In her thought-provoking and well-researched paper, Irene Jansen presents some of the main challenges within the facility-based long-term care (LTC) sector and advocates for three major policy changes and investments. But her aim in writing the paper is to start the conversation. I am happy to oblige Jansen's call to tackle other critical issues and thank the editors of Healthcare Papers for the opportunity to briefly express my views.

I concur that the federal government is not adequately fulfilling its stewardship role in helping to ensure – along with the provinces and territories – that the facility-based LTC system has the ways and means to meet the legitimate needs of LTC residents and the people who care for them. A national dialogue should be convened with an emphasis on what quality looks like to the resident, not to LTC ministries or funding authorities. The resident is the nucleus around which all else revolves.

The challenges in the areas of supply and demand, the patchwork of services and health human resources are huge. But additional staffing and more beds will not add real value to the system unless they are closely linked to the principles of culture change – the journey to improving living and working conditions in LTC across the Canadian landscape. And it is here where I make my prime contribution to the conversation.