Dissertation (Doctoral) Ontario’s Retirement Homes and Long-term Care Homes: Policy Implications for Care Services, Funding and Governance Regimes


Blair A. Roblin


Abstract Purpose: The Province of Ontario is experiencing substantial growth in the seniors’ population requiring care, with capacity, cost and regulatory pressures across all settings. This study compares long-term care homes (LTCHs) and retirement homes (RHs), significant residential care alternatives for seniors in Ontario, regarding pricing, levels of care and availability of services, in the context of different government funding and regulatory oversight. Attention is given to the way owners of homes shape their services in response to prevailing policy instruments and other environmental factors. Methods: The research uses an explanatory sequential mixed methods design, with a first phase involving the analysis of quantitative data regarding LTCHs and RHs, and a second phase involving qualitative (interview) data from key informants. The first phase informs the interview questions for the second phase, with integration occurring after Phase 2. Results: Substantial overlaps exist in the characteristics of the two resident populations (LTCHs and RHs), which are most evident among the population of seniors requiring high levels of care and support. However, the two sectors are funded and regulated differently, which affect how services are delivered. Most care costs in LTCHs are publicly funded, while residents in RHs generally cover these expenses personally. Equity of access issues arise from shortages of beds in LTCHs and limited government funding for care services in RHs. LTCH owner strategies are affected by excess demand for beds and by regulatory instruments that limit profit for care and accommodation. With RHs, more flexible owner strategies are evident for care levels, pricing and location. However, without public funding, availability and affordability of RHs to the resident suffer and owner strategies focus on areas of higher income, population density or community infrastructure. The two sectors are also regulated differently in respect of care standards, security and enforcement. Conclusions: Policy instruments influence the features of residential care service offerings by shaping how the owners of seniors’ residential care offer services, with important consequences regarding access to those services. Policy instruments play an important part in determining the availability and affordability of seniors’ residential care, and consistency of governance.


Raisa Deber