Fragmented care in assisted living linked to lower family doctor attachment

Toronto, ON, April 25, 2026 — Older adults residing within retirement homes in Ontario, Canada (also known as assisted living in the United States) are less likely to have a regular family physician for ongoing care than other older adults, according to a new study from ICES and McMaster University.

Retirement homes support older adults who need additional assistance, but not the intensive care provided in long term care homes, to remain independent in their own homes.

Using data linked to 740 retirement homes in Ontario, the researchers found that about 82 per cent of retirement home residents were attached to a family physician compared to previous estimates of 90 per cent for community-dwelling older adults and nearly 100 per cent for long-term care home residents. Furthermore, residents living in retirement homes with on-site medical services had a higher rate of doctor visits but were less likely to have a regular family physician, suggesting a trade-off in access over continuity.

“Older adults with complex care needs would benefit from seeing a regular primary care provider who knows their medical history,” says Zain Pasat, lead author of the study and a doctoral student at McMaster University and ICES. “Without continuity, they may rely more on walk-in clinics or emergency departments and have less coordinated chronic disease management, potentially leading to higher hospitalization rates and poor health outcomes.”

While on-site services provided by physicians, nurse practitioners and pharmacists are available to residents, not all retirement homes offer them. A retirement home must update their licence before it provides a new care service to its residents. Of the 740 retirement homes included in the study, 525 provided medical services, 706 had nursing services, and 671 had pharmacist services.

As physician involvement is not mandatory and residents often lose connection with their family doctor upon moving into a retirement home, care is frequently episodic and provided by multiple clinicians. This fragmentation is concerning, given that older adults experience increasing frailty and comorbidity while simultaneously having fewer supports.

Amidst record investments currently underway to attach Ontarians to a regular primary care clinician or team by 2029, this study highlights gaps across retirement homes. “We found lower attachment rates within retirement homes that provide access to on-site medical services and those located in marginalized areas,” shares Dr. Rebecca Correia, senior author of the study and postdoctoral fellow at Dalhousie University. This research builds on Correia’s PhD in Health Research Methodology at McMaster. “Older adults in assisted living represent one of many groups of complex patients who should be prioritized by primary care attachment efforts. The benefits of primary care—accessible contact, relational and information continuity, comprehensive service delivery, and care integration and coordination—are increasingly important to prioritize as people age and their care needs evolve.”

“Canada’s ageing population is projected to reach 10.4 million people by 2037,” says Pasat. “Improving coordinated, continued care, particularly within retirement homes, is urgently needed to reduce unnecessary hospital use and enable healthier ageing in place.”

The study “Trends in attachment to family physicians among assisted living residents in Ontario, Canada: a home-level repeated cross-sectional study” is in the April issue of the Journal of the American Medical Directors Association (JAMDA).

ICES is an independent, not-for-profit research and analytics institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. ICES leads cutting-edge studies and analyses evaluating healthcare policy, delivery, and population outcomes. Our knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about healthcare delivery and to develop policy. For the latest ICES news, follow us on BlueSky and LinkedIn: @ICESOntario   

McMaster University
McMaster is a research-intensive university ranked among the best in the world with a bold ambition to advance human and societal health and well-being. Among Canada’s top universities for student services, our research excellence is matched by our long history of teaching innovations and commitment to preparing students for an increasingly complex future. Our alumni continue to be among the most employable graduates globally, as they bring the McMaster vision of a brighter world to communities near and far.

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ICES    
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