As the Ontario Long Term Care Association (OLTCA), representing 70% of the long-term care homes in the Canadian province of Ontario, prepares to develop a new strategic plan, Chief Executive Officer Donna Duncan is excited about the process. Duncan, who also serves on the Global Ageing Network board as treasurer, said the process will involve expansive engagement with members along with plans to rethink models for serving veterans, those living with mental illness, neurodivergent populations, and others, as the Association continues to pursue its top policy advocacy priorities. “There’s a movement brewing which gives me a great sense of optimism,” Duncan said.

Duncan explained to Global Ageing Network how OLTCA’s three major policy advocacy priorities—growing the long-term care workforce, strengthening capital re/development pathways, and ensuring stable, predictable funding—intertwine to shape the environment for Ontario long-term care organizations.

Workforce Priorities

Like providers throughout the Global Ageing Network membership, Canadian long-term care organizations are afflicted by workforce shortages. Even before those shortages were greatly worsened by the COVID-19 pandemic, Duncan said, “we [were] identifying workforce problems since 2019, and had been flagging the crisis to come. In the midst of the pandemic, we even did a technical briefing for the media to say this is the burning platform everyone should be focusing on. We’re going to come out of this pandemic, but we need to make sure that we have people to care for people.”

Duncan believes the pandemic-driven loss of life in long-term care homes contributed to a negative public perception of the sector that continues to affect recruitment. “The sector came under intense scrutiny during COVID-19,” she said. During the COVID crisis, Ontario’s government repealed the Long Term Care Homes Act of 2007 and replaced it with 2021’s Fixing Long-Term Care Act, which took effect in 2022. The new act included important reforms such as accelerating workforce training and committing to an average of four hours of direct care per resident per day—a historic investment that OLTCA strongly supports. “The four hours target is essential to improving quality of care,” Duncan said. “At the same time, implementation, particularly in rural and smaller communities, has been difficult due to workforce shortages.”

Rebuilding or Developing While Advocating Stable Funding

In Ontario, all direct care provided to a resident in a long-term care home is publicly funded. “If you are a resident and your family member wants to buy or purchase additional services within the long-term care home, they cannot be purchased from the operator,” said Duncan, though “some families opt to provide additional support or hire a caregiver.” The provincial government provides construction funding subsidies over 25 years, but, notes Duncan, “Homes have to self-finance. Regardless of ownership, if you’re a not-for-profit or a hospital, you still have to secure your own [development] funding, and the lenders need to make sure your operating funding will help you cover the cost of operating and building.”

The Ontario government has committed to enabling 58,000 new or rebuilt spaces in long-term care homes, and the renovation of spaces includes the elimination of ward rooms in older homes. While there are approximately 50,000 people on a long-term care wait list in Ontario, Duncan said the province is on the path to approximately 150 new or rebuilt homes, but said there are about 200 older homes that don’t have a path to redevelopment. “The economics of small or rural homes are such that any homes under 128 spaces can’t make it work,” she said. “We are looking at different models and approaches for rural communities, including mixed use, more campuses that could embed shared community care models, diagnostics, other services and supports, day care programming, a campus with key worker housing or student housing on it, and looking at how technology could support those homes as well.”

Even in Toronto, where access to affordable land and building restrictions also limit possibilities for new construction or redevelopment, Duncan said there is a wait list of 10,000 people for a total census of about 15,000 spaces.

“Our policy priorities are all interconnected. You need buildings [to] accommodate new spaces and renewed spaces, but you also need staff to be beside the bed. And in order to build, you need to make sure you have stable operating funding to ensure you can actually operate the home and pay for the staff,” Duncan said.

The ‘Privilege’ of Partnership with the Global Ageing Network

Duncan values OLTCA’s membership in the Global Ageing Network: “We co-hosted a workforce summit in 2019 and found it to be enormously valuable. And then during the pandemic, we were able to have regular conversations to understand what was happening around the world. One, that made us feel less lonely. But two, it better prepared us for what was going to come in terms of potential policy changes, initiatives, or understanding of the evolution of the virus, and preparing our members to be in a position to respond. And I have the privilege of serving on the Global Ageing Network board.”

OLTCA is a co-host, with Global Ageing Network and the National Care forum, of the 2025 Global Virtual Roundtable Series, and Duncan moderated its first session, on Medical Assistance in Dying (MAID) & Emerging New Models. She also looks forward to attending this year’s Global Ageing Network conference, held in conjunction with the LeadingAge Annual Meeting, November 2-5 in Boston, Massachusetts: “It’s really important to be sharing these stories, sharing best practices, and talking about what’s happened in different countries, so we can learn from one another and think about how we can actually do things better. It’s been a real privilege.”