In their wish list for Ontario’s 2020 funding, advocates at Advantage Ontario are asking the provincial government to support more “campuses of care” for seniors.

Lisa Levin, CEO of Advantage Ontario, said campuses give seniors a range of housing options as they age, including assisted living, affordable housing, retirement homes, life leases and long-term care.

“One of the benefits of campuses is that you get seniors with different abilities together in one area,” said Levin, whose association represents not-for-profit, charitable and municipal homes for seniors. “They can share different services and supports. As seniors age, and become frailer, the idea is they would go from one part to another.”

Levin and Advantage board chair Jane Sinclair met with the Ontario Standing Committee on Finance and Economic Affairs on Jan. 23 with recommendations that included extra funding for more long-term care staff and a “quality improvement incentive” to financially reward homes that “consistently meet or exceed high standards of resident care.”

In an earlier interview, Levin said campuses like the Yee Hong Centre for Geriatric Care in Toronto or Simcoe County’s Georgian Village create little communities where older people develop deep friendships through games, clubs and other activities. Many have shops, a hair salon, a restaurant or a doctor’s office.

Some, like Yee Hong’s focus on the Chinese community, cater to people from specific cultures with familiar food and language that is comforting, particularly to those with dementia who often revert to their original language.

In its budget submission, called “The Way Forward,” Advantage Ontario is asking for changes to regulations that currently limit the campus model from a full aging-in-place experience. Right now, residents who need long-term care do not have priority access to the nursing home on site.

“It is very possible that you or your spouse could end up an hour away, which defeats the intention of the campuses,” Levin said.

“Seniors get transitional stress syndrome moving from place to place to place, from their home to long-term care.”

She is also asking the government to “cut the red tape” and create funding for a campus model instead of funding for separate housing types, all with different rules. Some rules limit where staff can work, she said. If the government supports a campus model, the operators would be able to save money by sharing the costs across the system, she said.

The Ontario government’s plans to redevelop 15,000 existing long-term care beds, including roughly 300 old-style nursing homes, means some buildings may be left vacant and could be used as the foundation for new seniors’ communities, the budget submission said.

The Ministry of Long-Term Care has also promised 15,000 beds in newly-built nursing homes. Half of those beds have been awarded to nursing home operators. Applications are underway for the rest. The applications, designed by the ministry, ask if the operator is proposing a “campus of care.”

Jill Knowlton, who sits on the board of the Ontario Long Term Care Association, said the ministry is increasingly open to the campus concept.

“Campuses are a way of keeping people out of long-term care,” said Knowlton, who is chief operating officer of Primacare Living, a private operator that is adding the emotion-focused care Butterfly model to its homes.

Primacare is building a campus in the Hamilton area and has five additional applications for campuses in Ontario, she said. Those would act as “anchors for the community,” Knowlton said, with social programs for people living in the campus retirement homes, assisted living or nursing homes, along with programs for people in the greater region, including community gardens.

Knowlton said the Ontario Long Term Care Association, which represents mostly for-profit homes, has pushed for overall “campus funding” instead of funding for each different type of housing on the site, creating different segments of care in one location. The association’s budget submissions include requests for stable long-term care funding and a “streamlined planning and approval process” for the development of new homes.

It’s a good time for change, said Frances Morton-Chang, a University of Toronto researcher who recently completed an in-depth study on the campus model, funded by Advantage Ontario and the Canadian Institutes of Health Research.

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“There is a window of opportunity right now, as we are investing in long-term-care homes, to be thinking broadly,” Morton-Chang said.

“It’s not for lack of imagination or ability to do things. We just need the will to put a framework behind it.”

Continuity of care is key to the success of the campuses, she said. “You can ratchet up or ratchet down care, as your needs progress.”

Morton-Chang said the legislative barriers that limit admission to the campus long-term-care home create angst among the residents and the staff who grow close to the people in their care.

At the same time, the supports found on a campus can keep people out of long-term care, creating a cost saving for the system, she said.

Morton-Chang, who is director of seniors’ programs and assisted living at the WoodGreen Community Centre, said there are many different models for campus living, but a mix of market rents help balance out the costs for affordable housing and rent geared to income.

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She envisions campuses that include younger families that have a parent living with early-onset dementia. Those campuses would need to be located in urban settings, for school and work, she said. Morton-Chang also sees an opportunity to have intergenerational living, with university students living amongst seniors, offering social engagement or assistance.

At the County of Simcoe, Advantage chair Jane Sinclair led the transformation of a small nursing home in Penetanguishene to the community now called Georgian Village. It has 143 nursing home beds and 139 mixed-housing units.

“I put together a plan for our council and said let’s pack as many different types of housing models as possible with the redevelopment of the home,” said Sinclair, general manager of health, emergency services for Simcoe County, which includes Midhurst and Penetanguishene.

“It’s built almost like a mini-community. We have affordable housing, life lease building, garden homes, independent housing with their own garage and a retirement home, which typically you don’t see” with municipally operated housing.

At Georgian Village all the housing options (except the separate “garden” homes) are connected by walkways to the community centre, so people don’t have to walk outside in the ice and snow.

A key part of the success is the cost savings created by economies of scale created by many housing models on one site, she said. Residents pay different monthly fees, depending on their housing model.

“We’ve been singing the praises of campuses for a long time,” she said. “I tell operators, don’t think about stand-alone long-term care homes, think about campuses. There are so many benefits.”