Abstract
Objectives
In this study, we (1) identify the terms used to describe the assisted living sector
and the legislation governing operation in all Canadian provinces and territories;
(2) identify the cost estimates associated with residency in these homes; and (3)
quantify the growth of the sector.
Design
Environmental scan.
Setting and Participants
Internet searches of Canadian provincial and territorial government websites and professional
associations were conducted in 2021 to retrieve publicly accessible sources related
to the assisted living sector.
Methods
We synthesized data that identified the terms used to describe the sector in all provinces
and territories, the legislation governing operation, financing, median fees per month
for care, and growth of the sector from 2012 to 2020. Counts and proportions were
calculated for some extracted variables. All data were narratively synthesized.
Results
The terms used to describe the assisted living sector varied across Canada. The terms
“assisted living,” “retirement homes,” and “supportive living” were prevalent. Ontario
was the only province to regulate the sector through an independent, not-for-profit
organization. Ontario, British Columbia, and Alberta had some of the highest median
fees for room, board, and care per month (range: $1873 to $6726). The licensed assisted
living sector in Ontario doubled in size (768 in 2020 vs 383 in 2012), and there was
a threefold increase in the number of corporate-owned chain assisted living facilities
(465 in 2020 vs 142 in 2012).
Conclusions and Implications
The rapid growth of the assisted living sector that is primarily financed through
out-of-pocket payments may indicate a rise in a two-tier system of housing and health
care for older adults. Policymakers need better mechanisms, such as standardized reporting
systems and assessments, to understand the needs of older adults who reside in assisted
living facilities and inform the need for sector regulation and oversight.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Actualizing better health and health care for older adults.Health Aff (Millwood). 2021; 40: 219-225
- A policy framework to guide a National Seniors Strategy for Canada.https://cma.ca/sites/default/files/pdf/News/policy-framework-to-guide-seniors_en.pdfDate: 2015Date accessed: September 20, 2021
- Aging in Ontario: Using population-based data in the evaluation of trends in health system use.Healthc Q. 2011; 14: 21-25
- Canada's elder care crisis: Addressing the doubling demand.https://www.cma.ca/news/demand-elder-care-set-double-10-years-new-report-commissioned-cmaDate: 2021Date accessed: September 21, 2021
- Population projections.
- Canada Health Act.https://laws-lois.justice.gc.ca/PDF/C-6.pdfDate accessed: May 18, 2020
- Treating Health Care: How the Canadian System Works and How It Could Work Better.University of Toronto Press, 2018
- Health Economics.1st ed. McGraw-Hill-Ryerson, 2010
- Location, location, location: Characteristics and services of long-stay home care recipients in retirement homes compared to others in private homes and long-term care homes.Healthc Policy Polit Sante. 2017; 12: 80-93
- Long-term care homes vs. retirement homes vs. home care in Ontario. Closing the Gap.https://www.closingthegap.ca/long-term-care-homes-vs-retirement-homes-vs-home-care-in-ontario/Date: 2019Date accessed: January 22, 2021
- Association between dementia care programs in assisted living facilities and transitions to nursing homes in Ontario, Canada: A population-based cohort study.J Am Med Dir Assoc. 2021; 22: 2115-2120
- Retirement Homes Act, 2010.
