Evidence-based considerations around long-term care

The Bottom Line

  • Long-term care services can be offered in various settings—home/community or a residential care facility—each associated with pros and cons. 
  • Once aging in place is no longer feasible, some older adults may need to transition to a long-term care facility.
  • Health status and previous institutionalization greatly influence whether or not older adults receiving informal care are likely to transition to a long-term care facility.
  • Tailored exercise programs that focus on balance and strength training and work alongside other fall prevention strategies can reduce the risk of falls amongst older adults in care facilities. 
  • Participating in meaningful activities outside one’s residential aged care facility may enhance psychological well-being in older adults with dementia.
  • Person-centred care can reduce agitation in people with dementia living in care facilities. 

It is no secret that many of us would prefer to age in place or, in other words, at home. With the support of caregivers, home modifications, technology, and different community-based housing models, this dream can be a reality for some (1-3). For others, the need for greater assistance and care may result in the transition to a residential care facility. In Canada, it is estimated that approximately half-a-million people live in such facilities. Nursing homes, also referred to as long-term care homes, and seniors’ residences, also referred to as retirement homes or assisted living facilities, house about 85% of this population (4).

Here are a few research-based considerations to think about and discuss prior to making a decision about moving yourself or a loved one into a long-term care facility. Click on the links below to learn more.

Part I: Background on long-term care

1. Options for long-term care

Folks who lose function because of disability, chronic illness, or advanced age require the assistance of a diverse set of services—such as medical care and help with completing activities of daily living. These services fall under the umbrella of long-term care (5). Long-term care can be delivered at the home of a patient or their loved one/in the community or, more traditionally, in a residential care facility. How do these different settings stack-up? Nursing homes and assisted living facilities appear to have similar effects on changes in residents' emotional well-being and thinking and physical abilities, and mortality rates. The evidence comparing nursing homes to home/community-based care is less clear-cut. However, it suggests that those residing in a nursing home may be at a lower risk of using anti-anxiety medications and experiencing pain but at a higher risk of developing pneumonia or pressure sores. Ultimately, each setting can be associated with benefits and harms (6).

2. Factors influencing transition to a long-term care facility

A variety of factors contribute to whether or not community-dwelling older adults who receive informal care (generally from a family member) end up being admitted to a long-term care facility. For instance, living with serious functional and cognitive impairments (such as dementia) or more than one chronic condition, using several medications, or having previously been hospitalized or temporarily placed in another care facility all increase an older adult's likelihood of admission. Caregiver stress also plays a role, albeit a very small one, unlike the other factors listed. Where people reside, the health care system in their area, long-term care bed availability, and the standards determining how available beds are distributed may also affect the transition to a long-term care facility (7).

Part II: Beneficial programs to seek within long-term care facilities

Long-term care facilities and other residential care settings offer a diverse range of programs, services, and care approaches. If a transition to such a facility is decided on, consider seeking out facilities that provide the following: 

1. Programs to battle loneliness and depression

Social isolation and depression are pressing issues that affect older adults residing in nursing homes. Reminiscence therapy is an activity that allows older adults to communicate personal stories and memories. Research shows that group reminiscence therapy led by a well-trained program facilitator can decrease social isolation and depression in older adults living in urban long-term care facilities (8). Another plus, in people with dementia, reminiscence therapy may even help to slightly enhance cognition, mood, communication, and quality of life (9).

2. Programs to reduce the risk of falls

In older adults, falls can lead to injury, hospitalization, lower self-confidence, a fear of falling again, and death (10;11). Research shows that exercise programs can be effective in preventing falls in older adults living in care facilities. These programs are especially successful when they are tailored to the individual, emphasize balance and strength training, and are combined with other fall prevention strategies—such as medication adjustments, education, and the use of mobility aids (12;13).

3. Opportunities to engage in meaningful activities

From severe cognitive impairment to depression, people with dementia who live in a long-term care facility can face many challenges (14). Research shows that, in this population, participating in meaningful activities outside of their care facility may improve well-being and mood and reduce depressive and behavioural symptoms. Meaningful activities are diverse in nature and can range from something as simple as walking to something more complex like horse riding. Patients and caregivers should consider whether facilities providing these offerings have the capacity to implement them effectively and safely (15).

4. Utilize a person-centred care approach  

The person-centred care model prioritizes patients’ needs, preferences, values, and abilities. Research shows that this model can benefit caregivers and patients working or living in care facilities. More specifically, it can reduce stress and burnout in caregivers and agitation in patients with dementia (16;17).

