r Region ct Peel Wottk.tttq lott qott

DATE: December 9, 2013

REPORT Meeting Date: January 16, 2014

Aging Population Term of Council Steering Committee

For Information

REPORT TITLE: UPDATE ON PEEL'S RETIREMENT HOME SECTOR

FROM:

OBJECTIVE

Janette Smith, Commissioner of Health Services Janet Menard, Commissioner of Human Services

To provide information on trends in the retirement home sector in Peel and to identify implications for the broader seniors' housing system.

REPORT HIGHLIGHTS • "Retirement home" generally refers to a privately owned and operated multi-unit

residential facility, which is designed to support older adults to live independently with varying levels of support for daily activities.

• Peel has among the lowest percentage of its total seniors' population (aged 75 years and older) living in a retirement home in Ontario.

• Peel's retirement home market has a larger share of one-bedroom and two-bedroom spaces (larger and more expensive spaces), compared to the rest of the Greater Toronto Area (GTA). However, the average rent for these spaces in Peel is below the average rent for similar spaces across the GT A.

• In Peel, the smaller and more affordable private/studio spaces make up a lesser share of the retirement home market, and have average rents that are higher than those across GTA.

• Overall vacancy rates for retirement spaces in Peel are currently well above those for the overall GTA, due mainly to vacancy rates for one bedroom and two bedroom spaces that are the highest in the GTA.

• There may be opportunities for the Region or our health and housing system partners to partner with the retirement homes sector to address issues of shared concern.

DISCUSSION

1. Background

Increasing focus is being placed on the needs of seniors, as Ontario's population continues to age and grow in size. The housing and care needs of seniors are at the forefront of this conversation, and will continue to be an important issue as seniors look for accommodation and care services that will support them as they age.

As noted by Dr. Samir Sinha (Provincial Expert Lead for Ontario's Seniors' Strategy) during his presentation to the Aging Population Term of Council Priority Steering Committee

V-()1.()02 2013/09

December 9, 2013 UPDATE ON PEEL'S RETIREMENT HOME SECTOR

(APSC) on August 22, 2013, housing options that span the continuum from home ownership to hospice palliative care are essential to promoting an age-friendly community and can enable seniors to age in place (see Appendix 1). In Ontario, retirement homes are increasingly being seen as an important part of the housing and care continuum that can support low to moderate need seniors to remain independent in the community.

a) Retirement Homes and Long Term Care Homes

This report refers to retirement homes as defined the Retirement Homes Act, 2010. Under this Act, a retirement home is a residential complex, or part of a residential complex that meets the following criteria:

• Occupied primarily by persons who are 65 years of age or older; • Occupied or intended to be occupied by at least six persons who are not related to

the operator of the home; and • Provides at least two care services (directly or indirectly} to residents. Typical

supports provided to residents include common facilities for food preparation and eating, housekeeping services and personalized medical services.

Retirement homes do not include premises or parts of premises that provide and are funded as supportive housing or a residential treatment under other legislation, such as the Long Term Care Homes Act, 2007.

As previously reported to Regional Council, retirement homes differ from long term care homes in several important ways. Appendix II includes a table that compares the retirement home and long term care home sectors in detail.

The first main point of difference is the amount of government oversight and regulation. Long term care homes operate in a highly regulated environment subject to provisions and extensive regulations in the Long-Term Care Homes Act, 2007. All long term care home reporting, monitoring and enforcement of standards are carried out by the Ministry of Health and Long-Term Care (MOHL TC}.

For retirement homes, the Retirement Homes Act, 2010 provides standards that are far less strict than those for long term care homes. The Retirement Homes Act, 2010 and regulations outline standards for each care service provided to residents (i.e. daily living supports, nursing, and administration of drugs, etc.) as well as requirements regarding the care and safety of residents (i.e. use of restraints, prevention of abuse, staff and volunteer screening and training and reporting or harm or risk of harm). The Retirement Homes Regulatory Authority is an independent corporation (i.e. not a provincial agency) that is accountable through a Memorandum of Understanding with the Minister Responsible for Seniors. The Retirement Homes Regulatory Authority monitors and licenses all retirement homes and enforces provincial regulations.

Further to this, the Long-Term Care Homes Act, 2007 mandates municipalities to operate at least one long term care home. The Retirement Homes Act, 2010 has no requirement for municipalities to operate or oversee the retirement home sector.

