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