On January 1, 1978, a new Long Term Care Program was introduced in British Columbia. Five levels of care are offered, any one of which may be provided at home or in a facility. This paper presents data from a longitudinal study of Program clients (N = 3516) in two health unit areas, one urban, one semi-rural. The period of analysis is five years from admission. By the end of the five years, 40.2 percent of clients had died; 35.0 percent were still in the Program; 24.7 percent had been discharged alive and were still alive. This paper focuses on the decedents.

It was established that approximately half of the males and half of those aged 75 or over at admission were deceased within five years of admission. Regardless of level of care at admission, at least one-third had died in the five year period. More than one-third of decedents did not change level or location of service prior to death.

While these data may assist care providers in identifying high risk clients, probably the most provocative finding was the similarity in the proportion and pattern of deaths among new clients admitted to care at home and those admitted to facility.

Canada faces a significant challenge in meeting the health care needs of older adults with complex mental and physical health issues. Studies have shown collaborative mental health services to effectively address the diverse health needs of this group. However, an often overlooked yet important aspect of service delivery planning for this population is to ensure that older adults are sufficiently able to access available best-practice services. The article reports on a national consensus-building exercise conducted by the Collaborative Mental Health Initiative—Seniors Working Group to develop a nationally informed framework on the accessibility needs of older adults as they relate to collaborative mental health care. The framework is intended to provide planners, administrators, and providers with an understanding of the unique accessibility needs of older adults across three priority pillars (personal, caregiver, systemic) and to enable them to embed strategies to address these issues within field-based collaborative mental health initiatives.