Secondly, retirement homes and long term care homes differ greatly with regards to funding and access to services. Long term care homes are operated by a mix of commercial and not-for-profit organizations that must each hold licenses issued by the MOHLTC for their long term care beds, and municipalities that operate beds "approved" by the MOHL TC. The MOHL TC provides per diem funding for each occupied long term

~·0\ -3-December 9, 2013 UPDATE ON PEEL'S RETIREMENT HOME SECTOR

care bed, and the Community Care Access Centres determine eligibility for these long term care beds.

On the other hand, retirement homes are operated mainly by the for-profit sector and are funded through rental fees paid by residents. Retirement homes do not receive any government funding and the government has no control over access to the spaces in retirement homes. As such, the supply of retirement homes is determined entirely by the market and admission is facilitated by the home operator, based on the suitability of the home for each resident.

2. Findings

Recently released data from the Retirement Homes Regulatory Authority and the Canada Mortgage and Housing Corporation (CMHC) provides new insight into the current supply and affordability of retirement spaces in Peel.

According to the registry of retirement homes, maintained by the Retirement Homes Regulatory Authority, there are 27 retirement homes in Peel, with 3,966 spaces. Most of these retirement homes are located in Mississauga (23 homes), with the balance in Brampton (4 homes). There are two not-for-profit retirement homes in Peel with a combined capacity for 139 residents. Appendix Ill provides a list of retirement homes in Peel that are licensed with the Retirement Homes Regulatory Authority.

Approximately 1,400 of the spaces counted by the Retirement Homes Regulatory Authority are considered "independent living units" that are equipped with a kitchen, while the balance have access to congregate dining. The CMHC, through its annual "Seniors Housing Report -Ontario," provides market data at the local and provincial level based on an annual survey of retirement homes. The CMHC survey does not include "independent living units" in its survey of retirement home spaces. As a result, the CMHC reports that Peel has 2,538 retirement spaces.

The following market information about the retirement home sector is based on the CMHC "Seniors Housing Report - Ontario," released in June 2013. The CMHC report offers valuable local, regional and provincial market data, enabling a comparison of Peel with other regions in the GT A.

a) Lower Proportion of Seniors Living in Retirement Homes

Regionally, Peel has 16 per cent of all retirement spaces in the GTA. York Region's share is similar to Peel with 18 per cent of spaces in the GTA. The City of Toronto accounts for 42 per cent of all spaces in the GT A.

However, according to the CMHC report, Peel has among the lowest percentage of its total seniors' population (aged 75 years and older) living in a retirement home in Ontario. This percentage, called the "capture rate," is 3.3 per cent in Peel, compared to a rate of 3. 7 per cent for the GTA, and 5.1 per cent for all of Ontario. While Peel has a relatively young population, the low capture rate in Peel suggests that seniors 75 years and older in Peel are accessing alternate forms of housing.

4 · ~ - 4 -December 9, 2013 UPDATE ON PEEL'S RETIREMENT HOME SECTOR

b) Greater Proportion of More Expensive Retirement Spaces

The CMHC reports that rent levels increase with the size of the space, with semi-private and ward spaces being the most affordable and one and two bedroom retirement spaces being the most expensive.

When compared to the rest of the GTA, Peel's retirement home sector has a higher proportion of larger (and more expensive) one and two bedroom spaces. These larger spaces in Peel together make up 56 per cent of the total supply of spaces. Within the GT A these types of retirement spaces make up fewer ( 4 7 per cent) of the total spaces.

Smaller spaces, namely the private/studio, semi-private and ward spaces make up 44 per cent of the total spaces in Peel. This is significantly less than the overall GTA where these smaller spaces comprise over half (53 per cent) of all spaces. Appendix IV shows the distribution of all types of retirement home spaces.

Furthermore, the CMHC report indicates that based on cost, the least expensive retirement spaces comprise a lower proportion of retirement spaces in Peel when compared to the GTA as a whole. Eight per cent of spaces in Peel are $2,500 per month or less compared to 11 per cent at the GTA level. Retirement spaces at the upper end of the market, costing $3,000 per month or more, make up 76 per cent of all spaces in Peel, similar to the GTA at 75 per cent.

