CCAC Client Services Policy Manual

Transcription

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Community Care Access Centres : Client Services Policy Manual
September 2006
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This CCAC Client Services Policy Manual sets out the requirements of the Ministry of Health and Long-Term Care
(MOHLTC) relating to the primary service functions of the Community Care Access Centre (CCAC) as follows :

assessing client needs, determining client eligibility, developing a plan of service, and providing or arranging for
professional, personal support and homemaking services.

providing information and referral services to the public about other community agencies and services.
admission into long-term care (LTC) homes.
The CCAC is required to comply with all laws. The CCAC Client Services Policy Manual sets out some of these
legislative and regulatory requirements as well as the policies with which the CCAC is required to comply.
This manual is written for CCACs and focuses on the delivery of services to clients. Statutory and regulatory provisions
are usually quoted directly. Where interpretation is needed, examples and further explanatory notes are provided.
For situations not covered in this manual, or situations that are covered but require special consideration, staff should
consult senior management and management may contact the MOHLTC for further consultation or direction.
The manual is intended to be a comprehensive document that will require updates and additions to reflect changes in
legislation, regulations and policies. This manual replaces the Home Care Policies and Procedures Manual (1984) and
the Placement Coordination Services Manual issued in 1994.
The manual is downloadable in individual sections below :
INDIVIDUAL SECTIONS
Notice
1 page | 696 Kb | PDF
Chapter 1 :
Introduction to the Manual
16 pages | 78 Kb | PDF
1.1 Overview of the Manual
1.2 Overview of Ontario's Long-Term Care System
1.3 Community Support Services
1.4 Long-Term Care Homes
1.5 The Ministry of Health and Long-Term Care
1.6 Development of the Community Care Access Centre
1.7 The Community Care Access Centre
Access to Home and Community Care Services (flowchart)
Chapter 2 :
Legislation
2.1 Introduction
2.2 Long-Term Care Act, 1994
2.3 Ontario Regulation 552 under the Health Insurance Act
2.4 Community Care Access Corporations Act, 2001
2.5 Legislation Governing Long-Term Care Homes
2.6 French Language Services Act
Chapter 3 :
Eligibility Criteria for CCAC Services
3.1 Overview of Eligibility Criteria
3.2 Validation of Ontario Health Cards
3.3 Residency Requirements for OHIP Coverage
3.4 Persons without OHIP Coverage are Ineligible for CCAC Services
3.5 Out-of-Province Applicants to Ontario's Long-Term Care Homes
3.6 OHIP Coverage/CCAC Services for Homeless Persons
3.7 OHIP Coverage/CCAC Services for Refugees
3.8 OHIP Coverage/CCAC Services for a Person on Leave of Absence from a LTC Home
3.9 Eligibility for Adult Day Services
3.10 Eligibility for Enhanced Respite Funding
3.11 Services to First Nations Persons
Chapter 4 :
Consent to Treatment, Admission to Long-Term Care Home and Community Services
4.1 Overview of Consent Provisions
4.2 Definitions of Terms of Health Care Consent Act, 1996
4.3 Consent to Treatment
4.4 Capacity to Consent to Treatment
4.5 Consent to Treatment on Behalf of an Incapable Person
4.6 Emergency Treatment Without Consent
4.7 Applications to the Consent and Capacity Board Regarding Treatment
4.8 Consent to Admission to a Long-Term Care Home
4.9 Consent to Admission to a Long-Term Care Home on Behalf of an Incapable Person
4.10 Applications to the Consent and Capacity Board Regarding Admission to a Long-Term Care Home
4.11 Consent to Personal Assistance Services
Chapter 5 :
Information and Referral Services
5.1 Overview of Information and Referral Services
5.2 Design of the Information and Referral Service
5.3 Required Information Services
5.4 Monitoring the Information and Referral Service
5.5 CCAC Information or Referral Services to Specific Communities
Chapter 6 :
CCAC Case Management
6.1 Introduction to Case Management
6.2 Responsibilities of Case Managers
6.3 Case Management Staff Qualifications
6.4 Supports to the Case Management Function
Chapter 7 :
CCAC Home Care Services
7.1 Professional Services
7.2 Personal Support and Homemaking Services
7.3 Management of Waiting Lists for CCAC Services
7.4 Ambulance Services for CCAC Clients
7.5 Drug Benefits for CCAC Clients
7.6 Influenza Services
7.7 Residential Hospices
Chapter 8 :
Supplementary Services
8.1 Home Oxygen Program
8.2 Northern Health Travel Grant Program
Chapter 9 :
CCAC School Services
9.1 Overview of CCAC School Services
9.2 Eligibility for CCAC School Services
9.3 Service Maximums
9.4 Equipment Relating to School Services
9.5 Transportation Relating to School Services
9.6 Case Management Function Relating to the Provision of CCAC School Services
9.7 CCAC Approaches to Service Delivery for School Services
9.8 Service Termination in Public, Private and Home Schools
9.9 CCAC Liaison Activities
9.10 Other Service Delivery Models
9.11 Responsibilities in Emergencies
Chapter 10 :
Complaints and Appeals
10.1 Complaint Resolution - Community Services
10.2 Appeal of CCAC Decisions - Community Services
10.3 Appeal Process Relating to Admission to a Long-Term Care Home
Chapter 11 :
Admission to Long-Term Care Homes
11.1 Introduction
11.2 Eligibility Criteria
11.3 Application Process for Long-Stay Eligibility Determination
11.4 Consents Required for Long-Stay Placement
11.5 LTC Home Selection for Long-Stay Applicants
11.6 Request for Approval of Admission and Response from the LTC Home
11.7 Accepting the Offer of Long-Stay Admission, Accommodation and Bed-Holding Fees
11.8 CCAC Authorization of Long-Stay Admission
11.9 Short-Stay Programs: Respite Care and Supportive Care (Convalescent Care)
Chapter 12 :
Management of Long-Term Care Home Waiting Lists by CCACs
12.1 Overview of Prioritization of Long-Term Care Home Waiting Lists
12.2 Crisis Admissions – Category 1A
12.3 Prioritization Criteria – Category 1A1
12.4 Prioritization Criteria – Category 1B
12.5 Prioritization Criteria – Category 2
12.7 Non-Numbered Categories
12.8 Ranking of Priority Categories
12.9 Waiting Lists for Interim Beds in LTC Homes
12.10 Refusals of Offers of Long-Stay Admission to LTC Homes
12.11 Waiting Lists for Short-Stay Programs
12.12 Refusals of Offers of Short-Stay Admissions to LTC Homes
APPENDICES

Appendix A – Glossary of Terms
Appendix B – Website Addresses
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Notice
This CCAC Client Services Policy Manual (“Manual”) sets out the policy of the Ontario Ministry of
Health and Long-Term Care (MOHLTC) relating to the provision of services by CCACs. The Manual
overrides all prior MOHLTC policies relating to these services.
The contents of this Manual are subject to change without notice from time to time and are for
informational purposes only and are not intended to provide any legal, financial or professional advice or
recommendations in any circumstances. The MOHLTC cannot and does not represent or guarantee that
the information in the Manual is current, accurate, complete or free of errors. Any reliance upon any
information contained in the Manual is solely at the risk of the user of the Manual.
The user should always seek legal, financial or such other professional advice relating to the information
contained in the Manual.
The MOHLTC assumes no responsibility for any changes, errors or omissions in any of the information
contained in the Manual. The MOHLTC makes no representation or warranty of any kind whatsoever
with respect to this Manual. In no event shall the MOHLTC, the Province of Ontario and their respective
officers, employees, servants or agents be liable for any failure to keep the content of this Manual up to
date, for errors or omissions contained in the Manual, or for any damages (including without limitation,
damages for loss of profits, business interruption or direct, indirect, incidental, special, consequential or
punitive damages) arising out of or related to the use of this Manual (including all contents), whether
under contract, in tort or under any other basis of liability.
This Manual is the property of the MOHLTC and it shall not, in whole or in part, be reproduced without
the MOHLTC’s prior written permission.
Version Date: September 2006
Chapter 1
1.1 Overview of the Manual
1.1.1 Purpose of the Manual
This CCAC Client Services Policy Manual sets out the requirements of the Ministry of Health
and Long-Term Care (MOHLTC) relating to the primary service functions of the Community
Care Access Centre (CCAC) as follows:
•
•
•
assessing client needs, determining client eligibility, developing a plan of service, and
providing or arranging for professional, personal support and homemaking services.
providing information and referral services to the public about other community agencies
and services.
admission into long-term care (LTC) homes.
The CCAC is required to comply with all laws. The CCAC Client Services Policy Manual sets
out some of these legislative and regulatory requirements as well as the policies with which the
CCAC is required to comply.
This manual is written for CCACs and focuses on the delivery of services to clients. Statutory
and regulatory provisions are usually quoted directly. Where interpretation is needed, examples
and further explanatory notes are provided.
For situations not covered in this manual, or situations that are covered but require special
consideration, staff should consult senior management and management may contact the
MOHLTC for further consultation or direction.
The manual is intended to be a comprehensive document that will require updates and additions
to reflect changes in legislation, regulations and policies. This manual replaces the Home Care
Policies and Procedures Manual (1984) and the Placement Coordination Services Manual
issued in 1994.
September 2006
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Chapter 1
1.1.2 How to Use the Manual
This manual is divided into chapters (e.g., chapter 4 is Consent to Treatment and/or Admission
to Long-Term Care Home, chapter 9 is CCAC School Services). Each chapter starts on a new
page and is divided into subsections. Chapter numbers are on every page. Page numbering
starts again at the beginning of each chapter. Thus, if a chapter is revised the pages can be
removed and replaced with new material.
The internet version of the manual is the authoritative reference. The manual is available online
at the MOHLTC website at:
[http://www.health.gov.on.ca/english/providers/providers_mn.html].
The MOHLTC is responsible for maintaining and updating the internet version. Readers should
ensure they are using the current hard copy by comparing the date in the footer with the online
version.
“Notes” are used in this manual to draw attention to information requiring special consideration
or extra caution. “Clarification” statements further explain or interpret cited legislation.
Legislation, regulations and document titles are in italics. If the date is part of an Act’s official
title, the date is included in the full name but not in the acronym. Each CCAC is advised to
review applicable laws, including the cited legislation, and to seek legal advice when questions
arise.
See Appendix #A in this manual, for a glossary of terms including the Acts and regulations,
definitions, acronyms and abbreviations used throughout this manual. For first references in
each chapter and section, terms are expressed in full form followed by the acronym in
parentheses.
This manual also references website addresses to provide readers with access to applicable
legislation, forms and other related information. See Appendix #B in this manual for a
complete list of these website addresses.
Information on procurement policies and procedures for CCACs can be found in the following
documents, developed in July 2003:
•
•
Client Services Procurement Policy for Community Care Access Centres; and
Client Services Procurement Procedures for Community Care Access Centres.
Information on the management information system (MIS) home care standards (including
service recipient codes) is available on the MOHLTC Finance and Information Management
(FIM) website (private site).
September 2006
2
Chapter 1
1.2 Overview of Ontario’s Long-Term Care System
Ontario has developed a system of home and community care with the following partners: the
Ministry of Health and Long-Term Care (MOHLTC), Community Care Access Centres
(CCACs), community services and long-term care (LTC) homes. The partners work together in
different combinations to meet the diverse needs of people accessing their services.
•
•
MOHLTC funds the LTC homes to meet the needs of people who can no longer live in
their own homes and the CCAC manages admissions to LTC homes.
The MOHLTC, the CCACs and community service agencies work together to provide
support to people of all ages in their places of residence and in their communities.
In the home and community care sector, 42 CCACs and over 800 community service agencies
receive funding from the Ontario government to help people remain independent and to live
with dignity in their homes and communities. Services include professional services, personal
support and homemaking, meals, community transportation, acquired brain injury (ABI)
services, assisted living services in supportive housing (ALSSH), and elderly persons centres.
Provision of community-based health and support services may be:
•
•
temporary or periodic (e.g., to enable a person to recover or receive treatment at home,
rather than in a hospital); or
ongoing or long-term (e.g., an elderly person who requires assistance with personal care
needs, such as bathing or dressing, to remain at home, or a child with a physical disability
who needs professional support to attend school).
1.2.1 Need for Home and Community Services
Two major factors affect the demand for home and community services in Ontario:
1. As Ontario’s population ages, the demand for community-based health and support
services increases
2. The increased volume of referrals from hospitals: hospital restructuring has resulted in
shorter hospital stays for patients, and a greater need for in-home supports to address care
needs after hospital discharge. In addition, in-home supports can reduce the need for
hospital admissions.
September 2006
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Chapter 1
1.2.2 Goals of the Home and Community Care System
The MOHLTC, CCACs, community support services, ALSSH, and ABI service agencies
together form the system of home and community care, which provides services to people
living in their homes or other community settings. The goals of the system of home and
community care are:
•
•
•
to ensure people have access to the services they need, when they need them;
to continue to develop a modern, comprehensive health care system to meet future needs
and ensure access to key community health services for people of all ages; and
to ensure that community-based health and support services are available to serve a
growing, aging population.
The remainder of this chapter provides the context for the CCAC by giving a brief description
of its three key partners:
•
•
•
community support services (see subsection #1.3 in this manual);
LTC homes (see subsection #1.4 in this manual); and
the MOHLTC (see subsection #1.5 in this manual).
(Also see subsection #1.7 in this manual for a brief description of the CCAC.)
September 2006
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Chapter 1
1.3 Community Support Services
Community support services are fully or partially funded by the Ministry of Health and LongTerm Care (MOHLTC) and are delivered by community-based, not-for-profit agencies that rely
heavily on volunteers. Historically, services were developed locally in response to local needs
and vary from community to community. Clients can access services directly through selfreferral.
The 15 key community support services (as per the 2001/2002 Planning, Funding and
Accountability Policies and Procedures Manual for Long-Term Care Community Services) are:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
meal services;
transportation services;
caregiver support services (these services include counselling, information and education to
caregivers and family members who have emotional, severe stress or mental health
problems impeding their ability to provide care and support for the client);
respite (these services replace the efforts of family and caregiver supports. This occurs both
in people's homes and outside the home);
homemaking;
adult day services (ADS);
home maintenance and repair services;
volunteer hospice services;
palliative care consultation services (e.g. pain and symptom management);
palliative education (this includes both physician palliative care education and community
and facility palliative care interdisciplinary education for front line health care staff);
Alzheimer services (e.g. public education coordinators and psychogeriatric resource
consultants);
friendly visiting services;
security checks;
social or recreational services (including services delivered by both elderly persons centres
as well as other community support service agencies); and
services for persons with physical disabilities (these are services specifically for persons
with physical disabilities, including attendant outreach, direct funding and special services
for the blind and hearing impaired. This also includes foot care, aphasia and personal
support and homemaking services.).
Some of these services are also provided to clients in assisted living services in supportive
housing (ALSSH) and there are services specifically for clients with acquired brain injury
(ABI).
September 2006
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Chapter 1
1.3.2 Legislation
Section 3 of the Long-Term Care Act, 1994 (LTCA) states:
For the purpose of this Act, the following are community services:
1. Community support services
2. Homemaking services
3. Personal support services
4. Professional services
Section 4 of the LTCA states:
For the purpose of this Act, the following are community support services:
1. Meal services
2. Transportation services
3. Caregiver support services
4. Adult day programs
5. Home maintenance and repair services
6. Friendly visiting services
7. Security checks or reassurance services
8. Social or recreational services
9. Providing prescribed equipment, supplies or other goods
10. Services prescribed as community support services
September 2006
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Chapter 1
1.4 Long-Term Care Homes
Long-term care (LTC) homes (nursing homes, charitable homes for the aged and municipal
homes for the aged) provide care for people who are not able to live independently in their own
homes and who require 24-hour nursing or personal care, support and/or supervision.
1.4.1 Funding of Long-Term Care Homes
LTC homes have two main sources of funds: Ministry of Health and Long-Term Care
(MOHLTC) funding for care and services and funding received from residents who pay
accommodation fees.
The MOHLTC provides funding to LTC homes according to a funding formula known as the
“envelope system”. These funding envelopes are:
• nursing and personal care;
• programming and support services;
• raw food; and
• other accommodation.
The MOHLTC also provides supplementary funding to support operating costs.
MOHLTC funding for nursing and personal care services is based on a resident needs-based
funding formula with MOHLTC paying the full amount. The MOHLTC pays a fixed per diem
for program and support services, which includes recreational activities, therapists, quality of
life and other programs designed to assist residents to maintain their optimal level of
functioning. The MOHLTC also assists residents who have limited income with their
accommodation charges. The MOHLTC pays the LTC home the difference between the basic
accommodation rate and what the resident can afford.
Further information about MOHLTC policies with respect to LTC homes can be found in the
Long-Term Care Home Program Manual, 1993, as revised in 1995, 1998 and 2006, available
in MOHLTC offices.
September 2006
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Chapter 1
1.5 The Ministry of Health and Long-Term Care
This subsection describes the role of the Ministry of Health and Long-Term Care (MOHLTC)
as it relates to the Community Care Access Centre (CCAC).
1.5.1 Role of the Ministry of Health and Long-Term Care
MOHLTC provides funding, administers legislation and regulations, and sets and ensures
compliance with policies and guidelines for Ontario’s health care system. The goal is
enhancing physical and mental health in all of life’s stages through a high quality system that is
easily accessible for all Ontarians.
MOHLTC is responsible for managing Ontario’s health care system including: health
insurance, drug benefits, assistive devices, care for the mentally ill, community services, home
care, community health, health promotion and disease prevention, hospitals and long-term care
(LTC) homes.
1.5.2 Role of Local Health Integration Networks
Local Health Integration Networks (LHINs) are non-profit organizations funded by the
Government of Ontario, through the MOHLTC. It is intended that LHINs will have authority to
make local decisions about health services and perform some functions that are currently done
centrally by the MOHLTC. Fourteen LHINs have been established in Ontario, each with
specific geographic boundaries. The intent is that LHINs will eventually be responsible for
planning, integrating and funding local health services.
LHIN functions will be phased in over time. LHINs will commence with planning and
community engagement responsibilities, move then to service coordination and system
integration, and finally to funding and resource allocation. LHINs will also be responsible for
engaging the health care providers and community stakeholders in their areas throughout their
evolution.
LHINs will eventually fund certain health service providers, including CCACs and community
service agencies, which will be accountable to the LHIN. Additional information is available
at: [http://www.lhins.on.ca/english/main/home.asp].
1.5.3 Community Health Division
The Community Health Division of the MOHLTC is responsible for programs relating to
community health centres, CCACs, community services, LTC homes, mental health
community services and the Psychiatric Patient Advocacy Office. The Community Health
Division also shares responsibility with the Acute Services Division for MOHLTC regional
offices, the Finance and Information Management Branch, French Language Services and the
Strategic Projects Unit.
September 2006
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Chapter 1
The Community Health Division funds its programs, supports best practices, monitors
compliance and takes corrective action concerning the province’s LTC homes and the
community agencies providing home and community care services to seniors, adults with
physical disabilities, and people of any age who need health services at home or in school.
1.5.4 The Home Care and Community Support Branch
The vision of the Home Care and Community Support Branch is:
“Getting care to people who need it in their home and community setting.”
The branch’s mission:
•
•
•
•
•
develops and supports the implementation of policy for home care and community services
under the direction of the government and in consultation with stakeholder groups;
assists regional offices in appropriate and consistent policy implementation across Ontario;
establishes standards for operation of home and community care programs;
develops program performance measures, monitoring and evaluation mechanisms for
application across the province; and
promotes legislative and government intent through funding, monitoring and evaluating
service delivery.
Given the vision and mission of the Home Care and Community Support Branch of the
MOHLTC, the key functions of the branch include:
•
•
•
•
development of legislation and regulations for the home and community care system;
development of operational policies aimed at ensuring the consistent administration,
implementation and management of community-based programs and services across the
province;
training and orientation on new program designs; and
provision of support to the regional offices in their role of monitoring home and community
care services.
1.5.5 Regional Offices
Seven MOHLTC regional offices (North, East, Central East, Toronto, Central West, Central
South, and South West) lead and support communities in developing and sustaining a locally
responsive, accountable and quality system of services in the areas of acute and community
health.
September 2006
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Chapter 1
Regional offices:
•
•
•
•
•
•
•
•
•
provide a primary point of contact and provide program expertise for MOHLTC transfer
payment agencies in the acute and community care health sectors;
enable co-ordination and collaboration in the delivery of services across the region;
facilitate an integrated approach to services resulting in better solutions for service issues;
flow funding directly to hospitals, LTC homes, CCACs, community services, community
health centres, and mental health and addictions programs in the regions, consistent with
corporate direction;
serve as a monitoring and accountability point for program delivery, including program
reviews;
work with transfer payment partners to develop and execute accountability frameworks;
ensure compliance with legislation, regulations and policies;
facilitate co-ordination of approvals and requests with other MOHLTC or health care
program divisional units; and
collaborate on policy development, and implement MOHLTC policies, strategic directions
and government initiatives within the region.
1.5.6 Regional Office Staff
Program Consultants
Program consultants are the point of contact for CCACs, hospitals, LTC homes, community
services agencies, and mental health and addiction program agencies. Program consultants in
the regional offices:
•
•
•
•
•
ensure CCAC compliance with MOHLTC legislation, regulations and policies;
provide individual transfer payment agencies with funding for services provided within
defined accountabilities;
support the community in developing and sustaining local programs;
facilitate integrated approaches to services; and
serve as the point of contact for the public to receive advice or complaints on MOHLTC
programs.
Finance and Information Staff
Finance and information staff ensure a strong financial controllership function is in place in the
region. Regional financial staff are responsible for:
•
•
•
•
•
cash flow to transfer payment agencies;
year-end reconciliation;
ensuring expenditures are appropriate;
resolving financial issues; and
ensuring that meaningful financial data is available to assist in planning.
September 2006
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Chapter 1
Planning Staff
Planning staff in regional offices are responsible for:
•
•
•
•
•
developing planning processes and helping to set planning agendas for MOHLTC regional
offices;
co-ordinating regional issues and communications;
developing and implementing internal management processes for the regional office;
working with external planning and health service delivery stakeholders to improve
decisions related to health services planning and delivery; and
providing project management, facilitation, negotiation, research and information analysis
services to the region.
LTC Home Compliance Staff (Nursing, Environmental Health and Dietary)
LTC home compliance staff monitor LTC home compliance with legislation, regulations,
MOHLTC policies, service agreements, and the standards and criteria contained in the LongTerm Care Home Program Manual. Compliance staff are responsible for reviewing resident
care, services, programs and operational aspects of LTC homes.
September 2006
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Chapter 1
1.6 Development of the Community Care Access Centre
The Ontario Minister of Health and Long-Term Care announced the creation of the Community
Care Access Centre (CCAC) on January 25, 1996. On January 1, 1998, implementation of 43
CCACs across Ontario was completed, consolidating the services formerly provided by 38
home care programs and 36 placement co-ordination services.
