Private vs. Public Home Care in Ontario

Two routes that are not really competing

Families often compare public and private home care as if they were rival products. One is a public program that provides specific services after an assessment. The other is a purchase. They answer different questions, and many parents who stay at home for long end up with some of each.

In Ontario, publicly funded home care is arranged by Ontario Health atHome after an assessment. The plan can include nursing, personal support, physiotherapy, occupational therapy, speech-language therapy, social work, nutrition counselling, medical supplies and equipment, and referrals to community supports such as meals and adult day programs, at no charge for the professional and personal support visits, in amounts set in an individual plan. Private home care is care you buy from an agency or a caregiver you hire: you choose the hours, the schedule, the scope, and usually the person, and you pay for it yourself. Receiving one does not stop you from using the other.

Public care gives you services. Private care gives you time. The question is not which one, but which jobs belong to which.

What public home care is, and what it is not

The public route runs on three eligibility rules set out in the current regulation under the Connecting Care Act, 2019: your parent is covered by OHIP, the services are needed for them to remain at home, and the home has the physical features those services require. Those are the criteria. There is no income threshold and no asset test. Anyone can make the referral, including you.

A care coordinator assesses your parent, writes the services and the amount into a plan, and stays the primary point of contact. The visits themselves come from Ontario Health atHome staff or from service provider organizations under contract to it. In 2023/24 the agency reported caring for about 670,000 patients across the province, so the system is large, and your parent is one file among many.

What the public route is not: it is not a bank of hours you draw on at will, it is not a schedule you control, and it is not usually the same worker every visit. The provider organization sets times to deliver the tasks in the plan. Homemaking on its own can carry a charge or may not be offered; it is covered when your parent also needs personal support. Community support services such as meal delivery, transportation, and adult day programs can carry a co-payment. Medical equipment may involve rental fees.

Two things families rarely hear. First, the current regulation sets no maximum number of hours; the amount is whatever the plan says, and the plan is meant to be revised when your parent's needs change. The old cap of 90 personal support hours a month belonged to a regulation that has since been repealed. Second, your parent has a Patient Bill of Rights under that same regulation: care that responds to their preferences, and the right to raise concerns without reprisal. If a worker or an organization is not working out, say so to the coordinator. For the wider map of who does what, navigating the system is the companion to this guide.

What private home care is, and what it is not

Private home care is anything you specify and pay for. The hours can be long or short, daily or occasional, daytime, evening, overnight, or around the clock through a team. The scope can include things the public plan does not reach: companionship, housekeeping on its own, cooking, accompanying your parent to appointments, supervision for a parent with dementia across an afternoon, or simply the same person at the same time each day. What a PSW does is the same role in either route; what changes is who sets the terms.

What private care is not: it is not covered by OHIP, and it is not inspected for you. Ontario does not license private home care agencies as a category. Individual workers can be checked (nurses must be registered with the College of Nurses of Ontario, and personal support workers can register with the Health and Supportive Care Providers Oversight Authority, voluntarily as of October 2026), but the agency itself you assess yourself. The questions that separate one from another are in how to choose a home care provider in Ontario , and the going rates are in what home care costs in Ontario .

Which jobs belong to which

Use the plan for what the plan is good at, and buy the rest. These are the matches families most often need to make. Your coordinator decides what the public plan can include, so treat the public column as a starting point for that conversation, not a promise.

Wound care, catheter care, or medication by a nurse after a hospital stay. Public nursing is built for exactly this. Ask the discharge planner what was ordered and make sure the referral to Ontario Health atHome has actually gone in.

A hospital bed, a walker, a commode. Ask the coordinator first; medical supplies and equipment are within the public plan's scope, though rental fees may apply.

A bath or shower, dressing, getting up safely. Personal support is in the public plan, and the visit will deliver those tasks. If the problem is the time of day, the length of the visit, or that your mother will only accept help from a face she knows, that is a private job, or a reason to ask the coordinator what can change.

