The aging population and the epidemic of chronic diseases requires an accompanying fi nance reform of long-term care
that will become increasingly dominant. Many countries have faced this situation and have set up a separate public
funding for such care on the basis of a universal insurance covering both home care and institutions. Canada and Quebec
must adopt such autonomy insurance and create a separate fund fi nanced partly by a more judicious use of current
budgets and tax credits, and also by a signifi cant investment in home care. An autonomy support benefi t could be
allocated in kind to fund public services and by contract to pay for services delivered by private, voluntary, and social
economy agencies. This benefi t would be established following a standardized assessment of functional autonomy
achieved by the case manager who will manage the services and control their quality.