Bill 108, More Homes, More…

Bill 108, More Homes, More Choice Act, 2019

The Ontario Long Term Care Association’s Submission to the Ministry of Municipal Affairs and Housing regarding Amendments to the Development Charges Act and Planning Act

May 31, 2019

Introduction

The Ontario Long Term Care Association is the largest association of long-term care providers in Canada and the only association that represents the full mix of long-term care operators – private, not-for-profit, charitable, and municipal. We represent nearly 70% of Ontario’s 630 long-term care homes, located in communities across the province. Our members provide care and accommodation services to more than 70,000 residents annually.

The Association supports the intentions of Bill 108, More Homes, More Choice Act, 2019, and the government’s goal to streamline the complex development approvals process to remove unnecessary duplication and barriers, while making costs and timelines more predictable. We are pleased to see new steps being taken to make it faster and easier to build the right types of housing services in the right places, to meet the needs of people in every part of Ontario. Further, we see long-term care as an indirect, but integral, part of the solution to ensure appropriate, affordable housing services for all Ontarians.

In fact, long-term care is often the only affordable, low-cost option for seniors who require care and cannot afford private care in their own homes or retirement home accommodations. More than 40 per cent of long-term care beds qualify for rate reductions based on residents’ income (based on the assumption that many C homes are offering a number of their preferred beds as basic).

Yet access to long-term care remains a real issue. Wait lists are growing at an astounding rate. As of February 2019, 34,834 Ontarians were waiting for a long-term care bed and the average time for placement was up to 161 days. Where seniors are unable to find a bed, they are cared for at home or in hospital. And that makes our problem a system problem.

On top of this, many of Ontario’s long-term care homes are 40 or more years old and some are nearing the end of their functional lives. These older homes feature three- and four-bed wards that do not meet the needs of residents, particularly those with Alzheimer’s disease and other dementias – a core population in long-term care. Ontario’s long-term care homes are getting older and we are not rebuilding them fast enough.

Approximately 300 homes (almost half of the province’s total homes), encompassing roughly 30,000 beds, are required to be redeveloped by June of 2025 to meet current design standards and provide greater comfort and safety for residents. In addition to these homes requiring redevelopment, the Government of Ontario has announced plans to develop an additional 15,000 beds over the next five years (and 30,000 over the next 10 years) to meet the existing and growing demand for care.

The government’s commitment to creating additional long-term care beds will help to further address the affordable housing requirements of thousands of the province’s frail and elderly seniors. However, the program implemented by the previous government to encourage redevelopment has been unsuccessful in allowing many long-term care operators to move forward.

As such, as the government moves forward with making amendments to schedules 3 and 12 (the Development Charges Act and Planning Act, respectively) the Association would like to draw the Ministry of Municipal Affairs and Housing’s attention to two key areas that, if addressed, would encourage redevelopment and the building of new long-term care homes, enabling the long-term care sector to more meaningfully contribute to tackling the housing crisis across the province.

Amendments to the Development Charges Act, 1997

With the understanding that Schedule 3 of Bill 108 proposes changes to the Development Charges Act that would make housing more attainable by reducing costs to build certain types of housing, the Association would like to bring forward its recommendation for an amendment to encourage more long-term care homes to move forward with redevelopment.

The issue

Long-term care homes, as defined in the Long-Term Care Homes Act, 2007, provide 24-hour publicly-funded services, including onsite nursing care and access to medical services, to OHIP-insured individuals over the age of 18 whose complex care needs can no longer be met by publicly-funded, community-based care. The provincial government provides a partial 25-year subsidy to long-term care homes to support resident care and home operations.

Development charges for long-term care homes are not eligible for subsidies because all homes in the province are allocated a standardized construction funding allocation by the provincial government. The allocation, however, does not cover the cost of development charges, as development charges vary significantly across the province – from $0 to more than $50,000 per long-term care bedroom.

In communities where these charges are prohibitive, operators will have no option but to move to another community with lower or no development charges, thereby reducing services for those requiring long-term care in the original community. It should also be noted that, as long-term care homes are significant employers within their communities, both directly by offering skilled, high-wage paying positions within the home, as well as indirectly by utilizing local businesses’ services, a move to new community will also have a significant local economic cost.

What’s needed?

Long-term care homes are similar to hospitals in that they both provide essential health services to Ontarians. Yet hospitals, as defined in the Public Hospitals Act, are currently included among the “exempted services” in this section. The Association believes long-term care should also be exempt.

It is recommended that the Government of Ontario include long-term care homes as defined in the Long-Term Care Homes Act, 2007, under the exclusion from all development charges set out in section 2(4) of the Development Charges Act.

Amendments to the Planning Act

With the understanding that Schedule 12 of Bill 108 proposes changes to the Planning Act that would help make the planning system more efficient and effective, increase housing supply in Ontario, and streamline planning approvals, the Association would like to bring forward its recommendation to allow long-term care homes to be permitted on employment lands.

The issue

To meet the needs of Ontario’s aging population and its increasing complex care needs, approximately 300 long-term care homes (30,000 beds) across Ontario require urgent redevelopment, and at least 30,000 new beds need to be added to the system. The current footprints for a majority of the existing homes are inadequate for redevelopment; green field sites will be required to accommodate larger footprints and meet design standards and code requirements. A typical long-term care home of a viable size requires a minimum of 3.5 acres. The price of land across much of the province – especially in urban centres – is prohibitive and represents a significant barrier for the redevelopment and development of long-term care beds in Ontario.

In municipalities where land is scarce, employment lands are the only properties available for redevelopment and development. These employment lands are often the only areas with large parcels of property available at a reasonable price. Currently, long-term care homes are not permitted use on lands designated as employment lands, even though long-term care homes employ far more individuals than other permitted uses (i.e. manufacturing facilities, storage facilities, automobile dealerships, retail, etc.). For example, just one 128-bed long-term care home would employ approximately 130 employees.

The designation of employment lands and the exclusion of long-term care as a permitted use of those lands has created significant barriers to the development and redevelopment of homes, and access to services in local communities. In one example, the lands on which a long-term care home had been built and operated were re-designated as employment lands. Now that the home is to be redeveloped, the municipality has advised the owner that the home cannot be redeveloped on that site because long-term care is not a permitted use of employment lands. This will have a significant impact on existing residents and staff, as well as on those requiring access to long-term care services and supports in that community in the future.

Excluding long-term care as a permitted use means there is no option but for an operator to relocate existing beds to another community, where land is more available and affordable, even if demand for services may be lower. This will have significant impact on access to long-term care services in the original community. Further, given that long-term care homes are significant employers within their communities, offering direct and indirect employment opportunities and driving local businesses, a move to a new community due to unavailability of affordable and appropriately sized parcels of land would have significant negative impact on the local economy.

What’s needed?

It is recommended that the Government of Ontario immediately include amendments to the Planning Act to allow long-term care homes to become a permitted use of employment lands.

The proposed change we recommend be made to the Planning Act to allow long-term care homes to be permitted in employment lands is as follows:

In section 1(5) of the Planning Act, add to the list under the heading “Uses re area of employment”:

(f) Long-term care homes as defined in the Long-Term Care Homes Act, 2007 (subject to an assessment of compatibility with adjacent uses)

Conclusion

The Ontario Long Term Care Association is a committed partner to government, not just in advancing Ontario’s health system but also to ensure appropriate housing services are available for all Ontarians, including seniors who require care. The Association strongly recommends that government implement the above changes as recommended, thereby improving the possibility for long-term care homes to redevelop and moving towards meeting the current needs of our seniors, which will continue to grow significantly over the next 20 years.