Insights July 2023

The Time for Small Care Homes Is Now

Dawn Harsch, John Yip and Samir K. Sinha


Canada, it is time to stop warehousing our elders and get creative in our thinking about long-term care (LTC). For decades, older Canadians have been telling us that they want to age in place in their own homes and communities, and now nearly 100% want to avoid institutional-style nursing homes in light of what they witnessed during the COVID-19 pandemic. As we emerge from the pandemic and take stock of the many lessons learned, there is a strong public and political appetite for new models that support better and sustainable aging and care experiences. 

Small care homes are not a new concept. They have been used for decades in Japan, across Scandinavia and even in the US to meet the challenges of caring for an aging population, while enabling older persons to retain a sense of personal dignity, autonomy and fulfilment as they age. Small care homes are purpose-built residences for up to 12 persons, which can easily be incorporated into any new or existing community from suburban subdivisions to high-rise condominiums in downtown cores and, yes, even small towns and rural communities. They have many of the design features you would expect to find in a modern nursing home: wide doorways, supportive handrails, private rooms with ensuite washrooms and accessible showers, elevator access, commercial sprinkler systems and so much more. But unlike institutional LTC homes, these buildings are designed to look and feel like a regular family home. From the sidewalk, you would not necessarily know the difference, and therein lies the point. Small care homes are nestled within neighbourhoods – close to services, schools, parks and social activities – offering the type of housing, living and care experiences that most Canadians overwhelmingly prefer to enable aging in the right place.

In small care homes when the doorbell rings, an older person may be the one who comes to answer the door – this is their home, after all. Meals are home-cooked by staff based on resident needs and preferences and shared family-style around a large dining room table. Like so many aspects of household living, everyone is invited to participate in daily social activities and even household tasks, such as preparing meals, washing dishes and doing the laundry. Grandchildren may drop by on their way home from school, and birthdays and special occasions are celebrated in the house or in the garden. 

The limited number of residents creates a more intimate level of familiarity for both the people who live and work here. At a time when the LTC sector is struggling to retain staff and must recruit tens of thousands more staff to meet current and future demands, we need to be thoughtful about the types of care settings that support not only healthier work environments but also personal and professional fulfilment. In our experience, small care homes can check all the boxes from higher staff engagement to lower staff turnover and, therefore, lead to better continuity of care. The staffing model within small care homes can be adapted to support a range of needs, including advanced dementia and complex care to palliative and end-of-life care. 

Studies show that small care homes can offer both economic and social benefits to our healthcare system. These models are quicker and easier to build than their large-scale institutional counterparts, offering a more immediate solution to our burgeoning LTC bed capacity crisis. Small care homes can ultimately generate savings for the healthcare system as residents in these settings tend to have better care outcomes that result in fewer emergency department visits and hospitalizations, and have seen significantly fewer cases and deaths related to COVID-19 since the pandemic began. Unsurprisingly, small care homes have been correlated with an improved quality of life, happiness and sense of freedom among residents, as well as family satisfaction and overall satisfaction with care

So, Canada, what are we waiting for? Faced with long wait lists, overburdened health systems and rising costs, governments are investing billions in fixing LTC. Let us ensure that the money being spent supports the type of housing and care models that aging Canadians both want and need when they can no longer live and receive care in their own homes. While Nova Scotia and Quebec have started to advance this model and Alberta has pledged to do the same, we need every Canadian jurisdiction to advance this model so as to better enable aging in the right place. Indeed, the time for small care homes is now.

About the Author(s)

Dawn Harsch is the president of Exquisicare, a small care home provider based in Edmonton, AB.

John Yip is the president and CEO of SE Health in Toronto, ON.

Samir K. Sinha is the director of Health Policy Research at Toronto Metropolitan University’s National Institute on Ageing in Toronto, ON.


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