McGrail Kimberlyn
Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia.
Healthc Pap. 2011;10(4):39-43; discussion 58-62. doi: 10.12927/hcpap.2011.22190.
Long-term care (LTC) is but one piece of a continuum of care that stretches from living at home completely independently to the 24-hour supervision and care provided in LTC facilities. People want to stay at home as long as possible and to retain as much independence as they can, and they are often aided in doing so with informal care provided by family and friends. These realities should inform the debates around the construction of the continuum of care. Canada's spending on facility-based long-term care puts us in the middle of the pack among OECD countries; if we consider the whole of continuing care, combining LTC, supportive housing/assisted living and home-based healthcare, Canada stands out as spending the highest proportion (among the 15 countries compared) on facility-based care. Predicting the number of new long-term care beds needed in the future is difficult because of shifting needs and changes in service delivery - new stops on the continuum of care. It is quite possible to organize a system of care that includes a continuum from home-based care to supportive housing and assisted living to LTC that de-emphasizes this last step. The increasing elderly population in Canada will not bring an apocalypse to the healthcare system, but caring for this population will require a redistribution of resources to increase the emphasis on home and community-based services. Our planning for just how many (if any) new long-term care beds are needed and our assessment of reasonable access to those beds need to rest on a vision for the full spectrum of care and attention to the desires of the population we are trying to serve.
长期护理（LTC）只是连续护理体系中的一部分，该体系涵盖了从完全独立居家生活到长期护理机构提供的24小时监督与护理。人们希望尽可能长时间地居家生活，并尽可能保持独立，家人和朋友提供的非正式护理常常有助于他们实现这一愿望。这些现实情况应贯穿于围绕连续护理体系构建的讨论之中。加拿大在机构型长期护理方面的支出使我们在经合组织国家中处于中等水平；如果我们考虑整个持续护理，将长期护理、支持性住房/辅助生活和居家医疗保健结合起来，加拿大在机构型护理方面的支出比例（在所比较的15个国家中）是最高的。由于需求变化和服务提供方式的改变——连续护理体系中的新环节，预测未来所需的新长期护理床位数量很困难。完全有可能构建一个护理体系，包括从居家护理到支持性住房和辅助生活再到长期护理的连续过程，同时淡化最后这一步骤。加拿大不断增加的老年人口不会给医疗保健系统带来灭顶之灾，但照顾这一人群将需要重新分配资源，以更加重视居家和社区服务。我们对于需要多少（如果需要的话）新长期护理床位的规划，以及对合理获得这些床位的评估，需要基于对全方位护理的愿景，并关注我们试图服务的人群的愿望。
