May 27, 2020

For many years, the long-term care home system in Ontario, (and other provinces), has struggled with a host of systemic under-funding, physical design and staffing challenges in meeting the dramatically increasing health complexity, heavy care and medical requirements and mental health needs of their residents. Almost 70% of the residents in Long-Term Care Homes have advanced stages of dementia, with higher risks of causing self-harm or harm to other residents and staff. The levels of staffing are inadequate to meet the heavy care needs of the LTC residents.

The current facility standards are inadequate at addressing the residents complex needs including dementia care. And, we are also learning about the huge gaps in facility design for infection controls.   There has been a lack of adequate capital funding for the physical renovations (or re-location) of existing long-term care homes to meet existing facility design standards.

During this COVID-19 crisis, even our national military have been brought in to help, and are reporting that the conditions in some of the LTC Homes are “shameful”. Is it any wonder that institutional models and LTC homes are considered a “place of last resort” for virtually all residents and their caregivers?  

As with all provinces, the Ontario government is responsible for overseeing most of healthcare including Long-Term Care Homes. This includes the funding, regulation and oversight of the over 600 LTC homes in Ontario. But these LTC homes have been left behind within the health care system. So too, have home care and community health services been under-designed and under-funded with systemic staff challenges, such as insufficient clinical resources. All of this combined, has caused an inability respond to the increasing needs of seniors.

Over the last decade the number of LTC beds in Ontario has actually decreased from 78,000 to just over 77,000 despite the growing number of seniors needing LTC care. During the same period, chronic care hospital beds and specialized geriatric beds have decreased. With the growing gap in our healthcare system and long wait times to move into an LTC Home, the only people getting into these homes have very serious health conditions including dementia. 

We have witnessed almost 15 years of an escalating cycle of Neglect, Abuse, Crisis, Review, Repeat. Now, here we are, in the midst of COVID-19 with over half of Ontario’s homes having had an outbreak and the resident death toll in LTC homes is 1,538 along with 6 staff deaths – all within a period of a few months. This incredible loss of so many valuable lives has been devastating for families, caregivers and the staff and their communities. Over these years, many alarms have been sounded about the issues in the quality of care, working conditions and safety risks. These issues have been well documented in a series of reviews of the Long Term Care Home System:

  • 2008 Commission of Level of Care in LTC Homes
  • 2012 Long Term Care Task Force on Resident Care and Safety
  • 2019 Public Inquiry Into the Safety and Security of Resident In LTC Homes Systems

While the headlines speak about reducing wait times in hospitals; and the need to ensure that patients are not treated in hallways, we have NEGLECTED the health care outside of hospitals. This has led to various levels of ABUSE; which then prompts a CRISIS, which then leads to REVIEW. We are poised to REPEAT this cycle with the announced LTC Commission in Ontario, unless we boldly do something differently. Without a laser focus on truly getting to addressing these known and complex challenges along with a parallel forward looking lens on sustainable solutions that will change this cycle, nothing will get better.

Time to Change the Cycle… Neglect. Abuse. Crisis. Review. IMPROVE

The first step: We can stop with the finger pointing. This is a systemic problem that will require collaboration and co-ordination across all levels of government; agencies, and advocacy groups. The province must move quickly to conduct its review of the situation in long-term care in order to build transparent action plans within the near future. We pretty much know the nature, depth and extent of the operational problems in long-term care homes. Seniors, caregivers and front-line staff must be the loudest voices at the table when creating transparent action plans for change and improvement.

Second Step – Part 1: We can pivot fast and commit to the following:

The Provincial Ministry of Health and Long-Term Care can create a roadmap to harness healthcare resources in the right ways, and build a better future. There have been some real innovative breakthroughs during the COVID-19 crisis showing us the benefits of better alignment between hospitals and long-term care homes. Other promising breakthroughs are the provision of virtual care for primary care and mental health. Building upon the lessons learned (good and bad) from COVID 19, the province can set the foundation for a modern and better designed, integrated model of the continuum of quality care from primary care, hospitals, home and community care, LTC homes, and hospices. 

