Andrea D. Foebel, University of Waterloo
April 19, 2026
Resident who rarely leave their rooms, a family told “we don’t have the staff,” a person dying in hospital less than a day after leaving their long-term care (LTC) home: these are some of the bleak realities too many Canadians and their loved ones face as they age.
These heartbreaking realities were shared with the Canadian Institute for Health Information through unpublished surveys of families and LTC staff about aging with dignity.
Moments of lost dignity are not invisible to the health system. But historically, a lopsided focus on clinical indicators left data gaps in our ability to measure and understand lived experience, and ultimately dignity, alongside clinical risks. This is something health-system leaders, clinicians and families are actively striving to change.
What is aging with dignity?
Over the next two decades, the number of Canadians aged 85 and older is expected to triple. This demographic shift will transform who needs care, who provides it, and how and where care is delivered.
Canada is expected to become a “super-aged nation” in 2026, with one in five people aged 65 or over. To put effective supports into place, we need to ask: What does aging with dignity mean to Canadians?
For many, aging with dignity means autonomy, respect and purpose. Older adults want to be valued for their individuality, life experience and ongoing contributions. This doesn’t change whether someone lives independently, receives home care or resides in LTC.
Thinking about preserving dignity as one ages and what life might look like as an older adult can feel daunting, and like something that can be avoided for a long time — until it can’t.
The COVID-19 pandemic forced Canadians to confront the reality of aging in ways we may have previously avoided. The tragedy was not only that many residents died in LTC, but that this happened in a system where well-meaning health-care workers were structurally unable to protect residents. It was a stress test for what can happen if care models aren’t redesigned in the context of a rapidly aging population.
To ensure older Canadians can age with dignity, society needs to think differently about how it measures dignity in health systems.
The aging continuum of care
Almost all Canadians (81 per cent) want to age at home as long as possible. Whether a person can do this depends on factors such as finances, access to home care, caregiver distress and any physical and/or cognitive ailments a person may have. The reality is that aging at home is not always possible for all Canadians.
Canada’s federal, provincial and territorial governments have identified aging with dignity as a shared health priority. The goal is to help Canadians live their later years with autonomy and respect, either at home with supports or in safe long-term care facilities.
This approach aligns with the goals of the World Health Organization’s (WHO) Decade of Healthy Aging and strives to focus on person-centred care.
What the data tells us about dignity
Historically, indicators measuring quality of care in LTC focused on clinical and health-system performance measurement. These include indicators like restraint use, potentially inappropriate anti-psychotic use and staffing levels in LTC. These metrics are critical for measuring quality, safety and capacity of care — but there’s room for reimagining how we interpret this data with a dignity lens and room for adding new data to the equation.
Prior to the COVID-19 pandemic, the rate of potentially inappropriate antipsychotic use in LTC was steadily declining before it rose again during the crisis. In 2024-25, about one in four LTC residents (24 per cent) were given anti-psychotic medication to manage behaviours and psychological symptoms without a diagnosis of psychosis.
When we apply a dignity lens to reimagine indicators like this, there’s more to the story than prescribing quality. Anti-psychotic drugs can make patients drowsy, increase confusion and cause sudden changes in communication. These are patterns that can be distressing to loved ones. Reading this data alongside other indicators — like falls in the last 30 days — can help flag issues such as understaffing, limited meaningful activity and environmental stress.
In 2025, the Appropriate Use Coalition, with support from the Canadian Institute for Health Information (CIHI), set a national target of no more than 15 per cent of residents receiving anti-psychotic medications without a diagnosis of psychosis. Achieving the target would mean about 21,000 fewer Canadians receiving the possibly inappropriate drugs.
Clinical indicators infer quality-of-care measurement through processes like prescribing practices. What these types of indicators don’t tell us is how care feels to residents and families.
CIHI is in the early stages of a new suite of indicators that focus on the experiential side of aging. While they don’t replace clinical indicators, they help contextualize them by giving us new ways to understand the humanity, and not merely the clinical risk within the aging continuum of care.
For example, data shows that in 2024, about two-thirds of LTC residents are socially engaged. LTC is not strictly a medical service; it’s also a home and social environment. For Canadians to age with dignity, we must honour their autonomy and purpose — and for Canadians to feel those things are honoured, people cannot be socially isolated.
We can’t improve what we don’t measure. That’s what makes experiential indicators a significant step in the right direction for better understanding how people feel about living in LTC. It broadens our understanding beyond clinical compliance and gives insight into care outcomes as experienced by both residents and health-care workers.
If dignity matters, it must be measured
Honouring a person’s humanity is arguably what provides them with dignity as they age. For Canadians in LTC, dignity is shaped by moments that acknowledge their humanity. Whether that’s the face of a familiar nurse, the opportunity to engage in social activities or spending their final days in a known place, dignity is not beyond measurement.
For Canadians to age with dignity, we need to continue rethinking how we use new and existing data to identify problems earlier, allocate resources more effectively and align accountability with what residents, families and health-care providers experience.
If Canada is committed to empowering its citizens to live and die with dignity, that dignity must be reflected in the data we use to measure success.
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Andrea D. Foebel, Manager, Indicator Research and Development, Canadian Institute for Health Information, University of Waterloo
This article is republished from The Conversation under a Creative Commons license. Read the original article.
