It's Time: A Guide for Families Facing a Care Transition
Updated: Aug 23
What families need to know when the current care arrangement may no longer be enough – from recognising the signs, to understanding the options, to having the conversations that matter most.
Published by Livia Care | Toronto, Ontario | August 2026
Why This Guide Exists
There comes a point in many caregiving journeys when the question shifts. It is no longer only "how do we manage this at home?" It becomes something harder: "Is home still the right place?" Or, more precisely: "Is what we are currently doing still working – for our loved one, and for us?"
This is one of the most emotionally complex questions a family can face. It sits at the intersection of love, guilt, practicality, grief, and competing versions of what the right thing to do actually looks like. It is rarely answered cleanly or quickly. And it is made more difficult by the fact that there is no single moment at which the answer becomes obvious – it tends to emerge gradually, through a series of smaller observations and harder conversations.
This guide is written for families who are somewhere in that process. It does not argue for any particular outcome. Moving to more intensive home care, transitioning to a retirement home, or applying for long-term care can each be the right decision in the right circumstances. What this guide aims to do is give families the information and the language they need to think through the question clearly – and to have the conversations that it requires.
Section 1: This Is Not a Single Conversation
One of the most useful things families can understand early is that a care transition is rarely the product of a single decisive conversation. It tends to unfold over a period of weeks or months – sometimes longer – through an accumulating series of smaller exchanges, observations, and decisions. Expecting to resolve it in one sitting often creates pressure that makes productive dialogue harder.
There are, broadly, several different conversations that need to happen – not necessarily in this order, and sometimes overlapping:
The observation conversation – naming, within the family, what has been noticed and what it might mean
The conversation with your loved one – bringing them into the discussion, in a way that respects their autonomy and their perspective
The family alignment conversation – reaching a shared understanding among family members about what the situation requires, and who will do what
The professional conversation – getting input from a physician, a care coordinator, or a social worker who can offer an outside perspective on needs and options
The decision conversation – when enough information has been gathered and enough dialogue has happened that a decision can be made
Families who approach the transition as a process – rather than a single event – tend to find it somewhat less overwhelming. There is more room for everyone's perspective to be heard, and more time for the person at the centre of the decision to adjust to what is being discussed.
Section 2: Signs It May Be Time to Consider a Change
There is no single threshold that tells a family when the current care arrangement is no longer adequate. What tends to happen instead is a gradual accumulation of signs – some related to the care recipient's needs, some related to the sustainability of the caregiving arrangement, and some related to safety. The following are among the most commonly noted signals that a thoughtful review of the current arrangement may be worth undertaking.
Signs Related to the Care Recipient
Increasing frequency of falls or near-misses – particularly if the person is spending time alone at home and a fall could go undetected for a significant period
Difficulty managing medications reliably – missed doses, double doses, or confusion about what to take and when, despite reminder systems being in place
Significant weight loss or signs of poor nutrition – indicating that meal preparation and eating are no longer being managed adequately
Declining personal hygiene – difficulty with bathing, grooming, or continence that has moved beyond what current supports can address
Worsening cognitive changes – increasing confusion, wandering, or behavioural symptoms that are becoming difficult to manage safely at home
Loneliness and social withdrawal – spending long periods without meaningful social contact, which can affect both wellbeing and cognitive health over time
Repeated hospital admissions or emergency department visits – a pattern that sometimes reflects unmet care needs that could be better addressed through a different care setting
The person's own expressed wishes – some older adults reach a point where they themselves feel they would benefit from a setting with more support, more activity, or more company. These expressions are worth taking seriously.
