Summary

Representing the largest proportion of home and community care clients in Alberta, we surveyed clients aged 18 and older who are cognitively well and are acute, long-term supportive, maintenance, rehabilitation, and wellness clients. A total of 10,690 of a possible 27,808 individuals participated in the survey, for a response rate of 38 per cent. Overall, we heard many clients are satisfied with the home and community care services they receive, as 55 per cent rated their overall experience of home and community care as Great (9 or 10 out of 10). We also heard there are opportunities for improvement and these are shared in more detail throughout the report.

It’s important to note, there was great variation in survey respondents. Clients shared their experiences with a variety of services (professional and/or personal care), in different settings (e.g., a clinic located in community or in a private residential setting such as in a house, apartment, or lodge), and for varying durations (short and long-term). To account for this variation and complexity, we analyzed the results in numerous ways to provide value and impact to a broad array of audiences.

Key takeaways from the 2024 Home Care Client Experience Survey are:

  • Staff and care consistency is important to establish trusting relationships.

  • To participate fully as partners in care, clients need to understand and be understood by their team.

  • Clients identified opportunities to enhance people-centred care and attend to social determinants of health, which include unmet service needs beyond those offered by home and community care.
    • How can this information be used?

    The experiences shared highlight that home and community care is a partnership that requires all involved to contribute to ongoing improvement. The information available in this report can be used by leaders and decision-makers to inform improvements to home and community care at a provincial-level. Type 1 providers (provided by the regional health authority) and Type 2 providers (a provider who has an agreement with the regional health authority) may reflect on these opportunities and how to address them within their unique context. Current clients and family and friend caregivers may use the information in this report to facilitate conversations with their home and community care provider, case manager, or staff.

    Thank you

    We would like to express our gratitude to all the individuals in Alberta who participated in the survey and shared their experience with home and community care. Hearing from you is vital to better understand how to improve home and community care. We would also like to thank our health system partners, the Ministry of Assisted Living and Social Services, Alberta Health (AH), Alberta Health Services (AHS), home and community care leaders, providers, and staff who supported the 2024 Alberta Home Care Client Experience Survey by sharing feedback, communicating support for the survey, and providing important information needed to conduct the survey. Your efforts ensured the success of this survey.

    About home and community care in Alberta

    What is home and community care?

    Under the Ministry of Assisted Living and Social Services, home and community care (formerly known as home care) provides publicly funded health and personal care services to clients of all ages. These services are a type of continuing care service that help clients live safely and independently in their own homes or communities. Home and community care supplements, rather than replaces, help and support from family, friends, and the community. Clients are considered partners in their care. Settings where supports and services are provided are diverse, ranging from a private residence, seniors lodge, supportive living accommodation, community clinic, or adult day program. Services may be received for short-term or long-term durations.

    Alberta residents may be referred or self-initiate access to home and community care services. If eligible, a case manager assesses a client’s needs using a standardized assessment tool and then develops a tailored care plan specifying the supports and services a client is eligible to receive. The case manager coordinates access and delivery of care and services as per the care plan.

    Types of services

    The types of services offered through home and community care in Alberta may include:

  • Professional care services - treatments such as care for wounds or physiotherapy that are typically provided by staff such as nurses, physical therapists, and occupational therapists.

  • Personal care services - services such as help with dressing, eating, bathing, and going to the bathroom. These services are typically provided by personal care staff sometimes referred to as health care aides.

  • Medication management.

  • Linking clients with the most appropriate medical supplies or assistive equipment and technology.

  • Supports for caregivers, such as respite.

    • Types of clients

    Home and community care clients are categorized into client types. The largest proportion (approximately 88 per cent) in Alberta are acute, long-term supportive, maintenance, rehabilitation, and wellness clients. These clients are described in the AHS Seniors Health Provincial Home Care Service Guidelines (June 2012) as follows:

  • Acute – A client who needs immediate or urgent, time-limited (within 3 months) interventions to improve or stabilize a medical or post-surgical condition.

  • Long-term supportive – A client who is at significant risk of institutionalization due to unstable, chronic health conditions and/or living conditions(s) and/or personal resources.

