The aging population and the epidemic of chronic diseases requires an accompanying finance reform of long-term care that will become increasingly dominant. Many countries have faced this situation and have set up a separate public funding for such care on the basis of a universal insurance covering both home care and institutions. Canada and Quebec must adopt such autonomy insurance and create a separate fund financed partly by a more judicious use of current budgets and tax credits, and also by a significant investment in home care. An autonomy support benefit could be allocated in kind to fund public services and by contract to pay for services delivered by private, voluntary, and social economy agencies. This benefit would be established following a standardized assessment of functional autonomy achieved by the case manager who will manage the services and control their quality.

Secondary analysis of data from the Health and Activity Limitations Survey (HALS) in the metropolitan Montreal area shows that 3.5 out of 10 elderly persons living in a household had a disability. In this descriptive research, we locate the dependency level according to the attributes of the elderly and of their residence. Approximately three out of four elderly with a disability receive help and one out of three are assessed as needing more help. Assistance varies with the person who helps. The family mostly helps for everyday activities, friends for shopping, and private or governmental services for personal care and household tasks. Assistance varies also with the marital status of the elderly person. Finally, the presence of special devices is associated with type of housing.