Introduction

Hospital and physician services for Canadians of all ages are shared responsibilities of the federal government and the governments of ten provinces and three territories. However, long-term care is regulated, funded and delivered only under the auspices of provincial/territorial governments with no major role for the federal government. Therefore, one cannot accurately refer to the ‘Canadian healthcare system’ as a singular entity. Rather healthcare, and long-term care, is delivered by thirteen different systems with national legislation guiding some, but not all, aspects of service delivery, regulation and administration (Beland and Shapiro, 1994). In addition, healthcare in Canada is provided by a mixture of public and privately funded services, and the balance between those sources of payment varies by region. The complexity of the Canadian healthcare mosaic has increased further with the introduction of regional authorities responsible for ‘local’ management of health services in the last two decades.

Rather than provide an encyclopedic summary of the regulatory structure of healthcare for the elderly in all regions of Canada, this chapter will focus on the experience of the province of Ontario to illustrate the experience of the country’s most populous province. It is also the province with the most fully integrated health information system across the continuum of care for older people, which is intended to improve clinical practice, quality, public accountability and funding of health services. That said, one must remain aware that this overview represents a single province’s experience that shares much, but not all, in common with other regions of the country. The chapter begins with a brief overview of the three levels of government (federal, provincial, regional) that have an influence over healthcare in Canada. The remainder deals specifically with the continuum of care for the elderly in Ontario.