DILEMMAS AND VALUES FOR LONG-TERM-CARE PO LICIES

Long-term care is available for individuals with functional incapaciti es. Long-term care includes medical, social, and personal hygiene serv ices, which help to maintain the autonomy of the elderly and allows th em 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 chron ically ill? Should long-term care services be conceptualized as indepe ndent from medical care? Provincial government policy documents promot e a social model of long-term care which privileges community services as opposed to institutional services. What in fact does this choice i mply? 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 incap acity and data from a historical survey of expenditures in Quebec for hospital care, medical care, institutional long-term care and communit y services indicates that illnesses, disabilities, and functional inca pacity, 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 fr om one professional group. As to costs, an examination of the data sho ws that in relative terms costs for community care tended to increase significantly in the recent past. Yet it is not clear that there has b een a transfer from short-term medical and hospital services to long-t erm care. However, there has been an important internal change in hosp ital costs, with the elderly representing the only group whose costs a re rising. In short, despite the political rhetoric on long-term care for the elderly promoting a community approach, these services' main f unction is still the surveillance of the vulnerable elderly in both sh ort- and long-term care facilities; adapting the elderly to their envi ronment and the environment to the elderly play a growing, though mino r, role in the overall picture of medical and social services.