When it comes to discussions and decisions around long-term care, older adults and their caregivers should be aware of all available options, weigh the pros and cons of each, and consider the specific needs and preferences of the individual receiving care.

Part III: Tools to help you reach a decision

Do you need additional support in making a decision around transitioning yourself or a loved one to a long-term care facility? Check out the following Patient Decision Aids:

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Author Details


  1. Stark S, Keglovits M, Arbesman M, et al. Effect of home modification interventions on the participation of community-dwelling adults with health conditions: A systematic review. Am J Occup Ther. 2017; 71(2):1-11. doi: 10.5014/ajot.2017.018887.
  2. Gochoo M, Alnajjar F, Tan TH, et al. Towards privacy-preserved aging in place: A systematic review. Sensors, 2021, 21(9):3082. doi: 10.3390/s21093082.
  3. Chum K, Fitzhenry G, Robinson K, et al. Examining community-based housing models to support aging in place: A scoping review. Gerontologist. 2020; 62(3):e178-e192. doi: 10.1093/geront/gnaa142.
  4. Statistics Canada. Impacts of the COVID-19 pandemic in nursing and residential care facilities in Canada. [Internet] 2021. [cited July 2022]. Available from https://www150.statcan.gc.ca/n1/pub/45-28-0001/2021001/article/00025-eng.htm
  5. Kaye HS, Harrington C, La Plante MP. Long-term care: Who gets it, who provides it, who pays, and how much? Health Aff. 2010; 29:11-21. doi: 10.1377/hlthaff.2009.0535.
  6. Wysocki A, Butler M, Kane RL, et al. Long-term care for older adults: A review of home and community-based services versus institutional care. Agency for Healthcare and Quality (US). 2012; Report no 12 (3):EHC134-EF.
  7. Donnelly NA, Hickey A, Burns A, et al. Systematic review and meta-analysis of the impact of carer stress on subsequent institutionalisation of community-dwelling older people. PLoS ONE. 2015; 10(6):e0128213. doi: 10.1371/journal.pone.0128213.
  8. Franck L, Molyneux N, Parkinson L. Systematic review of interventions addressing social isolation and depression in aged care clients. Qual Life Res. 2016; 25(6):1395-1407. doi: 10.1007/s11136-015-1197-y.
  9. Woods B, O’Philbin L, Farrell EM, et al. Reminiscence therapy for dementia. Cochrane Database Syst Rev. 2018; 3:CD001120. doi: 10.1002/14651858.CD001120.pub3.
  10. Canadian Institute for Health Information. Falls and vehicle collisions top causes of injury hospitalizations for seniors. [Internet] 2019. [cited July 2022]. Available from https://www.cihi.ca/en/falls-and-vehicle-collisions-top-causes-of-injury-hospitalizations-for-seniors  
  11. Public Health Agency of Canada. Seniors’ falls in Canada, second report. Ottawa (ON): PHAC; 2014. 62 p. Available from http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/assets/pdf/seniors_falls-chutes_aines-eng.pdf
  12. Lee SH, Kim HS. Exercise interventions for preventing falls among older people in care facilities: A meta-analysis. Worldviews Evid Based Nurs. 2017; 14(1): 74-80. doi: 10.1111/wvn.12193.  
  13. Silva R, Eslick G, Duque G. Exercise for falls and fracture prevention in long term care facilities: A systematic review and meta-analysis. J Am Med Dir Assoc. 2013; 14(9):685-9.e2. doi: 10.1016/j.jamda.2013.05.015. 
  14. Canadian Institute for Health Information. Dementia in long-term care. [Internet] 2022. [cited July      2022]. Available from https://www.cihi.ca/en/dementia-in-canada/dementia-care-across-the-health-system/dementia-in-long-term-care   
  15. D'Cunha NM, Isbel S, McKune AJ, et al. Activities outside of the care setting for people with dementia: A systematic review. BMJ Open. 2020; 10:e040753. doi: 10.1136/bmjopen-2020-040753.
  16. Livingston G, Kelly L, Lewis-Holmes E, et al. Non-pharmacological interventions for agitation in dementia: Systematic review of randomized controlled trials. Br J Psychiatry. 2014; 205(6):436-442. doi: 10.1192/bjp.bp.113.141119. 
  17. Barbosa A, Sousa L, Nolan M, et al. Effects of person-centered care approaches to dementia care on staff: A systematic review. Am J Alzheimers Dis Other Demen. 2015; 30(8):713-722.

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.