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Long-Term Care Guide

1.  Introduction

Navigating the long-term care (LTC) system can be a complicated and sometimes frustrating experience.  For over 30 years Concerned Friends has been assisting members of the public who contact us for advice and information at various points along their journey through the long-term care system.  We have developed this guide to help make your journey easier. Concerned Friends has been advocating for a quality LTC system that meets the needs of residents, families and staff since our inception in 1980.  Our Advocates Committee responds to calls from individuals with a variety of issues and concerns.  Members of our Board of Directors sit on a variety of committees related to long-term care (governmental, seniors organizations, family councils, advocacy, etc.).  All of this helps to keep us informed about what is going on in long-term care across the province.

2. Different Care Options for Seniors

There are several different options available to seniors in need of care and assistance. The decision will rely on different criteria including level of care required, availability and cost.

  • Home care
  • Retirement home
  • Assisted living services in supportive housing
  • Long-term care homes
  • Complex continuing care
  • Alternative levels of care

Home Care is ideal for seniors with moderate care needs who prefer to stay at home. Home and community support services provide flexible and practical solutions. Services can be obtained individually or in combination in your home or within the community. The provincial government, through the Community Care Access Centre, subsidizes home care services up to a certain maximum, if The CCAC finds you eligible. http://www.health.gov.on.ca/en/public/programs/ltc/8_home_comm_mn.aspx

Retirement Homes are paid accommodations for seniors who need minimal to moderate support with their daily living activities. Residents usually have their own private room or apartment and live independently with the retirement home providing services such as meals, cleaning, laundry, recreational and social activities.  Residents pay the full costs of accommodation and care.

Retirement homes are now regulated under the Retirement Homes Regulatory Authority (RHRA) which is modeled on the LTCH Act.

The RHRA licenses homes, conducts inspections and has enforcement powers, if necessary.

You can apply directly to the retirement home of your choosing.  Your local Community Care Access Centre can provide you with a list of homes in your area.

http://www.health.gov.on.ca/en/public/programs/ltc/14_retirement.aspx

Assisted Living Services support people with special needs who require services at a greater frequency or intensity than home care but without the medical monitoring or supervision that would be provided in a long-term care home. Core services include attendant services, personal care, essential homemaking and an emergency response system.  Assisted Living Services are offered in some Retirement Homes. Residents pay extra for these services.

http://www.health.gov.on.ca/en/public/programs/ltc/13_housing.aspx

Long-term Care Homes are places where seniors can live and receive support services and are often the right choice for seniors who need help with the activities of daily living, access to 24-hour nursing care or supervision in a secure setting. This guide will give much greater detail on long-term care homes. http://www.health.gov.on.ca/en/public/programs/ltc/15_facilities.aspx

Complex Continuing Care provides continuing, medically complex and specialized services over extended periods of time in hospitals for people with long-term illnesses or disability who require skilled, technology-based care not available at home or in long-term care homes.  Patients pay a co-payment towards their accommodation and meals. http://www.health.gov.on.ca/en/public/publications/chronic/chronic.aspx

Alternative Level of Care is a clinical designation given to patients occupying a bed in a hospital who do not require the intensity of services provided in a hospital. The patient, usually a senior, may be waiting for a long-term bed to become available and no longer requires services in a hospital. The hospital may attempt to have the patient discharged or transferred to one of a variety of settings including home, transitional care bed, group home, supportive housing and others. http://www.health.gov.on.ca/en/pro/programs/waittimes/edrs/alc_definition.aspx

3.  Choosing a Long-term care home

Choosing a long-term care home is a major life decision, so you need solid information to help you make the right decision. 

First of all, make sure that a LTC home is the best solution for you and that you have considered other alternatives, such as Home Care, Supportive Housing, Retirement Homes. 

