-
2Financial Accountability Office of Ontario | fao-on.org
Report was released in October of 2019
Reviews the Province’s commitment to add 15,000 new long-
term care beds (the LTC expansion).
The report:
▪ Explains how long-term care is funded by the Province
▪ Estimates the cost of the LTC expansion
▪ Analyzes how the LTC expansion will affect the wait list
and
wait times for long-term care
▪ Discusses how individuals waiting for long-term care
impact
hospital capacity and hallway health care
Overview
-
Background:
Long-Term Care in Ontario
3Financial Accountability Office of Ontario | fao-on.org
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4Financial Accountability Office of Ontario | fao-on.org
Long-Term Care in Ontario
There are 626 long-term care homes in Ontario that
house over 78,000 residents.
Most LTC residents are over the age of 75 and live with
conditions that have compromised their health.
LTC homes must be licensed by the ministry and can
be for profit, not for profit or municipal organizations.
-
5Financial Accountability Office of Ontario | fao-on.org
▪ In 2018-19, there were nearly 35,000 Ontarians on the wait
list for long-term care.
▪ The wait list for long-term care has grown substantially since
2011-12, increasing by
78 per cent.
The Wait List for Long-Term Care Has Increased
19,615 20,666 21,439
22,434
26,737
30,713 32,773
34,862
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18
2018-19
Lo
ng
-Term
Care
Wait L
ist
-
6Financial Accountability Office of Ontario | fao-on.org
▪ From 2011-12 to 2018-19, the median time to placement (or wait
time) for a long-
term care bed increased from 99 days to 152 days.
Time to Placement for LTC Has Also Increased
99
133126
111 113
133
146152
0
20
40
60
80
100
120
140
160
2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18
2018-19
Days
to
Pla
cem
en
t
-
7Financial Accountability Office of Ontario | fao-on.org
▪ High growth in the number of Ontarians aged 75 and over
combined with a lack of
investment in new long-term care beds.
▪ Between 2011 and 2018, the number of long-term care beds in
Ontario increased by only
0.8 per cent while the population of Ontarians aged 75 and over
grew by 20 per cent.
Why Did The Wait List and Wait Times Increase?
78,053
876,886
78,664
1,053,097
800,000
850,000
900,000
950,000
1,000,000
1,050,000
1,100,000
70,000
72,000
74,000
76,000
78,000
80,000
82,000
84,000
86,000
88,000
90,000
Long-Term Care Beds (left axis) Ontarians Aged 75+ (right
axis)
2011 | 20182011 | 2018
0.8% growth
20% growth
-
How Does the Province Fund
Long-Term Care?
8Financial Accountability Office of Ontario | fao-on.org
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9Financial Accountability Office of Ontario | fao-on.org
▪ The Province funds long-term care through the long-term care
homes program,
spending $4.3 billion in 2018-19.
▪ The Long-Term Care Homes program area represented 7 per cent
of health
sector spending in 2018-19.
Long-Term Care Homes Program Spending
Hospitals;
22.2; 35%OHIP (Physicians
and Practitioners),
14.9, 24%
Ontario Drug
Programs;
4.8; 8%
Long-Term Care Homes;
4.3; 7%
Community Programs;
6.2; 10%
Other Programs,
8.0, 13%
Capital;
1.9; 3%
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10Financial Accountability Office of Ontario | fao-on.org
▪ LTC home operators receive payments from the Province based on
the number of
beds in operation and the type of services provided.
▪ LTC home operators also receive payments from residents which
vary based on
the type of accommodation.
o LTC home operators remit the cost of basic accommodation to
the Province to offset
some of the program cost.
Long-Term Care Homes Program Spending
Category $ millions %
Nursing and Personal Care 2,919 50
Program and Support Services 279 5
Raw Food 268 5
Basic Accommodation 1,595 27
Total LOC Per Diem 5,062 87
Supplementary Funding Programs 764 13
Total Cost of Long-Term Care Homes Program 5,826 100
Less: Resident Co-payments -1,537
Net Cost to Province of Long-Term Care Homes Program
4,289
2018-19 long-term care homes program spending by category, $
millions
Note: Excludes payments made by residents that are retained by
LTC home operators (e.g. for semi-private and private
rooms).Source: Information provided to the FAO by MLTC.
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11Financial Accountability Office of Ontario | fao-on.org
▪ From 2011-12 to 2018-19 long-term care homes program spending
grew by an annual
average of 2.5 per cent, increasing from $3.6 billion in 2011-12
to $4.3 billion in 2018-19.
▪ Level of care per diem funding increased at an annual average
of 2.1 per cent which is
slightly higher than the rate of inflation over the same time
period at 1.7 per cent.
▪ Supplementary funding increased at an annual average of 4.2
per cent.
