Background: Focal spasticity affects up to 1 in 3 residents in long-term care (LTC), with potentially disabling consequences. Data are limited on access to care for patients requiring botulinum toxin (BoNT) treatment in LTC. Methods: This retrospective, observational, real-world study was conducted using the Ontario Drug Benefit claims database. Patients with ≥1 medical claim for BoNT for focal spasticity treatment were selected, and those residing in LTC were further identified. Data were analyzed for the utilization (2000–2019), treatment rate, and time-to-treatment with BoNT in LTC residents (2015–2019). Results: Over a 10-year period, the number of patients receiving BoNT for spasticity increased 7-fold and the proportion of patients residing in LTC versus community increased from 43% (2010) to 52% (2019). Of the LTC residents eligible for BoNT treatment, 33% received BoNT in 2015 compared with 63% in 2019. Injections/patient/year increased from 1.9 (2010) to 3.1 (2017). Following LTC admission, median time to first injection was 2.9 years. Conclusions: In this study, approximately 40% of eligible LTC residents in Ontario were not receiving BoNT treatment, and of those who were, median time to first injection was 2.9 years. Future policy considerations should prioritize uniform access to spasticity standards of care for LTC residents.