This thesis analyzes the role that stakeholder groups representing seniors, people with disabilities, service providers--both for-profit and not-for-profit, unions, and the Ontario Ministry of Health bureaucracy, played in attempting to influence the development of Phase One of long term care policy and legislation in Ontario, leading up to the passage of Bill 101 The Long Term Care Statute Law Amendment Act (1993).There has been very little written about the long term care reform process which took place in Ontario from 1989 to 1994. This thesis attempts to fill this gap in the academic literature.Most of the information for this work comes from interviews with stakeholder representatives, stakeholder exhibits to the Standing Committee on Social Development, documents furnished by stakeholder groups, archival sources, such as Hansard, policy and position papers from government Ministries, internal briefing documents from the Ministry of Health, and financial information from the Ministry of Finance.This material shows how the commercial nursing home industry benefitted from the reform of the long term care system, while non-profit homes for the aged, residents, and unions lost ground. Based upon a neo-Marxist, state theory perspective, it is argued that the outcome of the long term care reform initiative was the result of unequal power relations between diverse stakeholder groups which included the Ministry of Health bureaucracy.It is also argued that the state as a whole was in a somewhat ambivalent position vis a vis the demands of stakeholder groups towards the end of the reform process. Some members of the Ministry of Health bureaucracy appear to have made significant attempts to address the needs of the commercial nursing home sector, while elected officials, in particular the Minister of Health sought to maintain social harmony, by promising reforms beneficial to consumers of long term care. Together, public officials and civil servants secured the continued legitimacy of the existing socio-economic order in long term care.This study shows that the Ministry of Health succeeded in meeting the needs of business, while imposing its internal cost containment and system rationalization agenda on other stakeholders. This was done primarily at the expense of residents, and the non-profit institutional system, and, to a somewhat lesser extent, at the expense of labour. In spite of promises by the Minister of Health that the long term care reform would result in a more streamlined, accessible, and accountable system for service users, this study will show that it was service users who bore increased costs, and received the same or less care and accountability. This occurred because no stakeholder group was able to effectively challenge the socio-economic structure of the institutional long term care system, which is dominated by the commercial nursing home sector, and supported by the Ministry of Health bureaucracy.