1.6.1 History of Ontario’s Home Care and Placement Co-ordination Services
Date
Description
1958
Six acute home care pilot projects funded with federal health grants and
assistance from the Ontario Hospital Services Commission
1971
Three placement co-ordination pilots introduced
1972
Acute home care services implemented province-wide as an insured benefit
under the Ontario Health Insurance Plan (OHIP)
1975-84
Chronic home care services phased in province-wide
1978-84
Placement co-ordination services for admission to long-term care (LTC)
homes phased in province-wide
1984
School services in publicly-funded schools implemented to support
provincial education reforms and enable universal access to public education
for students with physical or developmental delays
1986
Integrated Homemaker Program phased in province-wide to provide
homemaking and personal care for adults who were living with a physical
disability or were frail and elderly
1993
The Long-Term Care Statute Law Amendment Act, 1993 (LTCSLAA)
required all admissions to LTC homes (nursing homes and homes for the
aged) be authorized by placement co-ordination services. Policy direction
was provided to CCACs in 1994.
1995
The Long-Term Care Act, 1994 (LTCA) proclaimed into force
1995
Regulation made under the LTCA relating to the conveyance of assets of an
approved agency
1995-96
Acute, chronic, school health and homemakers programs integrated into a
single service-based model
September 2006
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Chapter 1
Date
Description
1996-98
Establishment across the province of 43 CCACs consolidating 38 home care
programs and 36 placement co-ordination services under new community
boards
1999
Regulation made under the LTCA setting out eligibility criteria for persons
receiving homemaking services and maximums for homemaking, personal
support and nursing services
2000
Regulation made under the LTCA setting out eligibility and service
maximums for school health professional services to be provided to children
attending private schools and home schools. (Regulation under the Health
Insurance Act (HIA) relating to these services was revoked.)
2000
Regulation made under the LTCA setting out the eligibility criteria and
service maximums for school services to be provided to children attending
private and home schools. Policy direction was provided to CCACs in 2001.
2001
Community Care Access Corporations Act, 2001 (CCACA) proclaimed into
force making CCACs statutory corporations with Order in Council
appointments for board members and executive directors
2002
Forty-one of 43 CCACs were designated as statutory corporations by
regulation on February 16. (Two CCACs governed by integrated health
service agencies, Muskoka East Parry Sound and West Parry Sound Health
Centre, did not change their governance structures.) Regulation also deemed
CCACs to be approved agencies under the LTCA and approved CCACs to
provide all professional services and personal support services listed in the
LTCA as well as all homemaking services, except for ironing and mending.
2002
Regulation 386/99 under the LTCA amended to prohibit a CCAC from
providing personal support services to a person unless the person is insured
under the HIA
2003
The Etobicoke and York CCACs merged bringing the total CCACs in
Ontario to 42 (from 43)
2006
The CCACA was amended to allow for the reorganization and dissolution of
CCACs in support of their alignment with LHINs. Other changes allow for
an expanded role for CCACs as navigators for a wider range of services.
September 2006
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Chapter 1
1.7 The Community Care Access Centre
The Ministry of Health and Long-Term Care (MOHLTC) established CCACs across the
province to provide simplified access to home and community care; to deliver and make the
arrangements for the delivery of home care services to people in their homes, schools and
communities; to provide information and referral to the public on community-related services;
and to authorize admissions to long term care (LTC) homes. There is no age restriction, and no
charge for services provided by the CCAC. The duration of service depends on a person’s
needs.
The CCAC is responsible for:
•
•
•
•
•
•
•
assessment of applicant’s requirements and determination of eligibility for professional
health services, homemaking (excluding ironing and mending), and personal support
services provided in people’s homes, schools and in the community;
assessment of applicant’s requirements and determination of eligibility for professional
health and personal support services for children in schools and receiving home schooling;
development of plans of service;
information and referral for the public to home and community care and related services;
purchasing home care services from service providers through a procurement process;
admission to LTC homes; and
co-ordination of the delivery of home care services provided by the CCAC.
The CCAC plays an important role in collecting, reviewing and conveying information
regarding service needs, trends or gaps in the community. The CCAC participates with other
key health system partners (e.g., hospitals) on key community health system committees, and
works in collaboration with other service providers, planning agencies and educational
institutions to enhance services for people in the community.
CCAC services provided in the home or school on a visitation basis enable home care
recipients, resident pupils as defined by the Education Act (EA) and those who are home
instructed to:
•
•
•
•
remain in their own homes;
return home more quickly from hospital;
delay or prevent the need for admission to a hospital or LTC home; and
attend school and participate in school routines and receive instruction or receive home
schooling.
The CCAC accomplishes these objectives directly or indirectly by providing or purchasing and
arranging the following community services on behalf of eligible clients:
•
•
nursing;
personal support and homemaking;
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•
•
•
•
•
•
•
•
•
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Chapter 1
physiotherapy;
occupational therapy;
speech-language pathology;
social work;
dietetics;
medical supplies and dressings;
hospital and sickroom equipment;
assistance in obtaining drug card;
laboratory and diagnostic services; and
transportation to medical appointments and hospitals.
The CCAC serves clients who may be:
•
•
•
•
recovering from an acute illness;
living with a chronic disease, or are in the convalescent, rehabilitative, or terminal stage of
disease;
requiring support because of frailty or disability; or
requiring service to participate in school or home schooling.
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ACCESS TO HOME AND
COMMUNITY CARE
SERVICES
HEALTH
& SUPPORT SERVICES
(e.g., NURSING,
PERSONAL SUPPORT AND
HOMEMAKING)
INFORMATION &
REFERRAL
DIRECT
ACCESS
CCAC
CASE
MANAGEMENT
WITH CLIENT
COMMUNITY SERVICES
(E.G., MEAL PROGRAMS,
TRANSPORTATION,
ASSISTED LIVING SERVICES
IN SUPPORTIVE HOUSING,
ATTENDANT SERVICES,
ADULT DAY PROGRAMS,
ACQUIRED BRAIN INJURY)
ADMISSIONTO
LONG-TERM CARE
HOMES
3
As shown by the above diagram, CCACs are the first point of contact to home care services in
the community. CCAC case managers will assess a person’s needs, determine eligibility for
services, develop a plan of care and arrange for the delivery of professional services and
personal support and homemaking services, the provision of medical equipment and supplies,
and authorize admission into long-term care (LTC) homes.
The CCAC case manager will also make referrals for a client and provide information,
including information on how to access community services such as meal delivery,
transportation and attendant care services.
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Legislation
2.1 Introduction
The Community Care Access Centre (CCAC) is required to comply with all laws. The
following legislation is particularly significant to the government-funded system of community
services and placement co-ordination services that the CCAC is required to provide:
•
•
•
•
•
•
•
•
Long-Term Care Act, 1994 (LTCA);
Health Insurance Act (HIA);
Community Care Access Corporations Act, 2001 (CCACA);
Nursing Homes Act (NHA);
Charitable Institutions Act (CIA);
Homes for the Aged and Rest Homes Act (HARHA);
Local Health System Integration Act, 2006 (LHSIA); and
French Language Services Act (FLSA).
Each CCAC must also be familiar with the all other relevant laws, including but not limited to:
•
•
•
•
Health Care Consent Act, 1996 (HCCA);
Substitute Decisions Act, 1992 (SDA);
Personal Health Information Protection Act, 2004 (PHIPA); and
Ministry of Health Appeal and Review Boards Act, 1998 (MHARBA).
2.1.1 Background
A large portion of the current legislative framework was developed and implemented during
the first half of the 1990s, as part of a major reform of Ontario’s long-term care system.
The reform of the long-term care system was initiated in July 1993 with the enactment of the
Long-Term Care Statute Law Amendment Act, 1993 (LTCSLAA) which focused primarily on
reforms related to admission to and operation of long-term care (LTC) homes. The LTCSLAA
amended the NHA, the CIA and the HARHA to provide consistent expectations about
admission to and operation of all LTC homes. The amendments included:
•
•
setting out the admission process and role of placement co-ordinators;
requiring all admissions to LTC homes to be conducted by placement co-ordinators;
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•
•
•
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a service agreement between the province and each home;
maximum resident charges;
a plan of care for each resident;
a quality management system in each home;
requirements to give notice and post specific documents in the home;
residents’ councils at each home; and
new inspection criteria with protection from reprisals for persons making disclosures to an
inspector.
Two years later in March 1995, the LTCA came into force. The LTCA represented the second
phase of legislative change undertaken to support the reform of long-term care. The Act created
a new system of community-based long-term care home and community services for people of
all ages, including seniors, adults with physical disabilities and people of any age who need
health services at home or in school. There was also continued reliance on the regulations under
the HIA that addressed nursing and other professional home care services.
Following implementation of the LTCA, the Ministry of Health and Long-Term Care
(MOHLTC) established CCACs across the province between 1996 and 1998 by consolidating
38 home care programs and 36 placement co-ordination services under new community boards.
The intent was to provide Ontarians with simplified access to:
•
•
home and community care, including services in schools; and
LTC homes.
Separate legislation governing the structure and operations of the CCACs was subsequently
passed in December 2001. The CCACA was introduced to strengthen consistency and
accountability of CCAC operations across the province.
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2.2 Long-Term Care Act, 1994
2.2.1 Purpose of Act and Bill of Rights
As the primary legislation covering community-based long-term care home and community
services, the Long-Term Care Act, 1994 (LTCA) provides the authority for a significant portion
of the services provided by each Community Care Access Centre(CCAC). The LTCA sets out
the purpose of the Act:
Purposes of Act
s. 1 The purposes of this Act are,
(a) to ensure that a wide range of community services1 is available to people in their own
homes and in other community settings so that alternatives to institutional care exist;
(b) to provide support and relief to relatives, friends, neighbours and others who provide care
for a person at home;
(c) to improve the quality of community services and to promote the health and well-being of
persons requiring such services;
(d) to recognize, in all aspects of the management and delivery of community services, the
importance of a person’s needs and preferences, including preferences based on ethnic,
spiritual, linguistic, familial and cultural factors;
(e) to integrate community services that are health services with community services that are
social services in order to facilitate the provision of a continuum of care and support;
(f) to simplify and improve access to a continuum of community services by providing a
framework for the development of multi-service agencies2;
(g) to promote equitable access to community services through the application of consistent
eligibility criteria and uniform rules and procedures;
(h) to promote the effective and efficient management of human, financial and other resources
involved in the delivery of community services;
(i) to encourage local community involvement, including the involvement of volunteers, in
planning, co-ordinating, integrating and delivering community services and in governing the
agencies that deliver community services;
(j) to promote co-operation and co-ordination between providers of community services and
providers of other health and social services; and
(k) to ensure the co-ordination of community services provided by multi-service agencies with
those services offered by hospitals, long-term care facilities, mental health services, health care
professionals and social service agencies, and to promote a continuum of health and social
services.
The LTCA also sets out the Bill of Rights for persons receiving community services. The Bill
of Rights has been developed and enshrined in the LTCA in order to protect and promote an
individual’s personal well-being and safety. It outlines the privileges, choices and protections
available to individuals receiving community services under the LTCA.
1
2
See chapter #7 in this manual for definition of “community services.”
Multi-service agencies do not exist, however, references to them have not yet been repealed from the LTCA.
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In the following passages from the LTCA, “service provider” means the CCAC, all community
service agencies and all service providers with whom the CCAC has service contracts.
Bill of Rights
s. 3(1) A service provider shall ensure that the following rights of persons receiving community
services from the service provider are fully respected and promoted:
1. A person receiving a community service has the right to be dealt with by the service provider
in a courteous and respectful manner and to be free from mental, physical and financial abuse
by the service provider.
in a manner that respects the person’s dignity and privacy and that promotes the person’s
autonomy.
in a manner that recognizes the person’s individuality and that is sensitive to and responds to
the person’s needs and preferences, including preferences based on ethnic, spiritual, linguistic,
familial and cultural factors.
4. A person receiving a community service has the right to information about the community
services provided to him or her and to be told who will be providing the community services.
5. A person applying for a community service has the right to participate in the service
provider’s assessment of his or her requirements and a person who is determined under this
Act to be eligible for a community service has the right to participate in the service provider’s
development of the person’s plan of service, the service provider’s review of the person’s
requirements and the service provider’s evaluation and revision of the person’s plan of service.
6. A person has the right to give or refuse consent to the provision of any community service.
7. A person receiving a community service has the right to raise concerns or recommend
changes in connection with the community service provided to him or her and in connection
with policies and decisions that affect his or her interests, to the service provider, government
officials or any other person, without fear of interference, coercion, discrimination or reprisal.
8. A person receiving a community service has the right to be informed of the laws, rules and
policies affecting the operation of the service provider and to be informed in writing of the
procedures for initiating complaints about the service provider.
9. A person receiving a community service has the right to have his or her records kept
confidential in accordance with the law.
2.2.2 CCAC as an Approved Agency Under the LTCA
Regulation 33/02 of the Community Care Access Corporations Act, 2001, (CCACA) provides
that the CCAC is deemed to be an approved agency under the LTCA. As an approved agency,
the CCAC falls within the definition of “service provider” under the LTCA. The CCAC is
therefore required to comply with all the provisions in the LTCA relating to both approved
agencies and service providers.
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2.2.3 LTCA Provisions Applicable to the CCAC
The following provisions of the LTCA apply to the CCAC.
Section 3: Requires contracted service providers to fully respect and promote the rights of
persons receiving community services, as set out in the Bill of Rights.
Subsection 3(3): A service provider is deemed to have entered into a contract with each person
receiving a community service from that service provider, agreeing to respect and promote the
rights set out in the Bill of Rights.
Section 4: The Minister may fund the provision of community services and make agreements
for the provision of these services. The Minister may also fund operational and capital
expenditures relating to the provision of these services.
Section 5: The Minister may approve agencies. (However, a CCAC is deemed to be an
approved agency pursuant to the regulation under the CCACA.)
Section 6: The Minister may approve premises for the provision of community services and
provide financial assistance relating to the operation of the premises.
Section 7: The Minister may impose terms and conditions on any financial assistance and
require security for repayment of funds.
Section 19: The CCAC cannot transfer, assign, lease, encumber, or otherwise convey an
interest in any of the assets it acquires with financial assistance from the Province of Ontario,
except in accordance with the regulations. The regulations set restrictions on the transfer of
assets.
Section 22: When a person applies to a CCAC for service, the CCAC must assess the person's
requirements, determine the person’s eligibility for the services required, and develop a plan of
service for each person determined eligible. The plan of service must set out the amount of
service to be provided.
•
•
The CCAC must review the person’s requirements when appropriate depending on the
person's condition and circumstances, evaluate the person’s plan of service and revise it as
necessary when the person’s requirements change. The CCAC must also assist the person in
co-ordinating the services received, in accordance with the person’s wishes.
The CCAC must provide the person, their substitute decision-maker or any person
designated by the person with an opportunity to participate in the development, evaluation
and revision of the plan of service. In assessing and reviewing a person's requirements, the
CCAC must take into consideration all assessments and information provided to the CCAC
relating to the person's capacity, impairment or requirements for health care or community
services. In developing, evaluating and revising a person's plan of service, the CCAC must
take into account the person’s preferences, including preferences based on ethnic, spiritual,
linguistic, familial and cultural factors. In addition, in assessing a person's requirements,
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determining a person's eligibility and developing, evaluating and revising a plan of service,
the CCAC must comply with the regulations. The regulations set out the eligibility criteria
and service maximums for personal support services, homemaking services and school
services as well as service maximums for nursing services. (The regulations under the
Health Insurance Act (HIA) set out the eligibility criteria for professional services.)
Section 23: The CCAC must ensure that the available services in a person’s plan of service are
provided within a time that is reasonable in the circumstances. If the services are not
immediately available, the CCAC must place the person on a waiting list and advise the person
when the service becomes available.
Section 24: The CCAC must not assess a person’s requirements, determine eligibility for the
program and the service, or provide a community service without the consent of the person.
Section 25: The CCAC must notify a person, their substitute decision-maker or anyone
designated by the person in writing or in an alternative format prescribed by the regulations of
the following:
•
•
•
•
the person’s rights under the Bill of Rights, and the obligation upon the CCAC and the
contracted service providers to respect and promote those rights;
the procedure for making complaints or suggestions respecting the CCAC or the contracted
service provider;
the right to access the person’s record of personal health information, and the procedure for
doing so; and
the right to inspect and review the agreement (Memorandum of Understanding) between the
CCAC and Ministry of Health and Long-Term Care (MOHLTC) for the provision of
community service.
Section 26: The CCAC must develop and implement a plan for preventing, recognizing and
addressing physical, mental and financial abuse of persons receiving community services
provided or arranged by the CCAC. The plan must include, among other things, the education
and training of employees and volunteers of the CCAC in methods of preventing, recognizing
and addressing physical, mental and financial abuse.
Section 27: The CCAC must ensure that a quality management system is developed and
implemented for monitoring, evaluating and improving the quality of community services
provided or arranged by the CCAC.
Section 28: The CCAC cannot charge or accept payment for professional or personal support
services. The legislation provides a mechanism for the CCAC to charge for homemaking
services in accordance with the regulations; however, the current regulations do not address this
issue and therefore the CCAC is not permitted to charge for homemaking services.
Section 29: Service providers under contract with the CCAC cannot require or accept payment
for CCAC services from anyone other than a CCAC. The contracted service provider is
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permitted by the legislation to collect the fees permitted for homemaking services under section
28 of the LTCA on behalf of the CCAC; however, no fees are permitted at present.
Section 30: The CCAC must provide the reports, information and documents requested by the
Minister or as set out in the regulations. There are currently no regulations addressing this
issue.
Section 31: The CCAC must post in its business premises a copy of the Bill of Rights, the
CCAC’s agreement with the MOHLTC, and any other documents and information set out in
regulation.
Section 32-37: The CCAC may not disclose a person’s record of personal health information
except in accordance with sections 32, 33, 34, 35 and 36 of the LTCA. The CCAC must
provide an explanation of the plan of service if requested to do so. (The CCAC must also
comply with the provisions of the Personal Health Information and Protection Act, 2004
(PHIPA).)
Section 38: In providing or arranging community services, the CCAC must comply with the
rules and standards, and must follow the procedures set out in the regulations. There are
currently no regulations addressing this issue.
Sections 39-49: The CCAC must establish a process for reviewing complaints made relating to
eligibility, exclusion of a particular service from a service plan, amount of service, termination
of service, quality of service and violation of the Bill of Rights. The legislation sets out
requirements relating to time lines, notification and appeals. Clients can appeal CCAC
decisions relating to eligibility, exclusion of service, amount of service and termination of
service to the Health Services Appeal and Review Board. (See chapter #10 for information on
complaints and appeals.)
As of February 16, 2002, the provisions in sections 50, 51, 53, 54, 55, subsections 56(2), (3),
(4), (5), (6), and section 57 of the LTCA, regarding revocation of approved agency status and
takeover powers for approved agencies, do not apply to a CCAC.
Subsection 56(1): The Minister can order a CCAC to suspend or cease an activity and may
take other appropriate action if the CCAC is carrying on an activity that is causing or is likely
to cause harm to a person’s health, safety or well-being.
Section 62: Program supervisors have broad inspection powers to ensure compliance by the
CCAC with the LTCA, regulations and agreements. It is an offence to obstruct a program
supervisor.
Section 66: It is an offence to knowingly provide false information in an application or report,
notice or other document required under the LTCA or to contravene sections 28, 29, 30, 31, 32,
34, 35, 36, 37, 38, or subsections 59(7), (8), (10), (13), 62(6), (7) or (11).
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2.3 Ontario Regulation 552 Under the Health Insurance Act
The regulatory provisions under the Long-Term Care Act, 1994 (LTCA) that support
Community Care Access Centre (CCAC) service decisions do not include eligibility criteria for
the professional services the CCAC is mandated to provide. (Professional services include
nursing, occupational therapy, physiotherapy, social work, speech-language pathology and
dietetic services.) The eligibility requirements for these services are set out in the regulations
under the Health Insurance Act (HIA).
CCACs are “home care facilities” under subsection 13(3)(b) of the HIA regulation. A “home
care facility” means “an agency, approved by the Minister to provide home care services.”
The HIA regulation states:
s. 13(1) In this section,
"home care services" means,
(a) the services that are provided, on a visitation basis, by a nurse or a nursing assistant3,
(b) the services provided, on a visiting basis, by a physiotherapist, occupational therapist,
speech therapist, social worker or nutritionist4,
(c) the provision of dressings and medical supplies,
(d) the provision of diagnostic and laboratory services,
(e) the provision of hospital and sickroom equipment,
(f) the provision of transportation services to and from the home to a hospital, health facility or
the attending physician's office, as the case may be.
Furthermore, the HIA establishes the requirement that a person must be insured under the
Ontario Health Insurance Plan (OHIP) (i.e., the person must have a valid health insurance
number) and sets out the remaining conditions under which these services can be provided (i.e.,
eligibility requirements). The HIA states:
s. 13(3) Home care services provided by a home care facility to an insured person in his or her
home are prescribed as insured services.
Clarification: To be eligible for service from a CCAC, a person must be insured under the
OHIP. Generally, this means that the person is a resident of Ontario, and is eligible and entitled
to receive Ontario’s health care services.
s. 13(4) It is a condition of payment for insured services under subsection (3) that,
(a) Revoked: O. Reg. 173/95, s. 1 (1).
(b) the services are necessary to enable the insured person to remain in his or her home or to
make possible the insured person's return to his or her home from a hospital or other
institution;
3
4
Nursing assistants are also referred to as Registered Practical Nurses. See subsection #7.1.1 in this manual.
See “Dietetics” in subsection #7.1.3 in this manual.
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(c) the needs of the insured person cannot be met on an out-patient basis;
(d) the insured person is in need of at least one professional service, if the service for which
payment is sought is described in clause (c), (d), (e) or (f) of the definition of "home care
services" in subsection (1);
Clarification: The person must need at least one professional service in the home (i.e., nursing,
physiotherapy, occupational therapy or speech therapy. Note that social workers and dietitians
are excluded from the definition of professional services for this purpose) in order to be eligible
for dressings and medical supplies, diagnostic and laboratory services, hospital and sickroom
equipment, transportation services to and from home to a hospital, health facility or attending
physician’s office.
s. 13(4)(e) the services are provided in the insured person's home where such has been
approved by the Minister as being suitable to enable the required care to be given;
Clarification: The setting where the service is delivered must be appropriate in terms of safety,
space and privacy, and adequate to support the necessary equipment and supplies that may be
required. Where the setting is not appropriate, every effort must be made to adapt the program
or equipment to fit the space, or to assist the person to modify his or her environment in order
to allow the service to be provided there. When such arrangements cannot be made, alternative
courses of action should be discussed with the individual. Every effort should be made before
declaring the person ineligible on the grounds that the setting is unsuitable. This section also
restricts service provision to a person’s home to the exclusion of other sites.
s. 13(4)(f) the services are available in the area where the insured person resides; and
Clarification: The person can only access the services that are available within the person’s
CCAC catchment area (e.g., in some cases, not all services may be available within the area).
s. 13(4)(g) the services are reasonably expected to result in progress towards rehabilitation.
Clarification: It must be shown that the provision of service is goal oriented.
The HIA extends the provision of physiotherapy, occupational and speech therapy to include
persons in long-term care homes:
s. 13(5) Physiotherapy, occupational therapy and speech therapy provided by a home care
facility to an insured person who,
(a) is a resident in a nursing home;
(b) is a resident in a home for the aged, established and maintained under the Homes for the
Aged and Rest Homes Act; or
(c) is a resident in a charitable institution approved under the Charitable Institutions Act,
are prescribed as insured services.
