Beyond the Limits of a Decades-Old Model: improving equitable access to integrated care for residents of residential care facilities (RCFs) 4.b

Background: Residential Care Facilities (RCFs) are a vital part of the housing continuum, offering affordable housing with minimal support for nearly 1000 vulnerable residents in Hamilton. But the sector is in crisis. The complex needs of today’s residents have outgrown the RCF model of the 1950s. This gap, backed by outdated legislation and disconnected supports, undermines resident and staff well-being and fuels crisis situations with dire consequences.

 

Approach: The goal of our project was to improve the health and well-being of an under-served vulnerable population living and working in a community-based congregate setting (residential care facilities; RCFs) in Hamilton, Ontario. The project aimed to improve equitable access to coordinated health and social care for residents of subsidized residential care facilities (RCFs) through co-produced knowledge generated through community-based research, and implementation of impact activities designed to influence change at the frontline, legislative, and policy level. We report on two years of community-engaged research in partnership with the Greater Hamilton Health Network and its RCF Steering Committee of health, social, and housing partners as well as RCF operator and patient representatives.

 

 We co-developed the project proposal and the research plans of the subsequent studies. In the first year, to address power imbalances observed, changes were made to the research plan, and study approaches as well as targeted communication and knowledge sharing based on key partners to ensure all voices were heard. We conducted over 500 hours of ethnographic style fieldwork in 4 RCFs, over 50 interviews with different stakeholders, and secondary analysis of formal home care data.

 

Results: Our findings demonstrate a housing and care approach where there is:

Resident vulnerability: Many RCF residents live with significant mental health, substance use, and physical health needs.

Staff under strain: RCF operators and frontline staff are filling care gaps well beyond their roles—often without adequate training, compensation, or mental health supports— leading to burnout and turnover.

 

Costly acute care: RCF residents averaged 9.4 emergency department visits and 2.9 hospital admissions over five years. Challenges with accessing care in the community contribute to increased reliance on emergency and hospital services.

 

Disconnected systems: RCFs operate at the intersection of housing, health and social care, welfare, and legal systems. Outdated legislation, siloed sectors, and rigid policies reinforce a reactive, crisis-driven model.

 

Implications: Achieving sustainable change requires meaningful engagement with diverse perspectives. RCF residents, staff, operators, local health and social care providers, City of Hamilton, Ministry of Municipal Affairs and Housing, Ministry of Children, Community and Social Services, and Ministry of Health all have a collaborative role to play in transforming the RCF model to better serve those who live and work in RCFs. While there is no one-size-fits-all approach to RCFs, aligning funding, modernizing policy, and building pathways for ongoing collaboration and learning can move the system forward and make Hamilton a city where everyone has a safe and secure place to call home. The implications drawn from the RCF model in this Canadian city resonates with the challenges of housing provision for vulnerable populations globally