Municipal Implications

The lasting impact of the COVID-19 pandemic has had a disproportionate impact on residents in long-term care (LTC), profoundly affecting families and communities across the province and country. The situation improved significantly in 2022 but the experience has underscored the urgent need to continue transforming long-term care.

The sector has new legislation passed in 2021, the Fixing Long-Term Care Act, 2021. Key measures include a commitment to provide an average of four hours of daily direct care per resident, new compliance and enforcement tools, and aligning the Residents’ Bill of Rights with the Ontario Human Rights Code. AMO will continue to provide input and advocate for increased funding for municipal homes to implement the changes and for emotion-focused models of care.

With the implementation of the Phase 1 regulations under the new Act, AMO has some concerns that there may be greater financial impacts than initially estimated by the Ministry of Long-Term Care. The Ministry’s initial estimate of average annual direct compliance costs for all long-term care homes in Ontario was between $20 million to $23.5 million, or approximately $36,000 on average for each home, each year. AdvantAge Ontario conducted a broader analysis based on all aspects of the new regulations, including potential hiring of additional staff, and found that for all long-term care homes the cost would be between $369 million and $407 million, or approximately $590,000 to $650,000 per home, per year. AMO has called on the provincial government to provide sufficient funding that would address the full cost of the regulations.

New enhanced national standards for long-term care are currently being developed. These will require provincial and federal actions to guarantee their successful implementation over time. AMO has advised that the provincial government must ensure that provincial regulations are harmonized with the standards, provide full funding to meet higher standards, improve technology standards to address social isolation, and ensure sufficient staffing. Additionally, the federal government must provide funding to support the higher standards and invest in technology to address social isolation.

AMO has long called for adequate, stable, and predictable multi-year funding. Municipalities contribute significant dollars over and above the provincial funding subsidy, including capital. Given that long-term care has evolved to provide complex health care services, AMO believes that the municipal property tax base is neither a sufficient nor fair source to top up provincial funding. Rising construction costs present another challenge to expanding Long-Term Care. AMO has also highlighted the challenges for communities, particularly in northern and rural Ontario, 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.


While the provincial government is responsible for LTC legislation, regulation and program requirements, municipal governments go above and beyond 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. As per the Fixing Long-Term Care Act, upper and single-tier municipal governments in southern Ontario are responsible for establishing and maintaining long-term care facilities. In northern Ontario, municipal governments can operate a home or come together with other municipalities to jointly fund a home managed by a District Board of Management. The municipal sector operates 100 (16%) of the 626 LTC homes in Ontario – accounting for about one in five LTC beds in Ontario.

AMO remains committed to working with the government to implement changes and continue transforming the long-term care sector. Updates and resources can be found on the LTC and Seniors Services section of the AMO website.


Michael Jacek
Senior Advisor