Extendicare Inc. ($EXE)

Thank you for standing by. This is the conference operator. Welcome to Extendicare Inc. First Quarter 2026 Analyst Conference Call. [Operator Instructions] The conference is being recorded. [Operator Instructions] I would now like to turn the conference over to Jillian Fountain, Vice President, Investor Relations. Please go ahead.

Thank you, operator, and good morning, everyone. Welcome to Extendicare's 2026 First Quarter Results Conference Call. Joining me today are Extendicare's President and CEO, Michael Guerriere; and Executive Vice President and Chief Financial Officer, David Bacon. Our Q1 results were released yesterday and are available on our website, as is a live audio webcast of today's call, along with in the company's slide presentation. An archived recording will also be available on our website following the call today. As well, replay numbers and passcodes have been provided in our press release for those wishing to access an archived recording by phone until midnight on May 22. Before we get started, please be reminded that today's call may include forward-looking statements and non-GAAP and other financial measures. Such forward-looking statements involve known and unknown risks and uncertainties that may cause actual results to differ materially from those expressed or implied today. We have identified such factors as well as details of non-GAAP and other financial measures in our public filings with the securities regulators and suggest that you refer to those filings. With that, I'll turn the call over to Michael.

Thank you, Jillian, and good morning. Our first quarter results demonstrate the various components of our strategy working in concert. Strong organic growth in home health care augmented by acquisitions, progressing our long-term care construction activities in our joint venture with Axium and organic growth in SGP all benefiting from the operating leverage that results from a technology-enabled back office. Subsequent to the quarter, we closed the $570 million acquisition of CBI, and completed the sale of $450 million in unsecured notes, supported by a BBB credit rating from DBRS. These transactions provide us with new opportunities for growth and additional capital flexibility as we work to meet the increasing care needs of an aging population. The pyramid segment delivered volume growth of 32.7% over the prior year quarter, reflecting the addition of closing the gap and strong underlying organic growth. Higher volumes, combined with the scalability of our technology-enabled back office, drove an NOI margin of 13.3% after adjusting for out-of-period items, a 300 basis point increase over the prior year quarter. Our long-term care NOI margins improved by 90 basis points from the prior year to 10.9% after adjusting for out-of-period items with occupancy unchanged at 97.5%. Managed Service revenues declined year-over-year due to Revera's sale of its remaining portfolio, some to Extendicare and the balance to another operator. Nonetheless, third party and joint venture beds served by SGP grew to over 157,000, up 6% from the prior year. Managed Services NOI margins were 54.6%, remaining in line with our expectations of 50% to 55% margins for this segment. Driven by the strength of these results, AFFO adjusted for out-of-period items, increased to $0.276 per share, up 56% year-over-year, driving our payout ratio down to 41% on a trailing 12-month basis. Turning to Slide 4. We closed the CBI acquisition on April 1. The CBI Home Health is highly complementary to Pyramid as it materially expands our presence in Western Canada and introduces business models that offer new avenues for organic growth. The combination of the two companies provides an opportunity to achieve significant synergies as we manage additional volumes using our highly scalable technology platform. The added scale will enable further investments in technology, enabling us to provide reliable, high-quality services more efficiently to the thousands of people that rely on us for care each day. The transaction adds CBI's approximately 10 million hours of service and 8,500 team members to our home health segment, which as previously disclosed, generated an estimated $478 million in revenue and $61.9 million in adjusted EBITDA on a pro forma basis in the 12 months ending June 2025. Turning to Slide 5. We continue to advance our Ontario long-term care redevelopment agenda, through our joint venture with Axium. We currently have 7 projects under construction, 2 of which will open this year. At the end of May, we will welcome residents to Extendicare in Ottawa, followed later in the year by Extendicare Forest Trail in Peterborough. Together, these two homes will deliver 576 new and upgraded beds. We remain on track to open 4 new homes in 2027 delivering an additional 832 beds. In February, we completed the sale of our vacated West End Villa in Ottawa for $12.1 million, realizing a $9.8 million post-tax gain. This sale is another example of the capital recycling potential of our redevelopment strategy as we can invest these proceeds in new projects to advance our redevelopment pipeline. We continue to progress an additional 17 projects, which are at varying stages of planning and development under the Ontario Long-Term Care Home Capital Development program. We are actively working with government to put in place the necessary funding and other considerations required to begin construction on additional homes to fully realize our redevelopment agenda. I'll now turn the call over to our CFO, David Bacon, to discuss our financial results in more detail.

