When planning ahead, most older people will say they want to stay in their own home until the end of life. While this may be their goal, the reality is that care needs can escalate rapidly and become more complex, requiring specialized caregivers. Depending on the resources available to pay for caregivers, the breakpoint for decision-making is often twofold: the ability to manage multiple service providers in the home and the escalating cost of care. For most people, paying $20,000 to $30,000 per month for private caregivers is not sustainable. It prompts a decision to either move the family member to an Assisted Living program in a private Retirement Home setting or transfer them to a publicly subsidized Long-term Care Home.

Why can’t I get my parent into a Long-term Care Home immediately?

The short answer is that there are too many people waiting and not enough spaces available. According to the Ontario Long-Term Care Association (OLTCA), one in five seniors over the age of 80 has complex care needs that are better suited to a long-term care setting. However, in the last 10 years, the wait list has doubled in Ontario, and there are now an estimated 50,000 people waiting for long-term care home placements. [1]

To serve the number of people currently on the waiting list, the OLTCA estimates that 30,000 new spaces are needed. And due to growing demand, an additional 48,000 spaces will be required by 2029.

As of July 2025, the Government of Ontario had 148 projects with 24,101 new and redeveloped long-term care spaces either completed, under construction, or approved to move forward. The projects are part of a government commitment to build 58,000 new and upgraded spaces by 2028. Even if those spaces are delivered, we will still be approximately 20,000 spaces short by 2029. [2]

What is the profile of someone who needs long-term care?

The person may have complex care needs, involving multiple body systems and requiring round-the-clock supervision and specialized caregivers, such as nurses for wound care. There is a higher level of care required, and individuals typically need assistance with more than 10 medications per day. Many people with significant cognitive impairments require assistance with mobility and, typically, with Activities of Daily Living (ADLs) such as toileting, bathing, eating, and dressing. And the caregiver at home may be burned out or simply unable to cope with the complex needs.

Do people get admitted faster into Long-term Care Homes from the hospital?

According to data published by Health Quality Ontario, it appears that people are currently transferred more quickly into long-term care spaces from hospitals than from their homes in the community. At the provincial level, the mean wait time for transfer from the hospital is 72 days, and for transfer from the community, it is 200 days. [3]

Looking at a few examples of local sites, Baycrest Centre for Geriatric Care in Toronto shows a mean of 336 days from hospital versus 428 days in the community. West Park LTC in west Toronto shows 182 days from hospital versus 231 days in the community. Wyndham Manor in Oakville shows 47 days from hospital versus 163 days in the community.

Once admitted to the hospital, there appears to be significant confusion about hospital policies regarding discharge from the hospital to long-term care. Different hospitals seem to have different policies for interpreting Bill 7 – More Beds, Better Care Act, 2022. For example:

1. Patients who require admission and are fully eligible for long-term care might be told that they must be discharged from the hospital and wait “in the community” since the hospital needs the acute care bed. It may be suggested that they be discharged home under the “Home First” policy with increased care from Ontario Health at Home. What they do not realize is that this “increased care” is for a defined period of time, and then the services are reduced. However, the ill person still requires that care and families resort to paying for more private services to replace the previously promised government services.
2. Another common occurrence is that families are told that if the patient cannot be taken home, then they must go to a Retirement Home to wait. Yet if a person already requires a level of care that meets eligibility for long-term care, then many Retirement Homes simply cannot deliver that level of care. Families are told that they can pay the Retirement Home for their regular room and services and then hire additional private caregivers to “top up” the care for their older parent. This can result in substantial monthly fees.

What many families do not realize is that when a person has been approved for eligibility and requires admission to a Long-Term Care Home while in hospital, they are immediately placed in the “Crisis Category” for placement. However, if the family moves the person out of the hospital back to their home in the community, or they move them to a Retirement Home, they may no longer be deemed a crisis placement and drop down the priority list.[4]

If placement in a Long-Term Care home is part of your planning, consider starting the admissions process as soon as eligibility is confirmed. Anticipate escalating care needs and develop a crisis plan to bridge the extended period between home and admission. And pack your patience.

[1] https://www.oltca.com/about-long-term-care/the-data/

[2] https://budget.ontario.ca/2025/chapter-1b-services.html#:~:text=at%20that%20site.-,Building%20Long%2DTerm%20Care%20Homes,upgraded%20to%20modern%20design%20standards.

[3] https://www.hqontario.ca/system-performance/long-term-care-home-performance

[4] www.ACELAW.ca  https://www.acelaw.ca/wp-content/uploads/2023/10/Discharge-from-Hospital-to-Long-Term-Care-in-the-Wake-of-Bill-7-Important-Information-You-Need-to-Know.pdf