Long-Term Care Homes Program Spending
$ billions 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17
2017-18 2018-19Average Annual
Growth
Nursing and Personal Care 2.5 2.5 2.6 2.6 2.7 2.7 2.8 2.9
2.3%
Program and Support Services 0.2 0.2 0.2 0.3 0.3 0.3 0.3 0.3
2.4%
Raw Food 0.2 0.2 0.2 0.2 0.2 0.2 0.3 0.3 3.6%
Basic Accommodation 1.4 1.5 1.5 1.5 1.5 1.5 1.6 1.6 1.5%
Total LOC Per Diem 4.4 4.4 4.5 4.6 4.7 4.8 4.9 5.1
2.1%Supplementary Funding Programs 0.6 0.6 0.7 0.7 0.7 0.7 0.7 0.8
4.2%
Total Cost of Long-Term Care Homes Program
4.9 5.0 5.2 5.3 5.4 5.5 5.6 5.8 2.4%
Less: Resident Co-payments -1.3 -1.4 -1.4 -1.4 -1.5 -1.5 -1.5
-1.5 2.1%
Net Cost to Province of Long-Term Care Homes Program
3.6 3.7 3.8 3.9 3.9 4.0 4.1 4.3 2.5%
Number of Beds 78,053 77,444 77,862 78,006 78,340 78,357 78,517
78,664 0.1%
Long-term care homes spending, 2011-12 to 2018-19
Source: Information provided to the FAO by MLTC.
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Timing and Cost of
the LTC Expansion
12Financial Accountability Office of Ontario | fao-on.org
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13Financial Accountability Office of Ontario | fao-on.org
▪ In July 2018, the Province announced its commitment to add
15,000 new long-term
care beds over the next five years.
▪ The 15,000 new beds represent the first meaningful increase to
the supply of long-
term care beds in over 15 years.
▪ The process for building or redeveloping a long-term care bed
in Ontario begins
when the LTC home operator signs a development agreement with
the Ministry of
Long-Term Care.
▪ It takes approximately three years from the execution of a
development agreement to
when the first resident occupies a new bed.
Long-Term Care Expansion
-
14Financial Accountability Office of Ontario | fao-on.org
Long-Term Care Expansion Timing▪ As of October 2019, the
Province had allocated 7,889 of the 15,000 beds.
▪ If the remaining beds are allocated by March 2021, all 15,000
beds could be in
service by 2023-24.
1,030
6,134
2,757
5,079
15,000
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
2020-21 2021-22 2022-23 2023-24 Total
Nu
mb
er
of B
ed
s
-
15Financial Accountability Office of Ontario | fao-on.org
▪ The 15,000 new beds will not impact long-term care program
spending until each
bed comes into service and begins to receive LOC per diem
payments and
supplementary funding.
• The supplementary funding includes payments to subsidize the
construction of the
bed over 25 years.
• As of 2019, a newly constructed bed that is in operation is
eligible to receive a daily
payment of between $18.03 and $23.03 over 25 years to cover the
cost of
construction.
• In total, the FAO estimates the construction of the 15,000 new
beds will cost the
Province $2.0 billion (in 2019 dollars) or about $135,000 (in
2019 dollars) per bed.
Long Term Care Expansion Cost
-
16Financial Accountability Office of Ontario | fao-on.org
• LTC homes program spending will increase by a total of $1.7
billion over five years,
as new beds come into service.
• Once all 15,000 beds are in service provincial spending will
increase by an ongoing
annual amount of approximately $970 million.
Long Term Care Expansion Cost
($ millions) 2019-20 2020-21 2021-22 2022-23 2023-24 TotalLTC
homes program spending increase for 15,000 new LTC beds
0 14 350 505 863 1,732
15,000 new beds will increase LTC homes program spending by $1.7
billion over five years
Source: FAO.
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17Financial Accountability Office of Ontario | fao-on.org
▪ LTC homes program spending will grow at an annual average of
5.4 per cent over the
next five years, increasing from $4.3 billion in 2018-19 to $5.6
billion in 2023-24.
▪ LTC homes program spending growth will accelerate in 2021-22
as over 6,000 beds
are expected to come into service in that year.
LTC Homes Program Spending Forecast
4.34.4 4.4
4.9
5.1
5.6
3.0
3.5
4.0
4.5
5.0
5.5
6.0
2018-19 2019-20 2020-21 2021-22 2022-23 2023-24
Lo
ng
-Term
Care
Exp
en
se
-
Effect of the LTC Expansion on
the Wait List and Wait Times
18Financial Accountability Office of Ontario | fao-on.org
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19Financial Accountability Office of Ontario | fao-on.org
▪ The 15,000 new long-term care beds will increase the supply of
long-term care spaces
in Ontario from 78,700 in 2018-19 to approximately 93,700 in
2023-24.
Number of LTC Beds
78,66479,694
85,828
88,585
93,664
70,000
75,000
80,000
85,000
90,000
95,000
2019-20 2020-21 2021-22 2022-23 2023-24
Nu
mb
er
of B
ed
s
-
20Financial Accountability Office of Ontario | fao-on.org
▪ The wait list is projected to increase over the next five
years despite 15,000 new beds.
• The wait list is expected to peak in 2020-21, before most of
the new beds are opened.
