The Funding of Long-Term Care in Canada: What Do We Know, What Should We Know?

Abstract

Long-term care is a growing component of health care spending but how much is spent or who bears the cost is uncertain, and the measures vary depending on the source used. We drew on regularly published series and ad hoc publications to compile preferred estimates of the share of long-term care spending in total health care spending, the private share of long-term care spending, and the share of residential care within long-term care. For each series, we compared estimates obtainable from published sources (CIHI [Canadian Institute for Health Information] and OECD [Organization for Economic Cooperation and Development]) with our preferred estimates. We conclude that using published series without adjustment would lead to spurious conclusions on the level and evolution of spending on long-term care in Canada as well as on the distribution of costs between private and public funders and between residential and home care.

How Will COVID-19 Alter the Politics of Long-Term Care? A Comparative Policy Analysis of Popular Reform Options

“…The lack of meaningful shift towards home care, despite being a clear and quasi-universal policy priority across the country, is indicative of the difficulties to transform policy objective into concrete policy outcomes. Home care efforts represent on average 2.5% of public health expenditure, and the proportion of LTC financial resources going to home care has not shifted in the past 20 years (Grignon & Spencer, 2018)! By virtue of not being a core health program, LTC budgets have been more vulnerable to the ebbs and flows of fiscal politics than other health sectors (Marier, 2021, p. 161).…”

“…Strongly embedded in health organizations in nine provinces, LTC has not had the opportunity to flourish elsewhere, such as within municipalities, which is the case in the frequently cited Scandinavian countries. Consequently, LTC occupies a small portion of spending within all health budgets (13%) (Grignon & Spencer, 2018), which has facilitated the growth of diverse unregulated care providers (Afzal, Stolee, Heckman, Boscart, & Sanyal, 2018). In addition, consistent with our institutional bias in the delivery of health care, Canada distinguishes itself from other industrialized countries with a higher proportion of its LTC budget devoted to nursing homes.…”

The contemporary crisis of hallway healthcare: Implications of neoliberal health policy on the rise of emergency overcrowding

“…Due to the privatized nature of the majority of LTC homes, many receive limited funding from the provincial government to support growth and development, and as a result, find themselves experiencing issues of incapacity (Carter, 2020;Grignon & Spencer, 2018). This is concerning because the literature demonstrates that individuals who live in for-profit LTC homes exhibit higher rates of mortality, increased visits to the ED and greater likelihood of hospital admissions in contrast to individuals living in nonprofit and municipal LTC homes (Hsu et al, 2016;Tanuseputro et al, 2015).…”

COVID-19 and Long-Term Care Policy for Older People in Canada

“…This could have been part of a renewed focused on home care, in the context of aging at home strategies. However, despite two decades of advocating a shift toward home care, nursing home expenditures have constantly represented 80-82% of the long-term care budget in Canadian provinces (Grignon & Spencer, 2018), meaning that there has not been a noticeable shift in resources. Hence, as a result, this reduction in the number of beds in Quebec has led to more stringent admission criteria, rising waiting lists to access nursing homes, and a stronger reliance on unpaid family caregivers.…”