Health Care Coverage for Older People Canada

All acute care services and physician-provided primary care services for older people in Canada are funded through the universal public insurance system at no charge to the individual. A majority of physician services have always been provided by physicians on a fee-for-service basis. Continuing and community care services have historically been provided by a combination of public, private, and voluntary (not-for-profit) service providers.

Continuing care services fall under the category of extended health services in the Canada Health Act and as such are not fully insured services. Extended health care services that are covered by the Canada Health Act include certain aspects of long-term residential care (nursing home intermediate care and adult residential care services) and the health aspects of home care and ambulatory care services. Continuing care services are distinct across provinces, and while many provinces can include the same elements there is no nation-wide continuing care system, as these services are a matter of provincial jurisdiction.

In Canada, most medical care for older people is provided by family physicians. Although training programs in geriatric medicine have increased and geriatricians are more widely available than in the past, acute geriatric services (those provided by specialists in geriatric medicine working in conjunction with an associated multidisciplinary team) continue to be poorly understood and improperly utilized or underutilized in conventional physician referral processes.

The term continuing care is now used to describe the full range of care services for older people and people with disabilities in six provinces (British Columbia, Alberta, Manitoba, Nova Scotia, Prince Edward Island, and Newfoundland) and in the Northwest Territories. Saskatchewan uses the term "supportive services" and the Yukon and Quebec do not use a single umbrella term to describe their full array of services. Continuing care services are offered in Canada by private (for-profit) providers, and the voluntary (not-for-profit) sector, as well as by publicly funded provider organizations. Whatever the ownership of a continuing care center, residents typically pay an accommodation charge.

The newer models of care, and some other programs for older people in Canada, incorporate the five best practices that have been identified as characteristics of the most efficient continuing care systems in the world. These practices are: (1) a system of single entry, (2) coordinated assessment and placement, (3) a coordinated case management system, (4) a client-care level classification system, and (5) administrative arrangements.

The newer models of care for older people are designed to promote client-centered care by offering more individualized choice of programs and services, with the option to choose and purchase services, a la carte, in a residential environment. While some programs of this nature are offered through the continuing care system, others are privately owned and operated as senior housing in which residents have the opportunity to purchase a "care package."