08/25/2026
Susan Holt Lyne Chantal Boudreau - Champdoré-Irishtown
HOME FIRST
Before We Fund Another Bed, Let's Make Home a Real Option
New Brunswick is facing a serious challenge. Our hospitals need relief, families are exhausted, and seniors are waiting for long-term-care placements.
Building and securing additional long-term-care beds is part of the solution.
But we need to ask another question:
How many seniors are entering long-term care because they truly require institutional care—and how many are entering because their families simply cannot afford enough support to keep them safely at home?
Those are two very different problems.
Home First Should Mean Home First
Most families don't wake up one morning and decide they want to place their mother, father or spouse in long-term care.
Often, placement comes after months or years of trying to make things work.
A daughter stops by before work.
A spouse manages medications, meals and appointments.
Someone helps with bathing.
Someone else does groceries.
Family members rotate evenings and weekends.
Eventually, the needs become greater than the family can manage.
That does not necessarily mean the senior suddenly requires a long-term-care facility.
Sometimes it means they need more help at home.
Funding Has to Reflect the Real Cost of Care
If a self-managed option provides a family with approximately $15 per hour toward care, we need to have a serious conversation about what that buys in today's labour market.
Who are families expected to hire for $15 an hour?
Can they consistently find trained, dependable caregivers?
Can that rate support appropriate screening, insurance, payroll costs, supervision, training, scheduling and replacement coverage when a caregiver calls in sick?
Quality home care has a real cost.
If government funding does not reflect that cost, families are left with a difficult choice: personally pay the difference, provide the missing care themselves, go without necessary hours, or eventually consider residential placement.
For many middle-income families, paying the difference for several hours of care every day simply isn't sustainable.
A home-care program isn't truly accessible if the funding available cannot realistically purchase the care a senior requires.
We Need to Revisit the Co-Pay System
There is another group that deserves much more attention: families who earn too much to receive substantial assistance but nowhere near enough to privately fund extensive home care.
These are ordinary New Brunswick families.
They may have a modest pension, savings or retirement income.
On paper, they may appear capable of contributing toward care.
But there is an enormous difference between being able to contribute toward home care and being able to privately purchase 20, 30 or 40 hours of care every week.
The income threshold and co-pay structure should reflect that reality.
A Home First model could establish a much broader sliding scale.
Families who can afford to contribute should contribute.
But government assistance should gradually decrease as financial capacity increases rather than creating a situation where families face an unaffordable cost simply because their income falls above a particular threshold.
Give Families a Real Choice
Imagine a senior who requires help in the morning and evening.
They need assistance getting dressed, preparing meals, light housekeeping, medication reminders and personal care.
Perhaps they also need several hours of respite each week so their spouse or adult child can continue working and caregiving.
With sufficient support, that person may be able to remain safely at home.
Without it, the family eventually reaches its breaking point.
Then we begin looking for a long-term-care bed.
What if we intervened before reaching that point?
A New Brunswick Home First Program
Before a senior who wants to remain home is placed on a long-term-care pathway, New Brunswick could conduct a comprehensive Home First Assessment.
The assessment should ask:
What would it actually take to keep this individual safely at home?
Not:
How many hours can the existing program afford to give them?
Those are fundamentally different questions.
Once the person's actual needs are established, government could determine an appropriate enhanced home-care package.
Depending on assessed need, that could include:
Morning and evening home-support visits
Personal care
Meal preparation and nutrition support
Medication reminders and assistance within the worker's scope
Light housekeeping and laundry
Respite for family caregivers
Transportation and appointment support
Adult-day programming
Overnight support when appropriate
Increased support following hospitalization
Coordination with nursing and other community health services
The family's contribution could then be determined through a realistic sliding-scale co-pay based on ability to pay.
Pay Enough to Provide Quality Care
Government-funded home-care rates should also recognize what it actually costs to provide safe, dependable care.
We cannot simultaneously say that home care is essential to solving New Brunswick's health-care crisis while funding it as though the people delivering that care are an afterthought.
Home-support workers are helping seniors bathe, dress, eat, move safely around their homes and maintain their independence.
They notice changes.
They may recognize that a senior is confused, hasn't eaten, is becoming unsteady or isn't managing well.
They can be an important part of preventing the crisis that eventually sends someone to an emergency department.
If we want professional, reliable home care, our funding model has to support professional, reliable caregivers.
Home First Doesn't Mean Home at All Costs
There will always be New Brunswickers who require long-term care.
Advanced medical needs, significant cognitive impairment, behavioural concerns, unsafe environments and the need for continuous supervision can make residential care the safest and most appropriate choice.
Home First should never mean keeping someone home when it is unsafe.
It should mean:
No New Brunswicker should enter long-term care simply because adequate home support was financially out of reach.
Give Families More Before Asking Them to Give Up Home
If a family is willing to contribute $500, $800 or $1,000 a month toward keeping their loved one home, but the actual care required costs several thousand dollars, perhaps our response shouldn't be:
"You don't qualify for enough assistance."
Perhaps it should be:
"Let's determine what you can reasonably contribute and what government can contribute so we can keep your loved one safely at home."
That changes the conversation.
Government investment follows the person rather than forcing the person toward the service government has chosen to fund.
Measure Whether It Works
New Brunswick could pilot an Enhanced Home First program and track the results.
Compare participating seniors with the traditional pathway.
Measure:
Long-term-care placements delayed.
Hospital admissions and emergency-department visits.
Alternate-level-of-care hospital days.
Family caregiver burnout.
Average government expenditure per client.
Client and family satisfaction.
And perhaps the most meaningful measurement:
How many additional months or years did seniors safely remain in their own homes?
Before Another Bed, Ask One More Question
Long-term-care beds are necessary.
But beds alone will not solve the pressures facing our aging population.
We need to invest just as seriously in preventing or delaying the need for those beds.
Increase home-care funding.
Modernize the co-pay thresholds.
Fund care at rates capable of attracting and retaining qualified workers.
Give middle-income families meaningful assistance.
Provide substantially more hours when an assessment demonstrates that those hours can safely maintain someone at home.
Support family caregivers before they reach complete burnout.
And give seniors a genuine choice.
Because Home First cannot simply mean that we would prefer seniors to remain at home.
It has to mean that we are prepared to invest in making that possible.
Before New Brunswick asks:
"Where are we going to find a bed for this senior?"
Let's first ask:
"What would it take to keep them home?"
