Policy Implementation and Funding Mechanisms Imperative to Addressing Ontario’s Housing Crisis for Older Adults

By Patricia Thangaraj

Creating affordable, accessible and socially designed housing for older adults in Ontario that will improve population health for this group is imperative in tackling the social determinants of health (SDH) that this demographic faces in order to improve health and health equity.

This would involve key Government, private, social services and community-based stakeholders playing a key role that would lead to applied research, policy changes, knowledge mobilization, capacity building, innovative architectural housing designs, and support systems, which cater to the health and social needs of older adults and the environmental needs of Ontario.

Founder and Managing Director of Collaborative Aging, Sue Lantz said that it is important that organizations lead their planning in a way that knows what government offers or does not so that they can capitalize on what they do offer, while also recognising how important it is for older adults’ health and social well being to be socially connected and live in places where care and other supports are accessible.

She said that when it comes to Government support, the Ontario Government is moving towards more neighborhood-based health care solutions, so the Naturally Occurring Retirement Communities (NORC) model aligns with this kind of frame and policy direction. However, she has not heard yet of any type of government funding dedicated specifically to increase the NORC-based model within the City of Toronto and Ontario overall, but she is hoping that this would change in the future.

She highlighted an example wherethe provincial government could fund a NORC-based model with specific program elements in it, such as the model developed by OASIS Supportive Senior Living.  This model includes elements of wellness programs, social supports, supports with some meals, and an on-site personal support worker (PSW). These are also elements that involve shared programming that is co-organized by the seniors themselves.  

This can include classes in fresh meal preparations if there are the shared kitchens in the building for example. The original Oasis model in Kingston, Ontario involved a partnership with a charity that delivered some of the supports such as hiring a PSW, but the tenant group also partnered with a private company to cater the fresh meals and mixed it with other service partnerships. However, the NORC-based model is directed by the older adults so they can collaborate with each other to come up with the types of services that they want to see implemented, Lantz said.

The Need for Government Funding Schemes for Home and Community Care

The Collaborative Aging Managing Director is hoping that the Ontario Government will announce funding schemes for neighborhood-based health care teams including a designated program or funding envelope for the ongoing care and supports that older adults need in their homes and communities.

She explained that when it comes to ongoing supports in the community, there are critical areas that need to be addressed both within the GTA and Ontario in general.

“From my home care field experience, locally and provincially, there are shortages of this type of funding all across Canada.  In Ontario, with the patients coming from hospitals back home, there has been an increased pressure on home care funding to provide this type of home care – short-term and acute homecare, as opposed to the longer-term, ongoing home care and community supports that enable older adults – and their caregivers – to remain in the community.”

So for example, if an older adult comes out of a hospital, they’ve had surgery, such as a hip replacement or cancer surgery; clearly that senior needs homecare for a period of time as he/she transitions back into his/her home environment.  However, increasingly the home care budget is going towards people that have these legitimate, acute care needs. But, at the same time, the population is aging and rising in numbers too.  Yet, the day-to-day supports and care that older adults need such as dressing, bathing, meal preparations, or help with managing their health conditions, or preventative healthcare, has not been a priority. This means that there is a gap in the community care setting.  However, dedicated funding from the Federal and provincial Governments for NORC-based models can allow for some growth and stability, explained Lantz.

This is why she was pleased when she saw the Twitter post by Jen Recknagel at the NORC Innovation Centre, that the Federal Government and the provinces were in discussions about the benefits of expanding NORC-based models of supports and care. Her hope is that the three levels of government will work together and make a commitment to develop stable funding mechanisms for home and community care, including NORCs.

“A couple of years back, the Federal Government announced some funding for Aging at Home, and I was hoping that they might consider funding for NORC models. There is both a wisdom and an efficiency of working with people that are all in one building such as a NORC.  Ultimately, its about governments making a commitment to funding the ongoing supports – and caregiver respite – that older adults need in the community.”

Currently there are almost 489 buildings, which is a mix of apartments, condos and other buildings in Toronto that are designated as NORCs.

The Future Toronto Mayor and Accessible, Affordable Housing for Older Adults

With the Toronto Mayoral By-Election, scheduled for July 26^th, I asked Lantz what she hoped to see from the successful candidate post-election.

