Mrs. W is 84 years old and has lived independently for years. As physical and cognitive challenges have progressed, she now requires assistance with daily activities, medication management, meal preparation, and personal care. Her needs are no longer occasional – they are predictable and ongoing.

 

Home care was introduced to help Mrs. W remain in her apartment, but visits are brief and episodic. As her needs have increased, the gaps between visits have become harder for both Mrs. W and her family to manage. When something goes wrong – a missed medication or avoidable fall— she ends up spending hours in the emergency department. After treatment, she is discharged home, returning to the same conditions that led her there.

Ms. W no longer fits a model built around independence, but she does not yet require long-term care (LTC). She requires dependable, wrap-around support at home. Enhanced Assisted Living makes that possible.

The Structural Gap in Ontario’s Housing and Care Continuum


Ontario’s population aged 65+ is projected to grow significantly, from ~3.0 million in 2024 to ~4.6 million by 2051. As this cohort expands, rates of frailty, cognitive impairment, and functional decline will increase, driving sustained demand across both the housing and care continuums. Demographic change will also increase the number of older adults – like Mrs. W – whose needs fall between existing service models. These individuals will require:

  • Predictable, 24/7 access to personal support, and
  • Stable housing environments designed to accommodate increasing care needs

Ontario’s current housing and core continuum is not well positioned to support this group. It lacks a clearly defined, scalable housing model with embedded supports that enables individuals to remain safely in their communities as their care needs increase beyond what traditional home and community care services can provide.

The Solution: Enhanced Assisted Living


Enhanced Assisted Living (EAL) is the system’s missing middle – built for people whose needs are too complex for episodic home care, but who don’t yet require LTC. EAL pairs stable, affordable housing with 24/7 on-site support in community-based residences. By aligning housing and care together in one model, EAL can:

  • Match services to need with predictable, on-site support;
  • Prevent avoidable crises and reduce unnecessary hospital visits;
  • Delay or avoid premature placement in LTC; and,
  • Support aging in place with safety, dignity, and continuity.

Yet, Ontario has no clear way to implement and scale EAL.It is not formally recognized in Ontario’s housing and care continuum, and there is no coherent provincial policy or funding framework to support expansion. As a result, existing models have depended on local leadership and one-off solutions, limiting expansion and leaving growing population needs unmet.

Advancing EAL in Ontario: A Coordinated Path Forward

 

 

The Ministry of Health’s Role

 

  • Formal Recognition
    Establish EAL as a provincially defined and supported model within Ontario’s continuum of housing and care to guide coordinated planning, funding pathways, and system-wide scale.

 

  • Funding Alignment
    Funding Alignment supports federal investments in capital infrastructure by dedicating provincial operating funding to support implementation, scalability, and long-term sustainability.

 

  • Provincial Pipeline
    Establish a centralized EAL repository and project pipeline to inform coordinated planning, track capacity, and guide strategic investment decisions.

 

 

 

 

 

Operators’ Role

 

  • System Alignment
    Align partnerships, performance measurement, and outcome reporting with provincial health system priorities to demonstrate measurable impact and position EAL as a scalable system solution.

 

  • Regional & Local Planning
    Proactively align EAL model design and development with municipal housing plans, service managers, and regional priorities to strengthen local alignment and support regional scale.

As Ontario’s population continues to age, formally positioning EAL within the housing and care continuum will be essential to ensuring the system reflects the full distribution of support needs and remains sustainable over time.

Enhanced Assisted Living in Ontario Full Report