N.L.’s aging population is facing a growing crisis we can no longer pay lip service to
It is likely not news to any resident of the province that Newfoundland and Labrador’s aging population is amongst the biggest challenges facing the province today and over the coming decades.
Recently, N.L. became the first province to reach a key population milestone with at least 1 in 4 (25.2%) of its residents being 65 years of age or older, versus the national average of 19.5%. Furthermore, current projections estimate approximately 30% of N.L.’s population will be older than 65 by 2035, compared to approximately 24% nationally. Thus, N.L. is projected to remain Canada’s oldest province for the foreseeable future.
A recent report from N.L.’s Seniors Advocate also suggests older adults in N.L. are faring worse than elsewhere in Canada. They found older adults in N.L. have the lowest median incomes and lowest access to primary healthcare. The province also has the highest proportion of adults living with chronic diseases, with an estimated 88% of older adults living with at least one chronic disease.
Finally, the C.D. Howe Institute recently released a report on healthcare system performance for older adults across 10 high-income countries. N.L. scored the lowest, not only in Canada, but of any of the countries studied on overall healthcare system performance for older adults. Further, N.L. also scored the lowest on its quality of care and healthcare outcomes.
Altogether, these findings necessitate a massive imperative to address issues associated with N.L.’s rapidly aging population and associated challenges with its provincial healthcare system. These challenges also lie on a backdrop of a difficult provincial fiscal situation and widespread existing strains across its healthcare system. For instance, it was recently announced that the new provincial government cancelled plans for a new acute care hospital in St. John’s due to financial constraints. This underscores the urgent need to think differently about how healthcare is being organized and delivered in the province. N.L. spends a higher proportion of its budget on healthcare than almost any other province, yet older adults in N.L. experience worse health outcomes relative to elsewhere in Canada. This paradox - higher proportionate spending with worse outcomes - suggests the heart of the issue may not point solely to a lack of resources devoted to healthcare but should also question how resources are being allocated.
The N.L.’s recently released “Budget 2026” invests $5.4 billion in health, with $370 million in new spending including: $47 million to create over 200 new personal or long-term care beds, a 20% increase to the Seniors’ Benefit, $12.7 million for increasing home care worker wages, and $2.7 million to increase dementia care capacity. It is important to acknowledge these are meaningful investments in key areas. However, there is a considerable amount of work that needs to be done to allow the very high portion of older adults living in N.L. to age successfully well, to be as healthy as possible, and to live where and how they might want. All these tenets are intertwined and centre around a concept essential to aging well and improving the sustainability of its healthcare system: aging in the right place.
The National Institute on aging (NIA) defines aging in the right place as “the process of enabling healthy aging in the most appropriate setting based on an older person’s personal preferences, circumstances and care needs”. To facilitate this, the NIA has put forth a framework and series of policy recommendations to help foster aging in the right place across Canada, and promote healthy aging and the overall sustainability of health and social care systems. We believe there are three critical aspects of aging in the right place that must be invested in today, especially given the current demographic and healthcare challenges facing N.L..
First, the government should consider modernizing its housing policies to help older adults age well in their own homes and communities for as long as possible. The 2025 Seniors Advocate Report highlighted housing as a key issue for many older adults in N.L.. Moving forward, the provincial government should work to increase the availability of accessible housing for older adults with disabilities, and increase support or incentives for downsizing programs. Additionally, there should be incentives for the creation of community-level Naturally Occurring Retirement Community (NORC) programs, whereby buildings (or collections of buildings) have embedded and flexible services to better enable the care and support of older adults to age in place. Improved housing has been associated with fewer hospital visits (with shorter length of stays) and less need for long-term care (LTC) home placements, which can provide significant relief and economic savings for already overburdened systems.
Second, there is a need to increase availability of home care and community supports, which are imperative to help people age well in their own homes for as long as possible. In 2023, a Seniors Advocate Report noted increased home supports were reported as the greatest need by family members caring for older adults living with chronic conditions in N.L.. This is particularly vital in rural areas, where services are more limited compared to the St. John’s metro area. To allow people to successfully age in their own homes, the provincial government must increase funding and support for home care and community support services. This is another vital piece to help both prevent hospitalizations and premature admissions into LTC homes and the costs associated with them.
Finally, there can be no conversation about aging in the right place in N.L. without discussing access to primary care and other healthcare services. As mentioned, the recent C.D. Howe Institute report found older adults in N.L. have the worst access to healthcare compared to all other provinces and nine other countries studied. As the government decided against building a new acute care facility (based on cost), there needs to be a discussion around investing more in primary care, chronic disease management, rehabilitation services, homecare, and community support services.
Regarding primary care, older adults in N.L. have some of the highest rates of chronic disease yet the lowest access to primary care in Canada. It is well established that increased primary care access is associated with lower rates of hospitalization and LTC admissions. Given the considerable strain on both systems, there is a clear need to improve access to primary care, and this has been identified as a key mandate by the new government. However, progress must also occur elsewhere to enable aging in the right place, and there needs to be greater discussion around improving access to other healthcare providers. For instance, there is limited availability for publicly available rehabilitation services – such as physiotherapy and occupational therapy – across N.L.. The government can do more to leverage other community-based healthcare providers, like community pharmacists and paramedicine programs, to deliver additional healthcare services and help enable aging in the right place. These services can be vital to allowing more older adults to maintain their independence and level of function, and a lack of such services also increases the risk of hospitalization or LTC home admissions. Furthermore, community-based models of care are far less expensive to deliver than institutional models of care. Without more support for these services, the traditional healthcare system originally designed for younger populations often unnecessarily leads to older adults being unable to age successfully in their own homes and communities for as long as possible.
Altogether, N.L. faces immense challenges due to its demographic reality and current ability to provide care for its aging population. However, despite these challenges, older adults in N.L. report among the highest levels of life satisfaction and sense of belonging compared to elsewhere in Canada. We need to invest today to enable N.L. to become a great place for everyone to age well in their communities and to ensure the sustainability of its healthcare system for years to come.
Dr. Matthew Downer is a resident physician and post-doctoral researcher in physical medicine and rehabilitation at the University of Toronto, and an associate health policy research fellow at the National Institute on aging at Toronto Metropolitan University.
Dr. Samir Sinha was invited to advise N.L. Health Services in 2024 on the implementation of its Health Accord. He is also a geriatrician and clinician-scientist at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on aging at Toronto Metropolitan University, and a professor of medicine at the University of Toronto, and is supported by a Clinician Scientist Salary Support Award from the division of geriatric medicine, University of Toronto.