Thanks, Michael. I'll start with a brief overview of our consolidated results, review our individual business segments and provide an update on the recent changes to our capital structure. Our consolidated results for the quarter included approximately $8.7 million in net favorable out-of-period items related to retroactive funding in both LTC and home health, partially offset by retroactive wage adjustments in home health. The impact of the out-of-period items is summarized in the appendix to our presentation. Our consolidated Q1 revenue increased by 24.2% to $465.2 million driven by 32.7% growth in our home health care volumes, reflecting the organic growth in the acquisition of closing the gap last July, the acquisition of 9 LTC homes in June of 2025, long-term care funding enhancements, partially offset by the closure of the West End Villa Home that was vacated when we opened Extendicare Crossing Bridge in the Axium joint venture and lower management fees resulting from Revera's sale last year of the LTC homes that we previously managed. Excluding out-of-period items, our Q1 NOI improved by $16.7 million or 38.3%, reflecting the revenue growth, partially offset by higher operating costs. Excluding the impact of out-of-period items, our Q1 adjusted EBITDA increased by $15.2 million or 52%, reflecting the improvement in our NOI, partially offset by higher admin costs. Our Q1 AFFO improved by 65% to $32.7 million. When out-of-period items are excluded from both periods, our Q1 AFFO increased by $11.4 million or 76% from the prior year, reflecting the improved after-tax earnings partially offset by the cash impact of our annual settlements of our share-based compensation. The corresponding AFFO per basic share was $0.276 this quarter, an increase of 56% from the prior year and was impacted by the December equity offering which on a pro forma basis reduced AFFO by approximately $0.35. Turning to our individual segments. Home health care continues to deliver strong performance. The Q1 results were impacted by out-of-period revenue of $1.7 million and related costs of $900,000 for a net impact of $800,000. Last year's Q1 results were impacted by out-of-period revenue and offsetting costs of $11 million as well as workers' compensation rebates of $3.9 million. Excluding these out-of-period impacts, our Q1 revenue increased by $56.5 million or 38% year-over-year, driven by organic growth and the acquisition of closing the gap. Corresponding Q1 NOI improved by $12 million or 78%, driven by the revenue growth, partially offset by increased wages and benefits. On the same basis, excluding the out-of-period items, our NOI margins increased 300 basis points to 13.3% in the quarter. Turning to our Long-Term Care segment. The Q1 results were impacted by out-of-period funding of $7.9 million this year compared to workers' compensation rebates of $2.7 million in last year's quarter. Excluding out-of-period impacts, revenue increased by $37.9 million or 19%, driven by the contribution of $32.5 million from the 9 LTC homes acquired last June, and the timing of envelope spending, partially offset by the closure of the West End Villa Home in February as a result of the opening of Crossing Bridge in the joint venture. On the same basis, NOI increased by $5.8 million or 31%, driven by the increases in revenue and the contribution of approximately $3.5 million in NOI from the 9 LTC homes acquired, partially offset by higher operating costs and the closure of the redeveloped C-Class homes. Corresponding NOI margins increased 90 basis points over the prior year period to 10.3% in the quarter. Turning to our Managed Services segment. The anticipated decline in revenue and NOI this quarter reflects the termination of the management contracts resulting from Revera's sale of 30 LTC homes last year, 9 of which we acquired now are included in our LTC segment. Our managed services revenue decreased $2.4 million to $16.2 million and NOI declined $1.1 million to $8.9 million. Despite the reduction in the number of managed homes, earnings benefited from 6% organic growth in SGP clients and our increased management fees from the newly opened home in the joint venture. Turning to Slide 11. On April 1, we closed the CBI acquisition, utilizing the committed upsized senior credit facility as well as cash on hand, which included the $191.5 million in net proceeds from our December 2025 equity issuance. The addition of CBI meaningfully increases Extendicare's scale and diversifies our earnings base helping to broaden our access to the capital markets. On April 14, we successfully completed an inaugural investment-grade credit offering, issuing $450 million senior unsecured notes priced at 4.345% on a 5-year term maturing April 2031. Both the company and the notes received a BBB rating, stable rating from Morningstar, DBRS. We used approximately $427.7 million of the net proceeds to fully repay the delay draw term loan and to repay a portion of the revolving credit facility that we had drawn to fund the CBI acquisition on April 1. In conjunction with the notes offering and the repayment of the delayed draw term loan, we amended our senior secured credit facilities to establish an unsecured credit facility structure that ranks pursue with the notes. The new $250 million unsecured revolving facility provides us with lower credit spreads than our former senior secured credit facility and extends the maturity for a new 3-year term to April 2029. Turning to Slide 12 for a look at our credit metrics and liquidity position. We continue to maintain a prudent capital structure following the closing of the CBI acquisition and our new unsecured credit structure. We have improved our maturity profile with the maturity of our new revolving facility extended to April 2029 and the 5-year notes maturing in April 2031. We do intend to consider early prepayments of certain of our senior secured mortgages, including those that mature in 2027 to further improve our maturity profile outlook and improve our weighted cost of debt. Our pro forma liquidity position as at March is approximately $211 million, comprised of approximately $67 million in cash on hand and $161 million available on our unsecured revolving credit facility. This reflects the CBI acquisition and the notes offering and related to credit facility changes that I had outlined on the prior slide. Our pro forma debt to adjusted EBITDA as of March 31, 2026, is approximately 2.8x, reflecting the incremental debt we have taken on in 2025 and '26 to fund our acquisitions as well as the full year impact to EBITDA of our 2025 acquisitions and the pro forma adjusted EBITDA of $61.9 million from CBI. We are comfortable with this leverage at this level and have the opportunity to further delever, given our strong free cash flow profile and our capital-efficient redevelopment model, or to add leverage in support of accretive acquisitions as necessary. We are pleased with the strength of our capital structure and are well positioned to continue to pursue our growth agenda. We will remain disciplined in our approach to allocating capital, balancing our objectives to drive growth and create shareholder value, but also managing leverage commensurate with our new BBB stable rating. With that, I'll pass it back to Mike for his closing remarks.

