Long-term care is the only option for some seniors. Is enhanced assisted living a better way?

Pauline and Louis Philippe Coulombe were getting along great as a couple in their 80s: living active and independent lives, planning to stay in their Ottawa condo for as long as they could manage.

But in 2022 Louis Philippe survived a stroke, upending their dream of living at home together as his new medical needs exceeded what home-care visits could support. They weren’t quite ready for long-term care, but they thought it was their only choice.

Then, while Louis Philippe was admitted to the stroke rehabilitation program at Bruyère Health, someone suggested they move into Besserer Place, an enhanced assisted living facility.

“We didn’t know this place existed,” Pauline said, adding she was skeptical of the idea at first.

But it turned out to be exactly what the couple needed. They could live independently, and together, while having access to around-the-clock medical support for Louis Philippe at the facility run by Bruyère Health Senior Living.

“The only other choice was him going into long-term care and me living on my own or staying in the condo,” Pauline said. “It would have been too expensive to begin with, and we wouldn’t have been together.”

Besserer Place is one of only a handful of enhanced assisted living facilities in Ontario, and it is intended to function as a bridge between independent living and long-term care. The Ottawa facility is cited as a positive case study by a group of seniors housing advocates who say there is a structural gap in the province’s long-term care system, one that could be filled by making enhanced assisted living facilities an official part of the continuum of care.

Right now, the housing and care system is structured around two pathways: supporting seniors as they age at home, and transitioning them to long-term care. A patchwork of alternatives exists between these endpoints, but there is no overarching provincial plan for that middle ground.

“We have a massive void in our system for older adults who need more support in order to remain at home, but who are not ready for long term care,” said Lisa Levin, CEO of AdvantAGE Ontario, which represents not-for-profit seniors care centres in the province.

Enhanced assisted living, Levin said, is a housing model with those people in mind combining stable and often affordable housing with 24-hour, on-site support.

It’s designed for people who, like Louis Philippe, require daily assistance, but not institutional levels of care, and its proponents say it allows residents to live in the community longer and reduce reliance on higher-cost settings.

Denise Rousseau-Pistilli, executive director of senior living at Bruyère Health, said that was exactly the need they intended to meet when they first conceived of the idea in 2012. Noticing a trend of patients waiting in hospital beds for spaces in long-term care, they designed a facility that could fill that middle ground.

This local solution enabled those patients to get out of hospital, have somewhere to go where they had the support they needed, and in many cases prevented them from ever needing long-term care.

“It’s been a huge success. We don’t know why it doesn’t exist in other complexes,” Rousseau-Pistilli said.

According to a recent report from the Ontario Community Support Association, AdvantAGE Ontario and Woodgreen, similar models exist in France and the Netherlands, and it is also growing in Canada — Nova Scotia and British Columbia are expanding housing models that integrate around-the-clock care.

While some jurisdictions in Ontario have begun to implement these housing models in recent years, they are one-off projects, mostly led by non-profit operators and not recognized as a distinct part of the housing and care continuum in Ontario.

Making it an official pathway in Ontario’s system of care, the report says, would provide a stable housing option for those seniors whose needs fall somewhere between the existing endpoints.

That cohort of seniors is rising rapidly in Ottawa, and, in the absence of an official middle ground, the current housing options are scarce.

Grace Welch, a member of the Council on Aging of Ottawa’s Age-Friendly housing committee, says that there needs to be more affordable and accessible choices in the city and that more enhanced assisted living would be a welcome addition.

“There are very, very few supportive housing for seniors. It’s either staying at home or going into long-term care,” Welch said.

“It’s a bit bleak. There aren’t very many options available.”

Most people want to stay in their homes as they age, Welch said, but home care is limited in scope.

Once episodic home care is no longer suitable for someone, there are few reliable alternatives before resorting to long-term care. There are retirement homes, which are private and often prohibitively expensive, Welch said. Options for non-profit retirement homes like Abbeyfield House in Ottawa are rare, she added, and access is limited. Some supportive housing for seniors exists, but getting in is challenging.

Welch says the province needs to look at more innovative models for keeping seniors independent and out of long-term care, not only in the form of enhanced assisted living, but also by investing in naturally occurring retirement communities.

These are buildings or neighbourhoods with a high concentration of older adults who’ve banded together to bring services to their community, such as wellness and health services, social or recreational programming, personal care, and meal services.

There are 170 of these communities in Ottawa, five of which have official funding to provide some form of support services to residents, but that funding will dry up in March despite its potential, Welch said.

The need for that type of innovation in the health-care system is urgent, she added.

Nearly one in five Canadians is 65 or older, and that figure is expected to grow significantly in the coming years. According to official population projections from Ontario, the number of Canadians 65 or older will grow to 4.6 million, or 22.7 per cent of the population, by 2051.

While the number of beds in long-term care is on the rise, it’s not increasing rapidly enough to meet the growth in population. A report from the Financial Accountability Office of Ontario said that, despite the fact the number of long-term care beds in the province will grow from 82,128 to 88,324 by 2029, it actually represents a decline on a per-capita basis.

This means it’s imperative to push the envelope and create more housing options for seniors outside the long-term care system, Levin said.

“Why it’s so incredibly important now is that we’re running out of time,” she said.

“The system cannot withstand it.”

There are 60 long-term care homes in the Champlain region, which includes Ottawa, and 28 of those are in the city itself — all of which are full. The total number of beds in those 28 homes is 4,757, and every one of them has a significant wait list. As of June 30, 2026, the combined number of people on wait lists for those 28 homes was 13,723.

There was overlap in those numbers since seniors can join up to five wait lists, but without intervention that discrepancy is expected to grow.

“We can’t build our way out of this problem with more long-term care. Nor is it what people necessarily need or want. We need to treat long-term care beds as a scarce resource for those who need it most,” Levin said.

This idea was what drove Besserer Place into existence, and it’s had tangible results.

Since 2020, they were able to prevent 221 emergency department visits by treating people on-site. There is a medical clinic run by a family physician inside the building, a phlebotomist, internal medicine, dermatology and end-of-life care.

“Because of the services we offer, we are able to care for them internally,” Rousseau-Pistilli said.

Also, 78 per cent of residents remain in the community until the end of their lives, preventing the need to transition to long-term care.

That’s the goal for Pauline and Louis Philippe Coulombe, they said. Their needs are being met where they are, and they plan to stay at Besserer Place as long as they can.

“We’ve been married for 65 years. We’ve always been together,” Pauline said.

“We’re very happy here.”

This case study, according to the group of advocates, demonstrates the potential of these models.

“It’s what people want. It’s what people need,” Levin said. “And it’s not happening. Instead, the more expensive options are what’s being offered up, then people have to wait. Pretty much the only people who get into long-term care at this point are on the crisis list.

“You shouldn’t have to wait for a crisis to get help.”

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