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The HIA also sets out the eligibility criteria for these services:
(a) Revoked: O. Reg. 173/95, s. 1 (3).
(b) Revoked: O. Reg. 173/95, s. 1 (3).
(d) the services are available in the area of the facility in which the insured person is a
resident; and
(e) the services are reasonably expected to result in progress toward rehabilitation.
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2.4 Community Care Access Corporations Act, 2001
The Community Care Access Corporations Act, 2001 (CCACA) governs the continuation,
creation, reorganization and dissolution of Community Care Access Centres (CCACs). It also
sets out the objects and powers of CCACs and provides for the composition and powers of
boards of directors of these corporations. CCAC board members and executive directors are
appointed by Order in Council.
Concerning the objects of CCACs, the CCACA states:
s. 5 The following are the objects of a community care access corporation:
1. To provide, directly or indirectly, health and related social services and supplies and
equipment for the care of persons.
2. To provide, directly or indirectly, goods and services to assist relatives, friends and others in
the provision of care for such persons.
3. To manage the placement of persons into long-term care facilities.
4. To provide information to the public about community-based services, long-term care
facilities and related health and social services.
5. To co-operate with other organizations that have similar objects (CCACA).
6. To carry out any charitable object that is prescribed and that is related to any of the objects
described in paragraphs 1 to 5.
Pursuant to section 2 of the CCACA the following CCACs are Community Care Access
Corporations under the Act:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Access Centre for Community Care in Lanark, Leeds and Grenville;
Access Centre for Hastings & Prince Edward Counties;
Algoma Community Care Access Centre;
Brant Community Care Access Centre;
Chatham/Kent Community Care Access Centre;
Cochrane District Community Care Access Centre/Centre d’accès aux soins
communautaires du district de Cochrane;
Community Care Access Centre (CCAC) – Oxford;
Community Care Access Centre for Huron;
Community Care Access Centre for Kenora and Rainy River Districts;
Community Care Access Centre for the Eastern Counties/Centre d’accès aux soins
communautaires pour les comtés de l’Est;
Community Care Access Centre Niagara;
Community Care Access Centre of Halton;
Community Care Access Centre of London and Middlesex/Centre d’accès aux soins
communautaires de London et Middlesex;
Community Care Access Centre of Peel/Centre d’accès aux soins communautaires de Peel;
Community Care Access Centre of The District of Thunder Bay;
Community Care Access Centre of Waterloo Region;
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•
•
•
•
•
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•
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Community Care Access Centre of Wellington-Dufferin;
Community Care Access Centre of York Region;
Community Care Access Centre Perth County;
Community Care Access Centre Simcoe County/ Centre d’accès aux soins communautaires
comté de Simcoe;
Community Care Access Centre Timiskaming/ Centre d’accès aux soins communautaires
Timiskaming;
Durham Access to Care;
East York Access Centre for Community Services/Centre d’accès aux services
communautaires d’East York;
Elgin Community Care Access Centre;
Etobicoke Community Care Access Centre/ Centre d’accès aux soins communautaires
d’Etobicoke;
Grey-Bruce Community Care Access Centre;
Haliburton, Northumberland and Victoria Long-Term Care Access Centre;
Haldimand-Norfolk Community Care Access Centre;
Hamilton Community Care Access Centre;
Kingston, Frontenac, Lennox & Addington Community Care Access Centre;
Manitoulin-Sudbury Community Care Access Centre;
Near North Community Care Access Centre/ Centre d’accès aux soins communautaires du
Moyen-Nord;
North York Community Care Access Centre/ Centre d’accès aux soins communautaires de
North York;
Ottawa-Carleton Community Care Access Centre/Centre d’accès aux soins communautaires
d’Ottawa-Carleton;
Renfrew County Community Care Access Centre;
Sarnia/Lambton Community Care Access Centre;
Scarborough Community Care Access Centre/ Centre d’accès aux soins communautaires de
Scarborough;
The Peterborough Community Access Centre Incorporated;
Toronto Community Care Access Centre;
Windsor/Essex Community Care Access Centre; and
York Community Care Access Centre/Centre d’accès aux soins communautaires de York.
Two other CCACs that were not designated as corporations when the CCACA came into force
are governed by integrated health service agencies that include hospitals, LTC homes and
CCACs. These are:
•
•
Muskoka-East Parry Sound Community Care Access Centre; and
West Parry Sound Health Centre Community Care Access Centre.
Note: On April 1, 2003, the Etobicoke and York Community Care Access Centres merged
bringing the total number of CCACs to 42.
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Regulation 33/02 also sets out the community services that a CCAC is approved to provide as
follows:
•
•
•
all the professional services listed in the Long-Term Care Act, 1994 (LTCA) (nursing,
occupational therapy, physiotherapy, social work, speech-language, dietetics, training a
person to provide these services, and providing equipment, supplies or other goods relating
to these services);
all the personal support services listed in the LTCA (personal hygiene activities, routine
personal activities of living, assisting a person with these activities, training a person to
carry out or assist with these activities, and providing equipment, supplies or other goods
relating to these services); and
the following homemaking services listed in the LTCA (housecleaning, doing laundry,
shopping, banking, paying bills, planning menus, preparing meals, caring for children,
assisting a person with these activities, training a person to carry out or assist with these
activities, and providing equipment, supplies or other goods relating to these activities).
Note: The CCAC does not have the authority to provide ironing and mending services.
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2.5 Legislation Governing Long-Term Care Homes
The legislation governing long-term care (LTC) homes sets out a standard, province-wide
placement co-ordination system. Under this system, responsibility for long-term care home
placements resides with third party placement co-ordinators that are designated by the Minister
of Health and Long-Term Care.
Under the current system, the Community Care Access Centre (CCAC) is the designated
placement co-ordinator with responsibility for authorizing admissions to LTC homes according
to the legislated requirements. The following three acts set out the requirements for admission:
•
•
•
Nursing Homes Act (NHA) – governs nursing homes;
Charitable Institutions Act (CIA) – governs charitable homes for the aged; and
Homes for the Aged and Rest Homes Act (HARHA) – governs municipal homes for the
aged.
The CCAC, through its placement function, is responsible for:
•
•
•
•
determining a person’s eligibility for LTC home placement;
if the person is determined eligible, authorizing the person’s admission to the LTC home of
the person’s choice;
prioritizing persons for admission; and
keeping and managing the waiting list for admission to LTC homes.
In order to perform the placement services, the CCAC is expected to have detailed information
about the LTC homes in its area, such as available programming, unique features (including
ethnic, linguistic and dietary matters), in-house staffing, number of beds, and performance of
each home. In addition, the CCAC is required to provide information about retirement homes
and other alternative services to persons who wish to seek admission to a LTC home.
In carrying out these functions, the CCAC is required to comply with the relevant provisions of
the above listed statutes and their regulations.
Note: Placement related provisions of the above statutes are discussed in greater detail in
chapters #11 and #12 in this manual.
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Legislation
2.6 French Language Services Act
Community Care Access Centres (CCACs) fall within the definition of a government agency
under section 1(b) of the French Language Services Act (FLSA). The 22 CCACs that serve
areas designated under the FLSA (designated areas) are required to provide all their services
(including communications for the purpose of providing or arranging these services) in English
and French in accordance with clients’ preferences. The CCACs are accountable for services
provided both directly and indirectly. Request for proposal documents and contracts for inhome services must therefore clearly address French language service delivery obligations for
service providers. The CCACs are required to ensure compliance with the following criteria:
•
•
•
•
permanency and quality of service in French;
access to services provided in French (including communication for the purpose of
services);
accountability for French language services; and
performance measures regarding French language services.
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3.1 Overview of Eligibility Criteria
The Community Care Access Centre (CCAC) must determine eligibility for: professional,
personal support and homemaking services, supplies, equipment or other goods within their
legislative authority, school services (professional and personal support services), and
equipment for children/youths in schools and receiving home schooling within their legislative
authority, and long-term care (LTC) homes.
Chapter #7 in this manual describes eligibility criteria for CCAC home care services and
chapter #9 in this manual describes eligibility criteria for CCAC school services. Subsection
#3.9 in this manual describes eligibility for adult day services (ADS) while subsection #3.10 in
this manual describes eligibility for Enhanced Respite funding services.
This section outlines the legislation, regulations and policies relating to Ontario Health
Insurance Plan (OHIP) coverage as the primary eligibility requirement for CCAC services.
Subsection 2(1) of Regulation 33/02 of the Community Care Access Corporations Act, 2001
(CCACA) provides that the CCAC is deemed to be an approved agency under the Long-Term
Care Act, 1994 (LTCA). The LTCA states:
Plan of service
s. 22(1) When a person applies to an approved agency for any of the community services that
the agency provides or arranges, the agency shall,
(a) assess the person’s requirements;
(b) determine the person’s eligibility for the services that the person requires; and
(c) for each person who is determined to be eligible, develop a plan of service that sets out the
amount of each service to be provided to the person.
3.1.1 Legislated Criteria
Subsections 13(3) and (4) of Regulation 552 of the Health Insurance Act (HIA) provide the
conditions under which home care services are prescribed as insured services. The HIA states:
s. 13(3) Home care services provided by a home care facility to an insured person in his or her
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Clarification: To be eligible for service from a CCAC, a person must be insured under the
OHIP. Generally, this means that the person is a resident of Ontario, and is eligible and entitled
to receive Ontario’s health care services.
(a) Revoked: O. Reg. 173/95, s. 1 (1).
institution;
services" in subsection (1).
(See definition of home care services in subsection #2.3 in this manual.)
Clarification: The person must need at least one professional service in the home (i.e., nursing,
physiotherapy, occupational therapy or speech language pathology. Note that social workers
and dietitians are excluded from the definition of professional services for this purpose) in
order to be eligible for dressings and medical supplies, diagnostic and laboratory services,
hospital and sickroom equipment, and transportation services to and from home to a hospital,
health facility or attending physician’s office.
s. 13(4)(e) the services are provided in the insured person's home where such has been
approved by the Minister as being suitable to enable the required care to be given;
Clarification: The setting where the service is delivered must be appropriate in terms of safety,
space and privacy and adequate to support the necessary equipment and supplies that may be
required. Where the setting is not appropriate, every effort must be made to adapt the program
or equipment to fit the space, or to assist the person to modify his or her environment in order
to allow the service to be provided there safely and adequately. When such arrangements
cannot be made, alternative courses of action should be discussed with the individual or the
individual’s substitute decision-maker (SDM). Every effort should be made before declaring
the person ineligible on the grounds that the setting is unsuitable. This section also restricts
service provision to a person’s home to the exclusion of other sites.
s. 13(4)(f) the services are available in the area where the insured person resides; and
Clarification: The person can only access the services that are available within the person’s
CCAC catchment area (e.g., in some cases, not all services may be available within the area).
s. 13(4)(g) the services are reasonably expected to result in progress towards rehabilitation.
Clarification: It must be shown that the provision of service is goal-oriented.
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3.2 Validation of Ontario Health Cards
To be eligible for Community Care Access Centre (CCAC) services under the Long-Term Care
Act, 1994 (LTCA), a person must be an insured person under the Health Insurance Act (HIA)
pursuant to Regulation 386/99 under the HIA. Individuals who have not applied for a health
card number may apply to become insured persons and receive a health card in accordance with
section 11 of the HIA and sections 2, 3 and 3.1 of Regulation 552 of the HIA.
All Ontario health card numbers must be verified by the CCAC for all services and admissions
to long-term care (LTC) homes.
3.2.1 Validation Process
The CCAC must verify an applicant’s Ontario health card number by using one of the
following three health card validation systems:
1. The Ministry of Health and Long-Term Care (MOHLTC) Interactive Voice Response
(IVR) system, 1-800-262-6524.
The IVR system enables the CCAC to determine the status of a health card number and
version code at the time of service. IVR is accessed using a MOHLTC approved PIN
number and a touch tone phone.
2. The MOHLTC Health Number Look-Up (HNLU) service, 1-800-228-6519.
The HNLU service is appropriate to use in situations where a client does not have his or her
health number/version code available at the time of service or, if after validating the health
number/version code using the IVR system, the IVR system indicates the client has an
incorrect version code. Client consent is required before releasing any information. Health
Number Release form (#014-1265-84) can be printed from website:
[http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?openform&ENV
=WWE&NO=014-1265-84].
(For clients not having a health card or number in their possession, see subsection #3.2.2 in
this manual.)
3. For additional information, the CCAC can contact a MOHLTC staff person as follows:
•
•
•
•
call the local OHIP office (The number is in blue pages of the telephone book under
Health.);
check the website at: [http://www.health.gov.on.ca/english/public/public_mn.html] and
go to OHIP;
from anywhere in Ontario, call the general information line at 1-800-268-1154; or
from area code 416, call (416) 314-5518.
Hours of operation for these services are 8:30 a.m. to 5:00 p.m., Monday through Friday.
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3.2.2 Client Does Not Have a Health Card or Number in His or Her Possession
A CCAC that is registered with the HNLU system, will ask the person who does not have his or
her health card or number in his or her possession to complete and sign the Health Number
Release form (#014-1265-84) which can be printed from website:
[http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?openform&ENV=W
WE&NO=014-1265-84].
Client Has OHIP Coverage
•
•
•
•
•
With the release form completed, the CCAC calls a HNLU telephone number at anytime
(24 hours, seven days a week).
The HNLU agent provides the number to the CCAC at time of registration.
The CCAC identifies itself with its designated HNLU PIN number.
An HNLU agent releases the required information if available.
The CCAC follows up by faxing the person’s completed Health Number Release form to
the HNLU.
Client Does Not Have OHIP Coverage
(See subsection #3.4 in this manual.)
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3.3 Residency Requirements for OHIP Coverage
To qualify for Ontario Health Insurance Plan (OHIP) coverage, a person must be a resident of
Ontario as defined in Regulation 552 of the Health Insurance Act (HIA). Except for those
residents identified in section 1.1(1)(a) below, a resident must ordinarily be present in Ontario
which means the resident must make his or her permanent and principal home in Ontario and,
with some exceptions, be present in Ontario for 153 days in any given 12-month period.
Regulation 552 of the HIA states:
s. 1.1(1) a “resident” is an individual,
(a) who is present in Ontario by virtue of an employment authorization issued under the
Caribbean Commonwealth and Mexican Seasonal Agricultural Workers Programme
administered by the federal Department of Citizenship and Immigration, or
(b) who is ordinarily resident in Ontario and who is one of the following:
1. A Canadian citizen or a landed immigrant under the Immigration Act (Canada).
2. A person who is registered as an Indian under the Indian Act (Canada).
3. A Convention refugee as defined in the Immigration Act (Canada).
4. A person who has submitted an application for landing under the Immigration Act
(Canada), who has not yet been granted landing and who has been confirmed by the federal
Department of Citizenship and Immigration as having satisfied the medical requirements
for landing.
5. Revoked: O.Reg. 87/95, s. 1.
6. A person who has finalized a contract of employment or an agreement of employment
with a Canadian employer situated in Ontario and who, at the time the person makes his or
her application to become an insured person, holds an employment authorization under the
Immigration Act (Canada) which,
i. names the Canadian employer,
ii. states the person's prospective occupation, and
iii. has been issued for a period of at least six months.
7. The spouse, same-sex partner or dependent child under the age of 19 years of a person
referred to in paragraph 6 if the Canadian employer provides the General Manager with
written confirmation of the employer's intention to employ the person referred to in
paragraph 6 for a period of three continuous years.
Note: The General Manager is the person responsible for administering OHIP.
s. 1.1(1) 8. A member of the clergy of any religious denomination who has finalized an
agreement of employment to minister on a full-time basis to a religious congregation in
Ontario for a period of not less than six consecutive months and whose duties will consist
mainly of preaching doctrine, presiding at liturgical functions and spiritual counselling.
9. The spouse or same-sex partner and the dependent children under the age of 19 years of
a member of the clergy referred to in paragraph 8 if the religious congregation provides
the General Manager with written confirmation that it intends to employ the member for a
period of at least three consecutive years.
September 2006
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10. A person granted a minister's permit under section 37 of the Immigration Act (Canada)
which indicates on its face that the person is a member of an inadmissible class designated
as case type 86, 87, 88 or 89 or, if the permit is issued for the purpose of an adoption by an
insured person, as case type 80.
11. A person granted an employment authorization under the Live-in Care Givers in
Canada Programme or the Foreign Domestic Movement administered by the federal
Department of Citizenship and Immigration.
Regulation 552 of the HIA states:
s. 1.1(1) For the purposes of subsection (1), a person is ordinarily resident in Ontario only if,
(a) in the case of an insured person or of a person who comes to Ontario from another
province or territory in which that person was insured by the provincial or territorial health
insurance authority, the person,
(i) makes his or her permanent and principal home in Ontario, and
(ii) subject to subsections (3), (4), (5) and (6), is present in Ontario for at least 153 days in
any 12-month period; and
(b) in the case of a person who is applying to be an insured person for the first time or who is
re-establishing his or her entitlement after having been uninsured for a period of time, other
than a person who comes to Ontario from another province or territory in which that person
was insured by the provincial or territorial health insurance authority, the person,
(i) intends to make his or her permanent and principal home in Ontario, and
(ii) is present in Ontario for at least 153 days immediately following the application.
Subsections 1.1(3) and (4) of Regulation 552 of the HIA provide that some persons may be
exempted from the requirement to remain in Ontario for 153 days in 12-month period if:
•
•
•
the person is required to travel frequently outside Ontario for his or her employment;
the General Manager has approved payment for a treatment to be provided to the person
outside Canada; or
the person leaves Canada to work, to attend a full-time educational program, or to engage in
missionary work if he or she intends to return to make a permanent and principle home in
Ontario and met the 153 day requirement for the two years immediately prior to leaving
Ontario.
3.3.1 Three-Month Waiting Period for OHIP Coverage
Applications
The HIA states:
s. 3(1) A resident who is not otherwise an insured person may become an insured person by
submitting an application to the General Manager.
(1.1)1. An application under subsection (1) shall be in the form approved by the Minister.
September 2006
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Chapter 3
(2) A resident making an application under subsection (1), shall be present in Ontario at the
time of submitting the application.
(3) A resident who makes an application under subsection (1) shall only be enrolled as an
insured person three months after the day the person becomes a resident.
3.3.2 Exceptions to the Three-Month Waiting Period for OHIP Coverage
The HIA states:
s . 3(4) The three-month waiting period referred to in subsection (3) does not apply to the
following persons who are residents and who apply to become insured persons:
1. A child under the age of 16 who is adopted by an insured person.
2. A newborn born in Ontario to an insured person.
3. A person who satisfies the General Manager that he or she has been resident in Ontario for
at least three months at the time of his or her application to become an insured person.
4. A member of the Canadian Forces who was an insured person immediately before becoming
a member and is discharged from the Canadian Forces.
5. A member of the Royal Canadian Mounted Police who had been appointed to a rank therein
and who was an insured person immediately before becoming a member and is discharged.
6. A Canadian diplomat who returns to Ontario after a posting to a place outside Canada and
who was an insured person immediately before the posting.
7. The spouse, same-sex partner or dependent child under 19 years of age, of a Canadian
diplomat referred to in paragraph 6 who was an insured person immediately before the posting
of the Canadian diplomat.
8. An inmate at a penitentiary as defined in the Corrections and Conditional Release Act
(Canada) who is released.
9. An inmate at a correctional institution established or designated under Part II of the
Ministry of Correctional Services Act who is released.
10. A person who,
i. takes up residence in Ontario directly from elsewhere in Canada where the person was
insured under a government health plan or a hospital insurance plan, and
ii. upon taking up residence in Ontario, becomes a resident of an approved charitable
home for the aged under the Charitable Institutions Act , a home under the Homes for the
Aged and Rest Homes Act or a nursing home under the Nursing Homes Act .
11. A Convention refugee as defined in the Immigration Act (Canada).
12. A person who has made a claim to be a Convention refugee under the Immigration Act
(Canada) and in respect of whom,
i. a senior immigration officer has determined that the person is eligible to have his or her
claim determined by the Refugee Division, and
ii. a removal order, as defined in the Immigration Act (Canada), has not been executed.
13. A person granted a Minister's permit under section 37 of the Immigration Act (Canada)
which indicates on its face that the person is a member of an inadmissible class designated as
case type 86, 87, 88 or 89 or, if the permit is issued for the purpose of an adoption by an
insured person, as case type 80.
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14. A person who is present in Ontario by virtue of an employment authorization issued under
the Caribbean Commonwealth and Mexican Seasonal Agricultural Workers Programme
administered by the federal Department of Citizenship and Immigration.
15. A pregnant woman who became pregnant before April 1, 1994 and who applied to become
an insured person during the course of that pregnancy.
16. A pregnant woman who,
i. has submitted an application for landing under the Immigration Act (Canada) and has
not yet been granted landing,
ii. became pregnant before April 1, 1994, and applied to become an insured person during
the course of that pregnancy, and
iii. has been confirmed by the federal Department of Citizenship and Immigration as
having satisfied,
A. all the medical requirements for landing, or
B. all the medical requirements for landing except for the requirement to submit to an xray.
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3.4 Persons without OHIP Coverage are Ineligible for CCAC
Services
Ontario Health Insurance Plan (OHIP) coverage is one eligibility criterion for Community Care
Access Centre (CCAC) services. This subsection identifies the circumstances under which a
person may or may not be covered by OHIP and where CCAC services can be provided.
3.4.1 Persons Who May be Eligible for OHIP Coverage
•
•
Newcomers to Ontario from another country may be eligible for CCAC services if they
have applied for and are entitled to OHIP coverage and have served their three-month
waiting period.
Newcomers from another Canadian province or territory who have moved to Ontario may
be eligible for CCAC services if they have applied and qualify for OHIP coverage and have
served their three-month waiting period.
(See other eligibility criteria in section #3.1 in this manual.)
3.4.2 Persons Without OHIP Coverage Not Eligible for CCAC Services
•
•
Visitors to Ontario from another province or country, including foreign students, are not
eligible to receive CCAC services.
Royal Canadian Mounted Police (RCMP) are not eligible to receive CCAC services if these
services are covered by their Public Service Health Care Plan.
Note: RCMP personnel are not entitled to receive a drug card from the CCAC, as drug
coverage is available through their Public Service Health Care Pan.
•
•
Canadian Armed Forces personnel are not eligible to receive CCAC services if these
services are covered by the National Defense Medical Centre.
Inmates of federal penitentiaries are not eligible for OHIP as their health insurance
coverage is through the Canadian government (although inmates of the Province of Ontario
corrections institutions are covered by OHIP for their period of incarceration, CCACs must
assess whether these inmates require CCAC services if similar services are provided by
correctional institutions).
3.4.3 Visitors from Other Provinces/Territories Not Eligible for CCAC Services
May be Eligible for Hospital and Primary Care Services
Visitors to Ontario from another province or territory who require emergency or in-patient
services in a hospital are covered for these services by their home province’s or territory’s
health insurance plan through a reciprocal agreement between provinces or territories. Visitors
who require the services of a physician/nurse practitioner in an office, clinic or community
September 2006
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health centre may receive those services and the physician/clinic may directly bill the visitor’s
health insurance program of their home province or territory. Alternatively, the physician/clinic
may bill the visitor for the service and the visitor should submit the bill for reimbursement to
the health insurance plan in the visitor’s home province.
