Long-term care is available for individuals with functional incapacities. Long-term care includes medical, social, and personal hygiene services, which help to maintain the autonomy of the elderly and allows them to live with dignity in spite of loss of autonomy. This definition provides long-term care services with a goal and a clientele. However, are individuals with functional incapacities first and foremost chronically ill? Should long-term care services be conceptualized as independent from medical care? Provincial government policy documents promote a social model of long-term care which privileges community services as opposed to institutional services. What in fact does this choice imply? To what extent have resources been allocated in accordance with these objectives? A study of these questions based on Canadian data on the relationship between illnesses, disabilities and functional incapacity and data from a historical survey of expenditures in Quebec for hospital care, medical care, institutional long-term care and community services indicates that illnesses, disabilities, and functional incapacity, although strongly correlated in an elderly population, cannot be collapsed into one big category for planning services; co-ordinated services in a multidisciplinary approach are needed, not dominance from one professional group. As to costs, an examination of the data shows that in relative terms costs for community care tended to increase significantly in the recent past. Yet it is not clear that there has been a transfer from short-term medical and hospital services to long-term care. However, there has been an important internal change in hospital costs, with the elderly representing the only group whose costs are rising. In short, despite the political rhetoric on long-term care for the elderly promoting a community approach, these services' main function is still the surveillance of the vulnerable elderly in both short- and long-term care facilities; adapting the elderly to their environment and the environment to the elderly play a growing, though minor, role in the overall picture of medical and social services.

This article focusses on the likelihood of senior centre participation, the frequency of attendance among participants, changes in use/non-use over a four-year period, and associated characteristics. The data are from a longitudinal study conducted in Winnipeg and eight smaller Manitoba communities, with 1,399 individuals aged 65 and older interviewed in 1991/92 and 956 re-interviewed in 1995. About one in five individuals attended a senior centre in the six months prior to the interview, with a wide range among participants in the number of visits. Only 8 per cent joined a senior centre and 13 per cent ceased their participation over the four years. The influence of socio-demographic characteristics, health status, and social integration varied depending on the measure of participation and according to place of residence. Social factors, such as living arrangement, tended to be more important than health status. Directions for future research are discussed.

The purpose of this paper is to report research findings from a study of the nature of the relationship between informal and formal care of the elderly. There are several explanations for the link between informal and formal care: the task specific model, the compensatory model, the substitution model, the supplementary model, and the complementary model (which combines both the compensatory and supplementary functions of formal care). These explanations were evaluated using data from the 1985 General Social Survey for those aged 65 and older who have functional disabilities. Data were analysed using logistic regression analysis. The findings show support for the complementary function of formal care. The data indicate that formal care compensates for the absence of a spouse or child and, in a minority of cases, supplements work of the spouse or child caregiver for personal care tasks and to a lesser extent housework. Of these two, the compensatory effect of formal care appears to be more prevalent than the supplemental effect.

A shift in emphasis from institutions to community poses important challenges for providers and policy makers, key among them being the challenge of providing asufficient volume of high quality community-based services to meet consumer needs. This challenge is particularly evident in community-based long-term care (LTC) due to the complexity and diversity of the field, the vulnerability of the population served, and the current wave of demand for services generated by hospital downsizing. The most recent reform of long-term care in Ontario is of particular interest in this context because, as suggested by the provincial government's maxim “highest quality, best price,” it promises cost-efficiency while maintaining or improving quality. To do this it employs a “managed competition” model in which for-profit and not-for-profit providers compete for service contracts under the auspices of local Community Care Access Centres (CCACs) run by volunteer boards. In this paper we draw on the comments of senior government officials and representatives of provider organizations, as well as published documents, to highlight issues and problems posed by the province's latest reform. We argue that, particularly under conditions of capped budgets and increasing demands, the managed competition process may result in the subordination of service quality and consumer choice to pressures for cost-containment.