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Defining the Assisted Living Sector in Canada: An Environmental Scan

  • Derek R. Manis
    Correspondence
    Address correspondence to Derek R. Manis, PhD, McMaster University, 1280 Main Street W, CRL-201, Hamilton, ON L8S 4K1, Canada.
    Affiliations
    Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada

    Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

    ICES, Toronto, Ontario, Canada
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  • Susan E. Bronskill
    Affiliations
    ICES, Toronto, Ontario, Canada

    Women's College Research Institute, Toronto, Ontario, Canada

    Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada

    Sunnybrook Research Institute, Toronto, Ontario, Canada
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  • Paula A. Rochon
    Affiliations
    ICES, Toronto, Ontario, Canada

    Women's College Research Institute, Toronto, Ontario, Canada

    Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada

    Division of Geriatric Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Samir K. Sinha
    Affiliations
    Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada

    Division of General Internal Medicine and Geriatrics, Sinai Health and University Health Network, Toronto, Ontario, Canada

    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    National Institute on Ageing, Ryerson University, Toronto, Ontario, Canada
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  • Veronique Boscart
    Affiliations
    Schlegel Research Institute for Aging, Waterloo, Ontario, Canada

    Institute of Technology and Advanced Learning, Conestoga College, Kitchener, Ontario, Canada
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  • Peter Tanuseputro
    Affiliations
    ICES, Toronto, Ontario, Canada

    Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

    Bruyère Research Institute, Ottawa, Ontario, Canada
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  • Jeffrey W. Poss
    Affiliations
    School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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  • Ahmad Rahim
    Affiliations
    Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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  • Jean-Éric Tarride
    Affiliations
    Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada

    Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

    Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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  • Julia Abelson
    Affiliations
    Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada

    Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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  • Andrew P. Costa
    Affiliations
    Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada

    Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

    ICES, Toronto, Ontario, Canada

    Schlegel Research Institute for Aging, Waterloo, Ontario, Canada

    Centre for Integrated Care, St. Joseph's Health System, Hamilton, Ontario, Canada

    Department of Medicine, McMaster University, Hamilton, Ontario, Canada
    Search for articles by this author
Published:August 22, 2022DOI:https://doi.org/10.1016/j.jamda.2022.07.018

      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

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