Residential long-term care: public solutions to access and quality problems.

Residential long-term care in Canada is characterized by unequal access and quality problems largely due to inadequate public funding and regulation, commercial involvement and its exclusion from medicare. Programs are patchwork, with variations across provinces in the availability of services, level of public funding, eligibility criteria and out-of-pocket costs borne by residents. Most provinces have cut long-term care bed capacity relative to the senior population in the past decade, without sufficiently expanding home and community care or adequately increasing staffing to reflect the higher acuity of the remaining residents. As a result, care is often rushed and underfunded, with poor working conditions leading to poor quality of care and quality of life for residents. This relationship between workers' and residents' well-being is well documented but poorly addressed. Also well researched but rarely reported are the negative impacts of privatization, at all levels: financing, ownership, management and delivery. This article describes the state of residential long-term care in Canada and proposes three policy directions: creating a pan-Canadian long-term care program, improving quality and reversing privatization.