Ontario Election 2025 – Transforming Long Term Care

Posted on by Anthony Quinn

COVID brutally exposed the problems that have plagued Ontario’s long-term care (LTC) system for decades: inadequate facilities, lack of proper staffing, lack of inspections and infection control and above all, an obsolete model of care that robs residents of dignity and respect, giving them (and their families) little or no voice in their own care. 

This goes beyond bricks and mortar, or even more staffing. What we need is a total transformation in the culture of how LTC is provided.

It shouldn’t be an impossible dream. There are a number of innovative models, already embraced in the USA, Europe and Australia (and even in a handful of homes right here in Ontario itself). These include the Eden Alternative, the Green House Project, Hogeweyk Village and the Butterfly Homes model. They’re all based on a patient-centric, emotion-focused philosophy:

  • More hours of direct care for each resident
  • Using a relationship-based approach to care, where residents, their families, and staff feel part of a community
  • Creating of smaller “home-like” environments (as opposed to the present impersonal “warehousing” approach-harsh, minimalist, and unkempt  nursing institutions )
  • Recognizing families and caregivers as integral members of the team

The emotion-focused model is not only more humane, it produces better outcomes:

  • A decrease in aggressive incidents
  • A decrease in the use of anti-psychotic drugs
  • A decrease in the number of staff sick days (in one case, 75% less)
  • An increase in resident and staff satisfaction, and social interaction

Canada has made some traction in this regard with 26 LTC homes were either fully accredited or in the process of the Butterfly approach since 2023. However, the Green House Project uptake is limited. So far, only Quebec is transitioning its LTC homes based on the Green House Project philosophy. 

Although Ontario has made amendments to enhance the quality of care and life for residents in LTC facilities through the Fixing Long-Term Care Act, 2021 and new staffing regulations, this is not enough. There are nearly 48,000 people waiting for a LTC bed and this number is expected to explode and grow exponentially in the upcoming few years.

CARP advocates for:

  • A shift in approach from “institutional” to home-like environments. Whether we’re dealing with new buildings or the refurbishing of older facilities, there must be smaller clusters shared by fewer people, and more private bedrooms.
  • All nursing homes must develop written commitments, with specific timelines, to meet these standards. 
  • All nursing homes must be required, as a condition of their license, to adopt a culture of person-centered care, and present written plans for achieving it.
  • Stricter regulations must be created, inspected regularly and firmly enforced.

The Ontario government from June 2022- January 2024 seems to have made some progress toward transforming LTC systems by improving the quality of life for residents, changing legislation, and person-centered care by investing millions in this sector. Continued investments in infrastructure, specialized care, and workforce development/retainment will be key to addressing the systemic challenges LTC homes face across the province. However, more work remains to be done. To truly transform LTC, Ontario must further embrace emotion-based care models that prioritize the dignity, autonomy, and emotional well-being of residents. This includes expanding innovative approaches such as the Butterfly Model and Green House Project, fostering smaller, home-like environments, and strengthening the relationships between residents, families, and caregivers.

Government Report Card

How has the current government responded to the ‘CARP 5’ call to action on Long-Term Care?

PRIMER: TRANSFORMING LONG-TERM CARE IN ONTARIO 

SUMMARY 

Building New Long-Term Care (LTC) Beds

  • The government promised to build 30,000 new LTC beds by 2028, with 58,000 new/upgraded beds currently in progress.
  • As of April 2024, $155.5 million was invested to accelerate construction.
  • Some LTC homes are closing by June 2025 due to the costs of meeting new fire code regulations requiring sprinkler systems to be installed by January 2025. Toronto Star coverage
  • By January 2025, 131 projects representing 21,579 beds were completed or approved. It is difficult to track how many net new beds are available in Ontario as of the early election call.
  • Public land is being sold to for-profit LTC providers, e.g., Schlegel Villages’ Oakville project with 512 beds. Infrastructure Ontario Link
    Fixing Long-Term Care Act, 2021 (Bill 37)
  • Mandates 4 hours of direct care per resident per day by 2025.
  • Stronger enforcement through increased inspections and higher fines.

Workforce and Care Quality Initiatives

  • Up to $5,440 in incentives for personal support workers (PSW) students in LTC placements.
  • $17 million in 2025 to train 700 new PSWs and nurses.
  • $9 million was invested in improving skin and wound care, reducing emergency room (ER) visits.

Specialized Care and Local Priorities

  • $35 million in 2023-2024 for specialized care in dementia, mental health, and bariatric care.
  • The Support for Seniors and Caregivers Act, 2024, allocates $114 million for dementia care and caregiver support.

Expansion of Diagnostic Services

  • The Community Paramedicine for LTC Plus (CPLTC+) program delivers on-site diagnostics, reducing ER visits.
  • $9 million invested in 2024 for diagnostic equipment and training, with $6 million for 2024-2025.