  1. Gather Information

Once you have determined that long-term care is best for you, you will want to gather as much website information as possible about the process and your options. The Community Care Access (CCAC) has key information, including the wait times for individual homes in each CCAC catchment area. http://www.ccac-ont.ca/

Other on-line sources of information about long-term care homes are

  • MOH LTC website, especially the Inspection Reports on Individual Homes http://www.health.gov.on.ca/
  • Health Quality Ontario website provides information on how individual homes perform on specific indicators, such as falls prevention, wound care, etc. http://www.ohqc.ca/en/index.html
  • Also check Inspection Results on this site to learn about how the inspection process works and find out how long-term care homes are doing in areas such as general nursing care, dietary care, residents rights, and environmental safety.
  1. Tour homes

It is crucial to visit the homes you are considering, if at all possible.  Call the home and make an appointment for a tour.  Make a list of questions and then be prepared to ask them.  Look for posted information about Resident and Family Council meetings, inspection reports, and information about the home activities.

Our Long Term Care Homes Checklist (available on this site) has good information, suggested questions to ask, and a list of things to notice when you are visiting a home.

  1. Other information sources

Talk to your friends and family about their experiences with long-term care homes.  Word of mouth information can often be helpful. 

Call Concerned Friends for information about specific homes you are considering.  We can tell you about their inspection report results over recent years, and other relevant information we may have about the home.

Costs

The Ontario government funds nursing and personal care, programing and food costs in long-term care homes.  Residents pay for their accommodation costs.  This is called a “co-payment”. Residents also pay for optional services such as cable TV and hairdressing.

A rate reduction subsidy is available for those who cannot afford the co-payment for basic accommodation. Your CCAC will help you apply for this option.

As of July 1, 2017, the maximum accommodation rates are as follows:

 

Type Of Accommodation

Daily Co-payment 

Monthly Co-Payment

Long-Stay Program

 

Basic Long Stay

$59.82

$1,819.53

 

Semi-private Long Stay (Varies depending on a home’s structural class.)

$72.12 - $84.42

$2,193.65

 

Private Long Stay (Varies depending on a home’s structural class.)

$84.45 - $111.08

$2,599.11

Short-Stay Program

 

Respite

$38.72

N/A

 

4.  Admission Process

  • The first step is to contact your local Community Care Access Centre (CCAC). All admissions to long-term care homes in Ontario are made through the CCAC. 
  • When you contact your local CCAC about admission to a home, you will be assigned a placement coordinator to help you through the process.  You, or your substitute decision maker, must give informed consent to admission. 
  • The placement coordinator determines whether or not you are eligible for admission to a home, based on your health care needs
  • You are allowed to apply for admission to up to five (5) homes. 
  • The placement coordinator should be able to tell you about the suitability of particular homes for your situation, waiting times for your chosen homes and answer any questions you may have.
  • When a bed comes up in one of your chosen homes, you will get a phone call from the CCAC or the home. The bed will be held for you for 5 days. 
  • If you decline this first offer of a bed, your name may be dropped to the bottom of the waiting list.

When a bed comes up in one of your chosen homes, you will get a phone call from the CCAC . You have 24 hours to accept the bed offer. If you accept, you can move in the next day. But if you are not ready to move in so quickly, you can ask the home to hold the bed for you for up to 5 days. In that case a “bed holding” fee applies. 

 If you turn down a bed offer from a home on your list, you will be removed from all wait lists and you will have to wait 6 months to reapply.  (Unless your health deteriorates significantly in the meantime.) If a bed becomes available in a home not on your preferred list, you can decline with no penalty.

 

Admission to LTC from hospital

If you are hospitalized and unable to live safely at home any longer, the hospital discharge planner will discuss options with you and your family.  If you decide that a long-term care home is your best option, the discharge planner will work with the CCAC to arrange for admission to a home of your choice.  The hospital is usually anxious to discharge you as soon as possible, once your condition has stabilized, in order to free up your bed.  There may be pressure on you to put your name on the list for a home with shorter wait times even though it’s not a home of your choice. Resist such pressures and take the time you need to make an informed choice. On the other hand, a hospital is not the best place to be unless it’s absolutely necessary. The longer you are in hospital with little opportunity to move or exercise, the quicker you will lose your muscle strength. So in some circumstances it may be preferable to take a bed in a less desirable long-term care home, while you wait for an opening in the home of your choice.