  • Maintenance – A client with stable chronic health conditions, living conditions, and personal resources who requires ongoing support to remain at home.

  • Rehabilitation – A client with a stable health condition that is expected to improve with a time-limited focus on functional rehabilitation. The rehabilitation plan specifies goals and expected duration of therapy.

  • Wellness – A client who receives only professional service for a single unmet need and does not require case management by AHS Continuing Care. The client has stable health conditions, living arrangements, and personal resources and is otherwise able to identify and manage their health needs. A wellness client is expected to require AHS Continuing Care services for longer than three months. In Edmonton Zone, a wellness client does not require any case management services from a Home Living Case Manager. They have a single unmet need that can be provided by an AHS professional for longer than three months, or, one personal care service or program enrollment (i.e., weekly bath assist, pressure gradient stocking support, Adult Day Program (CHOICE is excluded), urinary catheter change, or Medication Assistance Program).

    • Types of providers

    Clients may receive services through one of the following types of home and community care providers in Alberta:

  • Type 1 – provided to a client directly by the regional health authority.

  • Type 2 – provided to a client by a provider who has an agreement with the regional health authority for home and community care services.

  • Type 3 – any service model where a client hires a home and community care provider of their choice. For example, client-directed home care or self-managed care.

    • About the survey

    Expansion of the 2024 Alberta Home Care Client Experience Survey

    Since 2015 Health Quality Alberta (formerly the Health Quality Council of Alberta) has surveyed older adult (aged 65 and older) long-term supportive and maintenance home and community care clients in Alberta about their experiences with care and services they receive. Through consultation with health system partners in 2023, we broadened the survey to include all acute, long-term supportive, maintenance, rehabilitation, and wellness clients, 18 and older, that receive services through Type 1 or Type 2 providers.

    This survey expansion contributes to a more comprehensive understanding of home and community care from the perspective of clients and can be used for ongoing monitoring and quality improvement. It provides information that supports Ministry of Assisted Living and Social Services priorities.

    Survey questionnaire

    Home and community care clients were surveyed using the 2024 Alberta Home Care Client Experience Survey. It contains 65 questions about a variety of topics relating to clients’ experiences with home and community care services. The 2024 survey was revised from previous versions to reflect the expanded scope of eligible clients. Revisions were made in consultation with health system partners, home and community care clients, and family caregivers in 2022 and 2023, and are described in the Appendix.

    How the survey was done

    Health Quality Alberta conducted the 2024 Alberta Home Care Client Experience Survey in collaboration with AHS and AH – including members who are under the Ministry of Assisted Living and Social Services. We mailed surveys to all eligible home and community care clients in Alberta between April 15, 2024 and September 3, 2024, who were:

  • 18 years and older
  • Cognitively well
  • Received home and community care services within the previous six months of survey administration
  • An acute, long-term supportive, maintenance, rehabilitation, or wellness client
  • A recipient of home and community care services within six months of survey administration
  • Receiving home and community care services in any setting (e.g., private residence such as a house, apartment or lodge), excluding Continuing Care Home Type A (formerly long-term care), B (formerly designated supportive living) or C (hospice)

    • 10,690 of a possible 27,808 clients responded to the survey by mail, online, or phone. This represents a 38 percent response rate.


    Response rate
    Client type Surveys mailed Respondents to survey (N) Response rate by client type (%)
    Acute 6,499 2,189 34%
    Long-term supportive 5,089 1,921 38%
    Maintenance 9,642 4,035 42%
    Rehabilitation 516 169 33%
    Wellness 6,062 2,376 39%
    TOTAL 27,808 10,690 38%

    How to interpret results

    Top-box and bottom-box results

    Top-box responses are the most favourable response(s) to a question. Bottom-box responses are the least favourable response(s) to a question. Both are provided to show variation in responses.

    Statistically significant differences 

    Statistically significant differences are noted when comparing data by client type, AHS zone, geographic location, client age, and for historical comparison. However, a statistically significant difference indicates a mathematical difference and may not reflect a meaningful or clinically relevant difference. When comparing results, consider other contextual factors like distribution of provider types and services across zones.

