Long-term care (LTC) is an umbrella concept used in Canada to describe a complex system of care for persons who are at significant risk of having progressive and/or chronic conditions, and who require services to meet their long-term functional needs. According to Chan & Kenny (2001) the four essential features of long-term care in Canada are that (1) the care will be long-term; (2) it is an integrated program of care across various service components, that is, a service continuum; (3) it is a complex service delivery system, not a type of service; and (4) the efficiency and effectiveness of the system are based not only on the efficiency and effectiveness of each component, but also on the way that the service delivery system is structured (p. 87).

The main components of long-term care service delivery systems in Canada are home care and community based services, and institutional care in LTC facilities. LTC services are not publicly insured services under the Canada Health Act; in fact, LTC is not fully-insured in any jurisdiction. The balance among these components and the range of services within each vary from province to province, within an overall national framework that sets guidelines for access to care. Each province has developed its own terms and conditions under which services will be provided (Canadian Health Care Association, 2004). For home care this has resulted in provincial differences in the policies, organization, availability, delivery, costs eligibility requirements, coverage limits, covered services, and public investment of non-insured health services. Further, there is no accepted terminology, standards, or comprehensive data for home care in Canada (MacAdam, 2004). In the case of institutional care, this has led to provincial differences in accountability, system design, funding, policies and regulations, facility ownership, costs to residents, residency requirements and minimum comfort allowances (Canadian Healthcare Association, 2004; Berta et. al., 2006). There is no accepted terminology or classification of types of care from province to province, though some provinces have adopted a case-mix classification system (i.e., Resource Utilization Groups (RUG-III) for funding purposes and the Minimum Data Set for the assessment of complex continuing care in hospitals, nursing homes and home care assessments (Hirdes, 2001)). Berta et al. (2006) provide provincial equivalencies for Canadian LTC facilities: Type 1 (limited personal and no supervisory care), Type 2 (nursing, extended, personal care with nursing supervision) and Type 3 (chronic, auxiliary hospitals, intensive care). LTC facilities generally provide a lower level of care than that offered in hospitals, though some overlap occurs.