Lantz said that the City of Toronto has actually been doing some great work already within their own buildings to recognize where NORCS exist, and to restructure how the city organizes and administers the supports to focus in on those buildings where many seniors on limited incomes are living.

“I would say that City staff have been working on engaging older adult tenants in their buildings, to talk about setting up more NORC based supports within those buildings. So, there has been some good leadership in that department within the City of Toronto that serves seniors, when it comes to the housing buildings the City directly funds.”

Nevertheless, there are sill shortcomings when it comes to areas such as architectural designs of buildings that would cater to the needs of an aging GTA population.

“Broadly speaking, for the large number of older citizens of Toronto that live in commercial rental buildings, or condo buildings, or neighborhood blocks, the City has not placed enough focus on incentivizing or supporting seniors getting ready to age in their buildings, including renovating for accessibility or common social spaces in a building where services could be added.”

In addition to structural design, accessibility and affordability are also important parts of the equation, said the Collaborative Aging Managing Director.

“The City of Toronto has created an effective, broad-based, Seniors Strategy 2.0, https://www.toronto.ca/city-government/accountability-operations-customer-service/long-term-vision-plans-and-strategies/toronto-seniors-strategy/ . But, when you look at the growing number of seniors, I feel that we need to do more, particularly in the supply of the right kind of housing for older adults to live in and age within their homes and communities such as accessibility and socially designed housing that is consistently affordable.”

Creating Socially Designed Housing for Older Adults in the GTA

Lantz explained that the housing that is currently being built in the City of Toronto is not beneficial for older adults. “There are several older adults living on limited incomes, yet housing in this city has become so expensive. The dominant form of new housing being created in the larger Canadian cities – including Toronto – is the high rise, multi-unit building. These very high-rise buildings are not exactly the kind of housing that is conducive to being socially connected with neighbours and for healthy aging.”

She said that even with modernized elements such as elevators and so on, older adults would still have difficult in these high-rises because as soon as there’s an emergency like a power outage, or a fire, the older adults would be caught in these high rise buildings and therefore, they are more at risk of not being able to get out. Also, many of the new high rises are not socially designed.  Research has also shown that people of different ages living in very high rises report higher levels of loneliness, an area where she has researched thoroughly.

Fortunately, it is possible to design multi-unit buildings in ways that are conducive to social connections, spontaneous social contact, and offer places where seniors can convene such as common rooms, a garden or another outdoor space, or even the foyer design. Accessibility features in buildings, and the units themselves, are also vital to aging in place, and successfully implementing NORC-based models, said the Collaborative Aging Managing Director.

In addition, the three levels of government – federal, provincial and municipal – could provide capital funding for the owners of NORC-based buildings to make adjustments to their existing units such as bathroom renovations, common living spaces for older adults to engage in various events, and other social gathering and accessible common spaces, that would enable more NORC-group based supports like physical therapy, she added.

All of these initiatives would lead to more positive mental and physical health outcomes for older adults in the City of Toronto. However, the question remains as to who would fund these projects.

“I guess I am asking the question about who will pay for these types of changes in multi-unit buildings?  Will it be government subsidizing or funding, will it be the commercial housing operator and/or property manager, or government providing grants or rebates to citizens and asking them raise or locate funds for all of the above?”

Right now, citizens can apply for a small provincial and/or federal tax rebate for “age-readiness” https://www.ontario.ca/page/seniors-home-safety-tax-credit or for home accessibility/safety outfitting.  In Ontario, you have to spend $10,000 to get $ 2,500.00 back. And, the Federal Government has announced a tax rebate too. https://www.canada.ca/en/revenue-agency/programs/about-canada-revenue-agency-cra/federal-government-budgets/budget-2022-plan-grow-economy-make-life-more-affordable/home-accessibility-tax-credit.html. Another option would be having older adults living in NORC buildings pool their tax credits for higher impact to create accessibility features or social spaces, she stated.