What to expect on admission day

If possible, plan to arrange your arrival at the home in the morning, to allow plenty of time to get settled in.  It’s also best to arrive on a week day, when there is a full complement of staff. You will be met by a staff person, hopefully the social worker (if the home has one), who may take you into an office to sign papers. Be sure to read carefully before signing anything.  You are not required to sign anything in order to be admitted to the home

Once the paperwork is completed, you will be shown to your room so you can unpack and settle in.  Hopefully the staff person who greeted you will introduce you to the nurse in charge of your unit, and to your roommate, if you have one.  Whoever accompanied you to the home may be able to stay and join you for lunch (or dinner) if he/she pays for their meal. 

A family member's first person account of admission day:

Mom and I arrived in the morning. There was a great rush, starting the day before, to get her clothes selected, cleaned and packed. At the home, we were met by a lovely young girl, the social worker, who ushered us into the office to sign papers. Then she took us up to the room Mom was to share with another woman, to whom she was not introduced but who was casually pointed out.

The room was plain but had good light and big windows and Mom soon settled herself into one of the chairs by the window. I told the social worker that we really wanted a private room for Mom and she was very quick to get that accomplished, saying that one would come up in a week or so. And she was right, thankfully. I don't remember that I stayed very long that day. I wasn't clear on dining room procedures – was it ok to have a meal with her at her table?  Only later I found out that I could pay to have a meal myself and even have it in her room with her instead of in the crowded dining room.

Mom and I had a meeting with nurses and doctor a few days later where we began to get orientated regarding who people were and what to expect. But after she was moved to the private room on another floor, everyone changed. We lost sight of the initial social worker. In other words there were no introductions, either to workers or residents. It would have been helpful to be introduced to the nurse in charge of the floor.  Maybe they feel that the newcomer won't remember, or were they just too busy?

5. Living in a long-term care home

The fundamental principle of the Long-term Care Act, 2007, states that a LTC home is primarily the home of its residents and is to be operated so that it is a place where they may live with dignity and in security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.

* Resident's Bill of Rights – The Act includes an expanded residents’ bill of 26 rights. Among other things, it protects the resident’s right to participate fully in the development, implementation, review and revision of his or her plan of care and includes the right to give or refuse consent to treatment, care or services.

* MOH LTC inspections – The Ministry must inspect every long-term care home at least once a year to ensure compliance with the requirements of the Act.. Every inspection results in a report that is posted publicly in the home and also available on the Ministry website. Inspections are generally unannounced.

* Resident Councils – Under the Act, every long-term care home must ensure that a residents’ council is established. Among other things, the residents’ council has the power to advise the home of any concerns or recommendations about the operation of the home and what they would like to see done to improve their quality of life and care, report any concerns to the Ministry, and review inspection reports and financial statements. The Home has a duty to respond to any concerns in writing within 10 days.

* Family Councils – Every long-term care home may have a family council if a family member or person of importance to the resident requests one. The Family Council has powers similar to those of the residents’ council.

* Resolving Issues - It is almost inevitable that at some point in one’s life in a long-term care home an issue may arise. Here are some suggestions for dealing with issues of concern:

a) First try speaking directly with the staff person involved. It is often helpful to include some positive comments along with your issue of concern.

b) If unsuccessful, ask to meet with unit nurse, supervisor, and/or administrator

c) Put your concerns in writing and include the remedy you are seeking

d) If you are a family member, it may be helpful to speak with other family members (or the Family Council if there is one) for advice and support. If there is no family council in the home and you think there should be you can contact the Family Council Program for assistance (416-487-4355 or toll-free 1-888-283-8806).

e) Call MOH LTC Action Line to lodge a complaint (1-866-434-0144).

f) Contact Concerned Friends for advice and information about resolving the issue (416-489-0146 or toll-free 1-855-489-0146).