Community Care for the Elderly
It is impossible to discuss the provision of community-based services to older adults without consideration of the range of services variously known as home care, continuing care, community care, long term care, les services à domicile, home support, etc. Part of the confusion over the use of terms is that they are used to refer to services organized for either episodic (acute) or chronic care. This linguistic confusion appears to reflect a confusion or conflict over the intended purpose of these services, a point which will be returned to later in the discussion. For the purposes of this discussion the term "community care" will be used to refer to the entire range of community‐ based services provided to seniors. Indeed as Jamieson (1989) has observed: "Before policies of community care there were no explicit [health care] policies for elderly people" (p. 450).
The major feature of these community care programs is their stated overall objective of supporting older adults to stay in their own homes as long as possible, with a wide variety of services depending on the jurisdiction but which can include: home nursing, involving a range of clinical services such as dialysis, IV therapy, etc.; homemaker services; respite care for family caregivers; some kind of meals program ("meals on wheels" or "wheels-to‐ meals"); supplements to public transportation; "friendly visiting"; handyman services; and other services depending on the community. These programs are also available to young adults with disabilities and to families with children with disabilities or in distress; by far, however, the over sixty-five group comprises the majority of the users of these services (Richardson 1990).
What characterizes these services from an organizational point of view is their overwhelming multiplicity, variability, public/private mix and lack of coordination at either a policy/planning level or a service delivery level (Marshall 1987; Richardson 1990; Ontario 1990a).