The Impact of Climate Change on Individual and Population Health

Lantz said that nowadays with climate change and it’s resulting more extreme weather patterns, organizations’ capacity to create affordable, accessible and socially designed housing applies to people of all ages, but it takes on an even greater significance for older adults because severe humid temperatures such as those associated with the summer season, is of greater risk to seniors. The rising costs of electricity and lack of air conditioning in some buildings definitely disproportionately impacts lower income people, including older adults. This in turn affects the federal, provincial and municipal governments’ capacity to achieve population health.

“Climate change, and more extreme fluctuations in temperatures like very hot weather, increases the necessity for proper air conditioning as a basic necessity of life for people of all ages. But, with aging, frailty, and more complex health conditions, older adults are extremely vulnerable, without air conditioning. There is a greater risk of dehydration and overheating, and there is a higher risk of death among seniors. As such, it is vital for care facilities such as long-term care homes, to have air conditioning,” explained Lantz.

This then begs the question as to how many long-term care and other senior residential facilities in the City of Toronto have air conditioning. “We should also ask the question: ‘Of those 489 buildings in Toronto, where NORCS exist, are all of these buildings equipped with air conditioning?’  This could be an important part of the capital repairs and improvement planning work. Some capital repairs are needed, including air conditioning and accessibility features. Common space renovations in buildings are the types of pragmatic and valuable preparation for buildings identified as NORCs.”

This calls for Government leaders at all three levels of Government to step forward and take accountability for ensuing that these renovations occur, said Lantz. “We need leadership on making the retrofits and changes that are needed for the air quality, heat, and air conditioning. We saw that during COVID-19, how air quality systems became even more important.”

The Collaborative Aging Founding Director said that there is some work to do in this regard as these factors significantly affect population health in light of the rising number of older adults. There are still a few LTC homes in Ontario, and beds that were built decades ago, that weren’t up to standards back in the early 2000s like the 2001-2003 period.  This was during the time when the Ontario Government funded and developed 20,000 new LTC beds. 

At that time, this brought the total number of LTC beds to around 80,000.  But, during COVID-19, this capacity was reduced. As many of the four-bedrooms located in the older LTC homes, were decommissioned. The latest LTC home physical design standards in Ontario call for a private room or a semi-private room. That’s all you can build now. However, with that being said, the older LTC homes, have not caught up to the new design standards in several ways.

The Importance of Forming Social Connections for Health Aging

Lantz said that constructing and organizing aging in place supports in NORC buildings can help older adults form new social connections within their buildings – including through the process of co-arranging these kinds of things. She highlighted an example where older adults decide which social activities they want and then – with the help of the building facilitators – plan these events. This could include activities like an exercise program, a game nights, a learning event, or a movie night.

“Organizing and hosting these types of activities in their residential buildings can help older adults get to know their neighbours more so that they can then call upon one another when they need help.  Of course, these contacts don’t mean they will become best friends. But having a number of social connections is really key to successful aging because they have people that they can call upon, that they are familiar with and visa versa. And that is really an important part of healthy aging in any community. When you think of younger people, this is true too. You need those social relationships within buildings and knowing who some of your neighbors are. Certainly for older adults, NORCs can be a mechanism for helping seniors to grow and strengthen their social neighbourly connections,” explained the Collaborative Aging Founder.

Addressing Urgent Social Determinants of Health to Reduce Health Inequities/Advance Population Health

Lantz said that the one of most pressing social determinants of health (SDH) that she sees right now in Ontario is housing and physical environments. The lack of the right type of affordable housing for older adults to live in as they age, is a concern that federal, provincial and municipal policy makers must address. The right type of housing includes things like social and accessibility features, said Lantz.

This right type of housing would allow older adults to live safely, as their physical needs change.  And, when they don’t have the safety of a home, or a roof over their head, everything else is negative impacted, such as their health, their mental well-being, their personal and financial security, and their safety, she stated.

On that note, Lantz said that “there needs to be an accelerated effort on housing, as the housing shortages cannot be fixed immediately.  We actually need the commitment of a variety of players, with government leadership and more funding to solving these challenges.”

With this in mind, she said that she was pleased to learn about the recent announcement that the Anglican Church Diocese in Toronto, Home – The Diocese of Toronto signed a partnership with Kindred Works Our Projects – Kindred Works – to unlock new opportunities to create housing on church properties.

