Ontarians are witnessing an escalating crisis in primary care that is exacerbated by the exponential rise in numbers of older adults and is resulting in overcrowded emergency rooms, preventable hospitalizations, poor health outcomes and even unnecessary deaths.

The crisis is now and the large cohort of baby boomers, sometimes called the “grey tsunami”, is about to move into more advanced stages of aging when dependence, frailty and the need for institutional care become more prevalent.

From 2022 to 20231, the number of “uncertainly-attached” seniors (those without access to reliable primary care) increased by 13.8%. Even more alarming, the number of those aged 80+ years surged by 20.7%, from 58,000 to 70,000. This was predicted given the demographics and the fact seniors are a disproportionate percentage of the roster of retiring physicians.

Despite inflows of federal money and provincial funding announcements, the Government of Ontario has failed to effectively address this growing crisis. Older Ontarians are right to feel abandoned!

A New Promise

Recently, Dr. Jane Philpott was hired by the Ontario government to craft a 5-year plan to provide primary care to every Ontario resident. The Ontario government’s announcement of January 27, 2025 is promising; however, seniors need reliable, accessible primary care now!

A Bold Proposal for Public Sector/Community Cooperation

The Seniors Health Innovations Hub (SHIH), in conjunction with Perley Health and the Centretown Community Health Centre, has championed a proposal since 2023: scalable, neighbourhood-based nurse practitioner (NP) clinics for unattached seniors in central Ottawa, to provide team-based primary care that is a cost-effective approach to primary care and aligns with the vision of Dr. Philpott for neighbourhood “health homes”.

Why Nurse Practitioners?

NPs already deliver the full spectrum of publicly-funded primary care in Ontario in Community Health Centres (CHC), Family Health Teams (FHT) and Nurse Practitioner Led Clinics. Their nursing background and advanced training align well with helping seniors prevent and manage age-related chronic diseases, co-morbidities and disabilities and their holistic approach supports aging in place. Recently, the federal government2 has called on the provinces to publicly fund all NP services for medically necessary care effective April 1, 2026.

Speed to Workforce: Solving the crisis requires a multifaceted approach – one of which is educating more health care providers including MDs, NPs, and RNs. Nine universities in Ontario offer a 2-year masters NP program. Entry into the NP program requires an undergraduate degree in nursing and two years of full-time clinical experience. Many of the 120,000 RNs working in Ontario already meet these requirements.

Cost-Effective: NP care is an affordable component of quality primary care as they are typically salaried with lower wages than MDs and have shorter and less expensive education and training.

Why Local Area Clinics?

Recent studies underline the value of community involvement in health care. A local area-based approach ensures that care is accessible to all, including marginalized and isolated seniors. Small clinics can be strategically located in community spaces, health institutions, CHC satellites or rented facilities. This vision was embraced by Dr. Philpott in her book “Health Care for All”.

Commitment and Timelines: Making Care a Reality

The SHIH proposal begins with a single clinic for seniors staffed by two NPs, an RN, an RPN, and a Medical Receptionist. Administrative support, allied health services and physician consultation will be provided by our partners Perley Health and Centretown Community Health Centre.

Year One: We estimate that two NPs will have a total of 1500 seniors on their roster. During the first year, the clinic will determine the appropriate size of roster and build the foundation for cost-effective expansion utilizing this Evaluation Framework.

Year Two and Beyond: With input from community and seniors’ organizations, FHTs, CHCs and other service providers, the model could be replicated across the city, as well as in communities across the province.

A Plea for Collaboration

To Politicians and Policy Makers
This city-wide and province-wide crisis demands immediate action – 5 years is too late for many seniors, especially those over 80. We urge the Primary Care Action Team, Ontario Health East and the Ottawa Health Team to partner with us, integrating this initiative into their broader primary care framework. Let’s transform this urgent challenge into an opportunity to lead with innovation, compassion and equity.

To the Ontario Public
Ask your candidates and elected officials what their plan is to ensure that older adults have primary care before it is too late.