Canada’s long-term care system faces enormous challenges, which are expected to get worse in coming years. Over the next two decades, the number of Canadians over the age of 85 is projected to grow by 145 per cent. The Canadian Medical Association predicts the cost of providing long-term care and home care will reach $58.5 billion by 2031, almost double the level it was in 2019.

Even now, with the full force of population ageing yet to be felt, the system isn’t working well. There are long waiting lists to access long-term care facilities across the country. The quality of care provided leaves much to be desired, as was made painfully clear during the early days of the COVID-19 pandemic. Publicly-funded home care is difficult to access, but privately purchased home care is costly. Instead, the system relies to a great degree on spouses, adult children and other caregivers, who report providing long hours of unpaid care, and feeling tired and overwhelmed.

The situation leaves Canadians with three choices: raise taxes and/or cut spending to finance improvements in the quality of long-term care while meeting growing demand; maintain current financing levels and witness the human cost of declining care; generate new sources of revenue by building on long-term financing models used elsewhere.

This study focuses on the third option. It evaluates how long-term care is financed and allocated in Canada in comparison to several international approaches. Contrary to common perceptions, much of Canada’s long-term care system is privately financed in the form of unpaid care provided by family members, privately purchased personal care and homemaking services, and privately funded assisted-living facilities. Publicly funded services are tightly rationed and the amount available falls far short of care needs.