    AHS zone

    Results are compared by AHS zone, which includes South, Calgary, Central, Edmonton, and North zones. More information about AHS zones can be found by clicking here.

    Geographic location

    Results are compared by geographic location and defined as:

  • Metropolitan (Metro): The cities of Calgary and Edmonton, and commuter communities surrounding Calgary and Edmonton.

  • Urban: Centres with populations over 25,000 people but fewer than 500,000, as well as local geographic areas surrounding these urban centres.

  • Rural: Centres with less than 25,000 people and/or areas greater than 200 kilometres from a metro or urban centre and remote areas located more than 200 kilometers from a metro and urban centre.
    • Age

    Results are reported by client age. The age groupings include:

  • 18 to 64
  • 65 and older

    • Historical comparisons

    Historical comparisons for long-term supportive and maintenance clients aged 65 and older are available when questions had the same wording between the 2018 and 2024 survey years. Statistically significant differences are noted for historical comparisons; however, a statistically significant difference indicates a mathematical difference and may not reflect a meaningful or clinically relevant difference. Though observed differences across survey years may help identify opportunities for improvement or areas of success for the province, these differences may be due to other factors such as changes to the survey population and the questionnaire.

    Other considerations

    Readers may interpret results differently depending on their lived experience, role, and context within home and community care. This report is one source of information that summarizes client self-reported experience. Leaders, decision-makers, and providers of home and community care are encouraged to consult other sources of information such as client demographics and levels of need, compliance and monitoring information, quality measures such as those derived from the Resident Assessment Instrument-Home Care (RAI-HC), and engage with clients, family or friend caregivers, and providers of home and community care to better understand clients’ experiences.

    Quality improvement

    How to use the results for quality improvement

    Leaders and decision-makers of home and community care are encouraged to reflect on the results to identify what is working well and where the greatest opportunities for improvement are provincially, at a zone or geographic-level, and locally. Type 1 and Type 2 providers of home and community care services may reflect on the results within the context of their role, and what information may be helpful when planning or prioritizing quality improvement efforts. To support thinking about quality improvement, the following resources are available.

  • The Home Care Client Experience Survey Resource List: Home and Community Care Providers, Case Managers, and Staff contains valuable resources for front line home and community care providers and managers who are seeking information about improving client experience.

  • The Home Care Client Experience Survey Resource List: Home and Community Care Leadership and Decision-makers provides resources for leaders and decision-makers to support improving client experience.

  • The Guide to Developing a Quality Improvement Action Plan from Survey Results supports the identification of quality improvement opportunities and offers a suggested approach to create and conduct a quality improvement plan.

  • Reach out to surveys@hqa.ca for more information about the survey and to access support with understanding your results.
    • Current clients and family and friend caregivers may use the information in this report to facilitate conversations with their home and community care provider, case manager, or staff. For individuals who are interested in learning more about home and community care, and/or steps involved to access services, phone 811 to be connected to a home and community care team in your zone.

    Overview of this report

    This report is organized from a broad to detailed view of clients’ home and community care experiences.

    1. Overall client experience presents the Overall Care Rating (Q51), an overall measure of clients’ experience with home and community care.

    2. Drivers of client overall experience identifies six drivers that represent a topic or theme that strongly influence the Overall Care Rating.

    Opportunities for improvement presents opportunities to improve overall client experience. This includes:

  • 3. The 12 questions that most strongly influence the Overall Care Rating and represent significant room for improvement provincially.

  • 4. The questions that make up each driver.

  • 5. Themes identified in client comments in response to open-ended survey questions. These insights further contextualize the information provided, as well as identify opportunities for improvement.
    • 6. Question-level results presents question-level results with full response options for each survey question.

    7. Client characteristics provides details about respondents.

    Key terms

    Acute care client: A client who needs immediate or urgent time-limited (within 3 months) interventions to improve or stabilize a medical or post-surgical condition.

    Average: The sum of scores, divided by the total number of scores. This is also known as a mean.

    Bottom-box: A way to present the least favourable response(s) to a particular question.

