Ontario Nursing Homes
Understanding The Nursing Home System
General Definition Of Ontario Nursing Homes
Definition of Nursing Home
In the province of Ontario nursing homes can be referred to as Nursing Homes, Long-term Care Homes, or Homes for the Aged, all of which I will refer to as a nursing home. As per the Ministry of Health and Long-term Care, a nursing home is a ‘home-like facility that provides care and services for people who no longer are able to live independently or who require onsite nursing care, 24 hour supervision, or personal support.” Nursing home residents have higher care needs compared to retirement home residents.
In order to be eligible for nursing home care you must:
- have valid Ontario health card
- be 18 years of age or older
- have care needs that cannot be met with community based programs
In the province of Ontario, the Ministry of Health and Long-term care is accountable for regulating, inspecting, and setting the fees for nursing home care.
Nursing Home Ownership
Nursing homes can be owned by private corporations, non-profit organizations, or the government.
Most nursing homes have a selection of room layouts from which to choose. A basic, or ward room consists of 3 or more beds. Semi-private rooms have only 2 beds, and a private room has a single bed in a room. See Costs of Nursing Homes below for fees associated with each accommodation type.
Applying To A Nursing Home In Ontario
In order to apply to a nursing home, you must first contact your local Community Care Access Centre (CCAC). Please see the “Applying to a Nursing Home” section of this website to find the contact number for the CCAC in your area. The CCAC will assist you with completing the Long-term Care application form, and determine if you are eligible for nursing home placement.
The following forms will be completed:
- Client Contact Information Form, which consist of basic personal information (i.e., name, address, phone number).
- A Health Care Professional will complete an Evaluator Questionnaire, which indicates if the potential resident has capacity to decide if they want to be admitted to a nursing home.
- A Consent Form enables the CCAC to coordinate and be responsible for the application process.
The CCAC will arrange for a physical, functional, and social assessment to determine your care needs. If you are eligible for nursing home placement, you will be asked to choose which nursing homes you prefer. Once you choose your nursing homes, the CCAC will forward your application to the homes, and staff at the home will review your application to determine if they can meet your care needs. If the home approves your application, they will notify the CCAC and advise them when a bed becomes available. The CCAC, not the nursing home, will call you to advise when a bed is available, and the date of your admission.
The CCAC manages waiting lists for all nursing homes in their region. Individuals with the highest health care needs and those in hospital are given first priority to a nursing home bed. If the homes that you choose have a waiting list, you will be asked to order them according to your first and last choice (you are allowed to choose 5 homes to place on your list). Should a bed become available, but it is not on your preferred list, you can decline the bed offer and maintain your position on the waiting list of the home of your choice. However, if you reject a bed offer from a home on your list, you will be removed from all waiting lists and you will be forced to wait 6 months to reapply for nursing home placement. If your health situation significantly changes within this time period, you are allowed to reapply. Once you are offered a bed, you have 24 hours to accept the offer, and you can usually move in the next day. If you are not ready to move in the next day, you can hold the bed for 5 days, however a bed holding fee will apply.
If, once you move into the nursing home, you decide that you want to relocate to another home, you can apply for a transfer.
If the CCAC determines that you are not eligible for nursing home placement, you can appeal the decision by contacting:
Health Services Appeal and Review Board
151 Bloor Street West, 9th Floor
When you enter a nursing home, you will be asked to bring the following documents to the home:
- Power of Attorney for Finances (if one)
- Power of Attorney for Care (if one)
- Notice of Assessment (if you are applying for a rate reduction)
- Advanced Health Care Directives (if one)
- Ontario Health Card
SECTION 3: ONTARIO NURSING HOME COSTS
In the province of Ontario, the Ministry of Health and Long-term Care determines the fees for private, non-profit, and government run nursing homes, and fees are the same regardless of the owner. Meaning, the cost of a semi-private room is the same in a private, non-profit, and government owned home. The following rates are effective July 1, 2013 through June 30, 2014.
|Daily Accommodation Rate||Monthly Accommodation Rate|
The rates typically change on an annual basis as of July.
The Ministry of Health and Long-term Care pays for all personal and nursing care provided in a nursing home. Nursing home residents only pay for accommodation charges, such as room and board.
Applying for a Rate Reduction.
If you are not able to pay the basic accommodation rate, you may be eligible for a rate reduction if you provide your notice of assessment from last year’s tax return. This will determine what rate you will pay. The Business Manager (or assigned individual) in the nursing home, will assist you with this process. Only your income, as indicated on your notice of assessment, will be factored into determining your reduced rate. Assets and other investments do not impact your nursing home accommodation fee, and you will not be required to sell your house.
If you have a spouse who lives in the community and they need financial assistance to continue living in the community because you reside in a nursing home, you can apply for Exceptional Circumstances and possibly have your nursing home accommodation fee reduced.
Only those who apply for a rate reduction are required to undergo a financial assessment.
In determining the accommodation fee a nursing home resident must pay, each resident must have $134 per month available for personal spending.
Short-stay Beds/Respite Care in Ontario
Respite care gives temporary relief to caregivers, or allows them to go on vacation knowing that their loved one’s care need are met. Supportive care gives an individual the opportunity to regain strength and health after a hospital stay, before returning home.
The number of Short-Stay beds varies in each home. A home may have a few short stay-beds, whereas other homes do not offer this service at all, therefore, it is best to contact your local CCAC to ask which homes in your area offer this program
The cost of a short-stay bed is $36.34/day and you must apply through the CCAC. You are limited to no more than 90 respite/short stay days per year.
