An Introduction to the NIA’s 2019 Policy Series: The Future of Long-Term Care

Adapted Excerpt, from Enabling the Future Provision of Long-Term Care in Canada

September 3, 2019

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Each year, the NIA identifies a key policy challenge to address through expert research, broad engagement, and actionable reports. This year, the NIA is launching a three-part policy series that examines the current system of home and community, and of care delivered for older Canadians in designated buildings such as nursing homes.

Canada’s provinces and territories are struggling now more than ever to meet the rapidly growing needs of the ageing population. Governments are looking for the right mix of publicly desired, clinically appropriate, and cost-effective services delivered across a variety of settings and to a population with an increasing diversity of needs, abilities, and challenges. At the same time, there is a growing demand and necessity to provide more high-quality long-term care to Canadians within the confines of strained healthcare budgets and limited household means. This has become particularly challenging, as Canadians are now living longer with more complex health, social, and functional issues than any previous generation.

When Canada established its universal healthcare system in the 1960s, the average age of Canadians was only 27 years and life expectancy was less than 70 years. Today, Canadians can expect to live longer than 80 years. Decision-makers of previous generations faced less pressure to comprehensively address how long-term care services should be provided or funded. When Medicare was founded across Canada, the population was young and growing and ensuring all Canadians had universal access to primary and hospital care was the priority. But Canada today is very different than it was 50 years ago, and while its citizens have matured, its health care system hasn’t kept pace with their evolving needs.

The Future of Long-Term Care in Canada is Largely Uncharted Territory

It’s always easier to be critical of the past and present than it is to optimistically envision the future and the path to get there. This NIA series will attempt to do both. And while the future is uncharted territory, challenges cannot be left to future generations of Canadians. The provision of health and social care, like all large, complex systems, requires constant evolution in response to changing circumstances and priorities. Therefore, the goal of this NIA policy series is to understand the present with an aim towards charting a clearer future for the provision of long-term care in Canada.


It is important that governments spend their tax revenues in the most effective and efficient ways to help ensure the future sustainability of systems, programs, and services, and to produce better outcomes for the ageing population. While government funding is crucial, better quality care is achievable by means other than just spending. Better, evidence-based policy, public education, targeted funding with clear accountability measures and aims, and political will to enact reforms can help achieve desired outcomes.

Governments have a central role to play in providing the right care and support, in the right place, at the right time and by the right provider. But Canadians of all ages also have the right and ability to understand how they can participate in determining the best ways for them to age with independence, dignity, and respect in the place of their choice. Canada’s universal health care system may not be perfect, but its principles are a clear point of pride for many Canadians. Canadians expect government to provide the essential care they will need and are therefore surprised when faced with a long-term care system that is not fully funded by government. Instead, the provision of long-term care relies on a mix of public and private funding and varies in the way it is structured, organized and delivered across every province and territory.

 What is further becoming clear is that the need for long-term care will not be easily met by current levels of public funding. Canadians are justified in asking: ‘What options do I have?,’ ‘What’s publicly funded?,’ ‘What should I organize and pay for myself?,’ ‘How much will I need to save to meet my goals?,’ ‘How can I stay in my home if I only need a little help to do so?,’ ‘Where do I go if I can no longer manage on my own at home?,’ and ’How can I best be supported and enabled as an unpaid caregiver to another person?’.

 In this context, Canadians will need more clarity on how existing publicly and privately funded options can be leveraged and integrated to produce the type and level of care they will want and need. Canadians may also need governments to enable them to better help themselves. A number of countries have turned to government-enabled, private or public mechanisms to pay for long-term care, some of which are surveyed in this report.

The NIA’s Future of Long-Term Care Policy Series Reports

In the inaugural report of the series, Dr. Samir Sinha, the NIA’s Director of Health Policy Research, and his team will explore what the provision of long-term care currently looks like across Canada and place it within the global context of comparable countries also tackling significant demographic transitions as they redevelop their systems of care. While Canada’s current challenges will be highlighted, so too will evidence-informed opportunities and enablers of innovation in this growing and important area of care. Dr. Sinha’s report will set the health policy stage for the rest of the series, which will work towards developing clear recommendations for government policy and decision-makers, care providers and citizens to consider that can improve the approach to the future provision of long-term care within the fiscal reality all governments are facing.

In the second report, Dr. Bonnie-Jeanne Macdonald, the NIA’s Director of Financial Security Research, Dr. Michael C. Wolfson, former assistant chief statistician at Statistics Canada, and Dr. John Hirdes, Professor at University of Waterloo and Ontario Home Care Research and Knowledge Exchange Chair, will investigate the projected future costs of providing home, community, and care provided in designated buildings such as nursing homes across Canada, if no action is taken to advance the status quo. In acknowledging that provincial and territorial budgets are currently stretched, the purpose of this report will be to project the real costs of providing home and community care, and care in designated buildings such as nursing homes over the next three decades. This report will build on existing research and literature, and use a large-scale population modelling tool to show projected costs and scenarios based on real-life data. This will allow policy and decision-makers and stakeholders to really understand for the first time what future care needs may actually truly cost for all of Canada. Where Dr. Sinha’s report will set the stage for necessary health policy reforms, this second paper will set the stage for necessary fiscal reforms.

The third and final report of the series will then bring together experts in financial and health policy to present options and recommendations for a feasible and fiscally responsible set of policy scenarios, which bring the right type of needed reforms to our future systems of care, and high-quality care services for older adults that can be both affordable and increasingly sustainable.

To enable the development of each report in this series the NIA will engage with a broad cross-section of experts, care providers, economists, government officials, and the public.

The overall goal of this Policy Series will be to help government policy and decision makers, existing care providers and members of the general public to clearly understand the options available to meet the long-term care needs for Canada’s ageing population.

This series is sponsored by, and in collaboration with:

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AdvantAge Ontario has been the trusted voice for senior care for close to 100 years. We are community-based, not-for-profit organizations dedicated to supporting the best possible aging experience. We represent not-for profit, charitable, and municipal long-term care homes, seniors’ housing, and seniors’ community services.

Since 1867, the Canadian Medical Association has been the national voice of Canada’s medical profession. We work with physicians, residents and medical students on issues that matter to the profession and the health of Canadians. We advocate for policy and programs that drive meaningful change for physicians and their patients.

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Essity is a leading global hygiene & health company dedicated to improving well-being through products and solutions.  Essentials for everyday life. Essity’s sustainable business model creates value for people and nature. Essity sells in approximately 150 countries under leading global brands TENA, Jobst, Leukoplast, Tork, and others. 

Home Instead Senior Care was founded in 1994 to respond to a need for person-centred, relationship-based senior care. Today, with over 1100 operations in a dozen countries around the world, including Canada, Home Instead is relied upon to provide an estimated 75 million hours of service per year.

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Allan McKee