Signs Related to the Caregiving Arrangement
The primary caregiver is showing signs of burnout – persistent exhaustion, emotional withdrawal, health effects, or a sense that they have reached their limit (see our Caregiver Burnout guide in this series)
Care needs have grown beyond what the caregiver can safely provide – tasks that now require clinical training, physical strength, or round-the-clock presence that one person cannot reasonably sustain
The caregiver's own health, relationships, or employment are being significantly affected – to a degree that is no longer sustainable
Night-time care needs are disrupting sleep regularly – chronic sleep disruption for the caregiver carries real health consequences and affects the quality of care that can be provided
The family's safety concerns have grown – a nagging sense that something could go seriously wrong, and that current arrangements would not be adequate to prevent or respond to it
Situations That May Warrant More Prompt Attention Most care transitions are gradual processes with time for planning and conversation. In some situations, however, a more immediate review of the current arrangement may be worth prioritising: • A fall resulting in a significant injury, or a pattern of falls that is accelerating • A medication error that has caused harm or a near-miss with serious consequences • An incident involving wandering where the person was found in an unsafe situation • A hospital admission that revealed care needs significantly beyond what is currently in place • The primary caregiver's own health has deteriorated to the point where they cannot safely continue • A physician or care coordinator has expressed concern about the safety of the current arrangement In these situations, it is worth contacting Ontario Health atHome (310-2222) to request an assessment. An assessment does not commit a family to any particular course of action – it opens a conversation about what options are available. |
A Useful Framing When assessing whether a change is needed, it can help to separate two distinct questions: "Is our loved one safe?" and "Is our loved one thriving?" A care arrangement can technically meet safety needs while still leaving a person isolated, bored, or without the level of social and physical engagement that supports quality of life. Both questions matter. A transition to a different care setting is sometimes motivated as much by the second question as the first. |
Section 3: Understanding the Options
One reason families find care transitions so difficult to navigate is that the landscape of options is genuinely complex – and not always well explained by the health system. What follows is a plain-language overview of the main care options available to families in Ontario, and what distinguishes each one.
Option 1 – Enhanced Home Care
Before a transition out of the home becomes necessary, it is worth asking whether significantly increased home care support could bridge the gap. For some families, the answer is yes – at least for a period of time.
Publicly funded home care through Ontario Health atHome (call 310-2222, no area code) includes personal support workers, nursing, physiotherapy, occupational therapy, and social work. The amount of funded support available varies by assessed need and regional capacity. Where publicly funded hours are insufficient, private home care agencies can supplement – providing care without a referral, often at relatively short notice.
Enhanced home care tends to work best when: the person has a strong preference to remain at home; the home environment is manageable with modifications; a family caregiver remains involved; and the level of need, while high, does not require round-the-clock clinical supervision.
Option 2 – Retirement Home
Retirement homes are privately operated residences that offer a range of accommodation, meals, social programming, and personal support services. They are not part of the publicly funded health system – residents pay privately, and costs vary widely depending on the home and the level of care required. Families can expect to budget anywhere from approximately $3,000 to $9,000 or more per month, depending on accommodation type and service level.
Retirement homes in Ontario are regulated by the Retirement Homes Regulatory Authority (RHRA), which inspects homes and handles complaints. The RHRA's public registry allows families to look up the inspection history of any licensed retirement home in Ontario.
Retirement homes tend to suit people who are relatively independent but benefit from the security of having staff on site, regular meals, and structured social activity. Many offer tiered care levels, so a resident can access more support as needs increase without necessarily having to move again.
Option 3 – Long-Term Care Home
Long-term care (LTC) homes are publicly funded and regulated by the Ontario government. They provide 24-hour nursing and personal care for people whose needs exceed what can be safely managed at home or in a retirement home setting. LTC is intended for individuals with complex, ongoing care needs – it is not designed as a transitional or short-term solution.
Access to LTC in Ontario is managed through Ontario Health atHome, which conducts a formal assessment of need. There is a standard co-payment for accommodation – as of 2025, the basic accommodation rate is set by the province at approximately $2,000 per month, with semi-private and private room rates higher. Co-payment rates are updated annually.
Waitlists for preferred LTC homes can be long – sometimes measured in months or years for higher-demand facilities. This is one of the most important reasons to begin the process earlier than feels immediately necessary. A person can be on a waitlist while still receiving care at home or in a retirement home, and can decline a placement offer if the timing is not right – though specific rules apply.
These Options Are Not Mutually Exclusive A family might use enhanced home care while waiting for a retirement home placement. A person might live in a retirement home for several years before their needs increase to the point where an LTC application becomes appropriate. The options exist on a continuum, and many families use more than one over time. Getting information early – before a crisis – means having more choices available when decisions need to be made. |
Section 4: Having the Conversation with Your Loved One
For many families, the most difficult part of a care transition is not the logistics – it is the conversation with the person at its centre. Fears about how the conversation will land, about resistance, about the relationship, and about what it means to be the one raising the subject can cause families to delay far longer than is in anyone's interest.