    Care meeting or care conference: The client, case manager, and/or families discuss the client’s care needs and create a personal care plan to support the client’s independence and wellness.

    Care plan: An evolving written document created by a case manager and/or interdisciplinary team and client, and includes the client’s assessed unmet healthcare needs, healthcare goals, and approved interventions.

    Case manager: An Alberta Health Services health professional accountable for providing case management services. The case manager assesses client needs, determines service options, makes service recommendations and referrals, and monitors service delivery. The case manager responsible for reassessment, waitlist and discharge of clients, and coordination of care transitions to other care settings.

    Cognitive Performance Scale score (CPS): This is a measure of the presence and degree of cognitive impairment, assessed using the Resident Assessment Instrument – Minimum Data Set (RAI-MDS), which considers memory impairment, level of consciousness, and executive function. Scores range from 0 (cognitively intact) to 6 (very severe impairment).

    Composite score: A single score that summarizes a series of questions or items which share a similar topic or theme.

    Driver: In this report, they are a representation of a theme that influences the Overall Care Rating.

    Home and community care: Publicly funded, prescribed health goods and services provided by a home and community care provider to an eligible person in their home or community, excluding facility-based care or supportive living services. It is governed by the legislated requirements and services as per the Continuing Care Act and Continuing Care Regulations.

    Long-term supportive client: A client who is at significant risk of institutionalization due to unstable, chronic health conditions and/or living conditions(s) and/or personal resources.

    Maintenance client: A client with stable chronic health conditions, living conditions, and personal resources who requires ongoing support to remain at home.

    Metropolitan (Metro): Determined by using postal codes, a metro location is defined as the cities of Calgary and Edmonton. It also includes areas immediately surrounding Calgary and Edmonton, known as commuter communities and are metropolitan influenced areas.

    People-centered care: People-centred care prioritizes the wholistic preferences, needs, and strengths of people and communities. It involves caring for the wellness of the whole person, including their physical, mental, emotional, spiritual, and socio-economic needs, while considering their dimensions of identity and personal determinants of health. It embraces the concept of “patients as partners” collaborative relationships between clients, family and friend caregivers, providers, and community resources.

    Personal care services: Often provided by staff such as health care aides, personal care services may include support with personal hygiene, dressing, toileting and incontinence management, and mobilizing and transferring.

    Professional care services: Provided by professional staff, such as nurses and therapists, professional care services may include services such as assessment of health, treatments and procedures, and rehabilitation to enhance function.

    Rehabilitation client: A client with a stable health condition that is expected to improve with a time-limited focus on functional rehabilitation. The rehabilitation plan specifies goals and expected duration of therapy.

    Rural: Determined by using postal codes, a rural location is up to 200 kilometres from a metro or urban centre, and is populated by fewer than 10,000 people. Also included are large rural centres and surrounding areas that have populations of 10,000 to fewer than 25,000, and remote areas located more than 200 kilometers from a metro and urban centre.

    Social determinants of health are social and economic factors such as income, education, culture, gender, and childhood experiences that influence individual and population health.

    Statistical significance: In this report, statistically significant means the probability of the event occurring by chance alone is less than or equal to one per cent (p < 0.01).

    Top-box: A way to present the most favourable response(s) to a question.

    Type 1 provider: The regional health authority provides home and community care directly to a client.

    Type 2 provider: A provider who has an agreement with the regional health authority to deliver home and community care.

    Urban: Determined by postal codes, an urban centre is defined as a location populated by more than 25,000 people, but fewer than 500,000 people, as well as local surrounding geographic areas.

    Wellness client: A client who receives only professional service for a single unmet need and does not require case management by AHS Continuing Care. The client has stable health condition(s), living arrangements and personal resources and is otherwise able to identify and manage their health needs. A wellness client is expected to require AHS Continuing Care services for longer than three months. In Edmonton Zone, a wellness client does not require any case management services from a Home Living Case Manager, and has a single unmet need that can be provided by an AHS professional for longer than three months, or, one personal care service or program enrollment (i.e., weekly bath assist, pressure gradient stocking support, Adult Day Program (CHOICE is excluded), urinary catheter change, or Medication Assistance Program).



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