Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 111
Most residential care is privately funded whereas most high-acuity long-term
care providing 24-hour a day nursing supervision is publicly funded by the
provincial and territorial governments. long-term care facilities face different
provincial and territorial regimes in terms of licensing and quality control as
well as accreditation requirements. Ownership also varies considerably across
the country (Berta et al., 2006). In some provinces, a majority of publicly
funded long-term care beds are in profit-making facilities: for example, in
Ontario, 60% of publicly-funded beds are in profit-making facilities (Berta,
Laporte & Valdamanis, 2005). In other provinces, a majority of publicly funded
long-term care beds are in not-for-profit facilities, owned either by the provincial
government and regional health authorities or by community-based or faithbased
organizations; for example, in British Columbia, 70% of publicly-funded
long-term care beds are in non-profit-making facilities (McGrail et al., 2007).
In all cases, the non-profit-making facilities tend to be larger with higher direct
care staffing levels because their residents’ needs tend to be more complex,
requiring higher levels of care (Berta et al., 2006). While there is some evidence
that better patient outcomes are associated with non-profit-making long-term
care facilities compared with profit-making homes, more research is needed to
test this association (McGrail et al., 2007).
In the more highly integrated provincial and territorial health systems,
home-based care can be a cost-effective alternative to facility-based care.
Moreover, increases in publicly funded home care in Canada have been shown
to reduce the use of hospital services, reduce reliance on informal caregivers
and increase self-perceived levels of health status (Stabile, Laporte & Coyte,
2006; Hollander et al., 2009). Although the percentage, and basic profile, of
Canadians receiving publicly subsidized home care changed little between the
mid-1990s and the mid-2000s (Table 5.2), there is evidence that the needs of
those receiving home care have grown in acuity. For example, while 8% of
home-care recipients were incontinent in 1994–1995, the proportion more than
doubled to 17% by 2003 (Wilkins, 2006).