Evenings, weekends, nights. Private, as a rule. If your father is unsafe at night, say so at the assessment, because it changes the plan, but do not plan your week around public overnight coverage. Around-the-clock presence is a team working in shifts, and families usually pay for it privately.

Several hours of supervision for a parent with dementia. Private. Public personal support delivers tasks; it is not designed to sit with someone through an afternoon.

Meals, rides to appointments, a day program. Ask the coordinator about community support services, which may carry a co-payment. A private companion can do the same errands on your schedule.

Housekeeping alone. Private, unless your parent also needs personal support, in which case homemaking can be part of the public plan without a charge.

A break for the spouse who is doing everything. Both. Ask the coordinator about caregiver support and respite services, and look at respite care privately for the stretch that is needed now rather than when the referral comes through.

Four things families get wrong

"OHIP covers home care," or "OHIP covers nothing." Both miss. OHIP pays for the services written into your parent's plan; it does not buy hours on demand. Anything outside the plan, you buy.

"We will not qualify because of Dad's pension." The eligibility criteria contain no income test. Apply.

"If we hire privately, they will cut the public hours." Nothing in the regulation makes eligibility depend on not buying private care, and the province's own guidance says you can pay for your own care through private companies. What you should do is tell the coordinator what is in place, so the two plans do not duplicate each other.

"The hours are the hours." The plan is meant to be revised when needs change. A hospital stay, a fall, a new diagnosis, or a spouse who can no longer cope are all reasons to ask for a reassessment, and the decision on amount can be complained about and appealed.

The third option: Family-Managed Home Care

For a smaller group, Ontario Health atHome offers funding instead of services. Under Family-Managed Home Care, the eligible patient or their substitute decision-maker receives funds to buy home care or employ their own providers, signs an agreement, manages the providers, and reports expenses each month. The eligible groups are children with complex medical needs, adults with an acquired brain injury, home-schooled children, and patients in extraordinary circumstances. Eligibility depends on the clinical assessment and on the family's ability to handle the contractual and administrative side.

It is worth asking about if your parent fits one of those groups, with two cautions. Providers you buy with that funding are not covered by the Patient Bill of Rights, and funding decisions are not appealable to the review board. Ask the coordinator which providers are eligible under the agreement before you count on hiring a particular person.

Other ways private hours get paid for

Self-pay is the default, but not the only route. Veterans Affairs Canada's Veterans Independence Program funds housekeeping, personal care, and professional support at home for eligible veterans. After a car collision, Ontario auto insurance includes an attendant care benefit. After a workplace injury, WSIB can fund a personal care attendant. On the tax side, the federal Canada caregiver credit and the medical expense credit for attendant care may apply, with conditions. Some extended health plans contribute; check yours. None of this is tax or legal advice, and each program has its own eligibility rules, so confirm with the program before you rely on it.

Running both without paying twice

The order matters. Open the public route first, even if you are also calling an agency, because the assessment runs on its own timeline and private hours can start while it does. When the plan arrives, list what it covers and when. Then buy only the hours and the jobs that are left: the early shower, the evenings, the long afternoon, the consistency.

Give the private agency a copy of the public plan, and give the coordinator the private schedule. Avoiding two people arriving for the same bath is the obvious reason. The better one is that each side then knows what the other has seen. A private caregiver who is there four afternoons a week will notice a change before a weekly public visit does, and the coordinator needs to hear it, because a change in needs is what triggers a revised plan.

When the pieces multiply, hospital, coordinator, provider organization, private agency, siblings, it helps to have one person holding the whole picture. For some families that is the adult child with the spreadsheet. For others it is case management.

Where Arcadia fits

We start by asking what Ontario Health atHome already provides, and we build private hours around it rather than on top of it. Coordinating publicly funded options and insurance is part of how care begins with us; the details are on pricing and funding. Private care covers the part of the week the public system was never designed to reach. It is not a judgment on the people who deliver the public visits.

If you have a public plan in hand and are trying to work out what is still uncovered, book a free consultation or call (844) 977-0050. Bring the plan. We will tell you honestly which gaps are worth paying for and which are worth asking the coordinator about first.