It is also worth noting that some neighbouring municipalities have proportionally more spaces at the upper end of the market. For example, 86 per cent of the retirement home market in Halton Region falls at the upper end of the market ($3,000 per month or more) while Jess expensive spaces (costing $2,500 per month or less) make up 1.5 per cent of the total supply.

c) Cost Pressure on Smaller Retirement Spaces

Private/studio spaces in Peel are on average more expensive, and one and two bedroom spaces are less expensive, compared to the GTA. Average rent for a private/ studio space is $3,499 per month in Peel, compared to $3,284 in the GT A. At the other end of the market rent for one and two bedroom spaces in Peel is lower than the overall GTA rent for these types of spaces. The average rent for a two bedroom space in Peel is $4,856 per month, below the GTA average of $5,492. The average rent across all types of spaces in Peel is $3,801 .

d) Higher Vacancy Rates

Overall vacancy rates for retirement spaces in Peel are currently well above those for the overall GTA, due mainly to high vacancy rates for larger one bedroom and two bedroom spaces in Peel. The overall vacancy rate for Peel is 24 per cent, compared to 18 per cent for the GT A. However, vacancy rates for larger spaces in Peel are the highest in the GTA. The vacancy rate for one bedroom units in Peel {32 per cent) is double that for the overall GT A ( 16 per cent). Vacancy rates for private/ studio spaces are similar to the overall rate for the GTA (approximately 15 per cent).

V-01-002 2013/09

~·0\ - 5 -December 9, 2013 UPDATE ON PEEL'S RETIREMENT HOME SECTOR

3. Implications

The implications of trends in the retirement homes sector should be considered in the context of broader initiatives in Peel to ensure accessible and affordable housing in available to Peel residents across the housing continuum.

Peel's Housing and Homelessness Plan (the Plan), approved by Regional Council on November 28, 2013, identified several themes, including the lack of affordable rental housing. The Plan includes strategies to increase the supply of housing options and housing with supports to meet community needs, and to ensure that affordable housing is developed in a way that is healthy, vibrant and inclusive. In this respect, the Plan may assist the Region's assessment of trends and developments in the retirement homes sector in Peel.

Findings in the CMHC report suggest that the retirement home market in Peel currently favours larger and more expensive spaces. It notes that even the smaller spaces in Peel are more expensive than spaces of the same size in other jurisdictions. This suggests that the retirement homes sector does not yet fully reflect the needs of seniors in Peel seeking access to appropriate and affordable housing. As a result, retirement homes may be too expensive for many seniors, without some form of assistance. Furthermore, seniors' housing and care needs that are not met in retirement homes may result in growing pressure on other housing options.

There may be opportunities for the Region and its housing system partners to explore measures aimed at providing more affordable options for those who wish or may need to live in a retirement home environment, but may not be able to afford typical rent levels. The Region may also seek to engage the retirement home sector, individually or through its association, to discuss issues of shared concern and potential partnership opportunities.

The increased attention given to the retirement homes sector by the provincial government suggests that this sector is increasingly being seen as occupying an important role in the housing and care continuum for seniors. Ontario's efforts to regulate retirement homes and provide some protections for seniors is a step towards ensuring better care for residents. However, it remains to be seen if this new oversight of the retirement homes sector provides adequate protections, particularly as the sector provides housing for more seniors, including seniors with complex health conditions.

V.Q1-002 2013/09

l...\ • 0\ - 6 -December 9, 2013 UPDATE ON PEEL'S RETIREMENT HOME SECTOR

CONCLUSION

The retirement homes sector is an increasingly important part of the seniors' housing continuum. With the growth of this sector come opportunities to ensure Peel seniors have access to a full range of housing options to allow for aging in place. The issues raised in this report concerning affordability and the ability of the sector to meet the needs of tomorrow's seniors are potential areas for dialogue and partnership with the retirement homes sector.

Janette Smith Janet Menard Commissioner of Health Services Commissioner of Human Services

Approved for Submission:

D. Szwarc, Chief Administrative Officer

For further information regarding this report, please contact Dawn Langtry at extension 4138 or via email at Dawn. Langtry@peelregion. ca

Authored By: Cullen Perry, Health Services and Kevin Mahadeo, Human Services

c. Legislative Services

V-{)1-{)02 2013/09

APPENDIX I December 9, 2013

UPDATE ON PEEL'S RETIREMENT HOME SECTOR

APPENDIX I Seniors Housing and Care Continuum

Services provided as needed

•··············•··· ········· . . t

Community-based Services (Mostly scheduled ca~e, some unscheduled)

HOME IN THE COMMUNITY

P«t"Sbnol hom~. aportment

condo, or fomHy dweHing.

Funding: Private.

Resident profile: Able to live independently at home o r with t he

support of family members and community

organizations.

Services provided: No organized care or

oversight by virtue of housing ilrrangement.

Primary Care & Dental Care Preventative care and treatment provided by family physfclan~ or

health tfi!'am.s at private or c:ommunity d inlc.s.

Preventative dentZII ~re and treatment provided by pr~te

dentists or through eovernment-funded proarams.

