During the 1960s and 1970s, The Netherlands had one of the youngest populations in Western Europe. In fact, a significant increase in the proportion of elderly in the population will not begin until after the year 2010. Despite this relatively late aging of the population, the Dutch government developed a policy on aging at an early stage, with particular attention to institutional care for the elderly. This move resulted in a high proportion of elderly living in institutions. In 1982, 3 per cent of the 65 + population lived in nursing homes and 9 per cent in homes for the elderly. These care institutions are organized on a non-profit basis and financed through direct or indirect taxation. Their population can be characterized as “frail elderly”. However, homes for the elderly were originally considered to be housing facilities for the elderly. The costs related to institutional care increased considerably in the 1960s and 1970s, but through procedures like specific planning criteria and assessing the need for admission into a home for the elderly, the government has attempted to contain the costs. Until the end of the 1980s, these attempts had not been very successful. One of the more successful means of containing costs seems to be the stipulation of community long-term care.

This account of nursing home care in Australia begins with a brief history of four phases of policy development from 1963 to the early 1990s. The structure of the nursing home system is then outlined; particular attention is given to data sets generated from administrative systems that are used for monitoring nursing home care. Arrangements for pre-admission assessment and assessment of resident dependency and care needs, to which reimbursement levels are related, are described next. A profile of resident characteristics and their patterns of utilization of nursing home care is presented, drawing on these assessment data. Policy issues arising in the 1990s are addressed in the conclusion; these concern the place of nursing home care in the overall balance of aged care services and the enhancement of outcomes of nursing home care in regard to quality of care and workforce training. Finally, the contribution of the continuing development of data sets for monitoring trends and outcomes to policy and program development is noted.

As community services replace institutional beds, clients must be ensured ready access to nursing home care when truly required. This study explores predictors of waiting time for nursing home admission in a typical voluntary single-entry system in Saskatchewan. The study examined a district-wide cohort of 777 clients awaiting a first nursing home admission over two years in Saskatoon, Saskatchewan. Median waiting time was 107 days. In multivariate time-to-event analysis, independently assessed priority status predicted a three times greater rate of admission. Living alone, living in seniors housing attached to a nursing home, and being ambulatory only with assistance also shortened waiting time. Co-operation problems increased waiting time. The study shows that in a voluntary single-entry system, admission is not solely by priority status.

Long-term care in Canada is situated within a universally accessible publicly insured program. The Government of Canada establishes certain minimum standards for health care as the basis for the federal share in funding health programs, although the programs themselves are administered provincially. Examples are drawn from the Province of Manitoba. While the dependency ratio has been decreasing due to a slower increase in the number of persons under 17 years of age, the percent of the population over 65 years continues to increase. Population projections forecast that by the year 2031, one-quarter of the population of Canada will be over 65 years of age. Expenditures on health care doubled from 1981 to 1990 for both Manitoba and Canada. The policy response to ever-increasing costs of delivering health care to an aging population has been to seek alternative methods of delivery. Specifically, the long-term care bed-to-population ratio has been reduced and the authors anticipate continued modest increases in the use of community care.

The overall use of acute care services by nursing home (NH) residents in Canada has not been well documented. Our objectives were to identify the major causes of hospitalization among NH facility residents and to compare rates to those of community-dwelling seniors. A retrospective cohort was defined using population-level health administrative data, including all individuals aged 65 years and older living in a British Columbia NH facility between April 1996 and March 1999. Hospitalization rates of NH residents were compared to estimated rates for community-dwelling seniors, using age- and sex-adjusted standardized incidence ratios (SIRs): SIR = 2.81 (95%CI: 2.71, 2.91) for femoral fractures, 1.96 (1.88, 2.04) for pneumonia, 0.73 (0.70, 0.76) for other heart disease, and 1.01 (0.99, 1.02) for all causes. NH residents have disproportionately higher rates of hospitalization for femoral fractures and pneumonia, with NH residents accounting for approximately one quarter of all femoral fracture hospitalizations of BC seniors.