As Ontario’s population grows and ages, we require new homes across the province. At the same time, nearly 200 older homes still need a path to redevelopment.
As Ontario’s population grows and ages, we require new homes across the province. At the same time, nearly 200 older homes still need a path to redevelopment.
Ontario’s long-term care homes are committed to delivering on the government’s promise of creating 30,000 new spaces while redeveloping 28,000 existing spaces. The 2024 Budget helped correct the historic underfunding that impacted the homes’ operations and their ability to secure financing.
However, additional support is needed.
Many long-term care homes urgently require redevelopment to meet the needs of today’s seniors with modern design standards for rooms, shared spaces, corridors and exits.
Ontario’s nearly 200 older homes, concentrated in small rural communities and Toronto, face significant redevelopment barriers.
Nearly 48,000 people in Ontario are currently waiting for long-term care. This waitlist has doubled over the past 10 years and is expected to surpass 50,000 in 2025.
With mounting health care capacity challenges, we must move quickly to safeguard the future of long-term care.
Long-term care homes throughout Ontario face rising construction and labour costs, along with high inflation and interest rates. Homes in urban areas, as well as those in small, rural or northern communities, face unique operating pressures.
Today’s economic realities hit Greater Toronto Area and small, rural homes especially hard. Without a capital funding model tailored for their specific needs, the long-term care homes and services in many Ontario communities will be lost.
Without these services:
Ontario’s population is aging and its complex care needs are growing. Long-term care homes are a critical part of our health care system for our vulnerable seniors.
OLTCA and its member homes continue working closely with the Government of Ontario to clear the path for capital renewal and expansion. This includes ensuring long-term care homes can demonstrate strong financial health to secure financing to redevelop or build a new home.
Ontario’s latest enhanced capital program has helped many building and redevelopment projects. However, we must find more solutions tailored to meet the needs of Ontario’s homes facing significant economic challenges and who are vital parts of their communities.
The provincial government approves whether a home can rebuild and provides a construction funding subsidy over 25 years. However, the operator of each home must also buy land if needed, arrange construction financing from private lenders, and put their own capital upfront. This applies to all homes, whether they are operated by a municipality, a not-for-profit, or a private organization.
Private lenders need to see that a long-term care home is financially stable and will be able to pay their mortgage and financing commitments. Even with significant operating increases to long-term care homes in the last budget, inflation and increased costs over the last few years in construction, goods and services, staffing, and ongoing infection prevention and control have left homes concerned about their ability to demonstrate financial stability to lenders. Higher interest rates to borrow are also a concern. The cost to build can exceed $500,000 per bed ($64 million for a 128-bed home), excluding long-term care financing costs.
Overall, long-term care operators need to raise $6 billion in equity and take on $20 billion in debt to fund the development of the government’s commitment to 58,000 new and redeveloped long-term care beds across the province.
If an existing long-term care home plans to tear down and rebuild, their residents must be moved to a different home while it is under construction. More typically, rebuilding a long-term care home means building a new home while continuing to operate the existing one. If the current site is not large enough for both the existing and new home, the owner must buy another piece of land.
In large urban areas like Toronto, the land where current long-term care homes are located is typically too small to build on to meet current design standards, as new long-term care homes require a significantly larger footprint of those built several decades ago. In addition, urban long-term care homes are often in residential areas with high density and zoning restrictions can prevent creative solutions. If an owner wants to buy more land to rebuild, the availability and affordability of land is prohibitive in cities like Toronto.
The Government of Ontario has extended the deadline for additional sprinklers in older long-term care homes to July 1, 2026, ensuring the shared responsibility of the health and safety of residents and staff.
This extension will help maintain system capacity while ensuring homes work in partnership with their local fire chiefs to meet fire safety criteria as set out in the proposed regulation.
As background, the majority of long-term care homes in Ontario have met the criteria for additional sprinklers. However, some older homes have been facing significant barriers to achieving the required sprinkler upgrades by the original deadline of Dec 31, 2024 due to issues that include asbestos in the walls and ceilings as well as structural challenges such as reliance on well water, insufficient water pressure to support the expanded sprinklers, insufficient electrical capacity to run pumps, and insufficient generator capacity to support the system. These are challenges that require major renovations from specialized contractors, plus homes have been facing labour shortages and supply chain delays. In addition, homes were at risk of losing insurance – and of being unable to continue to operate – if the sprinkler deadline had not been extended.
The original sprinkler deadline was set years ago with the anticipation that all older homes would be redeveloped by now. The province’s long-term care home capital program, however, was stalled until 2020 when the government took steps to improve long-term care homes, and then delayed due to the global pandemic bringing capital planning, construction or renovations to a halt. Additional investments in 2022 then worked for 111 projects.
Additional homes are now rebuilding or planning to rebuild their outdated buildings and the sprinkler upgrade extension means that Ontario can work to maintain the current capacity of long-term care while homes modernize to current standards.
Maintaining long-term capacity is key because Ontario is facing a long-term care wait list of nearly 48,000 people.
This is a critical time to fast-track the redevelopment and modernization of Ontario’s older long-term care homes. The population over 80 is rapidly growing and will double by 2040.
To assist, the province provided significant new investments through its 2024 budget to advance more safe, modern, long-term care spaces, expand the hours of direct care and bring specialized care to more communities – all of which are critical to high quality care and the quality of life for residents living in long-term care.
No other jurisdiction has made this level of continued commitment and investment in long-term care and the Ontario Long Term Care Association and its members are committed to continuing to work with the Ontario government to ensure that long-term care homes will be available to provide care and housing in communities across the province.
With nearly 48,000 people currently on the long-term care wait list, and as Ontario’s seniors’ population continues to grow, local emergency rooms, paramedics, hospitals, primary care providers and family caregivers will strain even more to keep up if we do not find a path forward to redevelop all types of long-term care homes that need to upgrade and rebuild.
Read our 2025 Provincial Budget Submission.
Read our paper shared at the Association of Municipalities of Ontario’s 2022 Annual Conference.