SUPPORTIVE HOUSING

o ... s ignoted emits fn social

housfng buitdings or

private units/ homes in designated service '?!u~.

Fundln1: MOHLTC. Resident profi le:

Require some unscheduled personal care and homemaking servtces on a 24 hour

basis. Services provided:

Scheduled and unscheduled personal

care and support available 24/7 by st aff

on·site

£.\ . ~ -1

- 1 -

twtflli~R"«iii'Mtii'1

ltmllln£ ;~1)1/f, t.101H II .,.~1

ruunu; l;_,• l• lll!':.

~J"fltft "'-~...J , H.' ' c.,. 'll , 1•b1l:o~• p.at1•n•• -"" '",.'i'•"c,

W"llor-.;a

Services provided as needed

· ·· ·· ~·················· · ··· . . t

Residential Health Care Services 'Unscheduled. 24/ 7 care)

RETIREMENT HOMES

Funding: Private. Resident profile: Able to nve independently and pay for necessary

or desired housing and care.

Services provided: Accommodation and daily living supports

such as meals. housekeepin&,

personal care, ~tc .

Private nursing servic!:s available in some

buildinss.

CCACHome Assisted

Core Services LMnQ/Supportlve

SctK-duled Q re Housing Services

and home visits up Sche<luled and

to 180 hour-5 per urucheduled care up

LTC Home Waitlist

CCAC Unli mited

Support Supports for sen iors w ait·listed for LTC

beds. Maximums c.an

CHRONIC CARE IN HOSPITAL

Rehob;/itation, Compltx Continuing, and PaUiatlve

care beds.

Funding: MOHLTC & resident.

Resident profile: Ongoing care required t o manage complex

Ulnesses and Improve functional abili ty. Services provided: 24/7 specialized,

multidisciplinary care to improve patient

functioning, stabilize condit ion or manage symptoms and pain.

Alternate Level of Care

Funding: MOHLTC. Resident profh:

Occupying a hospital bed but does not

requi re the Intensity of resources/se rvices

being provided.

II

f'I'IOhth. to 180 hours per exceed 180 houD per month. month. lEGEND

Increasing acuity and care needs II

RESIDENTIAL HOSPICE

Fundlns: MOHLTC. Resident proftle: Dla11nosed with

terminal illness (<3 months).

Sotrvlces provided: 24/7 nursing care to mana11e symptoms,

trea t pain, and preserve quality of life.

Region of Peel programs play roles (to varying degrees) within each of these sed o rs.

APPENDIX II December 9, 2013

UPDATE ON PEEL"S RETIREMENT HOME SECTOR

APPENDIX II

Comparison of Oversight and Operations of Retirement Homes and Long Term Care Homes from a Region of Peel Perspective

Retirement Homes Long Term Care Homes Legislative • No legislative mandate for • Under the Long Term Care Homes Mandate for municipalities or other operators Act, upper tier and single tier Municipal Role municipalities are required to

operate at least one Long Term Care home

Oversight • Retirement Homes Regulatory • Ministry of Health and Long-Term Authority {licensing and Care (Long Term Care Homes Act) enforcing standards), an • Local Health Integration Networks independent corporation (Long Term Care Service

• Retirement Homes Regulatory Accountability Agreements) Authority is accountable to • Regional Council is the Committee Ontario Minister Responsible of Management for five Regional for Seniors (Retirement Homes Long Term Care homes Act, 2010)

Current • No Regional ownership or • Region owns and operates five LTC Regional operation homes with 703 beds out of a total Operations of 26 homes with 4,100 beds in Peel

{ 17% of total stock in Peel) • Region's five Long Term Care

homes serve approximately 850 residents annually

Licensing and • No government approval • Long term care beds are licensed or Regulation required for retirement homes "approved" by the province to

• Supply is driven by the market control supply and ensure quality • Retirement Homes Regulatory • The Long Term Care Homes Act,

Authority licenses and 2007 includes extensive regulations regulates all retirement homes that detail all aspects of long term with six or more beds care operations

Funding • 100% resident rental fees (no • Ministry of Health and Long Term direct government Care ( 44% ), Region of Peel (38% ), contributions) resident accommodation fees ( 18%)

• Care and other services may • Regional contribution $30.2M be covered by a third party (private insurance, Community Care Access Centre, etc.)

