
Life with publicly funded home support provides basic support for body or bed care, but the level of assistance is limited and often not enough to fully relieve the burden on family caregivers. While it helps people maintain some independence, the number of visits and scope of services may fall short of creating a safe, comfortable, and dignified home environment.
Personal pay home support, on the other hand, allows seniors to access a higher level of support tailored to their needs. This can include more frequent visits, comprehensive assistance with personal care, meal prep, housekeeping, and companionship. With personal pay services, seniors can stay in their own home with consistent, trustworthy caregivers, reducing stress on spouses and family while creating a safer and more dignified living space.
That said, there are challenges too. Many people wish they had more time to chat and connect with their care aids, but staff are often pulled in so many directions. Meeting lots of different caregivers can feel a bit unsettling, and inconsistency can shake confidence. Still, home support lets your loved one stay in the comfort of their own homes, surrounded by familiar things, while getting the support they need.
Experiences in publicly funded long-term care facilities can vary widely, some facilities are enjoyed immensely, but for many residents, the environment can feel restrictive and isolating. Staff are often stretched thin, training and consistency may be limited, and it can be challenging to receive personalized attention. Many residents report increased feelings of loneliness, depression, and stress, and couples or friends are sometimes placed in separate facilities far from each other.
Private pay or higher-end facilities may offer more personalized attention, choice, and comfort, but these options come at a significant cost. Individual preferences strongly influence how residents experience long-term care; some appreciate the structure and support, while others feel it limits autonomy and independence.
Family caregivers play a crucial role in supporting seniors, but their experiences vary depending on the type of care accessed. Those using private pay home support, nonprofit programs, or day programs generally report feeling more supported, gaining relief from caregiving duties, and experiencing stronger relationships with their loved ones. In contrast, families navigating the publicly funded home support system often remain overburdened, spending many hours each month advocating for their loved one, coordinating services, and filling gaps in care. While public home support provides essential support, it often fails to fully relieve caregiver stress.
Access to care isn’t just about what someone needs, it’s also about what they can afford. In B.C., support often falls into two paths: subsidized care, which is based on a health authority’s assessment, or private pay options, which can be too expensive for many. For low income families, the choice can feel impossible. Even with help, people might pay up to 80% of their after-tax income, and while reductions exist, they don’t cover everyone. Many fall into the “grey zone” which are the people who don't qualify for full subsidies but can't afford private care, so they face long waitlists and limited home care options.
Location matters too. In rural areas, there just aren’t enough workers. And without strong family support, people may not get the help they need at all. These gaps hit vulnerable groups the hardest, like Indigenous elders, LGBTQ2S+ and immigrant seniors, leaving too many without the care they deserve.
Choosing care is never easy, and it’s more important than ever to plan ahead, given the long waitlists for every publicly supported option. A few key things can help guide the decision. First, think about your health needs. If 24-hour professional nursing is necessary and can’t be safely provided at home, long-term care might be the right fit. Home care works well if the goal is to stay independent at home, with help for daily activities, nursing, or rehab. Family and community support really matters too, since public home care is meant to supplement, not replace the care family or friends provide. If there’s no caregiver, or if the caregiver can’t safely continue, that can make someone eligible for urgent long-term care. And don’t forget personal preferences, some people want to keep their routines, others prefer a more structured support. BC has helpful resources like HealthLink BC, home and community care offices, and guides for picking long-term care to make this choice a little easier.
More at Home Society: More at Home Society is a BC-wide nonprofit dedicated to helping low- and moderate-income seniors age safely and comfortably at home. They provide financial subsidies to cover non-medical home care services, connect seniors with trained volunteers, and empower them to choose their own caregivers. Their programs reduce stress on family caregivers, help seniors stay in their communities, and improve mental health and safety outcomes. By keeping seniors at home, they can also increase life expectancy, support culturally sensitive care, and free up long-term care spaces for those with the greatest need.
United Way British Columbia (UWBC): UWBC administers the Better at Home program, offering non-medical home support services such as light housekeeping, grocery shopping, and transportation. Their Healthy Aging programs, generally delivered by volunteers through local community providers, also include caregiver support and social activities. UWBC’s community connectors can help seniors and caregivers find additional local organizations and resources to meet their individual needs
211 BC: A free, confidential helpline connecting individuals to community services, including housing, healthcare, and caregiver support.
Seniors First BC: Provides resources and advocacy for older adults, including information on community and family supports.
Home care and long-term care aren’t the only possibilities. BC offers a range of community-based alternatives depending on someone’s needs, resources, and preferences. These include:
These options can provide various levels of support, companionship, and affordability, and in many cases help seniors stay out of institutional care. If you’re not sure where to start, programs like Better at Home and More at Home Society can help connect you to the right services.
At the end of the day, there’s no one-size-fits-all answer when it comes to choosing between home care and long-term care in BC. It’s not just about numbers, it’s about the people. It’s about what makes someone feel safe, respected, and cared for. These decisions are layered with emotion, love, worry, and often guilt, and that’s normal. What matters most is having the conversation early, honestly, and with compassion. Talk with your family. Ask the hard questions like what kind of care feels right and what can you afford, not just financially, but emotionally too? There may not be a perfect option, but there is one that best supports your needs, honors your preferences, and preserves your dignity. And whatever path you choose, make sure it feels like the best fit for a comfortable, fulfilling life.
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