Conclusion
The Ontario government (2022-2024) seems to have committed to transforming LTC systems by improving the quality of life for residents, changing legislation, and slowly implementing person-centered, care by investing millions in this sector. To truly transform LTCs, Ontario must further embrace emotion-based care models that prioritize the dignity, autonomy, and emotional well-being of residents.  Find out more about CARP’s call to Change LTC Now! https://changeltcnow.ca/

Election Primer

Ontario’s healthcare system faces increasing pressure due to an aging population and the ongoing challenges posed by staffing shortages and infrastructure limitations. Nearly 48,000 seniors are waiting for LTC placements. However, LTCs facilities are long overdue for a transformation in the culture of how services are provided in the homes, calling for more emotion-based care for the residents. This primer outlines the province’s recent investments, legislative reforms, and ongoing challenges in the LTC sector since 2022.

BUILDING NEW LTC BEDS 

The Ontario government has committed to building 30,000 new LTC beds by 2028 and redeveloping older beds to meet modern standards.

  • Investment in Construction: As of April 2024, the government invested $155.5 million to accelerate the construction of new or redeveloped LTC facilities.
  • Facility Closures Due to Regulatory Challenges: Some LTC homes have closed or announced closures by June 2025 due to operators unwilling/unable to finance the retrofits needed to comply with modern fire code regulations and provincial design standards.
  • Fire Code Compliance: In 2014, the Ontario Fire Code was amended to require all LTC homes to have automatic sprinkler systems installed by January 1, 2025. Older facilities often need extensive renovations to meet this mandate.
  • Progress on Bed Development: By January 2025, 21,579 new and redeveloped beds have been completed, are under construction, or have received ministry approval.
  • Use of Public Land: The government has sold surplus public land to for-profit and other LTC providers to expedite development. E.g. public land was sold to Schlegel Villages for a new Oakville LTC project that will add 512 LTC beds.

LEGISLATIVE REFORMS: FIXING LONG-TERM CARE ACT, 2021 (BILL 37)

The Fixing Long-Term Care Act, 2021 was introduced to address systemic issues in LTC, with key provisions including:

  • Increase direct care to residents to 4 hours per resident per day by 2025.
  • More frequent inspections, stronger enforcement protocols, and higher fines for non-compliance. Implementation details and progress updates continued into 2022-2023.

WORKFORCE AND CARE QUALITY INITIATIVES

  • Up to $5,440 in incentive funding for PSW students during clinical placements in LTC or home/community settings.
  • Investing $17 million in 2025 to train 700 new PSWs and nurses.
  • Allocated $9 million to enhance skin and wound care in LTC homes. Up to 400 LTC homes have received training and resources through partnerships with Wounds Canada and Nurses Specialized in Wound, Ostomy, and Continence Canada (NSWOCC).

SPECIALIZED CARE AND LOCAL PRIORITIES

  • Local Priorities Fund: The province allocated $35 million in 2023-2024 (up from $20 million in 2022-23) to support specialized care in LTC for conditions like dementia, bariatric care, and mental health.
  • Support for Seniors and Caregivers Act, 2024: This Act allocates $114 million to enhance dementia care, support caregivers, and promote social connections for seniors. This also includes:
    • A $9 million investment over 3 years: LTC home staff training in emotion-based care. 
    • A $20 million investment over 3 years: Adult day programs for seniors that offer social programming and peer connections. 
    • A $15 million investment over 2 years: Pilot project giving home-living seniors access to LTC services.
    • A $20 million over three years: Respite services to support caregivers of people living with dementia. 

EXPANSION OF DIAGNOSTIC SERVICES 

  • Community Paramedicine for Long-Term Care Plus (CPLTC+): This program allows paramedics to deliver on-site diagnostic services such as bloodwork, ultrasounds, and urinalysis, reducing ER visits.
  • Funding for Diagnostic Services: $9 million was allocated for equipment and training, with an additional $6 million designated to continue support in 2024-2025.

CARP’S STANCE 

CARP wants to see the Ontario government make LTC homes one of its top priorities as there are a plethora of issues; inadequate facilities, lack of proper staffing, lack of inspections and infection control, and an obsolete model of care that robs residents of dignity and respect, giving them and their families little or no voice in their own decision-making for care. There needs to be a transformation in the culture of LTC.

This should not be an impossible dream as there are already several existing innovative models embraced in the USA, Europe, and Australia that follow emotion-based care. These include the Eden Alternative, the Green House Project, Hogeweyk Village, and the Butterfly Homes model. They’re all based on a patient-centric, emotion-focused philosophy. Canada has seen some progress, with 26 LTC homes adopting the Butterfly approach since 2023 but wider adoption is needed. 

The Ontarian government of 2022-2024 seems to have made waves to transform LTC systems by improving the quality of life for residents, changing legislation, and person-centered care by investing millions in this sector. Continued investments in infrastructure, specialized care, and workforce development/retainment will be key to addressing the systemic challenges LTC homes face across the province. To truly transform LTC, Ontario must further embrace emotion-based care models that prioritize the dignity, autonomy, and emotional well-being of residents.

 

WATCH: See what is possible with the Butterfly Model currently being “tested” in Malton, Ontario

 

WATCH: How Ontario can move from Institutional to Emotion-Based Care

 

WATCH: Butterfly Home Pioneer on the need for Revolution in LTC