BETTER CARE by modernizing long-term care homes

Nearly half of Ontario’s 630 long-term care homes need to be rebuilt or require significant renovations to meet current design standards and provide greater comfort and safety.

These older homes have four-bed rooms and confined living spaces whereas newer homes offer more resident privacy through private or semi- private rooms, as well as more attractive and spacious common spaces and more intimate dining areas. These aspects of congregate living are particularly important for people with dementia. Many residents with this condition are restless and need to move around; many also have a strong need for personal space and can become upset if they perceive it is being invaded. Living with multiple roommates is particularly stressful.

In 2014, the provincial government announced a renewed capital redevelopment program, called the Enhanced Long-Term Care Home Renewal Strategy. It provides funding and other supports to help older homes renovate or rebuild. However, many homes are facing barriers that could affect their ability to participate in the program, raising concerns that many homes will not be able to rebuild.

We need a tax environment that will encourage the building and rebuilding of long-term care homes.

Municipal and regional development charges vary across the province from $0 to more than $50,000 per long-term care bedroom. There is a high degree of variability and in most cases this will negatively impact a redevelopment project because homes don’t receive any funding to cover such charges.

In communities where these charges are perverse, an operator will be forced to consider leaving to another community, thus impacting the availability of services for those citizens. That’s why the Association believes there should be a cap set on these charges.

THE PACE OF THE PROJECT APPROVAL PROCESS

Another major impediment to the redevelopment of older homes is how the Ministry conducts
 its approval of capital projects. The capital working group (assembled by the Association) noted that the process is misaligned from traditional real estate processes, that it contains overzealous financial requirements, and that there is a lack of transparency specific to Ministry timelines. Once a home applies for redevelopment, it would appear that the Ministry has no defined response process by which to let an operator know the status of their application. As such, projects can remain in limbo for several years before being developed, delayed or cancelled outright.

URBAN LONG-TERM CARE HOMES NEED A SEPARATE STRATEGY

The way in which the CFS is allocated means that every home receives the same amount
per bed. This is simply not equitable in urban centres such as Toronto, where the cost of land is approximately $12 million per acre. What’s more, there is not enough land available in a place like Toronto to support the redevelopment of homes. Some sites are too small or “land-locked” and cannot redevelop in their current location.

The high cost of construction and land present serious barriers to relocation within Toronto. City of Toronto staff has warned “there is a significant risk in future years of long-term care homes closing or moving outside of the city due to land costs.” This is why the Association thinks a separate Toronto strategy must be developed, and it is a belief reaffirmed by the growing need for care.

Toronto’s population of seniors, aged 75 and over, has increased at a higher rate than that
of seniors overall. The number of older seniors increased by 56.7% between 1996 and 2016. Over the next decade, this age group is expected to increase by 38%, with an estimated population of 279,862 older seniors by 2026, up from 202,795 older seniors in 2016. As the population of older seniors rises, the challenge of accessing long-term care in Toronto and across Ontario will intensify if new homes are not opened.

What’s needed?
A separate urban redevelopment strategy. It should focus on the Greater Toronto Area and find solutions to the limitations related to capital redevelopment in these environments, inclusive of gaps in funding, land availability and design requirements.

The challenge of amalgamating small homes… and why it’s happening.

The most significant number of homes that require redevelopment are small (less than 96 beds), many
of which are situated in small and rural communities across Ontario. Many operators are moving to amalgamate their small homes so as to improve the economic viability of their capital projects. It has been noted that at a political level, the government would like to sustain small homes, particularly in small and rural communities, so as to stabilize access for seniors in those settings – hence the increasing challenges for operators to move forward with any capital project that requires home amalgamation.

WHAT DO WE NEED TO MODERNIZE LONG-TERM CARE HOMES?

  • The government should adjust the way that regional and municipal development charges are collected from long-term care homes. It should
set a maximum rate that can be charged for new long-term care beds being added to a home project in a region/municipality, and exempt existing beds within that project from being charged.
  • The timelines associated with the project and licencing approval process should also be improved so that it is targeted to be completed within six months from application submission. There also needs to be more transparency for homes submitting applications.

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