According to census data, approximately 185,000 people lived in Canada’s long-term care (LTC) facilities in 2021. Health Canada defines residential LTC as “living accommodation for people who require on-site delivery of 24 hour, 7 days a week supervised care, including professional health services, personal care and services such as meals, laundry and housekeeping.”
However, there is no common definition of LTC across the country. Long-term care facilities are sometimes confused with assisted living facilities, seniors’ residences, or retirement homes. Residents of the latter are generally independent and the medical services offered are limited.
This HillNote reviews jurisdictional issues related to LTC, summarizes the cost of accommodation in LTC facilities, lists the legislation that governs LTC across Canada, and provides an overview of the ownership of LTC facilities in Canada.
Jurisdiction Over Long-Term Care Facilities
Jurisdiction over health and health care is a responsibility shared between the federal and provincial governments. Sections 91 and 92 of the Constitution Act, 1867 assign exclusive legislative authority either to Parliament or to provincial legislatures, respectively.
Although there is no specific reference to health, some health-related subjects are listed in these sections. For example, section 91(11) assigns matters related to quarantine and marine hospitals to Parliament, while section 92(7) assigns responsibility for hospitals, other than marine hospitals, to the provinces.
Parliament has used its jurisdiction in criminal law power and spending power to enact several health-related statutes. The federal criminal law power (section 91(27) of the Constitution Act, 1867) can be used to enact legislation in the areas of public health and safety. Parliament also relies on its spending power – which has been inferred from sections 91(1A), 91(3) and 106 – to provide the Canada Health Transfer to the provinces under the Federal-Provincial Fiscal Arrangements Act and to set national standards and conditions under the Canada Health Act.
The provinces, on their part, hold, exclusive responsibility for the direct delivery of most medical services, the training and regulation of healthcare professionals, and related matters. This responsibility arises from their jurisdiction over property and civil rights under section 92(13) of the Constitution Act, 1867, as well as over matters of a local or private nature under section 92(16) of the same Act.
LTC facilities that provide both health care and social services to residents who are unable to care for themselves due to physical or cognitive impairments therefore fall under provincial jurisdiction. Consequently, legislation to regulate the delivery of these services has been implemented in all provinces and territories.
While the Canada Health Act defines the health services that must be included by each provincial health insurance program to qualify for federal funds, LTC is not included. Rather, section 2 of the Act considers LTC an extended health care service. Various stakeholders are urging the federal government to either include LTC in the Canada Health Act as an insured health service or introduce stand-alone LTC legislation with national standards.
In 2022, the House of Commons passed a motion advocating for a collaborative effort to develop a safe long-term care act to ensure safer and better care for seniors nationwide. Subsequently, in 2023, the CSA Group and the Health Standards Organization published independent national LTC standards aiming to enhance the safety, reliability and resident-centeredness of services. In 2024, the federal government conducted stakeholder consultations to inform the development of national LTC guiding principles, and it released the Safe Long Term Care Act engagement: What we heard report, which summarizes key insights.
Funding and Regulation of Long-Term Care Facilities in Canada
Although the Canada Health Act does not include LTC as an insured health service that must be publicly insured by the provinces and territories to qualify for federal funds, all jurisdictions allocate some public funds to LTC.
According to a 2023 working paper by the United States’ National Bureau of Economic Research, approximately 78.4% of LTC home costs is covered in Canada by provincial, territorial and municipal plans and agencies, whereas 21.6% of costs is covered by residents, either out of pocket or through supplementary private insurance.
The same 2023 working paper reported that, in 2019, total spending on nursing home care was $27.9 billion, with $19.6 billion from public funds (70.3%) and $8.3 billion (29.7%) from private funds. All provinces and territories subsidize the costs associated with providing health care services in LTC facilities, and most governments offer further subsidies to residents, as needed.
The table below shows the provincial and territorial legislation and regulations that govern LTC facilities and indicates the costs assumed by residents. While all provincial and territorial governments provide funding for LTC facilities, the specific allocation by each government could not be determined. However, it was determined that British Columbia paid a per diem rate of $204 to $312 per bed to contracted LTC facilities in 2023, and Ontario’s per diem rate was $208 per bed in 2024.
A variety of terms are used to refer to LTC facilities; “old-age home” is no longer used, while “nursing home” is commonly used. Other terms used are shown in the Table below.
