By: Matt Emma
Canada is heading toward a demographic tipping point. One in five Canadians is over the age of 65. By 2030, it is projected that seniors (ages 65 and older) will make up 23% of the population. This demographic is expected to grow significantly by 2050. For Marie-Josée Lafontaine, owner of Scarborough Retirement Residence, the writing is on the wall. “We are facing a capacity challenge. And it’s unlikely we will address it unless we consider all potential options,” she says. That includes the often-criticized two-tier system.
In Canada, eldercare is traditionally viewed through a public-good lens. But Lafontaine suggests that this mindset may be limiting meaningful reform. “There’s this idea that public care is virtuous and private care is self-serving,” she says. “That binary thinking could be preventing us from addressing the real needs of seniors. We need to find ways for collaboration to meet the increasing demand.”
She acknowledges that expanding government-funded care would be an ideal solution, but cautions that it may not be financially feasible in the current economic landscape. “To significantly expand public eldercare, we would likely need to increase taxes considerably,” she says. “In the current political and economic climate, this seems difficult to accomplish.”
With long waitlists for long-term care facilities, staffing shortages, and an overburdened healthcare system, the demand for care is exceeding the current capacity and resources. Private operators have stepped in to fill the gaps, though they are often met with skepticism. Lafontaine believes it is time to rethink the prevailing attitudes towards private care.
According to research, the monthly cost of long-term residential care can exceed $5,000 in many urban regions. That’s nearly double the average monthly income of Canadian seniors living on fixed pensions or Old Age Security. For those with memory impairments or complex health needs, the cost is even higher.
“We are seeing families torn between leaving their jobs to become caregivers or going into debt just to place their parents into private care as an alternative to long-term care,” Lafontaine explains.
The capacity and affordability crises are worsened not only by economic fluctuations and social disparity but also by a systemic shortage of resources and a variety of purpose-built housing types. “This is a complex social issue,” says Lafontaine. “We require a complex social redesign, and we need to act on it sooner rather than later.”
While innovation and tech solutions are increasingly entering the eldercare market, from AI monitoring to robotic companions, Lafontaine is concerned that the human aspect of care is being overshadowed by automation. “You can’t automate presence,” she says. “Care is relational, not transactional. A robot can remind you to take your medication, but who notices when you are anxious, grieving, or lonely?”
That human deficit is being filled, in part, by internationally trained workers. “It’s caregivers from different regions of the world who are supporting this system,” she notes. “They are often underpaid and undervalued, and without them, this industry would face significant challenges.”
Still, the sector struggles to attract and retain talent. A report from the Canadian Nurses Association found that by 2030, Canada could face a shortfall of nearly 117,000 nurses, many of whom are essential to eldercare facilities. “Young people are not entering this field because they don’t see it as rewarding,” Lafontaine says. “That responsibility lies with us. We have not made care careers viable, respected, or meaningful.”
To close the affordability gap, she argues, “The two-tier system offers a wider range of solutions and the possibility for co-designing the healthcare system through more effective partnerships.” But the constraints are real. With limited public funding and increasing oversight, many privately funded operators are struggling to work within shrinking margins, which can impact the quality of care. Some facilities have had to close, while others have had to cut staff or raise fees, decisions that can affect the level of care. “No one wants to cut corners,” she says. “But the reality is, when funding is insufficient, tough decisions must be made.”
For Lafontaine, what must never be compromised is the soul of care. “Even in times of scarcity, we can still be present. We can still offer dignity. We can still ask, ‘How would I want to be treated here?’”
Her mantra, “Design it as if you are designing it for yourself,” has become a core part of how she runs Scarborough Retirement Residence. Staff are trained not just to manage conditions but to build relationships. “We are not just here to treat symptoms. We are here to guide people through transitions, with compassion and respect,” she says.
She challenges policymakers, investors, and operators to consider a paradigm shift: less emphasis on efficiency, more on empathy. “We need policy that is rooted in humanity,” she says. “Metrics are important, but they can’t be the only guiding factor.”
She’s also calling for educational reform. “Let’s start teaching care work in high schools. Let’s offer scholarships for geriatric studies. Let’s make caregiving a choice, not just something people fall into,” she says.
Ultimately, Lafontaine believes the solution lies in collective ownership of the problem. She says, “This is not just a sector issue. It’s a societal issue. We are all aging. The question is: what kind of aging do we want to experience?”
At Scarborough Retirement Residence, the answer is already taking shape. Residents are treated as whole individuals. Staff are empowered to lead with presence. And systems are designed with both heart and foresight.
Ultimately, Lafontaine’s message is a call for pragmatism over ideology. “If we want to preserve dignity for our aging population, we need to stop treating the two-tier system as something taboo. Public care alone likely won’t be enough to meet the demand, and overlooking this reality could affect quality of care, individual choice, and dignity.”