3.4.4 Role of the Case Manager When a Person is Deemed Ineligible for Service
Because He or She Does Not Have a Valid Ontario Health Card
When an individual is deemed ineligible for CCAC services because the individual does not
have valid OHIP coverage, the case manager must:
•
•
•
explain the reasons for not providing CCAC funded service;
assist the person with his or her options (including directing the person to the local OHIP
office to confirm whether OHIP coverage is a possibility); and
link the person to the appropriate health, social service or community resources that can
address the person’s needs. The case manager’s judgement will determine the duration of
the provision of case management service to the individual (e.g., families requiring ongoing
assistance with end of life care to a loved one who does not have OHIP coverage, may
receive case management services).
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3.5 Out-of-Province Applicants to Ontario’s Long-Term Care
Homes
Residents of other provinces or a territory who plan to move to Ontario and need to be placed
in a long-term care (LTC) home are first required to have prior approval of Ontario Health
Insurance Plan (OHIP) coverage.
3.5.1 Pre-Registration Process for Obtaining an Ontario Health Card
When a Community Care Access Centre (CCAC) receives a request for placement of a person
who is planning to move from another province directly into a LTC home, the CCAC must
redirect the person, or the person’s lawfully authorized substitute decision-maker (SDM), to
OHIP head office at the following address:
OHIP Pre-Registration for Long-Term Care
Eligibility and Portability Services
Registration and Claims Branch
Ministry of Health and Long-Term Care
49 Place d’Armes, 3rd floor
Kingston, ON K7L 5J3
telephone: (613) 548-6363
facsimile: (613) 548-6557
Eligibility Services will provide a Registration for Ontario Health Coverage form and preregistration information to the person or the person’s lawfully authorized substitute (e.g., power
of attorney). The person or his or her SDM will complete and return the OHIP registration form
to Eligibility Services, along with a copy of a suitable citizenship or immigration document
such as a Canadian birth certificate, landed immigrant document or Canadian passport.
If the applicant is eligible for OHIP coverage, Eligibility Services will give prior approval of
the applicant’s OHIP coverage and send a letter confirming prior approval to the CCAC. This
letter will serve temporarily to fulfill the eligibility requirement that the person is insured under
the Health Insurance Act (HIA), and allows the CCAC to proceed with the applicant’s
eligibility determination and authorization of admission processes.
The applicant is not registered for OHIP coverage or issued a health insurance number until
after the applicant has arrived in Ontario and has been admitted to a LTC home. On the day of
admission to the LTC home, the CCAC must send Eligibility Services a completed
Authorization for Admission to a LTC Facility indicating that the applicant has been placed.
Eligibility Services will then complete the applicant’s OHIP registration, issue the new resident
an Ontario health insurance number that is effective on the day of admission to the LTC home
and will advise the CCAC.
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Note: To be eligible for this pre-registration process, the applicant must be an insured resident
of another province or territory in Canada when applying for OHIP coverage/admission to the
LTC home, and the applicant must move directly into a provincially-regulated LTC home (e.g.,
a resident in Winnipeg must move directly into a LTC home in Toronto). Applicants living
outside Canada are not eligible for this pre-registration process, even if they are Canadian
citizens returning to Ontario.
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3.6 OHIP Coverage/CCAC Services for Homeless Persons
Homeless persons do not always have Ontario Health Insurance Plan (OHIP) coverage or the
supporting documentation required to obtain coverage. With the person’s consent, a
Community Care Access Centre (CCAC) must contact the local district OHIP office to confirm
whether the individual has valid OHIP coverage using the Health Number Release form
process (outlined in subsection #3.2 in this manual).
A homeless person who does not have OHIP coverage nor the documents required to obtain
coverage, can apply for coverage with the support of an agency (as approved under the LongTerm Care Act, 1994 (LTCA)) that works with the homeless. The local OHIP office can advise
how to assist the person. The process is as follows:
•
•
•
•
To eliminate barriers to health care access, the Ministry of Health and Long-Term Care
(MOHLTC) policy permits an “approved agency” dedicated to serving the homeless to
issue a special “agency letter” that confirms the person’s identity and supports the person’s
application for OHIP coverage. In the letter, the agency commits to assisting the person in
obtaining necessary documents to meet eligibility requirements for health coverage and to
provide the agency’s residential/mailing address for the person.
The homeless person visits a local MOHLTC office or an outreach registration site (usually
a community health centre) and provides the “agency letter” plus whatever documents the
person has to register for health coverage.
The MOHLTC will usually provide the person with one-year interim health coverage to
allow the agency to assist the person in obtaining necessary documentation to meet
eligibility requirements for health coverage.
Persons who use the “agency letter” process to obtain health coverage must meet the photo
and signature requirements of the photo health card. There are no exemptions.
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3.7 OHIP Coverage/CCAC Services for Refugees
3.7.1 Interim Federal Health Program
Essential medical coverage for refugee claimants in Ontario is usually paid for by the Interim
Federal Health (IFH) program administered by Citizenship and Immigration Canada.
The purpose of the IFH is to pay for in-Canada health care for certain immigrants who are
unable to pay for expenses related to urgent and essential services. Coverage is provided
pending their qualification for other means of payment. This applies principally to refugee
claimants, convention refugees and members of the humanitarian designated classes.
The fund is not meant to replace provincial health plans and does not provide the same extent
of coverage allowed to permanent residents.
The IFH program benefits are limited to:
•
•
•
•
essential health services for the treatment and prevention of serious medical and dental
conditions (including immunizations and other vital preventative medical care);
essential prescription medications;
contraception, prenatal and obstetrical care; and
the immigration medical examination for those individuals who are unable to pay for the
exam.
Note: The IFH program does not cover routine medical or eye or dental exams.
3.7.2 Eligibility for Interim Federal Health Program
Eligibility for the IFH program is determined by Citizenship and Immigration Canada.
3.7.3 Process to Obtain Approval for CCAC In-home and School Services
Before a Community Care Access Centre (CCAC) may provide service to a refugee, prior
approval is required from Citizenship and Immigration Canada.
The person must be in possession of an Interim Health Certificate of Eligibility, a document
issued to the person by an immigration officer. Attached to the certificate is a letter that
outlines the benefits to which the person is entitled.
The CCAC must fax a copy of the Interim Health Certificate of Eligibility document and
background information that outlines the services required, the reason for home care, an
estimate of the time frame for the service to be carried out, and the expected date of discharge
from service to:
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Medical Director, IFH/CIC
Interim Federal Health Program
Jean Edmonds Building
365 Laurier Avenue West
South Tower, 14th Floor
Ottawa, ON K1A 1L1
toll free facsimile: 1-800-362-7456
Note: The Interim Federal Health Program Information Handbook for Health Care Providers
can be accessed at: [http://www.fasadmin.com/images/pdf/ifh_information_handbook.pdf].
Once the Medical Director of the IFH program reviews the information, the CCAC is advised if
the service has been approved and CCAC services may be initiated.
The CCAC must send a copy of the Interim Health Certificate of Eligibility with the first
invoice submission and monthly invoices to:
FAS Benefit Administrators Ltd.
9707-110 Street, 9th Floor
Edmonton, AB T5K 3T4
toll free telephone (English and French): 1-800-770-2998
e-mail: [email protected]
website: www.fasadmin.com
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3.8 OHIP Coverage/CCAC Services for a Person on Leave of
Absence from a LTC Home
A person who is a resident of a long-term care (LTC) home and who is on a leave of absence
from the LTC home (e.g., on vacation, or as a result of a home outbreak), may be eligible to
receive home care services from the Community Care Access Centre (CCAC). The same
applies to a person who is in the LTC home Convalescent Care Program or on a leave of
absence from a hospital.
The person must have valid Ontario Health Insurance Plan (OHIP) coverage and must be
assessed as eligible and needing services provided by the CCAC. The CCAC must determine
the priority for the person to receive the assessed services.
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3.9 Eligibility for Adult Day Services
3.9.1 Program Description
Adult day services (ADS) are community support services that provide supervised individual
programming in a group setting in order to:
•
•
•
assist individuals to achieve and maintain their maximum level of functioning;
prevent premature and inappropriate institutionalization; and
provide respite, information and support to caregivers.
ADS are intended to provide services to individuals with high care needs and their caregivers.
ADS serve the frail elderly and/or individuals with Alzheimer disease, progressive cognitive
disorders or dementias. Components of the service include: planned social, recreational and
physical activities; meals; transportation (if required); personal support/attendant care and
minor health care services (e.g., monitoring medications).
Note: Medical services are not included in the range of services offered in ADS.
3.9.2 Community Care Access Centre and Adult Day Services
In some cases, the Community Care Access Centre (CCAC) and the ADS may agree that the
CCAC will be responsible for assessments and determination of eligibility for ADS. In
collaboration with staff of the Ministry of Health and Long-Term Care (MOHLTC) regional
office, both the CCAC and ADS must establish local eligibility criteria for priority admission to
the ADS. The CCAC must develop agreements with other CCACs regarding the acceptance
and processing of applications from outside their catchment area.
3.9.3 Optional Trial Period
An optional trial period is available to assess whether ADS can appropriately serve a person
who is deemed eligible by the CCAC. For example, ADS may not be suitable for a person in
situations where the safety of other clients is compromised or the care needs of the client
exceed the ability of the services.
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3.10 Eligibility for Enhanced Respite Funding
3.10.1 Program Description
Enhanced Respite for Children who are Medically Fragile and/or Technology Dependent
(Enhanced Respite) is a grant paid to eligible families who are caring for a child at home who is
medically fragile and/or technology dependent.
The Ministry of Children and Youth Services (MCYS) is responsible for the provision of
funding and policies related to Enhanced Respite, including the criteria used by the Community
Care Access Centre (CCAC) to determine eligibility for funding.
Families caring for medically fragile and/or technology dependent children often need more
services and supports than may be available through other programs and service providers. The
respite needs of these parents are typically very high. Families may provide 16 or more hours
of care daily and routinely provide monitoring and care at night.1
Under Enhanced Respite, a family may receive up to $3500 per eligible child annually. There
are no restrictions on the type of respite a family may purchase. Funds may be used flexibly to
purchase in-home or out-of-home services or a combination of in-home and out-of-home
services.
The grant is provided in addition to care, treatment and/or funding from other sources. The
Enhanced Respite funding must not result in any reduction in existing funding from other
sources. This includes, but is not limited to, funds provided under the Special Services at Home
and/or the Assistance for Children with Severe Disabilities programs and home care services
arranged by the CCAC.
3.10.2 CCAC Responsibilities
The CCAC is responsible for determining a child’s eligibility in accordance with approved
eligibility criteria.
Related CCAC responsibilities include the following activities:
•
•
provide eligible families with written notification of their eligibility for Enhanced Respite;
and
notify the Ministry of Children and Youth Services-Ministry of Community and Social
Services (MCYS-MCSC) regional office of decisions of eligibility made on behalf of
children.
1
Enhanced Respite for Families Caring for Medically Fragile and/or Technology Dependent Children at Home:
Implementation Plan, 1999-2000.
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3.10.3 Role of the MCYS-MCSS Regional Office
The regional offices, which administer the funding paid on behalf of eligible families, are
responsible for the following activities:
•
•
•
inform eligible families of the amount approved for the current fiscal year and provide the
families with authorization numbers;
reimburse families based on submitted invoices for respite services or pay the service
provider directly; and
monitor the Enhanced Respite resources provided to eligible families.
3.10.4 Eligibility Criteria for Enhanced Respite Funding
Eligibility Criteria2
Only medically fragile and/or technology dependent children with chronic conditions who meet
the following eligibility criteria based on their age and care requirements will qualify for the
enhancement:
•
•
•
age: children under 18 years of age; and
care requirements:
• child’s care requirements resulting from medical or physiological condition(s) that
require ongoing, frequent or time-consuming caregiver intervention and monitoring on
a 24-hour basis for survival;
• there must be a demonstrable risk of significant exacerbation of the child’s health status
associated with not meeting the 24-hour care requirements;
• children with behavioural disorders alone are not eligible; and
only children who meet the above criteria and fall within the following categories of care
requirements will qualify:
2
Enhanced Respite for Families Caring for Medically Fragile and/or Technology Dependent Children at Home:
Implementation Plan, 1999-2000.
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Group
Care Requirements/Needs
Group 1
Children dependent at least part of each day on mechanical
ventilators
Group II
Children requiring prolonged intravenous administration of:
• nutritional substances
• drugs
Group III
Children with prolonged dependence on other device-based support
for:
• tracheotomy tube care
• suctioning
• oxygen support
• tube feeding
Group IV
Children with prolonged dependence on other devices which
compensate for vital body functions who require daily or near daily
nursing care, including children requiring:
• apnea monitors (cardio respiratory)
• renal dialysis due to kidney failure
• urinary catheters or colostomy bags plus substantial nursing care
Group V3
•
Medically fragile
who meet care
requirements, but
do not use
technological
device
•
Children who are medically fragile according to the care
requirements, but do not use a technological device are eligible,
even if the child sleeps through the night. Eligibility should not
be declined solely because the child sleeps through the night.
Enhanced Respite funding for a Group V child may be used to
purchase either in-home or out-of-home respite services or a
combination of in-home and out-of-home respite. There is no
restriction on the type of respite care that may be purchased by a
family.
Note: It is recognized that aspects of the eligibility criteria for Enhanced Respite funding would
benefit from additional clarification. Such requests most often are related to the Group V
category, children who are medically fragile according to the care requirements but who do not
use a technological device.
3
The addition of a fifth category of care was made in a February 15, 1999 memorandum sent to CCACs from the Office of
the ADM, Office of Integrated Services for Children (OISC).
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3.11 Services to First Nations Persons
3.11.1 Services to Persons Residing in First Nations Communities
Health and social services in First Nations communities are funded by both federal and
provincial levels of government through the Federal Department of Indian and Inuit Affairs,
Health Canada’s Medical Services Branch and the Ontario Ministry of Health and Long-Term
Care (MOHLTC).
The First Nations manage and deliver various health and social services such as healing
centres, clinics offering medical services and some long-term care services for their members.
The numbers and types of such services have been negotiated over time, under various
initiatives and funding sources, and vary from community to community.
Individuals residing in First Nations communities are eligible for Community Care Access
Centre (CCAC) services. CCACs must first assess whether these individuals require CCAC
services if similar services are provided through the First Nations community. CCAC services
should coordinate with and complement services available in the First Nations community
rather than duplicate those services. To achieve this goal, CCAC staff need to be aware of the
services available in First Nations communities within their service area.
The CCAC may enter into formal agreements with First Nations or organizations representing
First Nations (e.g., Union of Ontario Indians) in order to formalize a process that will facilitate
and ensure that ongoing, effective linkages are maintained.
3.11.2 Long-Term Care Services to Aboriginal Persons Not Residing in First
Nations Communities
Aboriginal people not living in First Nations communities may also receive services from the
CCAC. CCACs must assess requirements and determine eligibility for services on the same
basis as any other Ontario resident.
The MOHLTC provides funding to some aboriginal organizations to provide home and
community care services to aboriginal people both on and off reserve. The types and
availability of services vary across the province.
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Consent to Treatment, Admission to
Long-Term Care Home and Community
Services
4.1 Overview of Consent Provisions
Client consent is a critical component of the various pieces of legislation that affect the
functions of the Community Care Access Centre (CCAC). The Nursing Homes Act (NHA), the
Homes for the Aged and Rest Homes Act (HARHA), the Charitable Institutions Act (CIA), the
Long-Term Care Act, 1994 (LTCA) and the Health Care Consent Act, 1996 (HCCA) set out
the provisions that the CCAC must follow when obtaining consent from a person or, where the
person is incapable, from the person’s lawfully authorized substitute decision-maker (SDM) for
decisions regarding consent to community service, treatment, and/or admission to a long-term
care (LTC) home. A person who makes decisions for another person is called a “substitute
decision-maker” (SDM).
All legislative references in this chapter, unless stated otherwise, are to the HCCA. Subsections
4.3 to 4.7 in this manual outline the processes for seeking consent to treatment and subsections
4.8 to 4.10 outline the processes for seeking consent to admission to a LTC home.
4.1.1 Applicable Legislation
Long-Term Care Act, 1994
Section 24 of the LTCA states that “Nothing in this Act authorizes an approved agency to
assess a person’s requirements, determine a person’s eligibility or provide a community
service to a person without the person’s consent.”
Before the CCAC is authorized to assess a person’s requirements, determine eligibility or
provide any community service (e.g., homemaking or personal support services), informed
consent must be obtained from the person.
Subsection 3(1)6 of the LTCA states that “a person has the right to give or refuse consent to
the provision of any community service.”
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Under subsection 2(3) of the LTCA, community services are community support services,
homemaking services, personal support services and professional services. Each of these
services is defined in subsections 2(3) to (7) of the LTCA.
Under section 10 of the HCCA, a health practitioner (a defined term under the HCCA) must not
administer “treatment” (also a defined term under the HCCA) and must take reasonable steps to
ensure that it is not administered unless he or she is of the opinion that the person is capable
with respect to the treatment and the person has given consent. If the person is not capable of
giving consent to the “treatment”, consent must be sought from the person’s legally authorized
SDM who has the authority to make the decision. Therefore, the CCAC must obtain consent
from the person, or the person’s SDM, where applicable, to both the assessment for eligibility
and if determined to be eligible, the delivery of services.
(See subsection #2.2 in this manual for an overview of the LTCA.)
Health Care Consent Act, 1996
The HCCA comprehensively deals with the issue of consent to treatment and contains a
substitute decision-making scheme to obtain consent to treatment on behalf of persons who are
incapable of making a treatment decision. The HCCA also provides a substitute decisionmaking scheme to obtain consent on behalf of persons who are incapable of making decisions
about admission to “care facilities” (LTC homes) and the use of personal assistance services in
a LTC home.
The HCCA:
•
•
•
•
•
confirms the right of capable individuals to make informed decisions about treatment;
sets out the elements of consent and informed consent to treatment in one piece of
legislation that applies to treatment in all settings by health practitioners specified in the
HCCA;
provides a mechanism to obtain decisions from a SDM for those who, at the time
treatment, admission to a LTC home or personal assistance service in a LTC home is
proposed or required, are not mentally capable of making the decision on their own behalf;
allows persons who are found incapable of consenting to treatment, admission to a LTC
home or a personal assistance service in a LTC home to apply to the Consent and Capacity
Board to have the finding reviewed; and
requires that wishes regarding treatment, admission to a LTC home and personal assistance
services expressed by a person while capable and after reaching the 16 years of age, be
followed by the SDM when making a decision on behalf of an incapable person.
Substitute Decisions Act, 1992
The Substitute Decisions Act, 1992 (SDA) is also relevant when considering decision-making
for persons that are incapable of making decisions about their personal care and managing their
property. The SDA governs what may happen when a person is not mentally capable of making
certain decisions about their own property (including finances) or personal care.
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Under the SDA, a person who is capable of doing so may through the following documents
appoint a SDM to make decisions on his or her behalf if he or she becomes incapable of
making these decisions in the future:
•
•
Continuing power of attorney for property: a legal document in which a person gives
someone else (the attorney(s) for property) the legal authority to make decisions regarding his
or her finances (property) if he or she becomes mentally incapable of making those decisions.
The power of attorney may provide that it comes into effect on a specified date or when a
specified contingency happens (such as when the person becomes incapable of managing
property). A person must be at least 18 years old in order to make a continuing power of
attorney for property.
Power of attorney for personal care: a legal document in which a person gives someone
else (the attorney(s) for personal care) the legal authority to make personal care decisions
(regarding health care, nutrition, shelter, clothing, hygiene or safety) on his or her behalf if he
or she becomes mentally incapable of making decisions about any or all of those matters. A
person must be at least 16 years old to make a power of attorney for personal care.
A person who is incapable of making decisions about property or personal care may still be
capable of making a power of attorney. The person named in the power of attorney to make the
decisions is called the “attorney”; in this context attorney does not mean a lawyer. The attorney is
the SDM for the person when a valid power of attorney becomes effective.
There is no legal requirement that a person must appoint an attorney for property or personal
care. Where there is no power of attorney document, or there are other circumstances that make
appointing a guardian necessary, the SDA sets out the circumstances and procedures for the
appointment of a guardian who is authorized to act as the SDM for property or personal care for a
person who is mentally incapable.
It should not be assumed that attorneys or guardians have the authority to make all personal care
or property decisions on behalf of the incapable person. The terms of the power of attorney or the
court order appointing the guardian indicate the scope of the SDM’s authority to make decisions
and any limitations on the authority.
The SDA and the HCCA operate in tandem with each other. The SDA provides that the SDM
(either the attorney for personal care or guardian for personal care for an incapable person) is
required to follow the provisions of the HCCA when making decisions on the incapable person’s
behalf to which the HCCA applies. Decisions to which the HCCA applies are treatment,
admission to a LTC home, and personal assistance services in a LTC home. When an incapable
person does not have an SDM under the SDA with the authority to make a decision under the
HCCA, the HCCA permits other persons to act as the SDM to make decisions about treatment,
admission to a LTC home, and personal assistance services in a LTC home without a court
appointment. These other persons are family members, including spouses, a board appointed
representative or the Public Guardian and Trustee. See the discussion below for more details
about the HCCA.
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4.2 Definitions of Terms in the Health Care Consent Act, 1996
Subsection 2(1) of the Health Care Consent Act, 1996 (HCCA) sets out the following
definitions:
Board means the Consent and Capacity Board.
care facility means,
(a) an approved charitable home for the aged, as defined in the Charitable Institutions Act,
(b) a home or joint home, as defined in the Homes for the Aged and Rest Homes Act,
(c) a nursing home, as defined in the Nursing Homes Act, or
(d) a facility prescribed by the regulations as a care facility;
Note: The care facilities listed above are referred to as long-term care (LTC) homes throughout
this manual. At this time there are no regulations prescribing other facilities under (d).
course of treatment means a series or sequence of similar treatments administered to a person
over a period of time for a particular health problem.
health practitioner means,
(a) a member of the College of Audiologists and Speech-Language Pathologists of Ontario,
(b) a member of the College of Chiropodists of Ontario, including a member who is a
podiatrist,
(c) a member of the College of Chiropractors of Ontario,
(d) a member of the College of Dental Hygienists of Ontario,
(e) a member of the Royal College of Dental Surgeons of Ontario,
(f) a member of the College of Denturists of Ontario,
(g) a member of the College of Dietitians of Ontario,
(h) a member of the College of Massage Therapists of Ontario,
(i) a member of the College of Medical Laboratory Technologists of Ontario,
(j) a member of the College of Medical Radiation Technologists of Ontario,
(k) a member of the College of Midwives of Ontario,
(l) a member of the College of Nurses of Ontario,
(m) a member of the College of Occupational Therapists of Ontario,
(n) a member of the College of Optometrists of Ontario,
(o) a member of the College of Physicians and Surgeons of Ontario,
(p) a member of the College of Physiotherapists of Ontario,
(q) a member of the College of Psychologists of Ontario,
(r) a member of the College of Respiratory Therapists of Ontario,
(s) a naturopath registered as a drugless therapist under the Drugless Practitioners Act, or
(t) a member of a category of persons prescribed by the regulations as health practitioners.