Thank you, David. The closing of the CBI transaction, together with the recent transformation of our capital structure, creates meaningful new opportunities for Extendicare as we work to expand access to care for the growing number of Canadians who depend on us. Our Q1 results represent a strong start to 2026 with our strategy delivering across all business segments. For the remainder of the year, we will be intently focused on completing the integration of closing the gap and advancing the integration of CBI while continuing to deliver high-quality care to those we serve. The demographic realities of the aging population are driving sustained demand for our services and the scale and efficiency of our operations position us well to meet it. In the health care sector facing real challenges, we are confident that our scale and mix of services will help relieve pressure on hospital capacity by delivering care in the most appropriate and cost-effective settings. We will continue to build capacity to ensure that everyone in Canada receives the care they need to live their best lives. My sincere thanks to our growing team, including our new colleagues from CBI, for their commitment to advancing this important mission. With that, we welcome any questions that you might have.

[Operator Instructions] The first question comes from Kyle McPhee with ATB Cormark.

Everyone, great update. First one for me on your home health care business. You didn't report the organic change in hours of service this quarter. But I think backing out what I think came with closing the gap, it looks like organic growth for hours of service was up by just over 20% year-over-year. So even more momentum than we've seen in recent quarters. I think we all know the senior demand theme home health care, taking share from LTC, last quarter, you highlighted the acute care bed theme. Anything else worth highlighting here that benefited Q1, whether it's temporary or durable?

Well, Kyle, we've consistently been predicting that the volume growth would be driven by two major factors, one being the underlying demographic growth trend in the population that we serve primarily, which is around 4% a year. And then the failure of long-term care to keep up with that demographic trend. So Home Care is expanding to fill that gap. So we've often thought that mid- to high single digits is the kind of the long run organic growth trajectory that we would expect. It's been higher than that, I think partly because we're still filling the gap that emerged over the pandemic and backing up into acute care hospitals. We're seeing that start to be relieved in different provinces. And so we do think the organic growth is going to slow down. We just can't predict when. We seem to predict that every quarter, and it just hasn't happened yet, but we do expect that that's going to happen soon. As far as the the closing the gap numbers, as closing the gap becomes more and more integrated with the rest of our operation, our ability to really discern which volumes or which to be able to segment that out has passed. And so we're just going to continue to report it on a combined basis from here forward. .

