The Dangerous Gap: Why Ontario's 'Missing Middle' is Failing Seniors
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Experts warn that a lack of permanent funding for Enhanced Assisted Living is trapping seniors in unsuitable care and clogging long-term care waitlists.
Q: What is the "missing middle" in Ontario's seniors' care system?
A: As CBC Toronto first reported, the "missing middle" refers to older adults who require more support than standard home care can provide but do not yet have the level of need that requires a long-term care bed. This population is served by Enhanced Assisted Living (EAL), which provides wrap-around supports to keep seniors in the community.
Q: Why is the current lack of funding for this middle tier a problem for patients?
A: Dr. Samir Sinha, director of health policy research at the National Institute on Aging, told CBC Toronto that patients currently face a binary choice: they either stay in their own homes with only a few hours of home care per week or they end up in a nursing home. Eric Mariglia, senior director of public affairs at WoodGreen Community Services, told CBC Toronto that without these supports, clients often end up in hospitals or are placed on long-term care waiting lists.
Q: Could investing in this "missing middle" reduce the strain on the rest of the healthcare system?
A: Yes. A policy paper co-authored by WoodGreen, AdvantAge Ontario, and the Ontario Community Support Association suggests that EAL could keep thousands of seniors off long-term care waitlists. Specifically, WoodGreen's "cluster care" model—which features private rooms and 24/7 personal support workers for groups of eight to ten seniors—was shown to divert 83 percent of residents from entering long-term care homes.
Q: How does the cost of Enhanced Assisted Living compare to other care options?
A: According to Eric Mariglia, EAL costs the healthcare system approximately $92 to $169 per day. He told CBC Toronto this is about half the cost of long-term care and significantly cheaper than the cost of patients ending up in the hospital.
Q: What are the specific demands being made of the provincial government?
A: The report calls for the province to establish an official definition of Enhanced Assisted Living and to create a dedicated, permanent operating funding stream. Lisa Levin, CEO of AdvantAge Ontario, told CBC Toronto that while there are clear pathways to secure funding for hospitals or long-term care homes, no such pathway exists for EAL, leaving current models to rely on a "patchwork" of funding from various sources.
Q: How has the province responded to these concerns?
A: In a statement to CBC Toronto, Ministry of Health spokesperson Lily Barnes pointed to recent investments, including $5.6 billion this year for home and community care services, as well as roughly $724 million in provincial and federal funding for housing assistance and community housing. However, CBC Toronto noted that the statement did not directly address the specific questions raised in the policy paper.