The development of community care policy for the elderly: a comparative perspective

A comparison of the development of community care for the elderly in the province of Ontario, Canada, and in the State of Israel is presented in the light of the economic constraints currently challenging the expansion of welfare state services. The inquiry identified several common issues regarding the nature of the policy mandate for long-term care delivered in the home, the structure of the service delivery system and matters concerning funding arrangements for community care. Issues that emerged in both settings include the relationship between health and social services in the delivery of care at the local level; the separation of purchaser and provider functions; the question of needs-driven versus service-driven social care provisions; accessibility concerns and the aspiration for one-stop entry to the delivery system; the growing involvement of the private sector in the delivery of domiciliary-based personal care services; and the relative paucity of current efforts to address the needs of family caregivers.