Programs and Services That Are Covered
Accommodation fees and government subsidy will cover the following costs in a nursing home:
- room furnishings (bed, nightstand, easy chair, and dresser)
- meals and snacks (including special diets)
- laundry services
- social programs
- medication administration
- assistance with Activities of Daily Living
- physician care
- pastoral services
- 24 hour a day, 7 day a week nursing care
- personal hygiene
- some mobility aides for occasional use (i.e., walker)
Programs and Services Not Covered
The following programs and services are not covered by the government or the accommodation fees, therefore there will be out-of-pockets costs.
- T.V. cable
- newspaper delivery
- tuck shop
- dry cleaning
- phone for personal use
Residents do not have to pay for medications covered by Government pharmacy.
Nursing Home Policies, Programs And Services
Although nursing homes vary according to some programs and services, the following are fairly standard across all nursing homes.
- All nursing homes permit visitors, however each home determines their own visiting hours.
- The nursing home must provide each resident with a bed, bedside table, dresser, and comfortable easy chair.
- Residents are able to bring in personal items to make their room feel like home. It is recommended to bring in items such as pictures, a bedspread, and decorations. You may be able to bring in some furnishings, including your own bed, depending on the room size and dimensions. Speak with someone from the home prior to bringing in your own furniture.
- Residents are permitted to bring in some personal appliances, however, all must be approved by the home to ensure that they meet safety requirements. Some examples of appliances that are not permitted due to safety concerns are a hot plate, kettle, electric blanket, heating pads, toaster, iron, coffee maker, and heater.
- Homes are required to have a medical director and an attending physician on staff to provide medical care to all residents, however you are able to keep your own doctor if he/she has visiting privileges in the home.
- The home will tailor meals and snacks to residents’ dietary restriction. Some residents may need to be referred to a registered dietitian for an assessment.
- Each nursing home is required to abide by and post the Residents Bill of Rights.
- Nursing Home residents should be given the opportunity and support to establish and sustain a Resident’s Council.
- Nursing homes must provide laundry services.
- Each nursing home must provide activity programs and some programs should be offered in the evening, weekends, and outside the facility.
- Each nursing home should provide spiritual or religious programs.
- All nursing homes differ in the degree to which they offer palliative care. Some homes may provide comfort measures to a resident in their final hours, whereas other homes may have a separate room for palliative residents, and the room may allow family members to spend the night with the dying resident.
Homes vary in their use of restraints, but in all homes and individual resident situations, restraints must be used only if:
- it is used as a last resort
- the resident is harmful to self or others
- all other interventions have proven to be unsuccessful
- the restraint is as minimal as possible
- the resident is assessed on a regular basis to ensure the resident’s safety and comfort, and to establish if the restraint is still required
- the family must be informed
- the use of the restraint is documented, as well as each time the restraint is assessed
If you have to go to hospital for medical reasons while you are in the nursing home, you are required to continue paying your accommodation fee. The length of the medical leave must not exceed 30 days. A home may discharge the resident if the leaves extends beyond 30 days.
A resident may be away from the facility for a psychiatric leave that must not exceed 60 days, during which time the resident must continue to pay for the accommodation fee. If the psychiatric leave extends beyond 60 days, the residents may be discharged.
Weekend and Vacation Leaves
Residents are allowed to be out of the facility for vacation for no longer than 21 days per calendar year. During this time you are required to continuing paying the accommodation fee.
Residents are able to leave the nursing home on weekends, and they are not limited to the number of weekends they wish to be out of the facility.
Nursing Home Regulations And Inspections
In the province of Ontario, the Ministry of Health and Long-term Care is responsible for regulating and inspecting all nursing homes. Nursing homes must abide by the Long Term Care Act (2007). All nursing homes must be licensed. Most nursing homes in Ontario are accredited by Accreditation Canada (formerly the Canadian Council for Health Services Accreditation). Accreditation Canada is an independent, non-government agency that evaluates health care facilities. This is a voluntary program, and a home can operate without this designation. Homes that have been through this process, and have been granted accreditation are presented with a plaque, which most homes prominently display.
Nursing Home Inspections
Each nursing home is assigned a Compliance Advisor who regularly monitors and inspects the facility. Annual inspection reports must be posted in a conspicuous location so that all residents and family members can easily access and read the report. (Please see the ‘Government Reports’ tab on the left hand side of the screen to access inspection reports on-line). Upon the completion of an inspection, the Compliance Advisor presents the nursing home with a report that indicates if there were any areas of non-compliance. The Administrator develops a compliance plan, which outlines when and how the issues will be corrected. Compliance Advisors usually conduct a follow-up visit to ensure that all areas of non-compliance have been corrected.
If a home has not corrected the identified problem(s) or if residents are deemed to be at risk, the government has several options:
- stop admissions to the home
- revoke, suspend, or refuse to renew the nursing home’s license
- reduce or withhold funding
- occupy, operate, or takeover the home
- suspend or remove the ability to operate the home
- cease carrying on activities
Making a Complaint
If someone has a concern or complaint, I suggest that you first speak with the relevant staff to make them aware of the problem. If the problem is not dealt with properly or in a timely fashion, or if the complaint is of a serious nature, speak with the Administrator. Alternatively, you may call the Long-term Care Action Line, at 1-866-434-0144. This number is staffed 7 days a week, 8:30am – 7 pm.