Canada’s long-term care sector is in the midst of an unprecedented boom, with federal and provincial governments investing billions to fund the development of new facilities. In Ontario, for example, the government has committed to building 30,000 beds by 2028. In B.C., plans are underway to replace or build 5,070 publicly subsidized beds by 2030. Similarly, Nova Scotia has committed to adding or modernizing 5,700 long-term care beds by 2032.

To meet the demands of an aging population, the Canadian Medical Association has estimated that 199,000 new beds will be needed by 2035, costing $64 billion in capital.

This investment is both urgent and necessary.

But the investment requires more than beds alone. Building more beds has received far greater attention than supporting the care residents need. Equal emphasis must be placed on improving quality of care, otherwise we risk scaling up the very problems we set out to solve.

A clear example of this challenge is the ongoing use of antipsychotic medications in long-term care. These medications are often prescribed to manage behaviours in residents with dementia, even when there is no diagnosis, such as schizophrenia, that would warrant their use. This is considered inappropriate and can lead to serious harms, including sedation, falls, strokes and even death.

Despite years of awareness and improvement efforts, Canada’s rate of antipsychotic prescribing in long-term care has climbed following the COVID-19 pandemic. Currently, 24.5 per cent of residents are prescribed these drugs when there is not a diagnosis to indicate their use. This is more than double the rate in the United States at 10 per cent and well above the 18 per cent in Australia and 15 per cent in Sweden.

These differences point to a care system that is stretched thin, where medications are sometimes used as a substitute for time, training or resources to provide more personalized care.

In response to these rising rates, a national coalition has set a target to reduce inappropriate antipsychotic use in Canadian long-term care homes to 15 per cent. Developed by an expert panel through a months-long consensus process, this is an achievable and necessary goal. But meeting it requires reinvestment not only in where care is delivered, but how it is delivered.

This includes investing in training in behavioural support and dementia care. It means providing enough staffing hours, so care teams have the time to build relationships and understand resident needs. It also requires clear accountability supports in long-term care to sustain improvement efforts.

We already know these approaches work. Across Canada, many homes have successfully implemented behavioural approaches that reduce reliance on medications while improving resident well-being. Music therapy, access to outdoor space, one-on-one engagement and meaningful recreational activities have all been shown to support residents with responsive behaviours without the need for antipsychotics. These approaches not only improve symptoms safely but treat residents with the care and dignity they deserve.

Canada has an opportunity to renew long-term care. The success of this reinvestment must be measured not only by how many beds we add, but how well those beds are staffed, how care teams are supported, and how our residents are treated.

Prioritizing quality alongside quantity is the only way to deliver not just more care, but better care. 

This opinion editorial was originally published in the Vancouver Sun. 

Dr. Wendy Levinson is Chair of Choosing Wisely Canada and a Professor of Medicine at the University of Toronto.