By 1969, federal/provincial agreements had resulted in universally-insured access to hospital and medical services for all Canadians. In the absence of similar agreements for community and long-term care, each province has designed, implemented, and modified its own policies and programs during the last three decades. However, the communal values and the universal access to hospital and medical services which underpinned the national health plan influenced these policies and programs. Over time, the provincial programs have become more similar to each other but significant differences remain. However, all the provincial programs combine the assessment and delivery of short- and long-term community care and almost all combine the assessment of need for community care with that for long-term facility care placement. This article examines the development and changes in the community care and long-term facility care sectors in Canada over the recent past. Despite financial constraints which have resulted in the downsizing of hospitals and reductions in the ratio of long-term beds to the population aged 75 and over, community care budgets have increased substantially during this time. The article also discusses the major issues now confronting Canadian policy-makers and planning in regards to these programs and explores the potential impact of factors such as changes in funding and the organization and delivery of other health care services on long-term care.