Different care settings in Quebec use levels of medical intervention forms, also called levels of care (LOC), to determine the code status of patients and to improve end-of-life care planning. It is not currently possible to know whether the levels of care in hospitals benefit patients and staff in facilitating the decision making process of treatment options and resuscitation measures. No study, to the best of the authors’ knowledge, has been published about LOC, particularly in Quebec and Canada. This literature review was undertaken on levels of care in order to clarify this topic. Relevant articles are discussed under different themes that are pertinent to LOC. The themes addressed in this article include care at the end of life, do-not-resuscitate orders, treatment withdrawal, and decision making at end of life.

In 1988 the Alberta government introduced a new resident classification system to measure the care requirements of residents in the province's long-term care facilities, and to provide case-mix information for a new funding system. This paper presents the results of the first province-wide classification process, including data for both nursing homes and auxiliary hospitals on the distribution of residents by classification indicators and categories. Data on facility case-mix indices are also presented. The results show that throughout the nursing home and auxiliary hospital system there was substantial heterogeneity in resident care requirements. Comparing across facility type, there were fewer differences between nursing homes and auxiliary hospitals in the distribution of residents on behavioural indicators than there were on indicators of physical care requirements. The paper concludes by discussing policy and planning implications of the 1988 results and the classification system more generally.

In 1988 the Alberta government introduced a new resident classification system to measure the nursing care requirements of long-term care facility residents, and to provide case-mix information for a new funding system. This article describes the conceptual and methodological development of the system. Specific steps in the development process were to (1) define key care domains reflecting the major types of assistance required by long-term care residents; (2) identify indicators of care requirements within each care domain; (3) develop criteria for determining which items to include in the final version of the Resident Classification Form; (4) develop decision rules for combining scores on individual items in order to group residents into categories; and (5) test the psychometric properties of the classification system. The classification system has seven categories ordered from low to high in terms of nursing care requirements and a measure of nursing resource use.