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Beyond the ‘Iron Lungs of Gerontology’: Using Evidence to Shape the Future of Nursing Homes in Canada*

  • John P. Hirdes (a1), Lori Mitchell (a2), Colleen J. Maxwell (a3) and Nancy White (a4)

Institutionalization of the Elderly in Canada suggested that efforts to address the underlying causes of age-related declines in health might negate the need for nursing homes. However, the prevalence of chronic disease has increased, and conditions like dementia mean that nursing homes are likely to remain important features of the Canadian health care system. A fundamental problem limiting the ability to understand how nursing homes may change to better meet the needs of an aging population was the lack of person-level clinical information. The introduction of interRAI assessment instruments to most Canadian provinces/territories and the establishment of the national Continuing Care Reporting System represent important steps in our capacity to understand nursing home care in Canada. Evidence from eight provinces and territories shows that the needs of persons in long-term care are highly complex, resource allocations do not always correspond to needs, and quality varies substantially between and within provinces.


Institutionalization of the Elderly in Canada a proposé que les efforts de s’attaquer aux causes sous-jacentes de baisses liées à l’âge de santé pourraient éradiquer la necessité pour les maisons de soins infirmiers. Cependant, la prévalence des maladies chroniques a augmenté, et les conditions comme la démence signifie que les maisons de soins infirmiers sont susceptibles de rester des éléments importants du système de soins de santé canadien. Le manque d’information clinique à l’échelle individuelle a été un problème fondamental qui limite la capacité de comprendre comment les maisons de soins infirmiers peuvent changer pour mieux répondre aux besoins d’une population vieillissante L’introduction d’instruments d’évaluation interRAI pour la plupart des provinces et territoires canadiens et la création du Système d’information sur les soins représentent des étapes importantes dans notre capacité à comprendre les soins dispensés par les maisons de soins infirmiers au Canada. Le témoignage de huit provinces et territoires montre que les besoins des personnes dans les soins de longue durée sont très complexes, que les allocations de ressources ne correspondent pas toujours aux besoins, et que la qualité varie considérablement entre et au sein des provinces.

Corresponding author
Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: John P. Hirdes, Ph.D. Department of Health Studies and Gerontology University of Waterloo Waterloo ON, Canada, N2L 3G1 (
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Dr. Hirdes holds the Ontario Home Care Research and Knowledge Exchange Chair. The authors acknowledge the ACCES team members (particularly Dr. Laurel Strain) and data analysts (Dr. Erin Gilbart and Deanna Wanless) as well as the study participants and family members for their significant contributions to the data presented in this report. We also thank staff at the Canadian Institute for Health Information (CIHI; Joseph Griffiths, Robyn Hastie, Adrian Dalloo, and Maureen Kelly) and Micaela Jantzi who contributed towards the analyses of CCRS and HCRS data. The opinions expressed by Nancy White in this paper are her own and do not necessarily reflect those of CIHI.

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