- Ontario's retirement homes and long-term care homes: A comparison of care services and funding regimes.Can J Aging. 2019; 38: 155-167
- Variability and potential determinants of assisted living state regulatory stringency.J Am Med Dir Assoc. 2021; 22: 1714-1719.e2
- Risk factors for outbreaks of SARS-CoV-2 infection at retirement homes in Ontario, Canada: A population-level cohort study.CMAJ. 2021; 193: E672-E680
- Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada.BMC Geriatr. 2021; 21: 463
- Assisted living in British Columbia: Trends in access, affordability and ownership. Canadian Centre for Policy Alternatives.https://www.policyalternatives.ca/publications/reports/assisted-living-british-columbiaDate: 2020Date accessed: December 14, 2021
- Defining safety in the nursing home setting: Implications for future research.J Am Med Dir Assoc. 2016; 17: 473-481
- The imperative to reimagine assisted living.J Am Med Dir Assoc. 2022; 23: 225-234
- Reimagining medical care in assisted living.J Am Med Dir Assoc. 2022; 23: 201-203
- Completion of medical certificates of death after an assisted death: An environmental scan of practices.Healthc Policy. 2018; 14: 59-67
- Environmental scans: How useful are they for primary care research?.Can Fam Physician. 2008; 54: 1022-1023
- Environmental scanning as a public health tool: Kentucky's human papillomavirus vaccination project.Prev Chronic Dis. 2016; 13: E109
- Environmental scanning as information seeking and organizational learning.Inf Res. 2001; 7http://www.informationr.net/ir/7-1/paper112.htmlDate accessed: April 9, 2022
- The utility of the environmental scan for public health practice: lessons from an urban program to increase cancer screening.J Natl Med Assoc. 2005; 97: 527-534
- Characterizing early Canadian federal, provincial, territorial and municipal nonpharmaceutical interventions in response to COVID-19: A descriptive analysis.Can Med Assoc Open Access J. 2020; 8: E545-E553
- Opioid-related public health communication campaigns: An environmental scan.Am J Health Promot. 2022; 36: 913-919
- Artificial intelligence in radiology: A Canadian environmental scan.Can Assoc Radiol J. 2022; 73: 428-429
- Exploring privatization in Canadian primary care: An environmental scan of primary care clinics accepting private payment.Healthc Policy. 2022; 17: 65-80
- Results from the 2020 seniors housing survey.https://www.cmhc-schl.gc.ca/en/blog/2020-housing-observer/results-2020-seniors-housing-surveyDate: 2020Date accessed: July 15, 2021
- Seniors methodology. CMHC.https://www03.cmhc-schl.gc.ca/hmip-pimh/en/TableMapChart/SeniorsMethodologyDate: 2021Date accessed: July 6, 2021
- Population estimates on July 1st, by age and sex.https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000501Date: 2020Date accessed: February 18, 2021
- About RHRA—Retirement Homes Regulatory Authority.https://www.rhra.ca/en/about-rhra/Date accessed: January 26, 2021
- Increasing prevalence of assisted living as a substitute for private-pay long-term nursing care.Health Serv Res. 2018; 53: 4906-4920
- Changes in long-term care markets: Assisted living supply and the prevalence of low-care residents in nursing homes.J Am Med Dir Assoc. 2020; 21: 1161-1165.e4
- Developments in the market for assisted living: Residential care availability in 2017.J Am Med Dir Assoc. 2020; 21: 1718-1723
- Assisted living expansion and the market for nursing home care.Health Serv Res. 2012; 47: 2296-2315
- Rates of health services use among residents of retirement homes in Ontario: A population-based cohort study.CMAJ. 2022; 194: E730-E738
- Using Medicare enrollment data to identify beneficiaries in assisted living.J Am Med Dir Assoc. Published online February 22, 2022; (doi:10.1016/j.jamda.2022.01.062.)
- A methodology to identify a cohort of medicare beneficiaries residing in large assisted living facilities using administrative data.Med Care. 2018; 56: e10-e15
- Examining the Substitution Effect of Assisted Living Services in Retirement Homes in Ontario, Canada [dissertation].McMaster University, 2021
- Revisiting the role of physicians in assisted living and residential care settings.Gerontol Geriatr Med. 2020; 6 (2333721420979840)
- Retirement Homes and Residents of Retirement Homes in Ontario, 2012 to 2018.Big Data & Geriatric Models of Care Cluster, 2021
- Memory care reduces nursing home admissions among assisted-living residents with dementia.Alzheimers Dement. 2022; 18: 1880-1888
- The forgotten middle: Many middle-income seniors will have insufficient resources for housing and health care.Health Aff Proj Hope. 2019; 38 (101377hlthaff201805233)
- Long-term care home wait times in Ontario.https://www.hqontario.ca/System-Performance/Long-Term-Care-Home-Performance/Wait-TimesDate: 2021Date accessed: June 22, 2021
- Enabling the future provision of long-term care in Canada.https://www.nia-ryerson.ca/commentary-posts/8/28/an-introduction-to-the-nia-2019-policy-series-the-future-of-long-term-careDate: 2019Date accessed: June 21, 2022
- Principles of Microeconomics.University of Victoria, 2017
- Health Economics: Theories, Insights, and Industry Studies.5th ed. South-Western Cengage Learning, 2010
- Family satisfaction: Differences between nursing homes and residential care facilities.J Appl Gerontol. 2021; 40: 1733-1742
- Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.The National Academies Press, 2013
Article Info
Publication History
Published online: August 22, 2022
Accepted:
July 16,
2022
Received in revised form:
June 24,
2022
Received:
January 18,
2022
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