Table – Long-Term Care Legislation and Single Resident Costs Across Canada
| Province/Territory | Long-Term Care Terms Used | Legislation/Regulations | Accommodation Costs per Person for Residents |
| British Columbia | Residential care facilities, long-term care homes |
Community Care and Assisted Living Act (2002) and Residential Care Regulation Hospital Act (1996) and Hospital Act Regulation |
Income-based, up to 80% after tax, $1,417 to $3,974.10/month (2024) |
| Alberta | Long-term care homes, nursing homes, auxiliary hospitals |
Continuing Care Act (2024), Continuing Care Regulation and Continuing Care (Ministerial) Regulation See also the Continuing Care Health Service Standards that govern publicly-funded facilities and the Accommodation Standards – Continuing Care Home. |
$2,019 to $3,217/month (2024) |
| Saskatchewan | Special care homes, nursing homes | $1,377 to $3,428/month (2024) | |
| Manitoba | Personal care homes | The Health Services Insurance Act (1987), Personal Care Homes Standards Regulation and other regulations | Income-based, $41.80 to $101.10/day (2024–2025) |
| Ontario | Long-term care homes | Fixing Long-Term Care Act (2021) and Ontario Regulation 246/22 | $2,036 to $2,909/month (2024) |
| Quebec
[in French] |
Centre d’hébergement et de soins de longue durée (CHSLD) |
Act Respecting Health Services and Social Services and its regulations related to long-term care Private CHSLDs that are not under contract with the provincial government are not subject to the same regulations as CHSLDs that receive public funding, but are expected to follow provincial standards. |
$1,333.20 to $2,142.30/month (2024) |
| Nova Scotia | Residential care facilities, nursing homes |
Homes for Special Care Act (1989) and Homes for Special Care Regulations Ministerial guidance on required operating standards is issued by the province. |
Income-based up to 85% after tax, up to $110.50/day with a minimum of $355/month left to the resident (2024–2025) |
| New Brunswick | Nursing homes | $113/day to a maximum of $3,437.08/month (2014) | |
| Prince Edward Island | Nursing homes, manors | Community Care Facilities and Nursing Homes Act (1988), Community Care Facilities and Nursing Homes Act Regulations and Community Care Facilities and Nursing Homes Act – Nursing Home Regulations (2018) | $114.67/day (2024) |
| Newfoundland and Labrador | Long-term care facilities | Health and Community Services Act (1995) and Personal Care Home Regulations | Income-based, to a maximum of $2,990/month, with a minimum of $150/month left to the resident |
| Yukon | Long-term care homes, continuing care facilities |
Health Act (2002). Although a new statute under the Health Authority Act (2024) was introduced, it had not yet come into force on the date of this publication. See also Yukon Continuing Care: Bill of Rights and Responsibilities for Community Day Program Clients. |
$40/day or $1,217/month (2023) |
| Northwest Territories | Long-term care homes, assisted living facilities, continuing care centres. | Not addressed in legislation or regulations, but the Northwest Territories Continuing Care Standards were published in 2015. |
$976/month (2024) |
| Nunavut | Continuing care centres, nursing homes, elder homes |
Not addressed in legislation or regulations. |
No charge to the resident |
Sources: Table prepared by the Library of Parliament using data obtained from provincial, territorial and stakeholder websites and from Royal Society of Canada, Restoring Trust: COVID-19 and The Future of Long-Term Care – A Policy Briefing by the Working Group on Long-Term Care, pp. 53–54, June 2020.
Ownership of Long-Term Care Facilities in Canada
Long-term care facilities across Canada are a mix of publicly and privately owned facilities governed by provincial/territorial legislation. Publicly owned LTC facilities are all not for profit, and privately owned ones can be either for profit or not for profit. However, most receive public funds for the provision of LTC services.
As examples, in the territories, LTC facilities are 100% publicly owned, while in New Brunswick, they are 100% privately owned. In Quebec, privately owned and operated LTC homes (called centres d’hébergement et de soins de longue durée, or CHSLDs) that are not contracted by the provincial government do not receive any public funds. In British Columbia, a combination of publicly subsidized and private pay beds are permitted within the same facility.
The figure below illustrates LTC home ownership across Canada, by province and territory, and by funding type.
Figure – Ownership of Long-Term Care Facilities in Canada, 2021
Source: Canadian Institute for Health Information, Long-term care homes in Canada: How many and who owns them?,10 June 2021.
By Antoine Dedewanou, Library of Parliament
This publication is based on a previous Library of Parliament publication by
Sonya Norris.