There is no perfect script for this conversation. But there are approaches that tend to go better than others.
What Tends to Help
Start with curiosity, not conclusions. Approaching the conversation as an inquiry – "I've been thinking about how things are going and I'd like to talk about it. How are you feeling about things at the moment?" – tends to open more space than leading with a position or a decision already made.
Choose the right moment. A calm, unhurried setting with no other agenda works better than raising the subject in the middle of a difficult day or immediately after an incident. Neither person should feel rushed.
Name your concern without catastrophising. Being specific and grounded tends to be more effective than expressing global alarm. "I've noticed a few times recently that you've been having trouble with the steps, and I've been thinking about whether we should look at some options together" is easier to engage with than an expression of urgent crisis.
Listen as much as you speak. Your loved one's perspective – their fears, their preferences, their own assessment of how things are going – matters and may contain information you don't have. Resist the urge to respond to every concern immediately.
Separate the conversation from the decision. An initial conversation does not need to end with a decision. It can end with both parties agreeing to think about it, to gather more information, or to speak again. That is a reasonable and productive outcome for a first conversation.
Involve them in the process where possible. People adjust more readily to changes they have had some role in shaping. Visiting retirement homes together, involving the person in conversations with care coordinators, or asking for their input on what matters most to them in a care setting can make a meaningful difference to how a transition is experienced.
When There Is Resistance
Resistance to a care transition is very common and entirely understandable. Moving from one's home, or accepting a higher level of care, can feel like a loss of identity, independence, and control – because in some real ways, it is. That loss deserves to be acknowledged, not dismissed.
Acknowledge the loss directly: "I know this isn't what you wanted, and I understand why this is hard." Resistance often softens when people feel genuinely heard rather than managed.
Avoid framing the transition as something being done to them. Where possible, frame it as something being worked through together.
Give the process time where safety allows. Forced or rushed transitions tend to be harder for everyone. If the situation permits, allowing the conversation to unfold over several weeks is often worthwhile.
Seek outside input if the conversation is stuck. A family physician, a social worker, or a care coordinator can sometimes raise the same concerns more effectively precisely because they are not family. Some families also find that a professional mediator or geriatric care manager can help facilitate conversations that have become entrenched.
When Capacity Is a Factor If your loved one has a diagnosis of dementia or another condition that affects cognitive capacity, the conversation and the decision-making process may look different. A person with early dementia may still have the capacity to participate meaningfully in planning decisions – and their preferences and values remain important even as capacity changes. If there is genuine uncertainty about capacity, a physician can provide a formal assessment. If a Power of Attorney for Personal Care is in place, that person's role becomes more central as capacity diminishes. If one is not yet in place, it is worth addressing this as early as possible. |
Section 5: Having the Conversation Within the Family
Care transitions rarely involve just two people. They tend to involve siblings, spouses, adult children, and sometimes extended family – each of whom may have a different relationship with the care recipient, a different level of involvement in day-to-day care, and a different view of what the right decision is.
Family disagreement around care transitions is common. It is worth naming it as normal rather than treating it as a failure of family functioning.
Sources of Family Disagreement
Different levels of information. The family member who is most involved in day-to-day care typically has a very different picture of the situation than one who lives at a distance and visits occasionally. These different pictures can generate genuinely different assessments of what is needed – not bad faith, but incomplete information.
Different relationships with the care recipient. An adult child's relationship with a parent carries a different emotional weight than a sibling relationship. These differences affect how people assess situations and what they find acceptable.
Different values around care. Deeply held views about family obligation, about independence, about what constitutes a good life in older age – these vary between people and between families, and they shape how people approach care decisions.
Different capacities to contribute. Family members who are less involved in direct care sometimes hold stronger opinions about what should happen. This can create tension with those who are carrying the day-to-day weight of the arrangement.
Approaches That Can Help
Agree on the goal before discussing the solution. "We all want Mum to be safe and to have a good quality of life" is often a point of genuine consensus that can anchor a conversation even when the specific decisions are contested.
Involve a neutral third party. A social worker, a geriatric care manager, or a family mediator can bring structure and neutrality to a conversation that has become difficult to have within the family alone.
Make the care recipient's expressed wishes central. Where the person has stated preferences – even general ones about what they value or fear – these can serve as a shared reference point that takes some of the pressure off the family to resolve the disagreement themselves.