APPENDIX II December 9, 2013

~ ·0\ -ct -2-

UPDATE ON PEEL'S RETIREMENT HOME SECTOR

Retirement Homes Control of • Access determined by Access retirement home operator re

suitability of resident • No government involvement. • Tenant agreement between

operator and resident

System • None Planning

Decision • Retirement home operator has Authority to authority to change service Change • Retirement Homes Regulatory Services Authority power to revoke

license for non-compliance, subject to Retirement Homes Act and regulations

Long Term Care Homes • Community Care Access Centres

assess clients for eligibility, place residents in long term care homes and manage the wait lists

• Local Health Integration Networks

• Under the Long Term Care Homes Act, a decision to close a LTC home requires five years notice to the Ministry of Health and Long-Term Care plus an approved closure plan (applies to all types of LTC homes, including municipal homes)

• Province has discretion to allocate closed municipal "approved" beds to another region (i.e. beds could be moved from Peel)

• Licensed beds (non-profit and for-profit providers) can be transferred or sold by the operator within or outside the region

APPENDIX Ill December 9, 2013

£..{.D. - \0

- 1 -

UPDATE ON PEEL'S RETIREMENT HOME SECTOR

APPENDIX Ill

Retirement Homes in Peel Region

MISSISSAUGA Address

Arnica at City Centre (Arnica) 380 Princess Royal Dr.

Arnica at Erin Mills (Arnica) 4620 Kimbermount Ave.

Bough Beeches Place (Revera) 1130 Bough Beeches Blvd. Carmel Heights Seniors Residence 1720 Sherwood Forrest (Carmelite Sisters) Circle Chartwell Robert Speck Seniors

100 Robert Speck Pkwy. Residence (Chartwell) Chartwell Regency Retirement

29 Mississauga Road N. Residence (Chartwell) Constitution Place (Revera) 3051 Constitution Blvd. Evergreen Retirement Residence

820 Scollard Crt. (Diversicare) Greenway Lodge Retirement Home 860 The Greenway

Chartwell Heritage Glen Seniors 6509 Glen Erin Dr. Residence (Chartwell)

Heritage House Mississauga 73 King Street W.

King Gardens (Revera) 85 King Street E.

New Elmwood Retirement Residence 4609 Rosebush Rd.

Palisades on the Glen 1665 The Collegeway

Port Credit Residences (Diversicare) 33 Hurontario St.

Sunrise Senior Living Erin Mills 4046 Erin Mills Pkwy.

Sunrise Senior Living Mississauga 1279 Burnhamthorpe Rd E.

The Beechwood (Revera) 1490 Rathburn Rd E.

The Erinview (Sitton Properties) 2132 Dundas St W.

Tyndall Seniors Village 1044 Eglinton Ave E.

VIVA Mississauga 5575 Bonnie St.

Walden Circle Retirement 1907 Lakeshore Rd. W. Community (Signature Living) Wawel Villa Seniors Residences* 880 Clarkson Rd. S.

Mississauga Total

BRAMPTON

Greenway Retirement Village 1 00 Ken Whillans Dr.

Rosedale Retirement Residence 12 William St.

Southbrook Retirement Community 400 Ray Lawson Blvd.

Woodhall Park Retirement Village 10250 Kennedy Rd.

Brampton Total

Ownership Capacity

For-Profit 147

For-Profit 141

For-Profit 98

Not-For-Profit 48

For-Profit 226

For-Profit 92

For-Profit 65

For-Profit 160

For-Profit 9

For-Profit 646

For-Profit 77

For-Profit 148

For-Profit 14

For-Profit 124

For-Profit 300

For-Profit 140

For-Profit 104

For-Profit 202

For-Profit 140

For-Profit 86

For-Profit 263

For-Profit 150

Not-For-Profit 91

3471

For-Profit 275

For-Profit 10

For-Profit 125

For-Profit 85

495 * In February 2013, Wawel Vtlla was licensed as a rettrement home. As the Servtce System Manager for housing, the Region of Peel provides a subsidy for 45 spaces/RGI units.

APPENDIX IV December 9, 2013

~ .a - ' ' - 1 -

UPDATE ON PEEL'S RETIREMENT HOME SECTOR

APPENDIX IV

Distribution of Retirement Homes Spaces in Peel and the Greater Toronto Area (GTA)

Types of Retirement Home Spaces, Peel Region, 2013

204 Two Bedroom Spaces,

Bedroom Spaces

(48%)

90Semi Private &

Ward

source: CMHC, Seniors Housing Report-Ontario, 2013

Types of Retirement Home Spaces, All GTA, 2013

931 Two Bedroom

6,496 One

Bedroom Spaces (41%)

434Semi Private &

Ward

source: CMHC, Seniors Hous ing Report-Ontario, 2013

* The figures for Peel (above) total 2,538 retirement spaces because the CMHC survey does not include "independent living units" in its survey of retirement home spaces.