Note: At this time, there are no regulations that prescribe additional categories of health
practitioners. Social workers are not considered health practitioners under the HCCA.
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personal assistance service means assistance with or supervision of hygiene, washing,
dressing, grooming, eating, drinking, elimination, ambulation, positioning or any other routine
activity of living, and includes a group of personal assistance services or a plan setting out
personal assistance services to be provided to a person, but does not include anything
prescribed by the regulations as not constituting a personal assistance service.
plan of treatment means a plan that,
(a) is developed by one or more health practitioners,
(b) deals with one or more of the health problems that a person has and may, in addition, deal
with one or more of the health problems that the person is likely to have in the future given the
person's current health condition, and
(c) provides for the administration to the person of various treatments or courses of treatment
and may, in addition, provide for the withholding or withdrawal of treatment in light of the
person's current health condition.
treatment means anything that is done for a therapeutic, preventive, palliative, diagnostic,
cosmetic or other health-related purpose, and includes a course of treatment, plan of treatment
or community treatment plan, but does not include,
(a) the assessment for the purpose of this Act of a person's capacity with respect to a treatment,
admission to a care facility or a personal assistance service, the assessment for the purpose of
the Substitute Decisions Act, 1992 of a person's capacity to manage property or a person's
capacity for personal care, or the assessment of a person's capacity for any other purpose,
(b) the assessment or examination of a person to determine the general nature of the person's
condition,
(c) the taking of a person's health history,
(d) the communication of an assessment or diagnosis,
(e) the admission of a person to a hospital or other facility,
(f) a personal assistance service,
(g) a treatment that in the circumstances poses little or no risk of harm to the person,
(h) anything prescribed by the regulations as not constituting treatment.
Section 9 provides that, in Part II of the HCCA dealing with treatment, a substitute decisionmaker (SDM) means a person who is authorized under section 20 to give or refuse consent to a
treatment on behalf of a person who is incapable with respect to the treatment.
4.2.1 Capacity and Presumption of Capacity
The HCCA states:
Capacity
s. 4(1) A person is capable with respect to a treatment, admission to a care facility or a
personal assistance service if the person is able to understand the information that is relevant
to making a decision about the treatment, admission or personal assistance service, as the case
may be, and able to appreciate the reasonably foreseeable consequences of a decision or lack
of decision.
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Presumption of capacity
s. 4(2) A person is presumed to be capable with respect to treatment, admission to a care
facility and personal assistance services.
Exception
s. 4(3) A person is entitled to rely on the presumption of capacity with respect to another
person unless he or she has reasonable grounds to believe that the other person is incapable
with respect to the treatment, the admission or the personal assistance service, as the case may
be.
Note: The Community Care Access Centre (CCAC) may rely on the presumption that a person
has capacity unless reasonable grounds exist to believe otherwise.
Capacity with respect to personal care refers to a person’s ability to understand information
relevant to making decisions about aspects of the person’s personal care, such as health care,
nutrition, shelter, clothing, hygiene or safety, and ability to appreciate the reasonably
foreseeable consequences of a decision or lack of decision. (If the health care decisions are
about treatment, admission to a long-term care (LTC) home or personal assistance services for
a resident in a LTC home, the HCCA governs the substitute decision-making.) A person may
be capable of making decisions about one or more aspects of personal care, but not others. For
example, a person may be capable of making decisions about clothing but not health care; a
person may be capable of making decisions about health care, but may no longer be capable1 of
making decisions about property (e.g., banking, paying bills, managing investments) and vice
versa. It should also be noted that a person who is physically unable to care for himself or
herself may be capable of making decisions about personal care.
4.2.2 Wishes of Capable Person
The HCCA states:
Wishes
s. 5(1) A person may, while capable, express wishes with respect to treatment, admission to a
care facility or a personal assistance service.
Manner of expression
s. 5(2) Wishes may be expressed in a power of attorney, in a form prescribed by the
regulations, in any other written form, orally or in any other manner.
Later wishes prevail
s. 5(3) Later wishes expressed while capable prevail over earlier wishes.
1
Under the SDA, a person is incapable of managing property if the person is not able to understand information that is
relevant to making a decision in the management of his or her property or is not able to appreciate the reasonably
foreseeable consequences of a decision or lack of decision.
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4.2.3 Restraint, Confinement
The HCCA does not affect the duty to restrain or confine a person in certain circumstances:
s. 7 This Act does not affect the common law duty of a caregiver to restrain or confine a person
when immediate action is necessary to prevent serious bodily harm to the person or to others.
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4.3 Consent to Treatment
The Community Care Access Centre (CCAC) must not administer treatment to a person
without the express or implied consent (see subsection #4.3.4 in this manual) of the person who
is the subject of the treatment. If the person is incapable of making the decision, the consent of
the legally authorized substitute decision-maker (SDM) is required.
Legislative references in subsection 4.3 in this manual are all from the Health Care Consent
Act, 1996 (HCCA).
4.3.1 No Treatment Without Consent
s. 10(1) A health practitioner who proposes a treatment for a person shall not administer the
treatment, and shall take reasonable steps to ensure that it is not administered, unless,
(a) he or she is of the opinion that the person is capable with respect to the treatment, and the
person has given consent; or
(b) he or she is of the opinion that the person is incapable with respect to the treatment, and the
person's substitute decision-maker has given consent on the person's behalf in accordance with
this Act).
Opinion of Board or court governs
s. 10(2) If the health practitioner is of the opinion that the person is incapable with respect to
the treatment, but the person is found to be capable with respect to the treatment by the Board
on an application for review of the health practitioner’s finding, or by a court on an appeal of
the Board’s decision, the health practitioner shall not administer the treatment, and shall take
reasonable steps to ensure that it is not administered, unless the person has given consent.
4.3.2 Elements of Consent
s. 11(1) The following are the elements required for consent to treatment:
1. The consent must relate to the treatment.
2. The consent must be informed.
3. The consent must be given voluntarily.
4. The consent must not be obtained through misrepresentation or fraud.
4.3.3 Informed Consent
s. 11(2) A consent to treatment is informed if, before giving it,
(a) the person received the information about the matters set out in subsection (3) that a
reasonable person in the same circumstances would require in order to make a decision about
the treatment; and
(b) the person received responses to his or her requests for additional information about those
matters.
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s. 11(3) The matters referred to in subsection (2) are:
1. The nature of the treatment.
2. The expected benefits of the treatment.
3. The material risks of the treatment.
4. The material side effects of the treatment.
5. Alternative courses of action.
6. The likely consequences of not having the treatment.
Consent is only valid if the person has capacity to make the decision.
4.3.4 Express or Implied Consent
Section 11(4) of the HCCA states “consent to treatment may be express or implied.”
Express consent is consent that is written or spoken. Implied consent occurs when the person
whose consent is needed does something that in the circumstances a reasonable person would
understand to indicate that the person consents. For example, if a staff member says that they
are offering a person a spoonful of cough medicine, and the person opens his or her mouth and
swallows the medicine, the person has impliedly consented to take the medicine. In this
example, the staff member cannot rely on the implied consent unless the person is capable of
making the decision to consent to taking cough medicine.
4.3.5 Withdrawal of Consent
The client, or the SDM if the client is incapable, may withdraw the consent to treatment at any
time. The HCCA states:
s. 14 A consent that has been given by or on behalf of the person for whom the treatment was
proposed may be withdrawn at any time,
(a) by the person, if the person is capable with respect to the treatment at the time of the
withdrawal;
(b) by the person's substitute decision-maker, if the person is incapable with respect to the
treatment at the time of the withdrawal.
4.3.6 Responsibility for Consent to Treatment
The health practitioner proposing the particular treatment is responsible for determining
whether or not the person is capable with respect to the treatment. The HCCA states:
s. 10(1) A health practitioner who proposes a treatment for a person shall not administer the
treatment, and shall take reasonable steps to ensure that it is not administered, unless,
(a) he or she is of the opinion that the person is capable with respect to the treatment, and the
person has given consent; or
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(b) he or she is of the opinion that the person is incapable with respect to the treatment, and the
person's substitute decision-maker has given consent on the person's behalf in accordance with
this Act.
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4.4 Capacity to Consent to Treatment
Act, 1996 (HCCA).
4.4.1 Presumption that a Person is Capable
The HCCA states in section 4(2) “A person is presumed to be capable with respect to
treatment, admission to a care facility and personal assistance services.”
The Community Care Access Centre (CCAC) must presume that a person is capable of
making a decision with respect to treatment as defined in the HCCA (i.e., nursing,
occupational therapy, physiotherapy, speech-language pathology or dietetics services)
unless there are reasonable grounds to believe that the person is not capable. (See Consent
to Treatment, subsection #4.3 in this manual.)
4.4.2 Capacity to Consent to Treatment Under the HCCA
Capacity depends on treatment
s. 15(1) A person may be incapable with respect to some treatments and capable with respect
to others.
Capacity depends on time
s.15 (2) A person may be incapable with respect to a treatment at one time and capable at
another.
Return of capacity
s. 16 If, after consent to a treatment is given or refused on a person's behalf in accordance with
this Act, the person becomes capable with respect to the treatment in the opinion of the health
practitioner, the person's own decision to give or refuse consent to the treatment governs.
If, in the opinion of the health practitioner, capacity returns then the person’s own decision to
give or refuse consent governs.
For example, due to an injury or illness, a person may be incapable of making a decision about
a surgical intervention. After recovering from surgery, the person’s capacity may return. If
capacity returns, the capable person makes the decision to give or refuse consent to treatment.
4.4.3 Information to be Provided by Health Practitioner
Information
s.17 A health practitioner shall, in the circumstances and manner specified in guidelines
established by the governing body of the health practitioner's profession, provide to persons
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found by the health practitioner to be incapable with respect to treatment such information
about the consequences of the findings as is specified in the guidelines.
Health practitioners must follow their professional governing body’s guidelines with respect to
the information that must be provided to incapable persons about the consequences of the
finding of incapacity. The information referred to in section 17 includes advising persons that
they have the right to apply to the Consent and Capacity Board (the Board) (see definition of
Board in subsection #4.7 in this manual or Appendix #A in this manual) to review the finding
of incapacity.
4.4.4 Treatment Must Not Begin in Certain Circumstances
Section 18 of the HCCA deals with circumstances when treatment must not begin for a certain
period of time.
Treatment must not begin
s. 18(1) This section applies if,
(a) a health practitioner proposes a treatment for a person and finds that the person is
incapable with respect to the treatment;
(b) before the treatment is begun, the health practitioner is informed that the person intends to
apply, or has applied, to the Board for a review of the finding; and
(c) the application to the Board is not prohibited by subsection 32(2).
Same
s. 18(2) This section also applies if,
(a) a health practitioner proposes a treatment for a person and finds that the person is
incapable with respect to the treatment;
(b) before the treatment is begun, the health practitioner is informed that,
(i) the incapable person intends to apply, or has applied, to the Board for appointment of a
representative to give or refuse consent to the treatment on his or her behalf, or
(ii) another person intends to apply, or has applied, to the Board to be appointed as the
representative of the incapable person to give or refuse consent to the treatment on his or
her behalf; and
(c) the application to the Board is not prohibited by subsection 33(3).
(3) In the circumstances described in subsections (1) and (2), the health practitioner shall not
begin the treatment, and shall take reasonable steps to ensure that the treatment is not begun,
(a) until 48 hours have elapsed since the health practitioner was first informed of the intended
application to the Board without an application being made;
(b) until the application to the Board has been withdrawn;
(c) until the Board has rendered a decision in the matter, if none of the parties to the
application before the Board has informed the health practitioner that he or she intends to
appeal the Board’s decision; or
(d) if a party to the application before the Board has informed the health practitioner that he
or she intends to appeal the Board’s decision,
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(i) until the period for commencing the appeal has elapsed without an appeal being
commenced, or
(ii) until the appeal of the Board’s decision has been finally disposed of.
Emergency
s. 18 (4) This section does not apply if the health practitioner is of the opinion that there is an
emergency within the meaning of subsection 25 (1).
Note: There are situations where treatment can be provided in an emergency. (See subsection
#4.6 in this manual.)
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4.5 Consent to Treatment on Behalf of an Incapable Person
If a person is incapable of consenting to a treatment, the legally authorized substitute decisionmaker (SDM) may give or refuse consent to the treatment on the person’s behalf.
Act, 1996 (HCCA).
4.5.1 Substitute Decision-Maker
The SDM for treatment means a person who is authorized under section 20 of the HCCA to
give or refuse consent to a treatment on behalf of a person who is incapable with respect to the
treatment. (See section 9 of the HCCA.)
4.5.2 Information Required by the Substitute Decision-Maker
Information
s. 22(1) Before giving or refusing consent to a treatment on an incapable person's behalf, a
substitute decision-maker is entitled to receive all the information required for an informed
consent as described in subsection 11(2).
Conflict
s. 22(2) Subsection (1) prevails despite anything to the contrary in the Personal Health
Information Protection Act, 2004.
The SDM has the right to receive all the information needed for an informed consent before
making treatment decisions.
4.5.3 Identifying the Substitute Decision-Maker
List of persons who may give or refuse consent
s. 20(1) If a person is incapable with respect to a treatment, consent may be given or refused on
his or her behalf by a person described in one of the following paragraphs:
1. The incapable person's guardian of the person, if the guardian has authority to give or
refuse consent to the treatment.
2. The incapable person's attorney for personal care, if the power of attorney confers authority
to give or refuse consent to the treatment.
3. The incapable person's representative appointed by the Board under section 33, if the
representative has authority to give or refuse consent to the treatment.
4. The incapable person's spouse or partner.
5. A child or parent of the incapable person, or a children's aid society or other person who is
lawfully entitled to give or refuse consent to the treatment in the place of the parent. This
paragraph does not include a parent who has only a right of access. If a children's aid society
or other person is lawfully entitled to give or refuse consent to the treatment in the place of the
parent, this paragraph does not include the parent.
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6. A parent of the incapable person who has only a right of access.
7. A brother or sister of the incapable person.
8. Any other relative of the incapable person.
Note: This above list includes siblings, friends (under 1, 2 or 3), same sex partners or spouses.
The list of possible SDMs is ranked in descending order of priority, with 1 being the highest
priority. Those persons higher on the list take precedence over those below as long as they meet
the requirements of a SDM.
A power of attorney for personal care may authorize the attorney to make decisions regarding
the incapable person’s health care (including treatment, admission to a long-term care (LTC)
home, a personal assistance service in a LTC home under the HCCA), nutrition, shelter,
clothing, hygiene or safety. The power of attorney may not authorize the SDM to make
decisions about all these things: for example, a person may choose to limit the power of
attorney to one or more of these areas of personal care, including health care. Similarly, a court
appointing a guardian of the person may limit the types of decisions that the guardian has the
authority to make. For more information on the authority of an attorney or guardian for
personal care, see the Substitute Decisions Act, 1992 (SDA).
With respect to the list in subsection 20(1), the HCCA also provides the following:
Meaning of “spouse”
s. 20(7) Subject to subsection (8), two persons are spouses for the purpose of this section if,
(a) they are married to each other; or
(b) they are living in a conjugal relationship outside marriage and,
(i) have cohabited for at least one year,
(ii) are together the parents of a child, or
(iii) have together entered into a cohabitation agreement under section 53 of the Family
Law Act.
Not spouse
s. 20(8) Two persons are not spouses for the purpose of this section if they are living separate
and apart as a result of a breakdown of their relationship.
Meaning of "partner"
s. 20(9) For the purpose of this section,
"partner" means,
(a) Repealed.
(b) either of two persons who have lived together for at least one year and have a close
personal relationship that is of primary importance in both persons' lives.
Meaning of “relative”
s. 20(10) Two persons are relatives for the purpose of this section if they are related by blood,
marriage or adoption.
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4.5.4 Requirements of a Substitute Decision-Maker
A SDM (as defined the subsection 20(1) of the HCCA and subsection #4.5.3 in this manual)
may give or refuse consent only if he or she,
Requirements
s. 20(2)(a) is capable with respect to the treatment;
(b) is at least 16 years old, unless he or she is the incapable person's parent;
(c) is not prohibited by court order or separation agreement from having access to the
incapable person or giving or refusing consent on his or her behalf;
(d) is available; and
(e) is willing to assume the responsibility of giving or refusing consent.
Meaning of "available"
s. 20(11) For the purpose of clause (2)(d), a person is available if it is possible, within a time
that is reasonable in the circumstances, to communicate with the person and obtain a consent
or refusal.
4.5.5 Role of the Public Guardian and Trustee
No person in subs. (1) to make decision
s. 20(5) If no person described in subsection (1) meets the requirements of subsection (2), the
Public Guardian and Trustee shall make the decision to give or refuse consent.
Conflict between persons in same paragraph
s. 20(6) If two or more persons who are described in the same paragraph of subsection (1) and
who meet the requirements of subsection (2) disagree about whether to give or refuse consent,
and if their claims rank ahead of all others, the Public Guardian and Trustee shall make the
decision in their stead.
The Public Guardian and Trustee shall make the decision to give or refuse consent to treatment
if:
•
•
there is no person on the list of SDMs set out in subsection 20(1) who meets the
requirements of a SDM in subsection 20(2); or
there is a disagreement about whether to give consent between or among two or more
equally ranking potential substitute decision-makers if their claims rank ahead of all others
in the list; for example, two children of the incapable person disagree about the decision
and there is no person listed in number 1 through 4 of the list, children being ranked
number 5. (See HCCA, subsections 20(5) and (6) and the list of substitute decision-makers
in subsection 20(1) or #4.5.3 in this manual.)
4.5.6 Principles for Giving or Refusing Consent – Prior Capable Wishes
The HCCA requires the SDM to make decisions about treatment in accordance with any known
wishes applicable to the circumstances that were expressed by the incapable person while
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capable and after reaching the age of 16 years. If there are no such wishes, the decisions are
required to be made in the best interests of the incapable person. Best interests is a defined term
(see subsection #4.5.7 in this manual). In certain circumstances, the SDM or the health
practitioner proposing the treatment may apply to the Consent and Capacity Board (the Board)
(see definition of Board in subsection #4.7 in this manual or Appendix #A in this manual) for
directions about the expressed wishes.
Principles for giving or refusing consent
s. 21(1) A person who gives or refuses consent to a treatment on an incapable person’s behalf
shall do so in accordance with the following principles:
1. If the person knows of a wish applicable to the circumstances that the incapable person
expressed while capable and after attaining 16 years of age, the person shall give or refuse
consent in accordance with the wish.
2. If the person does not know of a wish applicable to the circumstances that the incapable
person expressed while capable and after attaining 16 years of age, or if it is impossible to
comply with the wish, the person shall act in the incapable person’s best interests.
4.5.7 Principles for Giving or Refusing Consent – Best Interests
Best interests
s. 21(2) In deciding what the incapable person's best interests are, the person who gives or
refuses consent on his or her behalf shall take into consideration,
(a) the values and beliefs that the person knows the incapable person held when capable and
believes he or she would still act on if capable;
(b) any wishes expressed by the incapable person with respect to the treatment that are not
required to be followed under paragraph 1 of subsection (1); and
(c) the following factors:
1. Whether the treatment is likely to,
i. improve the incapable person's condition or well-being,
ii. prevent the incapable person's condition or well-being from deteriorating, or
iii. reduce the extent to which, or the rate at which, the incapable person's condition or
well-being is likely to deteriorate.
2. Whether the incapable person's condition or well-being is likely to improve, remain the
same or deteriorate without the treatment.
3. Whether the benefit the incapable person is expected to obtain from the treatment
outweighs the risk of harm to him or her.
4. Whether a less restrictive or less intrusive treatment would be as beneficial as the
treatment that is proposed.
4.5.8 Consent to Ancillary Treatment
s. 23 Authority to consent to a treatment on an incapable person's behalf includes authority to
consent to another treatment that is necessary and ancillary to the treatment, even if the
incapable person is capable with respect to the necessary and ancillary treatment.
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For example, where a SDM has given consent to surgery, the SDM can give consent to pre or
post-operative treatment that is necessary or ancillary to the surgery even where the incapable
person is capable of making decisions about the pre or post-operative treatment.
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4.6 Emergency Treatment Without Consent
In emergency circumstances, a person may be incapable of consenting to treatment because the
person is unconscious or severely traumatized, or unable to communicate with health
practitioners due to a language difficulty, or for some other reason.
Section 25 of the Health Care Consent Act, 1996 (HCCA) allows treatment of a person without
consent in emergency situations, when the delay required to obtain consent or refusal from
either the person or the person’s substitute decision-maker (SDM) will prolong the person’s
suffering or put the person at risk of serious bodily harm.
Legislative references in subsection 4.6 in this manual are all from the HCCA.
4.6.1 Definition of Emergency Under the HCCA
Meaning of "emergency"
s. 25(1) For the purpose of this section and section 27, there is an emergency if the person for
whom the treatment is proposed is apparently experiencing severe suffering or is at risk, if the
treatment is not administered promptly, of sustaining serious bodily harm.
4.6.2 Examination Without Consent
In some situations, it may be necessary for a health practitioner to examine a person without
consent in order to determine whether or not an emergency exists. The HCCA states:
s. 25(4) Despite section 10, an examination or diagnostic procedure that constitutes treatment
may be conducted by a health practitioner without consent if,
(a) the examination or diagnostic procedure is reasonably necessary in order to determine
whether there is an emergency; and
(b) in the opinion of the health practitioner,
(i) the person is incapable with respect to the examination or diagnostic procedure, or
(ii) clauses (3) (b) and (c) apply to the examination or diagnostic procedure.
Clauses 25(3)(b) and (c) of the HCCA state:
s. 25(3)(b) the communication required in order for the person to give or refuse consent to the
treatment cannot take place because of a language barrier or because the person has a
disability that prevents the communication from taking place;
(c) steps that are reasonable in the circumstances have been taken to find a practical means of
enabling the communication to take place, but no such means has been found.
4.6.3 Emergency Treatment Without Consent: Incapable Person
The following provisions apply when the person for whom the emergency treatment is
proposed is incapable of making a decision to consent or refuse consent to treatment. The
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HCCA states:
Emergency treatment without consent: incapable person
s. 25(2) Despite section 10, a treatment may be administered without consent to a person who
is incapable with respect to the treatment, if, in the opinion of the health practitioner proposing
the treatment,
(a) there is an emergency; and
(b) the delay required to obtain a consent or refusal on the person's behalf will prolong the
suffering that the person is apparently experiencing or will put the person at risk of sustaining
serious bodily harm.
Continuing treatment
s. 25(6) Treatment under subsection (2) may be continued only for as long as is reasonably
necessary to find the incapable person's substitute decision-maker and to obtain from him or
her a consent, or refusal of consent, to the continuation of the treatment.
Search
s. 25(8) When a treatment is begun under subsection (2) or (3), the health practitioner shall
ensure that reasonable efforts are made for the purpose of finding the substitute decisionmaker, or a means of enabling the communication to take place, as the case may be.
Return of capacity
s. 25(9) If, after a treatment is begun under subsection (2), the person becomes capable with
respect to the treatment in the opinion of the health practitioner, the person's own decision to
give or refuse consent to the continuation of the treatment governs.