Name the imbalance in care contributions, if it exists. If one family member is carrying significantly more than others, that is relevant to the discussion – both practically and emotionally. Addressing it directly, rather than letting it simmer as resentment, tends to produce better outcomes.
Section 6: The Ontario Care Pathway: What Happens Next
Once a family has determined that a change is needed, the practical question becomes: how does the Ontario care system actually work, and what steps need to be taken? The following is a plain-language walkthrough of the key pathways.
Step 1 – Contact Ontario Health atHome
Ontario Health atHome (call 310-2222, no area code required anywhere in Ontario) is the entry point for both publicly funded home care and long-term care applications. A care coordinator will conduct an assessment of the person's needs and can help the family understand which options are appropriate and available.
Self-referrals are accepted – a physician referral is not required to initiate contact. It is generally worth reaching out earlier rather than later, as assessment and planning take time, and LTC waitlists in particular can be lengthy.
Step 2 – Applying for Long-Term Care
If LTC is determined to be appropriate, the application is initiated through Ontario Health atHome. The official provincial information on the LTC application process, eligibility criteria, and what to expect is available at ontario.ca/page/apply-long-term-care.
Key things Ontario families should know about the LTC application process:
A person can be placed on the waitlist for up to five LTC homes simultaneously. Applying to more than one home (including homes that may not be the first preference) can reduce overall wait time.
When a bed becomes available, the family typically has 24 hours to accept or decline the offer.
If an offer is declined, the person goes to the bottom of the waitlist for that particular home and must wait a further period before being eligible for another offer from the same home.
Waitlist times vary considerably between homes, between regions, and over time. A care coordinator can provide current estimates for specific homes.
Being on a waitlist does not prevent a person from receiving care at home or in a retirement home in the interim – these arrangements can continue while waiting for a placement.
Step 3 – Choosing and Visiting Homes
For retirement homes, families can search, visit, and apply directly without going through a government system. The RHRA's public registry at rhra.ca allows families to verify that a home is licensed and to review its inspection history before committing.
When visiting any care home – retirement or LTC – the following are worth assessing in person:
The atmosphere and the feel of the common areas – whether residents appear engaged and the environment feels calm
How staff interact with residents – tone, patience, and whether residents are addressed by name
The meal experience – quality, variety, and whether the dining environment is social or isolated
What structured activities and social programming are available, and how consistently they run
The physical environment – cleanliness, accessibility, and whether the space feels like somewhere a person could genuinely live
The home's approach to family involvement – whether families are welcomed as partners in care
Apply Early – Even If a Move Isn't Imminent One of the most consistent pieces of guidance from families who have navigated this process is to begin the LTC application earlier than feels immediately necessary. Being on a waitlist does not commit a family to accepting a placement – an offer can be declined if the timing is not right. But not being on a waitlist means having no access to a placement when one is needed urgently. Applying early preserves options; it does not foreclose them. |
Section 7: The Emotional Reality: What Families Actually Experience
The practical dimensions of a care transition – the assessments, the applications, the visits, the decisions – are demanding enough. But for most families, the harder part is emotional. Understanding what to expect on that level can make the experience somewhat more navigable.
Guilt
Guilt is among the most commonly reported emotions for families making a care transition decision. It tends to arise regardless of the circumstances – even when the decision is clearly the right one, and even when the care recipient has expressed support for it. Many families carry a persistent background sense that they are somehow failing a loved one by not managing everything at home.
It is worth noting that guilt in this context does not usually reflect wrongdoing. It tends to reflect how much a person cares – and the genuine difficulty of a situation in which no available option is perfect. Acknowledging guilt without letting it be the deciding factor in a care decision is something many families find useful to work through with a social worker, a counsellor, or a peer support group.
Grief
A care transition involves real loss – for the care recipient and for the family. The loss of a familiar home, of a particular version of family life, of a relationship as it has existed. This grief is legitimate and does not need to be minimised or rushed through. Many families find that it runs alongside relief and even gratitude – these emotions are not contradictory.
Relief
Relief is also common – and often comes with its own complicated feelings. Feeling relieved that a loved one is somewhere safe, or that the relentless pressure of caregiving has eased, can feel uncomfortable when it coexists with guilt or grief. It is, nonetheless, a very normal response. The Ontario Caregiver Organization offers peer support and counselling specifically for caregivers navigating transitions – including the complex emotional terrain that follows a placement.