Second Step – Part 2: Given the lack of the public’s desire for institutional models and the high prices of the current retirement homes, it’s also time to create a parallel track that moves us “upstream” to create alternative and sustainable solutions to help the growing number of seniors wanting to age in in their homes and communities. Going upstream is the only way we will stop the larger cycle to prevent the over-reliance on the institutional models and pressures on the LTC sector. Suggested “Upstream” solutions include:

  • A 10-Year seniors housing plan that ensures a dramatic increase the supply and range of housing alternatives to support seniors to safely age in their place of choice. Use citizen-led, co-design models to envision new housing models and bring this 10-year plan to fruition. This housing plan can include innovative designs, affordable housing options, grants, incentives, rent supplements. This housing plan can also encourage seniors to outfit their home early (modify for accessibility and technology) to enable the choice to stay in it longer.
  •  A 10-Year vision, redesign, and capital redevelopment plan for Long-Term Care Homes. This could include modernized physical design standards, federal/provincial capital funding, and a collaborative intra-provincial best practices exchange to promote the highest quality operational models (particularly for dementia care) and standards within long-term care homes.
  • Establish an ongoing, sustained federal/provincial health funding plan to expand the availability of high quality home and community care that enables self-directed home care, innovative respite and day program care, supports for caregivers, and other creative and modern delivery models which are enabled by technologies.

Last but not least, the upstream thinking and solutions must also occur at an individual level. While it is not possible to control all aspects of aging, there are many risks that can be predicted. Proactive actions and choices by seniors in their 60s (or early 70s) can be made to prevent a move in our later years into an institutional setting, such as:

  • make healthy lifestyle choices, and proactively managing health by working with others and using technology
  • make timely and wise housing decisions such as, outfitting an existing home before this is needed, OR moving to, or co-designing, a different home that is outfitted/accessible and allows the choice to stay there.
  • build stronger social networks and connections with neighbours, friends and family to help one another with daily life
  • select, prepare and organize future caregiving teams to support your aging in the right place.

Leaving it to governments to solve all of this for our future is not the answer. Citizens can take the lead too. It’s time to chart a new path for creating more choices for more affordable, inclusive and supportive housing and community care. Governments can support our individual efforts through new programs, grants, capital funding, financial/tax incentives and more.

Sue Lantz, BA. MPA

Managing Director

Collaborative Aging



  • May 29, 2020 at 5:13 pm

    Couldn’t agree more with the ideas set out. I’d add that it’s time to think outside ‘the box’ created by placing seniors support and care fully in the ‘health’ box. In part, because of the assumption that failing capacity in older age is a disease, and therefore requires hospital like solutions as capacity becomes diminished; and, in part, because leaders of ‘health box on aging’ (silo) rarely look to other domains for knowledge – such as mental health, the developmental disability and other related fields.

  • May 30, 2020 at 9:01 am

    Sue – this is a most comprehensive and well considered list of recommendations as the Long Term Healthcare lifeboat flounders off shore. Clearly Covid-19 has pulled back the curtain, to reveal the true sad “state of affairs” – no matter how ugly or untimely. I am not sure how such an advanced country as Canada has allowed this to happen at all and even for such a extended period of time !! . It is embarrassing and shameful to have to rely on the military to put things right. Clearly the time has come to right the boat and set sail towards the comfort of the shore. As you so rightly suggest, we can only do this by working together as individuals, families, and communities- hand-in-hand with both the federal and provincial governments, private enterprise and our provincial health care folks. We must understand the best and only solution is a “win, win” for all. We need to see that it takes a Village to heal the Village.

    Thanks for reminding us that the time for radical change is now upon us and for making invaluable suggestions as to how we might actually take the first critical steps on this journey together.

  • May 30, 2020 at 3:07 pm

    Sue – this is a concise and actionable roadmap for the future of long-term care in Ontario. You have my support on working on a parallel “upstream” model of service delivery so that people don’t find themselves in Long Term Care homes “by default” because the supports in the community to assist them to remain at home have not been explored. It is much easier to send someone to a long term care home (if there is a bed)… you don’t have to research equipment needs, support needs, renovation needs…. Together we can tackle some of these issues that we have been talking about (and researching) for decades!

  • June 1, 2020 at 9:59 am

    Sue, you have hit the nail on the head in spades! All the boxes have been checked as to how we can make change happen in long-term care. It’s time to have partnerships with both private and public enterprise, all levels of government and interested partners. Let’s investigate ways to start the conversation to make it a reality.

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  • June 20, 2020 at 7:43 pm

    I commend you for your comprehensive article. As a ‘boomer’ who has spent the past 30 years working in the private ‘senior living’ business, I know all to well what the options are and how many of them are not preferred by the majority. I think you’re right when you say that we need to put the focus much further upstream and much earlier in our aging journey to be sure that we have created ‘community’ where we want to live and we care supported as needed to live our own best life for as long as we live. Perhaps if the focus is on the ‘whole’ person and not just a couple as aspects of ‘living’, like housing and ‘physical care’, we could support many more people in living their best life. The co-housing movement, where the building of ‘community’ comes prior to the building of ‘housing’ might help us with an solution.

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