Long-term care homes face many challenges trying to build and redevelop.

Long term care homes are committed to delivering on the government’s pledge to redevelop older homes and to create 30,000 new long-term care spaces to provide quality care and living, affordable housing, individualized supports and a caring environment for residents.

The government’s latest enhanced capital program will help a number of building and redevelopment projects move forward.

We also know that some communities need additional supports and customized solutions due to significant economic and construction challenges – particularly homes in the Greater Toronto Area and in small, rural communities in Northeastern, Southwestern and Eastern Ontario. Their challenges include rising construction and labour costs due to inflation, access to affordable land, and rising interest rates on the money they need to borrow.

Nearly half of Ontario’s long-term care homes need to be redeveloped.

Nearly half of the province’s long-term care homes are older, with an estimated 20,000 residents living in older long-term care homes that need to be rebuilt and are waiting for approval to renovate or rebuild.

There is no time to waste because licenses for many of these homes expire in 2025. The action needed also includes municipalities who need to provide planning and building approvals for new and redeveloped not-for-profit and private long-term care homes that fall under their jurisdiction.

Data show that more than 43,000 people in Ontario are currently waiting for long-term care. Given the growing seniors’ population, by 2029, we will be looking at a waiting list of 48,000 – even with the new beds that are being built.

To see the numbers, visit our data page 

Impacts to local communities.

Today’s economic realities are hitting the Greater Toronto Area and small, rural homes especially hard. Without a capital funding model tailored for them, vital long-term care homes and services for seniors in many Ontario communities will be lost. This will mean:

  • No long-term care for seniors in their local communities. They will need to be cared for in homes in other communities, affecting their families’ abilities to visit.
  • Reduced long-term care capacity in communities across the province, resulting in longer wait times for the remaining homes, more pressure on seniors and their families, and growing pressures on the health care system such as local hospitals, primary care and more.

The size of Ontario’s elderly population and their complex care needs are rapidly growing. Long-term care homes are a critical part of our health care system for our vulnerable seniors.

The Ontario Long Term Care Association and its member homes continue to work closely with government to clear the path for capital renewal and expansion. This includes ensuring long-term care homes can demonstrate strong financial health in order to secure financing to redevelop or build a new home.

Our goal is to find solutions that are tailored to meet the needs of Ontario’s homes who face significant economic challenges and who are a vital part of their communities.

Rebuilding an older home is complex and there are many factors that can affect whether the project goes ahead.

The Ontario government has made significant and historic investments to modernize older long-term care homes and build new ones. Many projects have received government approval to rebuild in recent years after the province’s long-term care capital redevelopment program was stalled for decades under previous governments.

A further 200 older homes still need to be redeveloped and they are exploring how they can make it work with the government’s renewed long-term care capital redevelopment program.

Rebuilding older homes is complex and comes with challenges that have been decades in the making. The provincial government has been making unprecedented efforts in the past few years to begin to address these legacy issues. The Ontario Long Term Care Association, long-term care operators of all types of homes (e.g., non-profit, municipal and private) and the government continue to work together to find solutions to the complex challenges facing homes that need to build or rebuild.

There are some misunderstandings about what’s involved in modernizing long-term care homes, and why some have decided to close.

Below are commonly asked questions and some key considerations.

How do long-term care homes finance the cost of construction?

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.

Is it easy to find land to build on?

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.

Are homes able to meet the requirements of installing additional sprinklers?

Long-term care homes have extensive fire protection plans which are required by legislation and the Office of the Fire Marshal. These plans include regular fire drills, alarm testing, evacuation protocols and drills, staff training and inspections – and are approved by their local Fire Chief as part of their emergency training. In addition, long-term care homes are equipped with standpipes, fire separation and protection materials, as well as sprinkler coverage of high-risk areas such as kitchens, and laundry and boiler rooms.

A fire code requirement for additional sprinklers in resident rooms will come into effect on January 1, 2025. When that deadline was established, the assumption was that all older homes would be rebuilt by now under the government’s capital program, not anticipating that it would be stalled for decades or that the world would face the disruption of a pandemic.

Many older homes, particularly those in rural areas, also face structural barriers to additional sprinkler installation such as a reliance on well water, insufficient water pressure to support the expanded coverage, insufficient electrical capacity to run the pumps, inadequate electrical service, limited generator back-up capacity, and asbestos in the walls, ceilings and floors.

If homes are unable to install additional sprinklers or rebuild and modernize by the sprinkler deadline, they will lose their insurance. Without insurance, a home cannot remain open.

Multiple other factors can affect whether a home can stay in operation. For example, other homes have closed or are closing because of factors such as significant mould in the building, or because the home leases the land and the land owner has sold it for another purpose.

How critical is it for long-term care homes to rebuild?

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 more than 43,000 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.

For more information:

Read our paper shared at the Association of Municipalities of Ontario’s 2022 Annual Conference.

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Read our 2024 Provincial Budget Submission.

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