Got it. Okay. And then just shifting to another topic. You have a very resilient business model given the nature of demand and you're shielded from things like energy costs, which not a big cost bucket for you. But that's what I wanted to check in on. I think one cost bucket for your home health care platform is presumably vehicle fuel, your caregiver driving around to patients' homes. Can you offer any color on whether or not inflationary fuel environment will eat into any of your home health care margins. I'm not sure if it would be Extendicare eating the fuel cost at or the caregivers or the payers or if it's even a big enough cost bucket to matter?

Well, the most important cost driver for us is labor costs. It's approximately 85% of our cost structure. So any fuel cost impact is going to be small. We do reimburse our staff for travel costs. So it may have some impact on our cost going forward, but I don't think it would be material enough to call it out.

The next question comes from Jonathan Kelcher with TD Cohen.

Just a quick follow-up on that last one. When you reimburse for travel costs, is that kind of like a $1 or dollar amount per kilometer? Or how does that work?

Yes, that's how we structure it.

Okay. And then just sticking with the home health care. Do you have a sense of how big the gap is between what you're trying to fill and the demand?

It's -- Jonathan, it's really hard to see that to know how much home care is required to offset the pressure on hospitals. And it's difficult for a couple of reasons. One is some of the pent-up demand is hidden in the form of waiting lists that we don't have visibility to. And the second is that it's difficult to know how many hours of care those people would require to be able to remain safely independent in their own homes. So that combination of things makes it very difficult. I'll candidly say that we expected the volume growth to moderate long before now. So it has been a surprise to us to the degree to which it has continued to increase. And we just don't know when it will slow down, but we're quite certain it will at some point. .

Okay. That's helpful. And what's -- I guess -- in meeting that, you're adding labor all the -- like what's the capacity constraint on labor? Are you running into issues? Or is it still going very well?

It's different for different groups. The majority of home care employees or PSWs. And in recent years, we've had very good luck with adding to our PSW team, partly because we've partnered with colleges and we have a large number of students who are doing part of their training in our operations, which gives us a leg up when it comes to recruiting. So we have been able to recruit everything we need on that front. Where we've had more difficulty is in the Allied Health side of home care, physiotherapists, occupational therapists. They're in very, very short supply. So that has been a significant challenge, and we're continuing to struggle with that. But because it's a small, very small part of our volumes overall, it really isn't affecting our overall performance.

Next question comes from Tom Callaghan with BMO.

Maybe just following up on Jonathan's question there on labor. Like I guess you've been very open about the fact that you do expect a slowdown or return to more seasonality. I'm just curious on the PSW side, like if we continue to grow here kind of sequentially 4%, 5%, 6% a quarter. Is that something you can kind of support into 2027 with the current labor? Or just kind of how are you thinking about that if we are or remain in a situation where that volume growth kind of continues to come through like it has?

Yes. We believe that we'll have access to enough new recruits to be able to do that. We're also very focused on retention. And we've had very good luck over the last 2 or 3 years, reducing turnover in our staff. We've also invested quite heavily in our own training capability to be able to support onboarding and therefore, have a flexibility in our ability to increase the workforce in tandem with any demand for services that we're seeing from hospitals and from doctors' offices. So you can see that in how quickly our organic volume growth has increased. We've been more planning on the sort of mid- to high single-digit growth front, but we're able to flex our recruiting to meet demand as it comes in. So we expect that, that will continue to be the case as we go forward. As I said to Jonathan, I mean, that -- the exceptions are Allied Health, but physiotherapy also in some of the more remote and rural regions of the country that we serve, it can be a challenge to get staff. But those challenges really aren't reflected in our results.

Got it. Maybe a follow-up for me is just on capital allocation post CBI there. In the prepared remarks, I think you -- you mentioned both you're comfortable with current leverage on a pro forma basis, but also kind of going to focus on integration here. So just how are we thinking about capital allocation over the balance of the year and into '27.

Yes. I think our focus as Mike said, we'll be on the integration. I think from a capital perspective, there's a natural delevering, I think, that we'll focus on over the next few quarters as we do integrate the business and pay down the revolver. So you'll see the 2.8x come down a bit. So that will be kind of first priority as to where we put our capital to give us more dry powder and liquidity. And I think what we've said is as we get back into '27, we do still think there's opportunities on the acquisition front. And so we're hopeful that when we're ready to turn that back on that there's -- we still think there's good fragmentation out there and good opportunities for accretive acquisitions. So we'll turn our -- redirect the capital back to that. But for the next few quarters, it will be integration and delevering will be the focus.

