Ontario (Rajeev Sharma): A province-wide requirement for air conditioning in Ontario’s long-term care homes has prevented dozens of deaths, according to new research that underscores the growing health risks posed by extreme heat.
The study, published this week in JAMA Internal Medicine, examined more than 73,000 resident deaths recorded in Ontario nursing homes between 2010 and 2023. Researchers found that residents living in facilities without air conditioning in their individual rooms faced a significantly higher risk during heat waves. On days of extreme heat, the likelihood of death was about eight per cent higher compared to residents in rooms with air conditioning.
“Cooling is not a comfort anymore — it’s a medical necessity,” said lead researcher Dr. Nathan Stall, a geriatrician at Sinai Health. He noted that older adults are particularly vulnerable to high temperatures, a risk that has intensified as climate change drives more frequent and severe heat events.
Using historical data, the research team modeled what would have happened if Ontario had not enforced the air conditioning requirement. Their analysis suggests that between 2020 and 2023 alone, the policy helped prevent approximately 33 deaths. During that period, 308 deaths were recorded, compared with an estimated 341 deaths in a scenario where air conditioning had not been installed.
Ontario formally introduced the mandate in 2021, requiring all long-term care resident rooms to be equipped with air conditioning by June 2022. The move followed public scrutiny during the COVID-19 pandemic, when reports emerged of dangerously hot conditions in nursing homes and residents were often confined to their rooms, unable to access cooler shared spaces.
At the time of the announcement in 2020, more than half of Ontario’s long-term care homes lacked air conditioning in resident rooms. The Ministry of Long-Term Care now says that nearly all homes are compliant, with only two facilities exempt due to redevelopment projects. Under provincial rules, operators must ensure air conditioning is functional whenever outdoor temperatures reach or are expected to reach 26°C.
Dr. Stall said the roughly $200 million investment delivered clear value. “When you look at the return, it’s unmistakable — this policy saves lives,” he said, adding that the speed of implementation was notable given the scale of the system.
The findings have also reignited calls for broader action beyond Ontario. The study’s authors point out that many other provinces lack similar regulations, despite facing similar climate risks. Stall suggested Ontario’s approach could serve as a blueprint for national standards, emphasizing that the research only captured the most severe outcome — death — and did not account for heat-related hospitalizations or emergency visits.
Other experts agree. Pat Armstrong, a long-term care researcher and professor emeritus at York University, said cooling should be treated with the same urgency as heating in care facilities. She also stressed the need to examine how extreme heat affects staff working in long-term care homes. “We need enforceable national standards,” Armstrong said.
The Ministry of Long-Term Care says all homes are inspected at least once annually, with inspectors averaging five visits per facility this year. Since the air conditioning regulations took effect, the ministry has issued 37 sanctions, with penalties reaching up to $25,000 per violation.
As heat waves become more common, the study adds to growing evidence that adapting infrastructure in long-term care settings is not just a quality-of-life issue, but a critical public health measure.
