Controversies and Difficulties in Making Long-Term Care Predictions of Client Needs

Madhuri Reddy , MD, FRCPC,
Associate Editor, Geriatrics & Aging.

As the Canadian population ages, policy makers must begin to make predictions regarding the needs of long-term care (LTC) clients. This is confounded by a number of variables that make long-term predictions difficult. In the following article, different schools of thought and theories on the variables that will influence the needs of the LTC sector in the next several decades are reviewed.

Numbers of Clients that Require LTC
The Expansion of Morbidity Hypothesis

The expansion of morbidity hypothesis suggests that the numbers of clients requiring institutional LTC will increase, leading to an increased burden of disability and dependency.1,2 With advances in medical, social and economic conditions, active-life expectancy has increased3 and the age of onset of terminal dependency has been postponed; however, some believe that the duration of terminal dependency will eventually increase.1 There has been an increase in both the hospital length-of-stay of elderly clients and the proportion of the lifespan spent in long-term hospital care. The number of very old people, including centenarians, has also steadily risen. There is evidence that both disability and dependency have also increased. In Canada, up to 80% of the gain in life expectancy consists of increased years of disability.