The next question comes from Tal Woolley with CIBC.

The CBI pro forma numbers were given when you started the deal process, they're almost a year stale now. Is it fair to say that that $62 million in NOI is likely not the current run rate? And can you give us any sort of estimate of where that might be tracking right now?

Yes, Tal, good question. They are a bit dated. I think it'd be fair to say that over half the business in CBI is in Ontario and Ontario Health at Home contracts. So I don't think it's a big leap to suggest that, that business has performed similarly to what we've seen with ourselves and CPG. The Western business that we pick up as a slightly different mix to it, the SCS business within CBI, as we've said prior, wouldn't be growing at that same pace, but still growth. But -- so yes, the business is definitely performing better. I think our preference is to wait and you'll see a full quarter in Q2 given we closed April 1, and we can talk more about that improvement. But I think directionally it's not unreasonable to conclude that the business is probably doing better than the 62% we bought at.

For sure. And then, Michael, the Ontario came in and extended the funding for the -- beds for another several years on a sliding scale. I'm just wondering like it kind of reminds me a bit of the Class C license extension that was all supposed to fall off a cliff in 2025, and now they've subsequently been extended. What's your perspective on what those beds could be used for? And is the industry thinking about potentially how to repurpose some of these assets to maybe make them more useful, whether it's to help with hospital overload or long-term care overload? Appreciating that they're probably not in the shape to do everything they were originally designed to do.

David runs this portfolio for us. So I'm just going to ask him to comment on this. He's he's closer to it.

Yes. Just -- I mean, in terms of the C-beds, a couple of points, yes, they've extended that funding out for a few years. Obviously, that' a positive for us, but we don't have a lot of third and fourth board beds today, just over 200 in total and almost half of those are going to be put back in service with our -- the homes that we already have under construction. So from a financial point of view for us, it's helpful that it's been extended, but we also don't have a lot there. From a repurposing point of view, it's a good question. I think that what we've seen in our redevelopment to date is that people are buying our old C-bed homes and repurposing them for other social purpose. That's not long-term care, but affordable housing, multifamily housing. So to date, every C-bed home we've sold is still there and being repurposed to use for housing. So I think there's -- that's something that we're seeing. And I think other operators that are redeveloping are seeing the same thing is that people are finding new uses for them. I think that -- there has been some conversations in the sector with the ministry and the OLTCA about -- are there other ways we could extend using these homes for periods of time to help with transition. In the GTA, for example, people are going to need to -- it's hard to find land. So if you can rebuild potentially on the existing land you own, but you may need to decant the old home for a while in order to build the new one. So there has been some discussions, but I think it's fair to say that in the end, there's a reason there's a C-bed redevelopment program, which is we think all these homes as they serve -- all these homes should be redeveloped and they should be taken out of service as long-term care homes. And that's what we're committed to do. But we have seen repurposing of the facilities in a number of cases for other social purposes, which is not what we expected when we first set out, but it seems to be happening more commonly.

Okay. And then the February asset sale, do you have a rough estimate of the NOI contribution from that building?

For sub re 2, the new one?

No, no, for the sale. -- like so the buildings generating roughly how much NOI right now? .

For York. Yes, that -- again, we don't ever talk about NOI on a per home basis. But I think, again, I'd encourage you to go back to kind of just average NOI per bed, if you look at our bed NOI for LTC divided by sort of our total beds will give you a bit of a proxy given the size of that home. The current home is about 278 beds. So on average, if you just do the math, it's about $10,000 to $11,000 to $12,000 a bit, but that gives you a bit of a proxy.

Okay. And then just lastly, you guys have been hanging on to a lot of cash here as you're waiting for the -- you've been waiting for the CBI deal to close. But Extendicare has kind of historically held a lot of cash, I would say, over the course of its history. Just kind of wondering, like with the business mix changing, what is -- what's the right level you think going forward?