The Transition Period Itself
The period immediately following a move to a new care setting is often harder than families anticipate – for the care recipient and for the family. Adjustment to a new environment takes time. A person may seem more confused, more withdrawn, or more distressed in the first weeks than they were before the move. This is a common part of adjustment and does not necessarily mean the decision was wrong. Most families and most residents find that it takes several weeks to a few months before the new setting begins to feel genuinely familiar.
Frequent visits in the early weeks, involvement with the care team, and consistent routines can support a smoother adjustment. It is also worth building a relationship with the care home's staff – families who are engaged tend to have better information about their loved one's day-to-day experience, and staff tend to appreciate the partnership.
Section 8: Quick Reference Checklist
Assessing Whether a Change Is Needed
Having the Conversations
Exploring the Options
During and After the Transition
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Section 9: Key Resources for Ontario Families
Resource | What They Offer | How to Access |
The entry point for publicly funded home care and long-term care applications in Ontario. A care coordinator will assess needs and help navigate options. | Self-referral accepted. Call 310-2222 (no area code). ontariohealthathome.ca | |
Official provincial information on LTC eligibility, the application process, accommodation costs, and what to expect at each stage. | ontario.ca/page/apply-long-term-care. LTC applications are initiated through Ontario Health atHome. | |
Regulates retirement homes in Ontario. Public registry allows families to verify licensing and review inspection history of any retirement home before committing. | rhra.ca – search the public registry by home name or location. | |
Free helpline, peer support, and counselling for caregivers at any stage – including those navigating a care transition and the emotional aftermath of a placement. | 1-833-416-2273, 7 days a week. ontariocaregiver.ca | |
For families navigating a care transition for someone living with dementia: education, individual support counselling, and guidance on the specific considerations that apply. | 1-800-879-4226 or alzheimer.ca | |
Family Physician or Geriatrician | Can provide a medical assessment of care needs, a referral to Ontario Health atHome, documentation for LTC applications, and input on which care setting is most appropriate given the person's clinical needs. | Book an appointment. Be direct about what you are trying to assess: "We are wondering whether the current care arrangement is still meeting Mum's needs, and I'd like your view." |
Section 10: When Professional Home Care Can Help
A care transition is rarely instantaneous. Between the decision to pursue a different care arrangement and the moment that arrangement is in place, there is often a gap – sometimes a brief one, sometimes a longer one. Professional home care can play a meaningful role in bridging that gap, and in supporting both the care recipient and the family through the transition itself.
Situations Where Additional Home Care Is Worth Considering
While waiting for a long-term care placement – LTC waitlists can extend over many months. Increased home care support during this period can make the wait safer and more manageable for everyone involved
While a retirement home search is underway – finding the right home, visiting options, and completing the admission process takes time. Interim home care can help hold the situation steady during that process
When the primary caregiver needs relief – scheduled relief hours allow the caregiver to attend to their own health, rest, and relationships without the current arrangement breaking down
Following a hospital discharge pending a longer-term plan – the period immediately after discharge is often when care needs are highest and a longer-term decision is still being worked through
To supplement publicly funded care – when Ontario Health atHome hours are insufficient for the level of need, private home care can fill the gaps without requiring a change of setting
To provide overnight or weekend coverage – needs that fall outside standard publicly funded hours can often be addressed through a private care arrangement
To support the transition itself – a familiar care worker present through the early weeks of a move to a retirement home or LTC facility can ease the adjustment for someone who finds change difficult
You Don't Have to Have It All Figured Out Before Asking for Help Many families wait until they have a clear long-term plan before contacting a home care provider – when often the reverse is more helpful. A care conversation can help clarify what is actually needed, what options exist, and what a realistic next step looks like. There is no obligation in making an enquiry, and the information tends to make subsequent decisions easier to navigate. |
Livia Care – Here When the Questions Get Hard At Livia Care, we work with families who are navigating exactly these decisions – providing professional, compassionate home care that helps older adults remain at home safely for as long as that is the right choice, and supporting families through every stage of the care journey. If you are trying to work out what the right next step is for your family, we are happy to have that conversation. Livia Care | Toronto, Ontario Personalized 1:1 Senior Care www.liviacare.ca | 647-693-1504 | care@liviacare.ca |
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