The Collaborative Aging Founder added that the demand for housing units like the NORC-based model, will increase among older adults interested in living in a place that has the benefits of a caring surrounding community and support services, which are available on site. This in turn will help to address yet another SDH, which is their need for appropriate social supports and coping skills.

Another related SDH is the lack of access to health services, stemming from shortages in health care workers. This creates health issues for everyone residing in this province, but it is especially a concern for older adults given the various health conditions that increase with age. This can then lead to yet another SDH, which is older adults’ capacity to engage in heathy behaviours.

Accessible and Affordable Housing: Why Toronto Needs a Plan Similar to Hamilton

Lantz said there are certain neighbourhoods or pockets of towns such as the Yonge and St. Clair Mid-town area, where there are a higher number of people over the age of 65, and an even greater concentration of people over the age of 80. The city creates maps of different parts of Toronto, and the population statistics. However, over the last few years, particularly during and now after COVID, the demographics are changing rapidly as more aging boomers have moved out of the GTA. 

Capitalizing on NORC-based models is one of the ways forward for older adults who want to co-organize the range of types of supports and services that would allow them to stay in their homes for as long as possible as they age.  But growing the NORC-based model also relies heavily upon having a stable supply of enough accessible, socially designed, and affordable housing units.

On that note, the Ontario Government did announce some funding for the development of a supportive housing project in Hamilton, Ontario, which was funded through a social fund oriented to the COVID-19 relief funding. So, it was not a typical housing funding source, she said. https://news.ontario.ca/en/release/1003102/ontario-providing-more-supportive-housing-in-hamiltonhttps://news.ontario.ca/en/release/1003102/ontario-providing-more-supportive-housing-in-hamilton

Overall, the NORC-based model is gaining priority attention by the different levels of government, but she didn’t have more details to provide at the time of the interview.

She stated however, that the NORC Innovation Centre, and the team at the National Institute on Ageing (NIA) at the Toronto Metropolitan University (TMU) have been advocating strongly with governments and therefore, would know more about the government plans and proposals.  Other groups and organizations that are involved in advising the three levels of governments are the research teams at Queen’s University, the University of Toronto, including Age Lab, and researchers at the Women’s College Hospital (WCH).

Currently, there are two different national research projects underway on NORCs that these organizations are leading. She said that NORC-based models have reached a tipping point, with better evidence and more public interest within Canada. She is hoping that this would lead to politicians seeing their value and making the required commitments and investments.

Healthy Aging in Place for Older Adults in Seniors’ Communities

Enhancing social, health, and environmental benefits and building strong, connected and inclusive communities for older adults in Ontario is imperative. A critical component of this would be getting community and other sector organizations to partner with organizations involved in working with and advising Governments on appropriate housing for older adults.

A good starting point for groups and organizations interested in constructing new buildings, or renovating their current buildings into NORC-type facilities, is NORC Ambassadors website https://norcambassadors.ca/. The NORC Ambassadors Program may also offer some seed funding to help these groups and organizations form NORC based initiatives, which can be a good catalyst for helping them launch their NORCs, said Lantz. 

The NORC Ambassador website also provides a “Seniors Empowering Seniors” toolkit, for planning various supports for aging in place. This Ambassadors Program is therefore an excellent resource kit. Lantz’s Options Open Guide https://optionsopen.org/ can also be a resource for groups and organizations considering their various options. 

Another initiative that Lantz worked on was a national research project on citizen-led housing involving older adults.  They created a team of older adults, developers and field experts to examine the importance of accessibility and sociability, inclusiveness and affordability of a wider set of housing options, that can be led by older Canadians in collaboration with developers.  The website about the findings from this research project is www.co-createhousing.com

The Collaborative Aging Founder concluded that accelerating the housing co-creation process to look at supporting the development of the right kind of housing for aging in place in GTA communities is imperative. Larger companies have easier access to financing and capital, or other financing related aspects such as the Canada Mortgage and Housing Corporation (CMHC) loan and mortgage insurance. However, smaller non-profits, community, faith-based, cultural, and co-housing groups, face bigger barriers in creating housing for older adults living in the GTA, even when they have land and/or resources, and this is an area that needs to be addressed by federal, provincial and municipal government funding mechanisms in the near future.