4.6.4 Emergency Treatment Without Consent: Capable Person
The following provisions apply when the person for whom the emergency treatment is
proposed is apparently capable of consenting or refusing to consent to treatment.
A health practitioner may provide treatment to a capable person in an emergency under certain
circumstances set out in the HCCA. Therefore, where those circumstances exist, the CCAC
health practitioner may authorize the provision of service which is treatment to a capable
person without the person’s consent. The HCCA states:
Emergency treatment without consent: capable person
s. 25(3) Despite section 10, a treatment may be administered without consent to a person who
is apparently capable with respect to the treatment, if, in the opinion of the health practitioner
proposing the treatment,
(a) there is an emergency;
(b) the communication required in order for the person to give or refuse consent to the
treatment cannot take place because of a language barrier or because the person has a
disability that prevents the communication from taking place;
(c) steps that are reasonable in the circumstances have been taken to find a practical means of
enabling the communication to take place, but no such means has been found;
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(d) the delay required to find a practical means of enabling the communication to take place
will prolong the suffering that the person is apparently experiencing or will put the person at
risk of sustaining serious bodily harm; and
(e) there is no reason to believe that the person does not want the treatment.
s.25(7) Treatment under subsection (3) may be continued only for as long as is reasonably
necessary to find a practical means of enabling the communication to take place so that the
person can give or refuse consent to the continuation of the treatment.
Search
s.25(8) When a treatment is begun under subsection (2) or (3), the health practitioner shall
ensure that reasonable efforts are made for the purpose of finding the substitute decisionmaker, or a means of enabling the communication to take place, as the case may be.
4.6.5 No Treatment Contrary to Expressed Capable Wishes
No treatment contrary to wishes
s. 26 A health practitioner shall not administer a treatment under section 25 if the health
practitioner has reasonable grounds to believe that the person, while capable and after
attaining 16 years of age, expressed a wish applicable to the circumstances to refuse consent to
the treatment.
Despite section 25 of the HCCA, emergency treatment without consent is prohibited when the
health care practitioner has reasonable grounds to believe that the person expressed a prior
capable wish to not have the treatment. An example of this would be the inability of a physician
to provide a person of the Jehovah’s Witness faith with a blood transfusion if there are
reasonable grounds to believe that the person while capable and after attaining the age of 16
years expressed a wish not to have such treatment. A person may carry a card that identifies
himself or herself as a Jehovah’s Witness and indicates that he or she is not to be given a blood
transfusion even for life saving purposes.
4.6.6 Emergency Treatment Despite Refusal by the SDM
If a SDM has refused to consent to emergency treatment on behalf of an incapable person, but
the health care practitioner has reason to believe that the SDM has not made the decision in
accordance with the required principles for making a decision, the health care practitioner may
proceed to administer the emergency treatment. The HCCA states:
Emergency treatment despite refusal
s. 27 If consent to a treatment is refused on an incapable person's behalf by his or her
substitute decision-maker, the treatment may be administered despite the refusal if, in the
opinion of the health practitioner proposing the treatment,
(a) there is an emergency; and
(b) the substitute decision-maker did not comply with section 21.
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See section 21 of the HCCA or principles for giving or refusing consent in subsection #4.5.6 in
this manual. The required principles are that the SDM’s decision must be made in accordance
with the incapable person’s wishes applicable to the circumstances that were expressed while
capable and after reaching the age of 16 years. If there are no such wishes, the decision must be
made in accordance with the SDM’s determination of the incapable person’s best interests as
defined in the HCCA.
4.6.7 Keeping Records
Immediately after administering an emergency treatment without consent for a capable person
or an incapable person, the health care practitioner must record the reasons for the emergency
intervention. The HCCA states:
Record
s. 25(5) After administering a treatment in reliance on subsection (2) or (3), the health
practitioner shall promptly note in the person's record the opinions held by the health
practitioner that are required by the subsection on which he or she relied.
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4.7 Applications to the Consent and Capacity Board Regarding
Treatment
The Consent and Capacity Board (the Board) is an independent adjudicative body created to
conduct hearings under the Mental Health Act (MHA) and the Health Care Consent Act, 1996
(HCCA). The Board also conducts hearings about consent and capacity issues under the
Personal Health Information Protection Act, 2004 (PHIPA). A person who is found by a health
practitioner to be incapable with respect to treatment, has the right to have that finding
reviewed by the Board.
Under the HCCA, there are several applications that can be made to the Board and these
include:
Application
Reference in
this Manual
Application for review of finding of incapacity
#4.7.1
Application for appointment of a representative who will act as the
substitute decision-maker (SDM) on behalf of an incapable person
#4.7.2
Application by a proposed representative to act as the SDM on behalf
of an incapable person
#4.7.3
Application by a SDM or health practitioner for directions regarding
wishes expressed about treatment
#4.7.5
Application by a SDM or health practitioner to obtain permission for
the SDM to depart from wishes expressed by the incapable person
#4.7.6
Application by a health practitioner seeking determination as to
whether a SDM complied with principles for giving or refusing consent
#4.7.7
4.7.1. Application for a Review of Finding of Incapacity
s. 32(1) A person who is the subject of a treatment may apply to the Board for a review of a
health practitioner's finding that he or she is incapable with respect to the treatment.
Exception
s. 32(2) Subsection (1) does not apply to,
(a) a person who has a guardian of the person, if the guardian has authority to give or refuse
consent to the treatment;
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(b) a person who has an attorney for personal care, if the power of attorney contains a
provision waiving the person's right to apply for the review and the provision is effective under
subsection 50 (1) of the Substitute Decisions Act, 1992.
Parties
s. 32(3) The parties to the application are:
1. The person applying for the review.
2. The health practitioner.
3. Any other person whom the Board specifies.
Decision of the Board Regarding Finding of Incapacity
Powers of Board
s. 32(4) The Board may confirm the health practitioner’s finding or may determine that the
person is capable with respect to the treatment, and in doing so may substitute its opinion for
that of the health practitioner.
Restriction on repeated applications
s . 32(5) If a health practitioner’s finding that a person is incapable with respect to a treatment
is confirmed on the final disposition of an application under this section, the person shall not
make a new application for a review of a finding of incapacity with respect to the same or
similar treatment within six months after the final disposition of the earlier application, unless
the Board gives leave in advance.
Same
s. 32(6) The Board may give leave for the new application to be made if it is satisfied that there
has been a material change in circumstances that justifies reconsideration of the person’s
capacity.
Decision effective while application for leave pending
s. 32(7) The Board’s decision under subsection (5) remains in effect pending an application for
leave under subsection (6).
If the Board agrees with the health practitioner’s finding of incapacity, the person cannot apply
for another review regarding the same or similar treatment until six months after the Board’s
decision, unless the Board gives permission to do so. Subsection 32(6) of the HCCA sets out
when the Board would give permission for a further review before six months has elapsed.
4.7.2 Application for Appointment of Representative – by Incapable Person
An incapable person may ask the Board to appoint someone to give or refuse consent to a
proposed treatment on his or her behalf. Such an application may be made in circumstances
where there is no court appointed guardian with the authority to make the decision and the
incapable person did not make a power of attorney document while capable of doing so and
does not want a family member listed in subsection 20(1) in the HCCA to be the SDM. A
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representative appointed by the Board ranks above listed family members. (See list of SDMs in
subsection #4.5.3 in this manual.)
s. 33(1) A person who is 16 years old or older and who is incapable with respect to a proposed
treatment may apply to the Board for appointment of a representative to give or refuse consent
on his or her behalf.
s. 33(3) Subsections (1) and (2) do not apply if the incapable person has a guardian of the
person who has authority to give or refuse consent to the proposed treatment, or an attorney
for personal care under a power of attorney conferring that authority.
4.7.3 Application for Appointment of Representative – by Proposed
Representative
The proposed representative may make the application to the Board to be appointed as the
representative:
s. 33(2) A person who is 16 years old or older may apply to the Board to have himself or
herself appointed as the representative of a person who is incapable with respect to a proposed
treatment, to give or refuse consent on behalf of the incapable person.
person who has authority to give or refuse consent to the proposed treatment, or an attorney
for personal care under a power of attorney conferring that authority.
4.7.4 Appointment of Representative – Applicable Provisions
The following apply to applications to appoint a representative, as described in subsections
#4.7.2 and #4.7.3 in this manual.
Parties
1. The incapable person.
2. The proposed representative named in the application.
3. Every person who is described in paragraph 4, 5, 6 or 7 of subsection 20 (1).
4. The health practitioner who proposed the treatment.
Appointment
s. 33(5) In an appointment under this section, the Board may authorize the representative to
give or refuse consent on the incapable person's behalf,
(a) to the proposed treatment;
(b) to one or more treatments or kinds of treatment specified by the Board, whenever a health
practitioner proposing that treatment or a treatment of that kind finds that the person is
incapable with respect to it; or
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(c) to treatment of any kind, whenever a health practitioner proposing a treatment finds that the
person is incapable with respect to it.
Criteria for appointment
s. 33(6) The Board may make an appointment under this section if it is satisfied that the
following requirements are met:
1. The incapable person does not object to the appointment.
2. The representative consents to the appointment, is at least 16 years old and is capable with
respect to the treatments or the kinds of treatment for which the appointment is made.
3. The appointment is in the incapable person's best interests.
Powers of Board
s. 33(7) Unless the incapable person objects, the Board may,
(a) appoint as representative a different person than the one named in the application;
(b) limit the duration of the appointment;
(c) impose any other condition on the appointment;
(d) on any person's application, remove, vary or suspend a condition imposed on the
appointment or impose an additional condition on the appointment.
Termination
s. 33(8) The Board may, on any person's application, terminate an appointment made under
this section if,
(a) the incapable person or the representative requests the termination of the appointment;
(b) the representative is no longer capable with respect to the treatments or the kinds of
treatment for which the appointment was made;
(c) the appointment is no longer in the incapable person's best interests; or
(d) the incapable person has a guardian of the person who has authority to consent to the
treatments or the kinds of treatment for which the appointment was made, or an attorney for
personal care under a power of attorney conferring that authority.
4.7.5 Application for Directions About Wishes
Application for directions
s. 35(1) A substitute decision-maker or a health practitioner who proposed a treatment may
apply to the Board for directions if the incapable person expressed a wish with respect to the
treatment, but,
(a) the wish is not clear;
(b) it is not clear whether the wish is applicable to the circumstances;
(c) it is not clear whether the wish was expressed while the incapable person was capable; or
(d) it is not clear whether the wish was expressed after the incapable person attained 16 years
of age.
Notice to substitute decision-maker
s. 35(1.1) A health practitioner who intends to apply for directions shall inform the substitute
decision-maker of his or her intention before doing so.
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Parties
1. The substitute decision-maker.
Decision of the Board Regarding Directions
Directions
s. 35(3) The Board may give directions and, in doing so, shall apply section 21.
Section 21 sets out the required principles for giving or refusing consent (discussed under
subsection #4.5.6 in this manual).
4.7.6 Application to Depart from Wishes
Application to depart from wishes
s. 36(1) If a substitute decision-maker is required by paragraph 1 of subsection 21 (1) to refuse
consent to a treatment because of a wish expressed by the incapable person while capable and
after attaining 16 years of age,
(a) the substitute decision-maker may apply to the Board for permission to consent to the
treatment despite the wish; or
(b) the health practitioner who proposed the treatment may apply to the Board to obtain
permission for the substitute decision-maker to consent to the treatment despite the wish.
s. 36(1.1) A health practitioner who intends to apply under clause (1) (b) shall inform the
substitute decision-maker of his or her intention before doing so.
Parties
Decision of the Board Regarding Departing from Wishes
Criteria for permission
s. 36(3) The Board may give the substitute decision-maker permission to consent to the
treatment despite the wish if it is satisfied that the incapable person, if capable, would probably
give consent because the likely result of the treatment is significantly better than would have
been anticipated in comparable circumstances at the time the wish was expressed.
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4.7.7 Application to Determine Compliance with Section 21
Application to determine compliance with s. 21
s. 37(1) If consent to a treatment is given or refused on an incapable person's behalf by his or
her substitute decision-maker, and if the health practitioner who proposed the treatment is of
the opinion that the substitute decision-maker did not comply with section 21, the health
practitioner may apply to the Board for a determination as to whether the substitute decisionmaker complied with section 21.
The health practitioner proposing the treatment for the person may apply to the Board for a
determination as to whether the SDM followed the required principles set out in section 21 in
making a treatment decision on behalf of an incapable person. A health practitioner could do
this if the practitioner believed that the principles for giving and refusing consent, including the
person’s previously expressed capable wishes or, if applicable, the person’s best interests, were
not properly considered by the SDM.
Parties
Decision of the Board Regarding Compliance with Section 21
Power of Board
s. 37(3) In determining whether the substitute decision-maker complied with section 21, the
Board may substitute its opinion for that of the substitute decision-maker.
Directions
s. 37(4) If the Board determines that the substitute decision-maker did not comply with section
21, it may give him or her directions and, in doing so, shall apply section 21.
Time for compliance
s. 37(5) The Board shall specify the time within which its directions must be complied with.
Deemed not authorized
s. 37(6) If the substitute decision-maker does not comply with the Board’s directions within the
time specified by the Board, he or she shall be deemed not to meet the requirements of
subsection 20 (2).
Subsequent substitute decision-maker
s. 37(6.1) If, under subsection (6), the substitute decision-maker is deemed not to meet the
requirements of subsection 20 (2), any subsequent substitute decision-maker shall, subject to
subsections (6.2) and (6.3), comply with the directions given by the Board on the application
within the time specified by the Board.
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s. 37(6.2) If a subsequent substitute decision-maker knows of a wish expressed by the incapable
person with respect to the treatment, the substitute decision-maker may, with leave of the
Board, apply to the Board for directions under section 35.
Inconsistent directions
s. 37(6.3) Directions given by the Board under section 35 on a subsequent substitute decisionmaker’s application brought with leave under subsection (6.2) prevail over inconsistent
directions given under subsection (4) to the extent of the inconsistency.
P.G.T.
s. 37(7) If the substitute decision-maker who is given directions is the Public Guardian and
Trustee, he or she is required to comply with the directions, and subsection (6) does not apply
to him or her.
4.7.8 Deemed Application Concerning Capacity
Deemed application concerning capacity
s. 37.1 An application to the Board under section 33, 34, 35, 36 or 37 shall be deemed to
include an application to the Board under section 32 with respect to the person’s capacity to
consent to treatment proposed by a health practitioner unless the person’s capacity to consent
to such treatment has been determined by the Board within the previous six months.
It should be noted from section 37.1 that whenever one of the listed applications to the Board is
made, there is an automatic deemed application to the Board to review the finding of incapacity
of the person to consent to the proposed treatment, unless the Board has determined the issue of
capacity within the previous six months.
4.7.9 Protection from Liability
The HCCA contains the following protections from liability for health practitioners and SDMs:
Apparently valid consent to treatment
s. 29(1) If a treatment is administered to a person with a consent that a health practitioner
believes, on reasonable grounds and in good faith, to be sufficient for the purpose of this Act,
the health practitioner is not liable for administering the treatment without consent.
Apparently valid refusal of treatment
s. 29(2) If a treatment is not administered to a person because of a refusal that a health
practitioner believes, on reasonable grounds and in good faith, to be sufficient for the purpose
of this Act, the health practitioner is not liable for failing to administer the treatment.
Apparently valid consent to withholding or withdrawal
s. 29(3) If a treatment is withheld or withdrawn in accordance with a plan of treatment and
with a consent to the plan of treatment that a health practitioner believes, on reasonable
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grounds and in good faith, to be sufficient for the purpose of this Act, the health practitioner is
not liable for withholding or withdrawing the treatment.
Emergency: treatment administered
s. 29(4) A health practitioner who, in good faith, administers a treatment to a person under
section 25 or 27 is not liable for administering the treatment without consent
Emergency: treatment not administered
s. 29(5) A health practitioner who, in good faith, refrains from administering a treatment in
accordance with section 26 is not liable for failing to administer the treatment.
Reliance on assertion
s. 29(6) If a person who gives or refuses consent to a treatment on an incapable person’s behalf
asserts that he or she,
(a) is a person described in subsection 20 (1) or clause 24 (2) (a) or (b) or an attorney for
personal care described in clause 32 (2) (b);
(b) meets the requirement of clause 20 (2) (b) or (c); or
(c) holds the opinions required under subsection 20 (4),
a health practitioner is entitled to rely on the accuracy of the assertion, unless it is not
reasonable to do so in the circumstances.
Person making decision on another’s behalf
s. 30 A person who gives or refuses consent to a treatment on another person’s behalf, acting
in good faith and in accordance with this Act, is not liable for giving or refusing consent.
Admission to hospital, etc.
s. 30(1) Sections 29 and 30, except subsection 29 (4), apply, with necessary modifications, to
admission of the incapable person to a hospital, psychiatric facility or other health facility
referred to in section 24, for the purpose of treatment.
Same
s. 30(2) A health practitioner who, in good faith, has a person admitted to a hospital or
psychiatric facility under section 28 is not liable for having the person admitted without
consent.
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4.8 Consent to Admission to a Long-Term Care Home
4.8.1 Consent Required
In order for a person to be admitted to a long-term care (LTC) home, the consent of the person
being admitted is required. This requirement for consent is set out in subsection 9.6(13)(c) of
the Charitable Institutions Act (CIA), subsection 20.1(13)(c) of the Nursing Homes Act (NHA),
and subsection 18(13)(c) of the Homes for the Aged and Rest Homes Act (HARHA).
Where a person is not capable of making the decision about admission to a LTC home, the
Health Care Consent Act, 1996 (HCCA) in Part III provides a scheme for obtaining a substitute
decision. The HCCA uses the term “the person responsible for authorizing admissions to the
care facility.” This means the Community Care Access Centre (CCAC), as the CCAC is the
designated placement co-ordinator responsible for authorizing admissions to LTC homes under
the NHA, CIA and HARHA.
Legislative references in subsection 4.8 in this manual are all from the (HCCA).
4.8.2 Presumption that a Person is Capable
Presumption of capacity
s . 4(2) A person is presumed to be capable with respect to treatment, admission to a care
facility and personal assistance services.
Exception
s . 4(3) A person is entitled to rely on the presumption of capacity with respect to another
person unless he or she has reasonable grounds to believe that the other person is incapable
with respect to the treatment, the admission or the personal assistance service, as the case may
be.
The CCAC must presume that a person is capable of making a decision with respect to
admission to a LTC home unless there are reasonable grounds to believe that the person is not
capable.
4.8.3 Capacity to Consent to Admission to a LTC Home
s. 4(1) A person is capable with respect to a treatment, admission to a care facility or a
personal assistance service if the person is able to understand the information that is relevant
to making a decision about the treatment, admission or personal assistance service, as the case
may be, and able to appreciate the reasonably foreseeable consequences of a decision or lack
of decision.
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A person may be capable of making a decision regarding admission to a LTC home despite
being incapable of making decisions about other areas. For example, a person may be incapable
of managing property, but he or she may be capable of making a decision regarding his or her
admission to a LTC home.
4.8.4 Determination of Capacity
If there are reasonable grounds to believe that an applicant may be incapable of making a
decision regarding his or her admission to a LTC home, a determination of capacity must be
made by an evaluator who completes an evaluator questionnaire regarding capacity to make
admission decisions.
Reasonable grounds or “triggers” for undertaking an evaluation of capacity may come from
observation of the person in the past, written documentation, observations of the person while
the functional assessment is being conducted, and information provided by the person, family,
other caregivers or health practitioners (such as the family physician), including medical or
psychiatric information.
Reasonable grounds may include but are not limited to:
•
•
•
•
•
unusual behaviour;
disorientation to time, person or place;
lack of reasonable judgement and memory;
repetitive speech; and
aggression.
4.8.5 Capacity Determined by Evaluator
The HCCA states:
Consent on incapable person’s behalf
s. 40(1) If a person’s consent to his or her admission to a care facility is required by law and
the person is found by an evaluator to be incapable with respect to the admission, consent may
be given or refused on the person’s behalf by his or her substitute decision-maker in
accordance with this Act.
As noted in subsection #4.8.1 in this manual, the three statutes governing LTC homes set out
the legal requirement for consent for admission.
4.8.6 Evaluator
The evaluator, a defined term under the HCCA, is the professional who determines a person’s
capacity to make a decision to give or refuse consent to the admission to a LTC home.
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s. 2(2) “evaluator" means, in the circumstances prescribed by the regulations, a person
described in clause (a), (l), (m), (o), (p) or (q) of the definition of "health practitioner" in this
subsection or a member of a category of persons prescribed by the regulations as evaluators*.
“health practitioner” means,
(a) a member of the College of Audiologists and Speech-Language Pathologists of Ontario,
(l) a member of the College of Nurses of Ontario,
(m) a member of the College of Occupational Therapists of Ontario,
(o) a member of the College of Physicians and Surgeons of Ontario,
(p) a member of the College of Physiotherapists of Ontario,
(q) a member of the College of Psychologists of Ontario
*Subsections 1(1) and (2) of regulation 104/96 under the HCCA state:
s. 1(1) For the purpose of the definition of "evaluator" in subsection 2 (1) of the Act,
(a) social workers are evaluators;
(b) social workers and persons described in clause (a), (l), (m), (o), (p) or (q) of the definition
of " health practitioner" in subsection 2 (1) of the Act may act as evaluators for the purpose of
determining whether a person is capable with respect to his or her admission to a care facility
and for the purpose of determining whether a person is capable with respect to a personal
assistance service.
(2) In this section,
"social worker" means a member of the Ontario College of Social Workers and Social Service
Workers who holds a certificate of registration for social work.
4.8.7 Duties of the Evaluator
When an evaluator has determined that a person is incapable of making the admission decision,
the CCAC must ensure that the person has been informed of the following:
•
•
•
the finding of incapacity and help the person understand the relevant information, to the
extent permitted by the person’s incapacity;
that the authorized substitute decision-maker (SDM) will be asked to make the admission
decision on the person’s behalf; and
his or her right to apply to the Consent and Capacity Board (the Board) for a review of the
finding of incapacity and or for the appointment of a representative of the person’s choice
to act as the SDM (if there is not a guardian of the person or attorney for personal care with
the authority to make the decision on the person’s behalf).
The evaluator will usually be the appropriate person to communicate this information to the
person. If the evaluator is not employed or contracted by the CCAC, the CCAC must ensure
that the information is communicated to the person. The CCAC will confirm that the
information has been provided by the evaluator and where the evaluator has not done so, the
CCAC will provide the information to the person. The CCAC will document these matters in
accordance with the documentation standards of the evaluator’s professional governing body
and the CCAC policy.
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Provision of Information
The person found to be incapable, “the client” and/or the client’s family may contact the CCAC
after being informed of the incapable person’s right to have an evaluator’s determination of
incapacity reviewed by the Board. The CCAC will provide or clarify information about these
matters and refer the applicant to appropriate resources for information about the Board process
and assistance.
If the client wishes to have the determination of incapacity reviewed by the Board (subsection
#4.10 in this manual describes the process) or wishes to apply to the Board for the appointment
of a representative who will make the admission decision, the CCAC will refer the person to
the following resources as appropriate:
•
•
•
the Board;
Legal Aid Ontario; and
other legal resources in the community.
Note: The person providing the information to the client is not providing legal advice but is
providing information so that the client is able to make choices about how to proceed.
