Tensions in the provision of residential care facility housing with support model: evolving resident health care needs, systemic barriers and regulatory pressures

Residential Care Facilities (RCFs) refer to housing arrangements in the city where our research is based. As residents face more complex health and social challenges, RCFs, traditionally operating under a landlord-tenant model rather than a healthcare framework, are under increasing strain. Semi-structured interviews were conducted with two groups: RCF operators (n = 23) and supporting stakeholder services (n = 20). This paper reports on two key interrelated findings from a thematic analysis of the interview data through an integrated care lens: Evolving Resident Support and Care Needs, highlighting changing needs, individual preferences and individualized care, and Systemic and Operational Challenges, related to misalignment between care needs and resources, insufficient support services, and regulatory and funding constraints. We discuss the broad challenges in RCF delivery and conclude by emphasizing the need for coordinated stakeholder efforts to address outdated structures, improve resources, and implement care models that reflect the evolving needs of housing residents.