Canada’s universal, publicly funded health care system has not been designed in a way that establishes a national approach to long-term care of older adults. Community based home care and institutional LTC are not publicly insured services under the Canada Health Act and as a result each province has developed its own terms and conditions under which these services will be provided. As a result, an important problem facing the Canadian long-term care system is the regional disparities in the types of services available to seniors in Canada including access to home and facility based care. Provincial differences in funding have a direct impact on the types of services seniors receive.

Increasing demand for long term care is coming from multiple sources including the aging of the Canadian population as well as from changes within the system. Reforms to the health care system have shifted the locus of care from expensive acute care institutions into less expensive long-term care facilities and community and home based-settings causing a significant increase in the acuity and complexity of patients. Added to this cause for concern has been how funding for home and community care has not increased enough to meet the increasing demand and complexity of care (Chan & Kenny, 2001; Williams et. al., 2001). The long-term care sector is already under and will continue to be under stress in the coming years with the projected increase in the number and proportion of seniors, and the preference of seniors to ‘age in place’. The recruitment and retention of professional and home support staff to home care and residential/nursing home care will continue to be an issue. The ‘casualization’ of nursing and home support jobs coupled with remuneration levels that are less than acute hospital care make these jobs less attractive than jobs in other health care sectors. At issue is the future supply of workers to jobs in the long-term care sector.

The sustainability of the long-term care sector may be in question should present trends in relation to working conditions and funding levels and devolution continue. As increasing numbers of patients with high levels of acuity are being redirected to home and institutional care, there is question as to whether there will be sufficient numbers of well-trained health professionals to meet their needs (Armstrong and Armstrong 2003; Home Care Sector Study Corporation 2003a; Home Care Sector Study Corporation 2003b).