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4.9 Consent to Admission to a Long-Term Care Home on
Behalf of an Incapable Person
The Community Care Access Centre (CCAC) is responsible for finding the authorized
substitute decision-maker (SDM) for any person whom an evaluator has determined to be
incapable of making a decision regarding his or her admission to a long-term care (LTC) home.
The search should continue until a person has been found who meets the requirements for a
SDM under the Health Care Consent Act, 1996 (HCCA).
The CCAC should document efforts to locate a SDM, indicate who is the authorized SDM and
how that person can be contacted.
4.9.1 Consent on Behalf of an Incapable Person
Consent on incapable person’s behalf
s. 40(1) If a person's consent to his or her admission to a care facility is required by law and
the person is found by an evaluator to be incapable with respect to the admission, consent may
be given or refused on the person's behalf by his or her substitute decision-maker in
accordance with this Act.
s. 40(2) If a person who is found by an evaluator to be incapable with respect to his or her
admission to a care facility is found to be capable with respect to the admission by the Board
on an application for review of the evaluator’s finding, or by a court on an appeal of the
Board’s decision, subsection (1) does not apply.
As stated in subsection #4.8.1 in this manual, a person’s consent to his or her admission to a
LTC home (“care facility” under the HCCA) is required by the three LTC home statutes.
4.9.2 Identifying a Substitute Decision-Maker
If a person is determined to be incapable of making a decision regarding admission to a LTC
home, a SDM will make the decision on his or her behalf.
The criteria for identifying a SDM for this situation are the same as for cases regarding consent
to treatment. (Subsection #4.5.3 in this manual contains the list of individuals who may act as
SDMs in order of priority. Also see subsection #4.5.5 in this manual for role of the Public
Guardian and Trustee.)
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4.9.3 Information Needed by the Substitute Decision-Maker
The person making an admission decision on behalf of an incapable person has the right to
receive all the information required in order to make the decision.
Information
s. 43(1) Before giving or refusing consent on an incapable person's behalf to his or her
admission to a care facility, a substitute decision-maker is entitled to receive all the
information required in order to make the decision.
Conflict
s. 43(2) Subsection (1) prevails despite anything to the contrary in the Personal Health
Information Protection Act, 2004.
4.9.4 Requirements of a Substitute Decision-Maker
A SDM may give or refuse consent as long as he or she meets the requirements of a SDM as
specified in the HCCA. (For requirements of a SDM, see subsection #4.5.4 in this manual, with
necessary modifications: for example, the SDM making an admission decision must be capable
with respect to the admission (not treatment).)
4.9.5 Principles for Giving or Refusing Consent
The HCCA requires the SDM to make decisions in accordance with any known wishes
applicable to the circumstances that were expressed by the incapable person while capable and
after reaching the age of 16 years and, if there are no such wishes, the decisions are to be made
in the best interests of the incapable person. Best interests is a defined term (see subsection
#4.9.6 in this manual). In certain circumstances, the SDM or the CCAC may apply to the
Consent and Capacity Board (the Board) (see definition of Board in subsection #4.7 in this
manual or Appendix #A in this manual) for directions about the expressed wishes, as described
in subsection #4.10.4 in this manual.
Principles for giving or refusing consent
s. 42(1) A person who gives or refuses consent on an incapable person's behalf to his or her
admission to a care facility shall do so in accordance with the following principles:
1. If the person knows of a wish applicable to the circumstances that the incapable person
expressed while capable and after attaining 16 years of age, the person shall give or refuse
consent in accordance with the wish.
2. If the person does not know of a wish applicable to the circumstances that the incapable
person expressed while capable and after attaining 16 years of age, or if it is impossible to
comply with the wish, the person shall act in the incapable person's best interests.
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4.9.6 Best Interests of the Incapable Person
Best interests
s. 42(2) In deciding what the incapable person's best interests are, the person who gives or
refuses consent on his or her behalf shall take into consideration,
(a) the values and beliefs that the person knows the incapable person held when capable and
believes he or she would still act on if capable;
(b) any wishes expressed by the incapable person with respect to admission to a care facility
that are not required to be followed under paragraph 1 of subsection (1); and
(c) the following factors:
1. Whether admission to the care facility is likely to,
i. improve the quality of the incapable person's life,
ii. prevent the quality of the incapable person's life from deteriorating, or
iii. reduce the extent to which, or the rate at which, the quality of the incapable person's life
is likely to deteriorate.
2. Whether the quality of the incapable person's life is likely to improve, remain the same or
deteriorate without admission to the care facility.
3. Whether the benefit the incapable person is expected to obtain from admission to the care
facility outweighs the risk of negative consequences to him or her.
4. Whether a course of action that is less restrictive than admission to the care facility is
available and is appropriate in the circumstances.
Subsection 42(2) sets out what the SDM must take into consideration in making a decision
based on the best interests of the incapable person.
4.9.7 Consent to Ancillary Decisions
Ancillary decisions
s. 44(1) Authority to consent on an incapable person's behalf to his or her admission to a care
facility includes authority to make decisions that are necessary and ancillary to the admission.
Collection and disclosure of information
s.44(2) A decision concerning the collection and disclosure of information relating to the
incapable person is a decision that is necessary and ancillary to the admission, if the
information is required for the purpose of the admission and is not personal health information
within the meaning of the Personal Health Information Protection Act, 2004.
Exception
s. 44(3) Subsection (1) does not authorize the making of a decision concerning the incapable
person’s property.
If the person is incapable of managing his or her property, only the legally authorized SDM for
property can make decisions about property, such as payment of the resident co-payment (see
subsection #4.1.1 in this manual).
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4.9.8 Withdrawal of Consent
Withdrawal of consent
s. 45 Authority to consent on an incapable person's behalf to his or her admission to a care
facility includes authority to withdraw the consent at any time before the admission.
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4.9.9 When Admission Must Not be Authorized
Admission must not be authorized
s. 46(1) This section applies if,
(a) an evaluator finds that a person is incapable with respect to his or her admission to a care
facility;
(b) before the admission takes place, the person responsible for authorizing admissions to the
care facility is informed that the person who was found to be incapable intends to apply, or has
applied, to the Board for a review of the finding; and
(c) the application to the Board is not prohibited by subsection 50 (2).
Same
s. 46(2) This section also applies if,
(a) an evaluator finds that a person is incapable with respect to his or her admission to a care
facility;
(b) before the admission takes place, the person responsible for authorizing admissions to the
care facility is informed that,
(i) the incapable person intends to apply, or has applied, to the Board for appointment of a
representative to give or refuse consent to the admission on his or her behalf, or
(ii) another person intends to apply, or has applied, to the Board to be appointed as the
representative of the incapable person to give or refuse consent to the admission on his or
her behalf; and
(c) the application to the Board is not prohibited by subsection 51 (3).
Same
s. 46(3) In the circumstances described in subsections (1) and (2), the person responsible for
authorizing admissions to the care facility shall take reasonable steps to ensure that the
person's admission is not authorized and that the person is not admitted,
(a) until 48 hours have elapsed since the person responsible for authorizing admissions to the
care facility was first informed of the intended application to the Board without an application
being made;
(b) until the application to the Board has been withdrawn;
(c) until the Board has rendered a decision in the matter, if none of the parties to the
application before the Board has informed the person responsible for authorizing admissions to
the care facility that he or she intends to appeal the Board's decision; or
(d) if a party to the application before the Board has informed the person responsible for
authorizing admissions to the care facility that he or she intends to appeal the Board's decision,
(i) until the period for commencing the appeal has elapsed without an appeal being
commenced, or
(ii) until the appeal of the Board's decision has been finally disposed of.
4.9.10 Crisis Admission
Section 46 (discussed in subsection #4.9.9 in this manual) does not apply when the CCAC is of
the opinion that the incapable person requires immediate admission to a LTC home as a result
of a crisis or when the admission is for a definite number of days not exceeding 90.
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Crisis
s. 46(4) This section does not apply if the person responsible for authorizing admissions to the
care facility is of the opinion that the incapable person requires immediate admission to a care
facility as a result of a crisis.
Admission for definite stay
s. 46(5) This section does not apply to a person’s admission, or the authorization of a person’s
admission, to a care facility for a stay of a definite number of days not exceeding 90.
Definition of crisis
s. 39 In this Part,
"crisis" means a crisis relating to the condition or circumstances of the person who is to be
admitted to the care facility.
Under this definition, it is not considered to be a crisis if someone other than the person being
admitted is experiencing a crisis. For example, a family in crisis does not warrant the admission
of the incapable person to a LTC home without the consent of his or her SDM. The crisis must
relate directly to the condition or circumstances of the person to be admitted. Circumstances
could include the fact that the incapable person’s primary caregiver is no longer available to
assist with the person’s care.
4.9.11 Crisis Admission of Incapable Person Without Consent
The CCAC may authorize the admission of an incapable person to a LTC home without the
consent of the SDM, where the CCAC is of the opinion that the incapable person requires
immediate admission as a result of a crisis and where it is not reasonably possible to obtain the
immediate consent or refusal of the person’s SDM. When admission is authorized under this
provision, the CCAC is required to ensure that reasonable efforts are subsequently made to
locate the person’s SDM in order to obtain his or her consent or refusal of consent to the
admission. It should be noted that prior to reaching this point in the admission process (that is,
authorization of admission), the CCAC would have received an application for a determination
of the person’s eligibility for admission and would have determined the person eligible for
admission.
Authorization of admission without consent
s. 47(1) Despite any law to the contrary, if a person is found by an evaluator to be incapable
with respect to his or her admission to a care facility, the person's admission may be
authorized, and the person may be admitted, without consent, if in the opinion of the person
responsible for authorizing admissions to the care facility,
(a) the incapable person requires immediate admission to a care facility as a result of a crisis;
and
(b) it is not reasonably possible to obtain an immediate consent or refusal on the incapable
person's behalf.
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Search
s. 47(2) When an admission to a care facility is authorized under subsection (1), the person
responsible for authorizing admissions to the care facility shall ensure that reasonable efforts
are made for the purpose of finding the incapable person's substitute decision-maker and
obtaining from him or her a consent, or refusal of consent, to the admission.
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4.10 Applications to the Consent and Capacity Board Regarding
Admission to a Long-Term Care Home
Under the Health Care Consent Act, 1996 (HCCA), applications may be made to the Consent
and Capacity Board (the Board) to deal with the following matters related to long-term care
(LTC) home admissions:
Application
Reference in
this Manual
#4.10.1
Application for appointment of a representative who will act as the
substitute decision-maker (SDM) on behalf of an incapable person
#4.10.2
Application by a proposed representative to act as the SDM on behalf
of an incapable person
#4.10.3
Application by a SDM or the person responsible for authorizing
admissions (the Community Care Access Centre (CCAC)) for
directions regarding wishes expressed about admission to a LTC home
#4.10.4
Application by a SDM or the person responsible for authorizing
admissions (the CCAC) to obtain permission for the SDM to depart
from wishes expressed by the incapable person
#4.10.5
Application by the person responsible for authorizing admissions (the
CCAC) seeking determination as to whether a SDM complied with
principles for giving or refusing consent
#4.10.6
Each application is briefly described in this subsection.
4.10.1 Application for Review of Finding of Incapacity
s. 50(1) A person may apply to the Board for a review of an evaluator's finding that he or she is
incapable with respect to his or her admission to a care facility.
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Exception
s. 50(2) Subsection (1) does not apply to,
(a) a person who has a guardian of the person, if the guardian has authority to give or refuse
consent to the person's admission to a care facility;
(b) a person who has an attorney for personal care, if the power of attorney contains a
provision waiving the person's right to apply for the review and the provision is effective under
subsection 50 (1) of the Substitute Decisions Act, 1992.
Parties
1. The person applying for the review.
2. The evaluator.
3. The person responsible for authorizing admissions to the care facility.
Subss. 32 (4) to (7) apply
s. 50(4) Subsections 32 (4) to (7) apply, with necessary modifications, to an application under
this section.
Decision of the Board Regarding Finding of Incapacity
The following provisions of the HCCA apply, with necessary modifications, to applications to
review the finding of incapacity regarding admission to a LTC home:
Powers of Board
s. 32(4) The Board may confirm the health practitioner’s finding or may determine that the
person is capable with respect to the treatment, and in doing so may substitute its opinion for
that of the health practitioner.
Restriction on repeated applications
s . 32(5) If a health practitioner’s finding that a person is incapable with respect to a treatment
is confirmed on the final disposition of an application under this section, the person shall not
make a new application for a review of a finding of incapacity with respect to the same or
similar treatment within six months after the final disposition of the earlier application, unless
the Board gives leave in advance.
Same
s. 32(6) The Board may give leave for the new application to be made if it is satisfied that there
has been a material change in circumstances that justifies reconsideration of the person’s
capacity.
Decision effective while application for leave pending
s. 32(7) The Board’s decision under subsection (5) remains in effect pending an application for
leave under subsection (6).
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If the Board agrees with the evaluator’s finding of incapacity, the person cannot apply for
another review regarding the finding until six months after the Board’s decision, unless the
Board gives permission to do so. Subsection 32(6) of the HCCA sets out when the Board would
give permission for a further review before six months has elapsed.
Opinion of the Board or Court Governs
Where a person is found by an evaluator to be incapable regarding admission to a LTC home
and the finding has been confirmed by the Board on a review (see definition of Board in
subsection #4.7 in this manual or Appendix #A in this manual) or by the court on appeal of the
Board’s decision (after an application by the person to review the evaluator’s finding), the
person makes the decision, not the SDM.
s. 40(2) If a person who is found by an evaluator to be incapable with respect to his or her
admission to a care facility is found to be capable with respect to the admission by the Board
on an application for review of the evaluator's finding, or by a court on an appeal of the
Board's decision, subsection (1) does not apply.
4.10.2 Application for Appointment of Representative – by Incapable Person
An incapable person may ask the Board to appoint someone to give or refuse consent to
admission on his or her behalf. Such an application may be made in circumstances where there
is no court appointed guardian with the authority to make the decision and the incapable person
did not make a power of attorney document while capable of doing so and does not want a
family member listed in subsection 20(1) in the HCCA to be the SDM. A representative
appointed by the Board ranks above listed family members. (See list of SDMs in subsection
#4.5.3 in this manual.)
s. 51(1) A person who is 16 years old or older and who is incapable with respect to his or her
admission to a care facility may apply to the Board for appointment of a representative to give
or refuse consent on his or her behalf.
Exception
person who has authority to give or refuse consent to the person’s admission to a care facility,
or an attorney for personal care under a power of attorney conferring that authority.
It should be noted that under the legislation governing LTC homes, a person must be at least 18
years of age to be eligible for admission to a LTC home. The above provision refers to “16
years or older” as there is power by regulation to prescribe other facilities as “care facilities”
under the HCCA (currently, only LTC homes are “care facilities”).
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4.10.3 Application for Appointment of Representative – by Proposed
Representative
The proposed representative may make the application to the Board to be appointed as the
representative:
s. 51(2) A person who is 16 years old or older may apply to the Board to have himself or
herself appointed as the representative of a person who is incapable with respect to his or her
admission to a care facility, to give or refuse consent on behalf of the incapable person.
Exception
person who has authority to give or refuse consent to the person’s admission to a care facility,
or an attorney for personal care under a power of attorney conferring that authority.
Note: The proposed representative may be 16 years of age or older.
4.10.4 Appointment of Representative – Applicable Provisions
The following provisions apply to applications to appoint a representative under either
subsection 51(1) or (2), as described in subsections #4.10.2 and #4.10.3 in this manual.
Parties
2. The proposed representative named in the application.
3. Every person who is described in paragraph 4, 5, 6 or 7 of subsection 20 (1), as it applies for
the purpose of section 41.
Appointment
s.51(5) In an appointment under this section, the Board may authorize the representative to
give or refuse consent on the incapable person’s behalf,
(a) to his or her admission to the care facility; or
(b) to his or her admission to any care facility, or to any of several care facilities specified by
the Board, whenever an evaluator finds that the person is incapable with respect to the
admission.
Subss. 33 (6) to (8) apply
s. 51(6) Subsections 33 (6) to (8) apply, with necessary modifications, to an appointment under
this section.
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4.10.5 Application for Directions About Wishes
s. 52(1) A substitute decision-maker or the person responsible for authorizing admissions to a
care facility may apply to the Board for directions if the incapable person expressed a wish
with respect to his or her admission to the care facility, but,
(a) the wish is not clear;
(b) it is not clear whether the wish is applicable to the circumstances;
(c) it is not clear whether the wish was expressed while the incapable person was capable; or
(d) it is not clear whether the wish was expressed after the incapable person attained 16 years
of age.
s. 52(1.1) If the person responsible for authorizing admissions to the care facility intends to
apply for directions, the person shall inform the substitute decision-maker of his or her
intention before doing so.
Parties
Directions given by Board
s. 52(3) The Board may give directions and, in doing so, shall apply section 42.
Note: Section 42 of the HCCA and subsection #4.9.5 in this manual set out the required
principles for the SDM to follow in making the admission decision.
The CCAC must inform the SDM of its intention to make an application under section 52(1),
before doing so.
4.10.6 Application to Depart from Wishes
Application to depart from wishes
s. 53(1) If a substitute decision-maker is required by paragraph 1 of subsection 42 (1) to refuse
consent to the incapable person's admission to a care facility because of a wish expressed by
the incapable person while capable and after attaining 16 years of age,
(a) the substitute decision-maker may apply to the Board for permission to consent to the
admission despite the wish; or
(b) the person responsible for authorizing admissions to the care facility may apply to the
Board to obtain permission for the substitute decision-maker to consent to the admission
despite the wish.
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s. 53(1.1) If the person responsible for authorizing admissions to the care facility intends to
apply under subsection (1), the person shall inform the substitute decision-maker of his or her
intention before doing so.
Criteria for permission
s. 53(3) The Board may give the substitute decision-maker permission to consent to the
admission despite the wish if it is satisfied that the incapable person, if capable, would
probably give consent because the likely result of the admission is significantly better than
would have been anticipated in comparable circumstances at the time the wish was expressed.
The CCAC must inform the SDM of its intention to make an application under section 53(1),
before doing so.
4.10.7 Application to Determine Compliance with Section 42
Application to determine compliance with section 42
s. 54(1) If consent to admission to a care facility is given or refused on an incapable person's
behalf by his or her substitute decision-maker, and if the person responsible for authorizing
admissions to the care facility is of the opinion that the substitute decision-maker did not
comply with section 42, the person responsible for authorizing admissions to the care facility
may apply to the Board for a determination as to whether the substitute decision-maker
complied with section 42.
Parties
The CCAC would make this application if it believes that the principles that a SDM is required
to follow when giving or refusing consent, including the person’s previously expressed capable
wishes, or if applicable, the person’s best interests, were not properly considered by the SDM
in making his or her decision about the person’s admission to a LTC home.
Power of Board
s. 54(3) In determining whether the substitute decision-maker complied with section 42, the
Board may substitute its opinion for that of the substitute decision-maker.
Directions
s. 54(4) If the Board determines that the substitute decision-maker did not comply with section
42, it may give him or her directions and, in doing so, shall apply section 42.
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Time for compliance
s. 54(5) The Board shall specify the time within which its directions must be complied with.
Deemed not authorized
s. 54(6) If the substitute decision-maker does not comply with the Board’s directions within the
time specified by the Board, he or she shall be deemed not to meet the requirements of
subsection 20 (2), as it applies for the purpose of section 41.
Subsequent substitute decision-maker
s. 54(6.1) If, under subsection (6), the substitute decision-maker is deemed not to meet the
requirements of subsection 20 (2), any subsequent substitute decision-maker shall, subject to
subsections (6.2) and (6.3), comply with the directions given by the Board on the application
within the time specified by the Board.
s. 54(6.2) If a subsequent substitute decision-maker knows of a wish expressed by the incapable
person with respect to the admission to a care facility, the substitute decision-maker may, with
leave of the Board, apply to the Board for directions under section 52.
Inconsistent directions
s. 54(6.3) Directions given by the Board under section 52 on a subsequent substitute decisionmaker’s application brought with leave under subsection (6.2) prevail over inconsistent
directions given under subsection (4) to the extent of the inconsistency.
P.G.T.
s. 54(7) If the substitute decision-maker who is given directions is the Public Guardian and
Trustee, he or she is required to comply with the directions, and subsection (6) does not apply
to him or her.
4.10.8 Deemed Application Concerning Capacity
Deemed application concerning capacity
s. 54.1 An application to the Board under section 51, 52, 53 or 54 shall be deemed to include
an application to the Board under section 50 with respect to the person’s capacity to consent to
his or her admission to a care facility unless the person’s capacity to consent to such admission
has been determined by the Board within the previous six months.
It should be noted from section 54.1 that whenever one of the listed applications to the Board is
made, there is an automatic deemed application to the Board to review the finding of incapacity
of the person to consent to the admission, unless the Board has determined the issue of capacity
within the previous six months.
Note: Further information as well as application forms and detailed contact information for the
regional and head offices of the Board can be obtained by calling 1-800-461-2036 or from the
Board’s internet website at: [http://www.ccboard.on.ca/].
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4.10.9 Protection from Liability
The CCAC case manager who is responsible for authorizing an admission to a LTC home has
protection from liability in the following circumstances which relate to the decision of the SDM
on behalf of an incapable person:
Apparently valid consent to admission
s. 48(1) If the person responsible for authorizing admissions to a care facility admits, or
authorizes the admission of, a person to the care facility with a consent that he or she believes,
on reasonable grounds and in good faith, to be sufficient for the purpose of this Act, he or she
is not liable for admitting the person, or authorizing the person’s admission, without consent.
Apparently valid refusal of admission
s. 48(2) If the person responsible for authorizing admissions to a care facility does not admit,
or does not authorize the admission of, a person to the care facility because of a refusal that he
or she believes, on reasonable grounds and in good faith, to be sufficient for the purpose of this
Act, he or she is not liable for failing to admit the person or failing to authorize the person’s
admission.
Admission
s. 48(3) If the person responsible for authorizing admissions to a care facility admits, or
authorizes the admission of, a person to the care facility under section 47 in good faith, he or
she is not liable for admitting the person, or authorizing the person’s admission, without
consent.
Reliance on assertion
s. 48(4) If a person who gives or refuses consent to admission to a care facility on an incapable
person’s behalf asserts that he or she,
(a) is a person described in subsection 20 (1), as it applies for the purpose of section 41, or an
attorney for personal care described in clause 50 (2) (b);
(b) meets the requirement of clause 20 (2) (b) or (c), as it applies for the purpose of section 41;
or
(c) holds the opinions required under subsection 20 (4), as it applies for the purpose of section
41,the person responsible for authorizing admissions to the care facility is entitled to rely on
the accuracy of the assertion, unless it is not reasonable to do so in the circumstances.
The SDM has the following protection from liability:
Person making decision on another’s behalf
s. 49 A person who gives or refuses consent on another person’s behalf to his or her admission
to a care facility, acting in good faith and in accordance with this Act, is not liable for giving
or refusing consent.
