Experts have identified a "missing middle" in Ontario’s seniors' care and housing continuum that could keep thousands of older adults off long-term care waitlists and cut institutional costs in half.
Enhanced Assisted Living (EAL) serves older adults who need more help than home care can provide, but do not yet require a long-term care bed.
Eric Mariglia is senior director of public affairs at WoodGreen Community Services, which just co-authored a new policy paper outlining the benefits of EAL and calling on the province to scale successful models.
"We're supporting clients that, without these wrap-around supports, often then end up in the hospital or put on a long-term care waiting list," he told CBC Toronto. "We're alleviating pressure off of the hospital, off of long-term care, and serving clients in the community where they want to be."
The report — a joint effort between WoodGreen, the Ontario Community Support Association and AdvantAge Ontario — outlines 20 years of successful EAL models but notes the concept remains a patchwork of one-off services. It calls on the province to introduce an official definition and to create a dedicated, permanent operating funding stream.
In a statement responding to the report, Ministry of Health spokesperson Lily Barnes highlighted recent government investments, including $5.6 billion from the province this year to strengthen and expand home and community care services and approximately $724 million in provincial and federal funding for community housing, housing assistance and other supports.
The statement did not directly address questions about the policy paper.
The report looked at five EAL models, including WoodGreen’s own "cluster care" model — where eight to 10 seniors live in a complex with private rooms, shared living and dining rooms, and round-the-clock personal support workers. This model was shown to divert 83 per cent of residents from entering long-term care homes.
It also found that widespread EAL programming would cost taxpayers much less than the current system which focuses mostly on long-term care.
"EAL costs the healthcare system about $92 to $169 per day," Mariglia said. "That's around half the cost of long-term care and of course a lot cheaper than those clients ending up in the hospital with nowhere to go."
Dr. Samir Sinha, director of health policy research at the National Institute on Aging, told CBC Toronto he’s been calling for more investment into EAL — or supportive housing services — for years.
"For a lot of my patients, it's either you're in your own home getting a few hours a week of home care or you end up in a nursing home. It's one or the other," he said. "We haven't spent enough time in Ontario thinking about how we build out that 'missing middle.'"
While acknowledging there is still a need for more long-term care facilities, Sinha feels the province needs to shift its focus to accommodate this gap.
"When the government says we're going to spend $6.4 billion to build 30,000 long-term care beds, that's where all the oxygen in the room goes," he said. "If we took a fraction of that money and invested it in home and community care, we'd actually divert thousands of people from ever needing those beds in the first place."
Lisa Levin, CEO of AdvantAge Ontario, told CBC Toronto the current system creates a series of barriers for new EAL projects.
"If you want to build a long term care home, there's a department you can go and talk to. If you want to build a hospital … you go to the Ministry of Health and talk to them," she said. "There's no pathway to get that kind of funding."
Levin acknowledged that most existing EAL models have secured some government funding, but described it as a patchwork of "knit-together funding from different sources."
She also highlighted the part of the report that shows, with the appropriate funding channel, new EAL programs could be rolled out across the province very quickly.
"You could take existing buildings and retrofit some of the units to create the kind of cluster living model that this is calling for," Levin said. "You don't necessarily have to construct a whole new building."
Getting this done is also a matter of urgency, she added, noting that Ontario’s senior population is expected to grow to 4.6 million people in the next 25 years — that’s up from 3 million documented in 2024.
