An elderly woman sits in the dining room of a long-term care home, waiting for lunch, her world reduced to this building, these hallways, these routines. She did not choose this - no one chooses this - but her dementia progressed until home care could not keep her safe, and this is where she lives now. A family visits their father, noting that he seems thinner, that his room smells, that staff seem rushed. They wonder if they made the right choice but know they had no capacity to care for him themselves. A personal support worker moves quickly between residents, providing the intimate care - bathing, toileting, feeding - that occupies most of each shift, the ratio of staff to residents leaving little time for conversation or connection. A pandemic sweeps through a home, the outbreak revealing how little protection residents had, how ill-prepared the sector was for crisis. A new long-term care home opens, its modern design promising better care, but the staff shortages that plague the sector mean even new buildings cannot guarantee quality. Long-term care facilities, the nursing homes where Canadians too frail for independent living spend their final years, have become symbols of healthcare system failure. How these facilities are funded, staffed, and regulated shapes the experience of vulnerability.
The Case for LTC Investment
Advocates argue that long-term care requires fundamental transformation. From this view, current conditions are unacceptable.
LTC has failed residents. Pandemic death rates, inadequate staffing, and poor conditions are evidence of systemic failure. Residents deserve better. Transformation is moral imperative.
Investment must increase. Funding levels are inadequate for quality care. More staff, better facilities, and improved conditions all require investment. Governments must spend more.
Staffing is the key. Care quality depends on having enough workers with enough time. Staffing standards must be mandated and enforced. Investment in workers is investment in care.
From this perspective, long-term care requires: significant new funding; mandatory staffing standards; improved wages and conditions for workers; and cultural transformation of how residents are treated.
The Case for Alternative Models
Others argue that traditional LTC should be replaced with different approaches. From this view, institutional care is inherently problematic.
Fewer people should need LTC. Expanded home care and community support could allow more people to age in place. Reducing demand for institutional care should be priority.
Institutional model is flawed. Large facilities with medical model may not serve residents well. Smaller, more home-like settings with consistent staff may provide better care.
Innovation should be embraced. Different models of care - small homes, intergenerational living, green house models - may serve better than traditional nursing homes. Experimentation with alternatives should be encouraged.
From this perspective, alternatives to traditional LTC should be developed while improving care in existing facilities.
The Staffing Crisis
LTC faces severe staffing shortages.
From one view, staffing standards must be mandatory. Without required staff-to-resident ratios, operators cut staffing to save costs. Mandated minimums are necessary.
From another view, mandating ratios without addressing workforce shortage cannot work. Operators cannot hire workers who don't exist. Workforce development must accompany any standards.
How staffing is addressed shapes care quality.
The For-Profit Question
For-profit LTC providers face criticism.
From one perspective, profit motive is incompatible with care for vulnerable residents. For-profit homes have shown worse outcomes. LTC should be public or non-profit only.
From another perspective, ownership type is less important than standards and enforcement. Well-regulated for-profit homes can provide good care. Focus should be on outcomes, not ownership.
How ownership type is addressed shapes the LTC sector.
The Regulation Gap
LTC regulation and enforcement varies.
From one view, regulation is inadequate. Inspections are infrequent, violations have no consequences, and operators face no accountability. Regulation must be strengthened with meaningful enforcement.
From another view, excessive regulation creates burden without improving care. Focus should be on outcomes rather than process compliance. Smart regulation is more important than more regulation.
How regulation works shapes accountability.
The Waitlist Problem
Many Canadians wait months or years for LTC placement.
From one perspective, waitlists are unacceptable. People waiting in hospitals or struggling unsafely at home need LTC now. Capacity must expand to eliminate waits.
From another perspective, some waiting may be acceptable if alternatives exist. Waitlists for preferred facilities are different from waitlists for any placement. Understanding wait patterns matters.
How waitlists are addressed shapes access.
The Canadian Context
Canadian long-term care varies provincially. Pandemic exposed serious problems including inadequate staffing, infection control failures, and high death rates. Multiple inquiries made recommendations. Some provinces are implementing staffing standards. Workforce shortages persist. For-profit, non-profit, and public homes coexist. New capital investment is occurring. Wages have increased in some jurisdictions. Reform is promised but implementation varies. The sector remains troubled despite increased attention.
From one perspective, Canada must transform long-term care through investment and reform.
From another perspective, alternative models should be prioritized over traditional institutional care.
How Canada approaches long-term care shapes end-of-life experience for many Canadians.
The Question
If LTC has failed residents, if pandemic revealed systemic problems, if staffing is inadequate, if conditions are unacceptable - what are we prepared to do? When someone's final years are spent in a facility where staff have no time for kindness, what have we provided? When families choose LTC because they have no alternative, is that a choice? When workers providing the most intimate care earn poverty wages, what does that say about what we value? When for-profit homes show worse outcomes, what role should profit play? When we speak of caring for our elderly, what care are we actually providing? And when someone we love needs long-term care, what should they expect?