Yes. No, it's a great question. I think there's been a huge shift this quarter with part of our plan to move with CBI in particular. We've now moved into a much more -- a couple of years ago, we moved into a secured credit facility. Now we've moved into the unsecured with a $250 million revolver. So I do think you'll see us running sort of more modest cash balances and using the revolver for, again, '27 and beyond smaller tuck-in type acquisitions. So I don't think you'll see us carrying as much cash as we historically had. Obviously, quite purposeful with sort of how high our cash balances got late last year with the equity offering for CBI. But in the deck, it shows pro forma after you've washed through all the subsequent events with buying CBI and the bond deal. We have about $67 million of cash and about $160 million left on the revolver. So sort of a more modest cash position than certainly what we've been running at for the last little while.

Next question comes from Lorne Kalmar with Desjardins.

Congrats on a great result this quarter. On the home health care margins, I'm sorry if I missed this, if you guys are running at these ADV growth levels that are above expectations. Is it fair to assume that so long as that continues, you can actually achieve margins in excess of the 13% sort of long-term average target that you provided previously?

Yes. I think a couple of things just to put into context there. Just this quarter, we were 13.3% when you normalize it. If you go back the last few quarters normalize, we are running just over 13%. For the full year last year, we did 12.8%. And I think we've said in past calls that we do believe this will be 50 to 100 basis point improvement over time in that business as we continue to grow, integrate the acquisitions, invest more in sort of efficiency gains through technology. So I think that we're still into a 13% margin business. The one thing -- and I think we talked about this in Q4, we've -- with this double-digit growth we've been experiencing now for what we -- is an extended period of time, we've been able to grow a lot with with the back office we have. But there is -- the back office is a bit of a step function. So if we -- with the sustained levels of growth organically, if that stretches in, we will need to put some additional investments into the back office to support just that higher volume. So I think that -- I think the end result is still the same. This will be a higher -- this can be a modestly higher business, but I think that given the sustained growth in volumes, I think that 50 to 100 basis points might be stretched out or a little further out because I do think we need to -- we're going to need to put some investment back into just the supporting functions and back office that are been doing a lot to support the growth, but it's now run pretty hot for a while and needs more investment. So we're not changing what we've said. I think it's just the timing. So I think we're now running at that just above 13%, probably moderates here for a little bit before before we'd see some of those increases we've talked about in the past kicking in.

And do you expect -- if I recall correctly, I know it's still kind of new to the story here, but there typically is a little bit of seasonality in home health is the idea that with the environment being what it is, that seasonality kind of goes away until things start to normalize?

I mean the underlying things that happened that gave us those seasonal patterns in the past still happen. They've just been masked with 5%, 6% sequential growth quarter-over-quarter. So there's still the holidays still fall. There's still snowstorms in December and January. We still have -- certainly in home care, we still give every -- all of our nonunionized people get their raises on January 1, and we don't get rate increases until later in the year. So all those things still happen. I think they've just been masked. So the quarter-over-quarter patterns are important, but we really try and focus when we think about the business, think about outlook and planning, we really try and look at a TTM kind of four kind of rolling basis to just knock all that out, but it has been masked for the last couple of years, just given the sequential pace of growth.

Okay. I appreciate that. And then maybe just switching over to the LTC redevelopments you called out you got basically the entire pipeline with the except of Sudbury, expect to be finished and call it the next 12 or so months. How are you thinking about new project initiations? What can we sort of expect on that front over the balance of the year?

Yes. I think for this year, we've got 2 scheduled to open, which are on track. We hope to bring at least 1 more project in by the end of the year. We've got -- we're very active on the 17. We were -- so I think that 1 by the end of the year is probably quite -- you can expect that. And there's a few that are quite close behind, but probably don't make the cutoff for 2026. So I think you'll have to see a more robust number of new starts next year, but we're pretty confident that we'll get another 1 going in the fall.

Okay. And then maybe just last 1 on Sudbury. Can you give us maybe a rough idea of what the development costs that you've had to incur so far for that project are?

Yes. The best proxy I can give you -- if you look at the financial statements, we have in the -- in our property, plant and equipment note, you're going to have construction in progress category, that's in there. So that's probably the best place to look to date. So it's not purely just this project because we also have some larger scale kind of leasehold improvement, capital improvement projects that go on through our maintenance CapEx. But you're looking in the sort of $20 million to $25 million range. You'll see about $30 million in our construction in progress, but that's not all

[Operator Instructions] Next question comes from Giuliano Thornhill with National Bank.

