The Home Care Cost Model: A Reference Framework for Aging in Place in Canada
# The Home Care Cost Model: A Reference Framework for Aging in Place in Canada
Families across Canada routinely make high-stakes decisions about home care for older adults and people living with disability. Three distinct service categories — personal support (PSW, HCA, HSW), skilled nursing (LPN, RN), and housekeeping or cleaning services — are regulated, priced, and subsidised differently and cannot be freely substituted. The single most common misunderstanding is whether a housekeeper or cleaning service can substitute for a PSW. Legally, the answer is no whenever personal care tasks are required.
## The cost model
The reference implementation takes an assessment triple (Katz ADL score, Lawton IADL score, cognitive and mobility status), the recipient's jurisdiction, household composition, and primary diagnosis, and returns a recommended service mix, private-pay cost, allocated subsidised hours, and a full federal-plus-provincial tax relief stack indexed to the 2026 taxation year.
## Datasets
Eight open datasets are published under CC BY 4.0:
- `home_care_services_canada.csv` — scope of practice and rate bands across 13 Canadian jurisdictions
- `home_care_tax_parameters_2026.csv` — METC, DTC, CCC, VAC VIP parameters
- `home_care_subsidy_programs.csv` — provincial and territorial subsidised programs
- `home_care_scenarios.csv` — 5,000 synthetic household scenarios
- `home_care_per_province_rate_bands.csv` — CPI-adjusted 2019–2026 rate bands
- `home_care_cost_model_archetypes.csv` — canonical archetype lookup grid
- `home_care_tax_relief_sensitivity.csv` — tax credit sensitivity by income band
- `home_care_subsidy_gap.csv` — cross-province subsidy gap analysis
## Engines
Seven language implementations (Python, Rust, Java, Ruby, Elixir, PHP, Go) compute identical results to the cent.
## Findings
- Hybrid service mix (PSW for personal care + cleaning service for housekeeping) is typically 10–20% cheaper than an all-PSW plan.
- METC + DTC + CCC stacking reduces eligible households' out-of-pocket by 15–35% but is routinely under-claimed.
- Cross-province subsidy gap (model-recommended hours vs allocated hours) varies by a factor of three.
Reference model only. Not clinical or financial advice.
Working paper: https://www.binx.ca/guides/home-care-cost-model-guide.pdf
Zenodo DOI: 10.5281/zenodo.19491364
Repository: https://github.com/DaveCookVectorLabs/home-care-cost-model
