Transformative Shift in Long-Term Care Facilities Across Canada: The Rise of Small Home Units

📅 5 days ago

A growing trend in Canada's long-term care sector is shifting from traditional institutional models to innovative small home units, aimed at creating more supportive and comfortable living environments for seniors. This article explores the implications of this shift, the involvement of various stakeholders, and the projected developments across the country.

In Canada, a significant transformation is underway in the realm of long-term care facilities, driven by elder care providers advocating for a new approach to senior living. This movement is characterized by the adoption of small home units, also referred to as pods or cottage-living spaces, which represent a departure from the large institutionalized settings that have long been the norm. Many care providers attribute this shift to the impact of COVID-19, which has highlighted the vulnerabilities of traditional care models. According to the Canadian Institute for Health Information, over 14,000 seniors and staff—approximately 43 to 50 percent of COVID-related deaths—occurred in care facilities, underscoring the urgent need for change.
The small home unit model aims to foster a more homelike atmosphere, accommodating up to 16 residents who often engage in communal activities such as cooking, pet care, and gardening. Tony Ross, a principal at Ontario’s Montgomery Sisam Architects, which has a 40-year history of designing long-term care facilities, describes this evolution as a transition from a compliance-focused mindset to one that embraces innovation in elder care. He posits that this small living arrangement is particularly beneficial for individuals in the later stages of life, as it helps mitigate the disruptive nature of transitioning to a larger, more institutional setting. "It creates a sense of normal," he noted.
The design of these small living units can be incorporated into larger buildings, but the key feature remains the grouping of residents, each having private rooms with ensuite bathrooms, along with shared spaces such as kitchens and family rooms. However, these units come at a higher cost to construct and operate, as the space allocation per resident increases from 650 square feet to 900 square feet, necessitating additional staffing hours. In Ontario, the care hours per person are nearing four hours, reflecting the growing demand for this model, with up to 40 percent of clients now inquiring about small home options.
In Alberta, the government is actively promoting this model, currently overseeing 398 small care home spaces and seeking innovative proposals to further develop small group home-style continuing care and supportive living environments, particularly for fewer than ten residents. Jonah Pickle, press secretary for Assisted Living and Social Services, indicated that the next intake for the Continuing Care Capital Program, which supports community needs, is anticipated this fall, welcoming applications from small care home operators.
In British Columbia, Providence Health Care is also embracing the small home concept, aiming to redefine senior care. Their St. Vincent Heather facility, scheduled to open in fall 2028, will include innovative design elements across 20 households, each housing 12 residents in single-bed rooms with accessible bathrooms, alongside communal living spaces. Providence Living initiated its small home units project in 2024 with The Views in Comox, a 240-bed facility comprised of 13 small households. Additional facilities are planned in locations such as Prince George, Quesnel, and Smithers, with opening dates stretching into 2030.
Vancouver Coastal Health has taken a different approach by renovating existing homes into small care homes, which are deemed more cost-effective than constructing large new facilities. Manitoba's government is also modernizing its personal care homes, integrating the small house model into their designs, as seen in new developments like the Lac du Bonnet and Arborg PCHs.
Nova Scotia is emerging as a leader in the small home movement, having released a design guidance document in mid-2025 that emphasizes smaller, residential-scale care facilities. Bill Benbow, a retired consultant and early advocate for small homes, has long championed this model since the 1990s, especially for dementia care. His designs led to the establishment of Heritage Woods, featuring interconnecting self-contained cottages.
The Sherbrook Community Centre in Saskatoon is recognized as a pioneer in adopting the small house model since 1972, inspiring similar projects, including the Green House in the U.S. and the De Hogeweyk dementia village in the Netherlands. Benbow asserts that the small home concept benefits all seniors, not just those with cognitive impairments, although discussions continue about the optimal size for these living arrangements.
The Canadian Standards Association has developed design standards for small homes, which are being integrated into provincial building codes. As the demand for patient care hours rises, Ross emphasizes the challenge of reducing construction costs while maintaining the unique design needs of each facility. Although prefabrication has potential, it has not yet fully addressed the diverse requirements of medical services needed in these developments. "These places are between a residence and a hospital," he concluded.

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