August 2019
Backgrounder

The Ministry of Long-Term Care changed the funding model for long-term care mid-year in 2019. While there was a 1.7% overall increase in the funding envelope for the long-term care sector, there have been some significant in-year reductions due to the changed funding model that has disproportionately affected municipal homes. Continuing reductions of greater magnitude are coming next year. These reductions place added pressure on the municipal property tax base to bridge the funding gap and/or may result in reduced services for senior residents.   

AMO is working with AdvantAge Ontario, the association that represents municipal and non-profit long-term care service providers, to analyze the impact of these reductions when municipal budgets and property tax levies for the year have already been set. AMO has called on the province to defer the changes indefinitely until a review of the model is completed jointly with the sector to ensure that there is adequate, stable and predictable multi-year funding available on a go-forward basis. The province has now agreed to delay the funding cuts until October 1, 2019. While welcome, this only provides a few more months to adjust to the new funding reality.

Another matter to address is that in most communities, particularly in northern and rural Ontario, it is even more challenging to recruit and retain qualified staff such as nurses and personal support workers. The Province needs to work with the sector to develop a province-wide human resources strategy to address staffing issues. Otherwise, quality of care may diminish and homes operators risk non-compliance with legislated requirements.

To address capacity and rising demand due to demographic change of an aging population, the provincial government has committed to expanding beds in existing and new long-term care facilities across Ontario. This commitment is welcome.  A focus on the modernization and renovation of existing homes is also important to provide quality services to current and future residents.  Input at this stage is critical to reducing barriers on the ground that may limit municipal government uptake. An area of consideration that should continue for re-development and new development is facilitating innovative models like campuses of care, which can offer a range of services to meet the local needs of seniors in the community. With the right partnerships in place, integrated campuses containing a mix of independent living, supportive housing and access to health services when required, could be a more sustainable model than just stand-alone long-term care homes.

With health care transformation underway, the role of municipal long-term care homes within the newly emerging provincial Ontario Health Teams (OHTs) is also unclear. The Province has indicated that eventually that the OHTs will have a self-governing model with a designated, lead agency. Within this model, municipal governments need a guarantee for the maintenance of a targeted and steady funding stream for long-term care homes and an appropriate government-to-government relationship with the Ministry of Long-Term Care.

AMO continues to advocate for a greater municipal ‘say for pay’ as co-funders, service providers and employers. Municipal consultation is key to developing locally informed long-term care policies, planning, and funding decisions. AMO will be analyzing the recommendations of the Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System and updating its long-term care positions in response to this and other recent developments.

Background

Long-term care homes in Ontario, are today serving increasingly complex patient groups with high-acuity needs. They are providing 24-hour medical care and supervision in a secure and comfortable environment. Ontario’s municipal order of government is an important player in the provision of long-term care services. As per the Long-Term Care Homes Act, upper and single-tier municipal governments in southern Ontario are responsible for establishing and maintaining long-term care facilities. However, in northern Ontario, municipal governments often jointly fund a home managed by a District Board Home Board of Management. The municipal sector operates over 100, or 16%, of the homes with 17, 000 beds. About 1 in 5 beds is in a municipal home. As well, municipalities contribute significant money over and above the provincial funding subsidy, about $350 million per year not including capital.

While the provincial government is responsible for long-term care legislation, regulation, and program requirements; municipal governments go beyond legislative requirements to make sure local seniors have access to quality services in the community. Many local governments operate additional homes and offer services that surpass provincial requirements. Municipal homes usually take residents who are more difficult to serve than other LTC homes, and they typically offer fewer beds at the preferred rates – thereby serving lower income residents.

Across Ontario, the demand for long-term care services has overtaken capacity. Provincial funding has not increased to meet the increased needs of residents.  Municipal governments continue to face even greater challenges in recruiting and retaining workers, funding and adapting to the complexity of health care needs. These challenges point to the continuous need to assess capacity, predict future need, re-examine the funding model, and provide flexibility to allow for creative problem solving.

Given the evolution of long-term care into complex health care service, property tax base is neither a sufficient nor a fair source to top-up provincial funding for what is essentially is an area of provincial jurisdiction. Municipal governments sometimes question whether to remain in the business of providing long-term care services given the rising costs and other operational challenges. However, they are committed to providing the highest quality of care to residents and ensuring that there are sufficient long-term care options for their communities.