Originally published at The London Free Press

Most Ontarians can be excused for confusing retirement homes with long-term care homes. Both provide care to seniors, are regulated by government, and have roughly equivalent numbers of homes and residents across the province.

While some retirement homes focus on more independent seniors who require less care, others have stepped up their offerings in assisted living and dementia care — some even in palliative care — to become direct substitutes for long-term care homes.

A major difference between the sectors remains government funding. LTC homes receive funding from the Ministry of Health and Long-term Care of about $3,500 per month for each resident’s nursing, therapies and food. Retirement home residents, on the other hand, cover their care costs principally out of their own pockets. In both settings, the cost of accommodation or rent, as distinct from care, is generally the responsibility of the resident, though some LTC residents are eligible for subsidies based on income.

Both Premier Kathleen Wynne and Health and Long-Term Care Minister Helena Jaczek recently addressed an annual joint conference called Together We Care by recounting recent budget pledges directed at the long-term care sector, including 30,000 new beds over the next 10 years and a target of four hours of daily care per long-term resident. But the elephants in the room were the hundreds of representatives from the retirement home sector, who did not figure into any of this new funding.

How does this apparent inequity continue to exist? Part of the reason lies in the regulatory structure. Though the Retirement Homes Act prescribes standards, retirement homes are under the jurisdiction of a different ministry, the Ministry of Seniors Affairs, which does not have the financial resources of the Ministry of Health and Long-Term Care.

Numerous myths about retirement homes persist. One is that retirement home residents “choose” the private pay route and therefore the care costs that come with it. With respect, no one chooses to pay for care that is otherwise funded for others. More correctly, retirement home residents choose a domicile and begrudgingly pay the care costs that come with it.

The reality in Ontario is that many seniors enter or remain in a retirement home by default. The wait list of people assessed as eligible for long-term care beds numbers 34,000.

Another myth is that retirement home living is the expensive luxury of the affluent. But analysis shows that the average cost of high acuity care and accommodation in a retirement home in Ontario is competitive with that in a long-term care room of equivalent size. It is only after factoring in the government subsidy that the long-term care alternative becomes about half the cost of the retirement home room.

Ontario has a two-tier system for seniors’ residential care. By itself, this is not problematic. The real problem may be the lack of any means testing. Long-term care residents receive the same funding for care, regardless of how wealthy they are, and retirement home residents pay the full cost regardless of how poor they are. Without an adequate means test based on assets or income, the determination of who pays for care is based not on need, but on who is best able to navigate the system.

There are many ways to address this inequity. Some involve selfdirected care, where the person is afforded a budget based on their assessed need. Individuals can take their funding “voucher” to an eligible care provider instead of waiting for care dollars to trickle down to them.

The population of Ontarians over 90 is set to quadruple by 2040. Problems regarding funding will compound without policies to address equity of access to public dollars.

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