Long Term Care Wait List Projection
34,862
37,229
40,206
37,664
38,456
36,876
30,000
32,000
34,000
36,000
38,000
40,000
42,000
2018-19 2019-20 2020-21 2021-22 2022-23 2023-24
Lo
ng
-Term
Care
Wait lis
t
-
21Financial Accountability Office of Ontario | fao-on.org
▪ High growth in Ontarians aged 75 and over will lead to
long-term care demand
outpacing the 15,000 new beds.
▪ The number of Ontarians in need of a long-term care bed
placement is expected to
increase by 17,000, outpacing the 15,000 new beds.
▪ From 2018-19 to 2023-24, the number of Ontarians aged 75 and
over is projected to
grow by an annual average of 4.3 per cent.
Reasons for Wait List Increase
2.8%
4.3%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
2013-14 to 2018-19 2018-19 to 2023-24
Avera
ge A
nn
ual G
row
th
-
22Financial Accountability Office of Ontario | fao-on.org
▪ The FAO projects a decrease in wait times by 2023-24.
Long Term Care Wait Times Projection
152159
179
158 159
140
0
50
100
150
200
250
2018-19 2019-20 2020-21 2021-22 2022-23 2023-24
Days
to
Pla
cem
en
t
-
23Financial Accountability Office of Ontario | fao-on.org
▪ The Ministry of Long-Term Care does not have a target or
benchmark for the wait list
or wait times.
▪ Health Quality Ontario (HQO) publicly reports on five LTC
indicators that currently
have targets or benchmarks.
▪ While median time to placement (or wait times) is an indicator
measured by HQO, and
reported publicly, HQO has not identified an appropriate target
or benchmark for LTC
wait times.
Program Targets and Benchmarks
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24Financial Accountability Office of Ontario | fao-on.org
▪ Compared to British Columbia and Alberta, Ontario has
significantly longer wait
times for a long-term care bed.
▪ In British Columbia, there are 28,000 long-term care beds with
a wait list of about
1,400 people and a median time to placement of 12 days.
▪ Alberta has a target of placing 65 per cent of patients into
continuing care within
30 days.
o In 2017-18, Alberta fell short of the target, placing only 52
per cent of clients within the 30-day window.
o Less than three per cent of long-term care homes in Ontario
place 50 per cent of clients within 30 days.
Comparison to Other Jurisdictions
-
Long-Term Implications
25Financial Accountability Office of Ontario | fao-on.org
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26Financial Accountability Office of Ontario | fao-on.org
▪ Beyond 2023-24, high growth in the number of elderly Ontarians
will continue.
▪ To maintain the projected wait list at 36,900 Ontarians, the
Province would need to add
55,000 more LTC beds by 2033-34.
Long-Term Implications
4.3% 4.2%
3.0%
4.7%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
5.0%
2018-19 to 2023-24 2023-24 to 2033-34
Avera
ge A
nn
ual G
row
th
75+ Population Growth 85+ Population Growth
-
Impact on Hallway Healthcare
27Financial Accountability Office of Ontario | fao-on.org
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28Financial Accountability Office of Ontario | fao-on.org
▪ “Hallway health care” refers to the estimated 1,000 patients
receiving care in
unconventional hospital spaces in Ontario on any given day.
▪ Patients are in unconventional spaces partly because hospital
beds are occupied by
patients waiting to go elsewhere (e.g., long-term care or
rehabilitation facility).
▪ In November 2018, over 4,600 of the Province’s 34,000 hospital
beds were occupied by
patients waiting to go elsewhere.
Hallway Health Care
-
29Financial Accountability Office of Ontario | fao-on.org
▪ ALC patients waiting for long-term care wait much longer than
other ALC patients.
▪ In 2017-18, patients waiting in hospitals for a long-term care
placement occupied
340,000 hospital bed days or about five per cent of all hospital
bed days in Ontario.
▪ In 2017-18, patients waiting in hospitals for long-term care
beds cost the Province
approximately $170 million.
LTC Wait Times Contribute to Hallway Health Care
Acute Care Days ALC DaysTotal average length
of stay in hospital
ALC patients waiting for a long-term
care bed15 54 69
All other ALC patients 14 15 29
Average hospital length of stay for ALC patients in Ontario
Source: Information provided to the FAO by MLTC.
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30Financial Accountability Office of Ontario | fao-on.org
• LTC beds are being placed in areas of the Province with the
longest LTC wait lists and
most hospital capacity occupied by patients waiting for an LTC
placement.
• However, the FAO projects that the wait list and wait times
for LTC will peak in 2020-21.
o This implies that, in the absence of other health sector
changes, the problem of hallway health care will get worse over the
next two years.
• By 2023-24, the FAO projects that wait times will drop below
2018-19 levels.
o If this also reduces the number of hospital bed days occupied
by patients waiting for an LTC bed, then, all else being equal,
there could be an improvement in hallway health care by
2023-24.
Will the LTC Expansion Help End Hallway
Health Care?
-
2 Bloor Street West, Suite 900, Toronto, Ontario, M4W 3E2
416.644.0702
[email protected]
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