Integrating Long-Term Care into a Community-Based Continuum

In Ontario, for mostly political reasons, the government’s response has primarily been to expand the supply of institutional long-term care beds, whereas the most pressing problem is a lack of community care resources that allow people to remain in their own homes and communities. The prevailing policy has entrenched a system that essentially equates care for older people with institutional care. Longer hospital stays for chronically ill patients who cannot be discharged, and their placement in residential long-term care because of a lack of other options, are examples of the resulting inappropriate and costly utilisation of resources.

Patients’ inability to perform activities of daily living such as preparing meals or using transportation is the key reason they are being referred to residential long-term care. The authors of this IRPP study argue that if more community support were available, the tipping point at which patients with greater care needs require residential long-term care would be higher, and people would be able to stay at home longer.

Drawing on research in Ontario and overseas, the authors examine some promising community–based rural and urban initiatives. Through the lens of neo-institutional political theory, they analyze the hurdles encountered in attempting to scale up or replicate such initiatives.

The authors say that in order to successfully meet the growing care needs of an aging population, governments will need to fulfill three essential conditions. First, instead of simply expanding the supply of residential long-term care beds, they should plan for “places” within a community-based care continuum, which includes supportive housing, attendant care, adult day programs and home care. Second, they should establish the conditions that enable promising community-care initiatives to be replicated or expanded. Third, they should channel funds based on patients’ needs, rather than on the location of care.

To view the full article, please visit the Institute for Research on Public Policy.