I'm just wondering on the volume and kind of the strong volume like the risk there. Would you say the reduction in ALC volumes or funding or like possibly labor, like out of the three, like which do you think is the biggest risk to a sequential step down whenever that does happen.

Well, it could really come from one of two things. It could come from the benefit of additional services tailing off in terms of not seeing as much reduction in demand for service in the hospital sector. So I think that one is important, like just what -- how much benefit are we getting from the additional home care expenditures. And the other is going to be a fiscal consideration. This has been growing quite a bit faster than government expected. They are seeing the benefit because this is the lowest cost way of managing the aging demographic. But nonetheless, it is still accelerating costs and governments have fiscal challenges. So I think it will be one of those two things that will moderate the growth pace at this point. I think governments are very encouraged but what they're seeing, and that's why they keep putting one investment on top of another. You saw $1.1 billion in the fall economic statement in Ontario. You saw another $1.1 billion in the spring budget. So they're seeing the benefit and so making further investment. So I think it's just a question of at what point does the benefit that they're seeing in the hospitals and kind of the policy agenda intersect to slow things down again. So it's very tough to tell what's going to drive that. The reduction in ALC patients in Ontario was absolutely unprecedented over the last year. I've never seen that before. It took the ALC numbers down to levels that haven't been seen since long before the pandemic. So I think this is a very large-scale social experiment to see how far we can improve things. It is nice that all the poll results show that people vastly prefer to get care in their own homes than to go into institutions of any sort. So we are aligned with both the kind of fiscal imperatives but also the preferences of the voting public. So I think both of those things are reasons for optimism.

And then just on that, did you have any visibility into like the number of ALC patients? Or could you give us like a sense of what that year-over-year reduction has been? Is that still that 17% that you mentioned last quarter?

I think it was 14%. That's the last number that I've heard from government sources.

Okay. And then I'm just wondering kind of what does the strain on the hospital -- capacity constraint. How does that translate to policy risk for your LTC side? Do you think you're going to see more solid support for the operational aspect of the business because it is part of the system going forward?

Yes. Well, we have seen that. I mean the degree to which the government has elevated staffing levels since the pandemic has been remarkable and has been the case across multiple provinces. So 20% to 30% increase in staffing overall for the long-term care sector. Recently, the Alberta government -- a premier in Alberta announced a 15,000 bed, 10-year agenda for that province. So we're seeing capital expenditures for long-term care spinning up in Alberta. So I think the government is very clear minded that long-term care is far less expensive than acute care beds and that home care is far less expensive than long-term care. So I expect the investments to continue. I mean that's why we ended on in our investment -- investor deck this quarter with the demographic chart. I mean that doubling and then tripling of the demographic that we care for is something that the health care system has to grapple with. And so the only way they can do that is to keep up with the curve and keep expanding the capacity in this sector. Otherwise, we know what happens, the acute care hospital system just gets completely blocked by people who should be better cared for elsewhere.

And just with the kind of state of all of that, what you just stated. I'm just wondering, does that really eliminate any oblescence risk of your Class C portfolio, just because I know some of them are a little more rurally located, smaller markets and maybe smaller buildings. I'm just wondering if like the issues in the hospitals really remove that overhanging risk that could be there.

Sorry, you were saying obsolescence risk. Do you mean that they won't redeveloped?

Yes.

Yes. No, First of all, I think that the C-beds have to be maintained somehow until they're replaced. The thought that we could have them removed from the system, I just don't think there's a great risk of that. What I would say is that if any particular operator fails to redevelop their own C-beds that the government will seek another operator to step in and replace them that way. So it's not necessarily obsolescence, it would be that that some other operator would win new licenses to replace those C-beds. I don't think that's a risk for Extendicare. In fact, I think that there's a potential opportunity for greenfield sites for us where other operators have failed to step up. But at the moment, our 17 project pipeline is all replacements for our own homes with significant additions of beds to each of those projects to expand capacity.

This concludes the question-and-answer question. I would like to turn the conference back over to Jillian Fountain for any closing remarks. Please go ahead.

Thank you, operator. That concludes our call for today. This presentation is available on our website, along with a link to a replay of the call. Thank you all for joining us, and please don't hesitate to reach out if you have any questions. Goodbye.

This concludes today's conference call. You may disconnect your lines. Thank you for participating, and have a pleasant day.