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3 • about 50,000 strokes occur in Canada each year, with stroke being the leading cause of transfer from a hospital to long-term care. Undoubtedly, as the relative age of Canadians rises in the coming decades, the absolute numbers will rise dramatically and put increasing pressure on the capacity of long-term care in Canada. Given the above, this implies there will be almost 1 million Canadians with dementia by 2036 compared to about 450,000 today. 5 Moreover, it can be extrapolated that over 750,000 Canadians over the age of 65 will reside in health care institutions by 2036 compared to about 300,000 today. 6 It is important that governments, providers and individual Canadians take appropriate actions in the short-term so that we can meet these expected longer-term demands for long-term care. Long-term care is not included under the Canada Health Act and, therefore, is not available to Canadians on a universal basis. Unfortunately, many Canadians continue to have the mistaken belief that all of their long-term care needs will be met by governments. While there are government programs aimed at assisting Canadians with long-term care needs, these programs vary by jurisdiction and typically are income-based. Canadians need to understand that in many cases they will be largely responsible for the cost of their long-term care needs. Policies need to be put in place now to help mitigate against the considerable stresses on our long-term care infrastructure that that the aging baby boomer generation will likely generate. GUIDING PRINCIPLES The remainder of this policy paper presents actionable recommendations to help Canadians and Canadian governments address the coming long-term care challenge. The recommendations are grounded in some fundamental principles that we believe should guide policy makers in this regard: 1. Accessibility: All Canadians should have access to the appropriate level of long-term care support when they need it. 2. Intergenerational Fairness: The financial burden of providing for long-term care services should not fall disproportionately on one generation. 3. Quality Services: Canadian should have access high quality long-term care services. 4. Sustainability: The long-term care system should operate within Canada's economic capacity over time. 5 Statistics Canada estimates that there will be 43.8 million Canadians in 2036. The estimate was then derived by assuming 25 per cent of the population will be over 65 years of age and that one in 11 will have dementia. 6 Currently, 7 per cent of Canadians age 65 and over reside in health care institutions. By 2036, 25 per cent of the population will be over the age of 65. We estimate a 1 per cent growth rate in the Canadian population each year between now and then. According to the Canadian Healthcare Association (New Directions for Facility-Based Long- term Care) there were about 300,000 Canadians living in nursing homes, residences for senior citizens, and chronic and long-term care and related facilities.