As indicated in section 48(4) of the HCCA, the CCAC is entitled to rely on the accuracy of a
person’s assertions of the following matters, unless it is not reasonable to do so in the
circumstances:
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•
•
•
•
that the person is the legally authorized SDM (from the list of persons set out in subsection
20(1)) who may give or refuse consent to the admission;
that the person is the attorney for personal care under a power of attorney that contains a
provision waiving the alleged incapable person’s right to apply for a review of an
evaluator’s finding of incapacity and the provision is effective under subsection 50(1) of the
Substitute Decisions Act, 1992;
that the person meets the following requirements of a SDM:
• is at least 16 years old (unless he or she is the incapable person’s parent); and
• is not prohibited by court order or separation agreement from having access to the
incapable person or giving or refusing consent on his or her behalf; and
that the person believes there is no one else with a higher ranking on the list of those who
may act as the SDM or that there is no one else of the same ranking or that although such a
person exists the person does not object to the person making the decision and is not one of
the following three persons:
• the incapable person’s guardian or the person with the authority to make the decision;
• the incapable person’s attorney for personal care under a power of attorney that confers
the authority to make the decision; or
• the incapable person’s representative appointed by the Board to make the decision.
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4.11 Consent to Personal Assistance Services
Part IV of the Health Care Consent Act, 1996 (HCCA) sets out the legislative requirements
with respect to consent to a personal assistance service on behalf of a person whom an
“evaluator” finds incapable of making the decision. For Part IV of the HCCA, evaluator has the
same meaning as for Part III, which deals with substitute decisions on behalf of persons who
are incapable of making a decision about admission to a long-term care (LTC) home. (See
subsection #4.8 in this manual.)
The HCCA provides the following definition:
s. 2(1) "personal assistance service" means assistance with or supervision of hygiene, washing,
dressing, grooming, eating, drinking, elimination, ambulation, positioning or any other routine
activity of living, and includes a group of personal assistance services or a plan setting out
personal assistance services to be provided to a person, but does not include anything
prescribed by the regulations as not constituting a personal assistance service.
Note: There are currently no regulations under this provision.
4.11.1 Application of Part IV of the HCCA
The provisions in Part IV of the HCCA apply to a “recipient” of a personal assistance service.
The HCCA defines recipient of personal assistance services referred to in Part IV as:
s. 2(1)… a person who is to be provided with one or more personal assistance services,
(a) in an approved charitable home for the aged, as defined by the Charitable Institutions Act,
(b) in a home or joint home , as defined by the Homes for the Aged and Rest Homes Act;
(c) in a nursing home, as defined by the Nursing Homes Act,
(d) in a place prescribed by the regulations in the circumstances prescribed by the regulations,
(e) under a program prescribed by the regulations in the circumstances prescribed by the
regulations, or
(f) by a provider prescribed by the regulations in the circumstances prescribed by the
regulation.
There are currently no regulations under (d), (e) or (f) above. Thus, the scheme for substitute
decisionmaking for personal assistance services referred to in Part IV of the HCCA apply only
to personal assistance services for residents of LTC homes who are incapable of making the
decision.
4.11.2 Consent to Community Services
It should be noted that there is a consent requirement with respect to community services
provided under the Long-Term Care Act, 1994 (LTCA). Subsection 3(1)6, the Bill of Rights
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under the LTCA (see subsection #2.2.1 in this manual) provides that “a person has the right to
give or refuse consent to the provision of any community service.” This is a reference to the
consent of the client who receives the service.
In addition, the following provision of the LTCA addresses the issue of consent to community
services:
Consent required
s. 24 Nothing in this Act authorizes an approved agency to assess a person’s requirements,
determine a person’s eligibility or provide a community service to a person, without the
person’s consent.
4.11.3 Consent to Community Services on Behalf of Incapable Person
As noted in subsection #4.1.1 of this manual, clients who are incapable of making a decision
about a community service may have a substitute decision-maker (SDM) who is authorized
under the Substitute Decisions Act, 1992 (SDA) to make personal care decisions on their
behalf. The SDM may be either an attorney for personal care or a guardian of the person who is
authorized to make personal care decisions. Personal care decisions are decisions about health
care, nutrition, shelter, clothing, hygiene or safety. To the extent that a community service is
one of these things (health care, nutrition, shelter, clothing, hygiene or safety), the SDM with
the required authority may provide consent on behalf of the incapable person.
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5.1 Overview of Information and Referral Services
One of the primary service functions of the Community Care Access Centre (CCAC) is to
provide information and referral services to members of the community. The CCAC must
ensure that this service is timely and responsive to the needs of individuals.
5.1.1 Legislative Requirements
The Community Care Access Corporations Act, 2001 (CCACA) states that one of the objects of
a CCAC is to provide information to the public about community-based care services, longterm care (LTC) homes and related health and social services.
5.1.2 Requirements of the CCAC Information and Referral Service
The CCAC must ensure that its information and referral service meets the following
requirements:
•
•
•
•
•
•
establishes and maintains a comprehensive database on long-term care services (both
community and LTC home services);
provides information to the client (and caregiver) on the health and related social services
provided or arranged by the CCAC (The service must provide people with the information
necessary to make informed independent decisions.);
informs people of other community resources that may be helpful to them, provides
information on key government funded programs and, where appropriate, directs persons to
those other community resources that operate within the CCAC’s designated geographic
area (The CCAC may also provide information about services beyond its boundaries.);
serves as an information resource to other health and community service providers so that
they are equipped with the most current knowledge of long-term care services;
informs the person accessing CCAC services about program requirements;
ensures that clients receive advice regarding their rights (including right to confidentiality,
right to consent, and right to make a complaint or appeal a decision affecting their care.
Consent to treatment is discussed in chapter #4 in this manual. Complaints and appeals are
discussed in chapter #10 in this manual) and are referred to appropriate resources. Case
managers must adhere to the Long-Term Care Act, 1994 (LTCA), Ministry of Health and
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•
•
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Long-Term Care (MOHLTC) policy, and CCAC protocols with respect to clients’
complaints and appeals (see chapter #10 in this manual);
ensures that clients are aware of the procedure for bringing forward issues and suggestions,
and the procedure to access their plan of service and personal health information; and
advocates on behalf of their clients.
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5.2 Design of the Information and Referral Service
The information and referral function of the Community Care Access Centre (CCAC) must be
comprehensive enough to reflect the needs of people who access CCAC services, including
children, seniors, caregivers, and other interested individuals such as businesses, other health
and social service agencies and professionals.
The information and referral service must include the following features:
•
•
•
•
Services must be accessible. The location of the CCAC and contact information such as
telephone number and e-mail address must be well publicized. The CCAC must develop
other methods to increase public awareness of its services (e.g., pamphlets, posters and/or
information sessions). The CCAC must also investigate providing publicity in alternate
formats such as Braille or large print.
Telephone attendant(s) must be available during regular working hours as determined by
the CCAC to address questions or concerns. While the CCAC may use voice activated
systems that enable people to access information, these systems must not be viewed as a
substitute for a telephone attendant during normal working hours. Telephone technology
must also meet the special needs of people with disabilities.
French language services must be provided in areas designated under the French Language
Services Act (FLSA). Once a client's language preference is determined during information
and referral by the CCAC, the CCAC must respect the client's wishes in accordance with
the Act in providing or arranging services, including communications for the purpose of the
services. When providing service or referring clients to external services, the CCAC must
take language preference into consideration and when possible, inform clients of providers
that can meet their needs.
Services must be responsive to the ethno-cultural needs of the community. Services must
address the information access needs of the major linguistic groups served by the CCAC.
5.2.1 Information and Referral Protocols
Each CCAC must develop protocols for the information and referral service to ensure that:
•
•
•
•
•
•
the information provided is current and accurate;
information is provided in a timely manner;
people are directed to a case manager, where appropriate;
people are referred to the appropriate programs or services (including culturally and
linguistically appropriate);
people with special needs receive assistance in understanding the information; and
processes are clearly explained so clients are able to understand what to expect of services
that are to be received.
The CCAC must develop these protocols in collaboration with community service agencies,
community health and social service providers and LTC home operators.
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5.2.2 Inquiries that Should be Referred to Case Management Staff
Callers must be referred to case management staff when:
•
•
•
the caller has complaints regarding CCAC services;
the caller requests a service arranged through the CCAC; or
the circumstances and needs of the caller are complex and require detailed clarification and
articulation.
5.2.3 Emergency Calls
Either the CCAC or the caller must phone emergency services when:
•
•
the person needs emergency counselling; or
the person needs emergency intervention.
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5.3 Required Information Services
The CCAC must be able to provide inquirers with information about the following kinds of
services:
•
•
•
services provided or arranged through the CCAC;
services provided by other approved agencies; and
other health and social service programs.
Services provided or arranged through the CCAC are:
•
•
•
•
assessment and eligibility determination for professional, personal support and
homemaking;
providing or arranging for the following services:
• professional services (nursing, occupational therapy, physiotherapy, social work,
speech-language pathology, dietetics);
• personal support services (personal hygiene, routine personal activities of living);
• homemaking services (housecleaning, doing laundry, shopping, banking, paying bills,
planning menus, preparing meals, caring for children); and
• providing equipment, supplies and other goods within their legislated authority;
providing information and referral for community services; and
admission to long-term care (LTC) homes.
The 15 key community support services (as per the 2001/2002 Planning, Funding and
Accountability Policies and Procedures Manual for Long-Term Care Community Services) are:
•
•
•
•
•
•
•
•
•
•
•
•
meal services;
transportation services;
caregiver support services (these services include counselling, information and education to
caregivers and family members who have emotional, severe stress or mental health
problems impeding their ability to provide care and support for the client);
respite (these services replace the efforts of family and caregiver supports. This occurs both
in people's homes and outside the home);
homemaking;
adult day services (ADS);
home maintenance and repair services;
volunteer hospice services;
palliative care consultation services (e.g., pain and symptom management);
palliative education (this includes both physician palliative care education and community
and facility palliative care interdisciplinary education for front line health care staff);
Alzheimer services (e.g., public education coordinators and psychogeriatric resource
consultants);
friendly visiting services;
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•
•
•
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security checks;
social or recreational services (including services delivered by both elderly persons centres
as well as other community support service agencies); and
services for persons with physical disabilities (these are services specifically for persons
with physical disabilities, including attendant outreach, direct funding and special services
for the blind and hearing impaired. This also includes foot care, aphasia, and homemaking
and personal support services.).
Some of these services are also provided to clients in assisted living services in supportive
housing (ALSSH) and there are services specifically for clients with acquired brain injury
(ABI).
All of the above services may not be available within each CCAC’s catchment area.
For each of the above services, staff providing information and referrals must be
knowledgeable about:
•
•
•
•
•
actual services provided (hours of service, whether fees apply, and other significant
information);
eligibility determination process and criteria;
intended target population for community services;
service capacity and waiting lists, if applicable; and
consumer rights, including the right to appeal.
Other health and social service programs (including government programs or other programs
provided by community agencies) include but are not limited to:
•
•
•
•
•
•
•
•
•
•
•
•
•
services to First Nations (see subsection #3.11 in this manual);
mental health programs and services (e.g., psychiatric hospitals/units, addictions services
programs, psychiatric assessment and treatment crisis response, supports for housing,
consumer/survivor and family initiatives) (see subsection #5.5 in this manual);
Ontario Health Insurance Plan (OHIP);
Ontario Drug Benefit (ODB) Program;
Assistive Devices Program (ADP);
hospital inpatient and community services (e.g., outpatient clinics and day hospitals);
service agencies providing services to specific groups (e.g., Canadian Hearing Society,
cancer care programs, independent living centres);
seniors centres;
voluntary service agencies that provide information, outreach and advocacy services for
specific client groups;
ethno-cultural services and resources;
women’s shelters and transition houses;
abuse prevention/intervention services;
child welfare services, children and family intervention services, child treatment services
and child care resources;
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•
•
•
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other housing options (e.g., retirement homes);
other personal support worker services; and
other homemakers and nurses services.
Staff providing information and referral services should be able to provide a general description
of the health and social service programs listed above, and how to access them. Staff may
contact the program on the person’s behalf if the person is not capable of contacting the outside
service directly.
5.3.1 Collaboration with Other Information Providers
The CCAC must develop and maintain its information service in collaboration with other
community service agencies and service providers within the geographic area it serves.
5.3.2 CCAC Not Responsible for Other General Community Information
The CCAC is not required to provide information related to consumer/commercial inquiries,
education, labour market information (e.g., employment), environment or financial counselling.
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5.4 Monitoring the Information and Referral Service
The Community Care Access Centre (CCAC) must monitor the quality of the information and
referral service and collect the following information:
•
•
•
•
source of call (e.g., client, caregiver, member of the public, other CCAC staff, other service
provider or other);
type of inquiry;
action taken (e.g., appointment, publication sent, information provided, information and
referral to another agency, follow-up or contact agency/service); and
number and duration of calls.
At regular intervals, staff of the CCAC must analyze the collected data in order to:
•
•
•
•
•
•
determine basic statistics (e.g., numbers of calls by type, source, action response, the
average length of each call);
compare records from different time periods to show trends over time, if any;
identify patterns (Are the numbers of calls higher at certain times of the day or week? Is the
service being used disproportionately by one source? Is the response time getting longer or
shorter? Is the CCAC able to respond to the queries for information?);
identify gaps and address them accordingly (Are there repeated calls for a service that does
not currently exist?);
evaluate the information (Is the CCAC getting a high number of calls that are referred to the
case manager, and if so, why? Could non-case management staff who are properly trained
handle the calls?); and
consider alternatives (If the service is answering the same question repeatedly, is there a
way to disseminate the answer to the community by other means such as media coverage or
inclusion in CCAC brochures?).
The CCAC must conduct a survey of callers periodically to measure caller satisfaction with
information and referral services. Responses should be analyzed for indicators of:
•
•
•
•
•
accessibility;
continuity;
safety;
timeliness; and
quality of information provided.
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5.5 CCAC Information or Referral Services to Specific
Communities
5.5.1 Persons Who Require Mental Health Services
Mental health programs and services for persons over the age of 16 are the responsibility of the
Ministry of Health and Long-Term Care (MOHLTC). These programs are delivered by
community mental health programs, Schedule 1 hospitals, and mental health facilities.
Most mental health programs and services for children/youths under the age of 16 are the
responsibility of the Ministry of Community and Social Services (MCSS) and the Ministry of
Children and Youth Services (MCYS) . These programs are delivered by children’s mental
health programs and some Schedule 1 hospitals. Some mental health programs are delivered by
the MOHLTC.
If a person of any age has a severe physical disability or illness in addition to a mental illness,
he or she may be assessed as eligible for services provided by a Community Care Access
Centre (CCAC) (e.g., service for post-operative care).
The CCAC should not provide services to individuals to monitor their medications, assist in
routine personal activities of daily living, or provide homemaking services when these services
are required solely due to a mental illness. Case managers should refer individuals to
community mental health services or other resources that support persons with mental illnesses
to live successfully in a community setting.
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6.1 Introduction to Case Management
The Long-Term Care Act, 1994 (LTCA) assigns specific duties to agencies approved to provide
community services. In regulation 33/02 under the Community Care Access Corporations Act,
2001 (CCACA), a Community Care Access Centre (CCAC) is deemed to be an approved
agency under the LTCA and is approved to provide the community services set out in this
regulation.
Two key CCAC responsibilities are: provision of home care and managing the placement
process into long-term care (LTC) homes. The CCAC manages these key activities through
case management services, a core service of the CCAC.
Case management in the CCAC is vested in case managers who must assess and review
requirements, determine eligibility, and develop and evaluate the plans of service for CCAC
services and authorize the expenditures of funds for services in accordance with sections 22 and
23 of the LTCA, and authorize admissions to LTC homes in accordance with subsection 20.1
of the Nursing Homes Act (NHA), section 18 of the Homes for the Aged and Rest Homes Act
(HARHA), and subsection 9.6 of the Charitable Institutions Act (CIA). (The admission to LTC
care homes is discussed in chapter #11 in this manual.)
6.1.1 CCAC Case Management
The LTCA sets out the case management function of the CCAC for community services:
Plan of service
Revision of plan of service
s. 22(2) If a person is receiving a community service provided or arranged by an approved
agency, the agency shall,
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(a) review the person’s requirements when appropriate, depending on the person’s condition
and circumstances; and
(b) evaluate the person’s plan of service and revise it as necessary when the person’s
requirements change.
Co-ordination of services
s. 22(3) If a person is receiving more than one community service provided or arranged by an
approved agency, the agency shall assist the person in co-ordinating the services he or she
receives, in accordance with the person’s wishes.
Participation in plan of service
s. 22(4) An approved agency shall provide an opportunity to participate fully in the
development, evaluation and revision of a plan of service to,
(a) the person who is the subject of the plan of service;
(b) if the person who is the subject of the plan of service is mentally incapable, the person or
persons who are lawfully authorized to make a decision on his or her behalf concerning the
community services in the plan of service; and
(c) the person, if any, designated by the persons referred to in clauses (a) and (b).
Other assessments to be considered
s. 22(5) In assessing a person’s requirements under clause (1) (a) and in reviewing a person’s
requirements under clause (2) (a), an approved agency shall take into account all assessments
and information that are provided to it relating to the person’s capacity, the person’s
impairment or the person’s requirements for health care or community services.
Person’s preferences to be considered
s. 22(6) In developing, evaluating and revising a person’s plan of service, an approved agency
shall take into account the person’s preferences, including preferences based on ethnic,
spiritual, linguistic, familial and cultural factors.
Compliance with regulations
s. 22(7) An approved agency shall apply the prescribed criteria, follow the prescribed
procedures and comply with the prescribed rules and standards in assessing a person’s
requirements, determining a person’s eligibility and developing, evaluating and revising a plan
of service.
Provision of services
s. 23(1) An approved agency shall ensure that the services outlined in a person’s plan of
service are provided to the person within a time that is reasonable in the circumstances.
Waiting list
s. 23(2) If a community service outlined in a person’s plan of service is not immediately
available, the approved agency shall place the person on the waiting list for that service and
shall advise the person when the service becomes available.
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Case management is a core service provided by the CCAC, and the mechanism through which
individuals access a range of services. The interactive involvement and relationship between a
case manager and clients must be supportive and assist clients to live independently and make
their own health choices. In addition to being a service to individual clients, CCAC case
management also serves a system-level function, promoting service consistency, co-ordination,
quality and accountability while maximizing client independence and optimizing resource
utilization.
Case management is knowledge-based, and incorporates skills, abilities and experience to
successfully carry out the processes of collecting and analyzing information, and developing
and managing a plan of service that is mutually agreed to by the client and/or substitute
decision-maker (SDM). Communication and client education are key elements in linking the
processes with the client, and linking the client with the CCAC and other parts of the health
care system.
The CCAC must comply with the LTCA when providing case management and be guided by
the following principles:
•
•
•
•
•
respect for the person’s rights, dignity, values and preferences;
promotion of the highest level of independence possible for the person within the person’s
capacity by focusing on the person’s strengths, needs and preferences;
promotion of quality improvement in all aspects of service management;
promotion of a collaborative and co-ordinated approach to service delivery; and
promotion of efficient, effective and equitable use of resources.
Case management is available to persons requesting in-home services, school services, and
admission to LTC homes. Case management intensity may vary according to the needs and
goals of the individual client. Some clients may benefit from care pathways, while others may
require intensive case management.
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6.2 Responsibilities of Case Managers
Case managers must co-ordinate service delivery provided by the Community Care Access
Centre (CCAC), their contracted service providers and informal caregivers, and link clients to
appropriate volunteer and community resources. Case managers must collaborate with clients
and service providers to determine the nature, intensity and duration of services required to
address the client’s needs and ensure the most effective use of resources.
A case manager must authorize each CCAC service provided to a client. The case manager
must have the knowledge and skills to work with clients and local community resources to
provide efficient and effective services to clients. Community services can supplement those
provided through the CCAC to complement and strengthen the individual's plan of service.
Case managers must ensure that their practices use quality improvement, risk management and
best practice principles that strengthen service delivery.
As a primary objective the CCAC case manager must ensure that the right services are
provided to the right clients at the right time. The primary objective is achieved by:
•
•
•
•
•
•
•
•
assessing client needs (see subsection #6.2.1 in this manual);
determining eligibility for services (see subsection #6.2.2 in this manual);
developing plans of service for eligible clients in collaboration with client/caregivers (see
subsection #6.2.3 in this manual);
co-ordinating services to help clients meet the goals of optimal health and independence
(see subsection #6.2.4 in this manual);
conducting regular reassessments of clients (see subsection #6.2.5 in this manual);
adjusting CCAC services when client requirements change (see subsection #6.2.6 in this
manual);
discharging clients as soon as the services are no longer required, the client is no longer
eligible for services, the client withdraws consent to receive services or the client is no
longer available (see subsection #6.2.7 in this manual); and
supporting clients through the health and social support systems.
Case managers must assess needs, determine eligibility based on eligibility criteria, and
develop, authorize, monitor and evaluate plans of service. These plans of service may include
professional services, personal support services, homemaking services, and school services as
well as supplies, equipment or other goods within their legislated authority.
Case managers must provide other supports to the client and the caregiver by:
•
•
counselling clients and families that are adapting to change or are in crisis and having
difficulty coping, making decisions and problem solving;
assisting persons to develop the knowledge, skills and ability to make choices that enhance
their health and well being;
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•
•
•
Chapter 6
developing appropriate strategies for clients who may be resistant to services and who live
at risk in the community;
assisting and supporting family caregivers or substitute decision-makers (SDMs) that must
act on behalf of family members who are no longer capable; and
monitoring clients who are at risk, including clients with medical conditions that have the
potential to deteriorate at any time; clients who may have an urgent requirement for 24-hour,
seven-day supervision; clients who may need crisis placement; clients with cognitive
disabilities and an inadequate support system; caregivers at risk of burn out; and clients who
may be subject to abuse, neglect or self-neglect.
Under the Long-Term Care Act, 1994 (LTCA), case managers are responsible for the following
functions:
Function
Reference in this
Manual
assessment
#6.2.1
eligibility determination
#6.2.2
service planning (plan of service development and resource allocation)
#6.2.3
service co-ordination
#6.2.4
reassessment
#6.2.5
monitoring and revision of plan of service
#6.2.6
service termination (discharge)
#6.2.7
(See case managers’ functions with respect to long-term care (LTC) home admissions in
chapter #11 in this manual.)
6.2.1 Assessment
The assessment process is set out in the LTCA:
Plan of service
(a) assess the person’s requirements; …
s. 22(5) In assessing a person’s requirements under clause (1)(a) and in reviewing a person’s
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of service.
There are currently no regulations relating to the assessment of a person’s requirements.
Assessment is a dynamic and collaborative process that actively involves the client and others.
The CCAC case manager must collect and analyze relevant information in order to understand
and identify an individual’s requirements for care. This process serves as the foundation for
consistent service planning across the CCAC.
The CCAC case manager must ensure that the client’s values, functional and cognitive
capacity, strengths, impairments, abilities, preferences, non-financial resources, supports, and
needs are identified and documented consistently and accurately in a timely manner and that
client needs are well understood. Service providers and external community resources provide
valuable information that contribute to the CCAC case management function.
Client assessment is the foundation for many other functions. Assessment must be completed
before the CCAC can determine eligibility for CCAC services or referral to other services. It is
also important for goal setting, service planning, service authorization and client outcome
evaluation. In addition to standardized client assessment data, the CCAC requires significant
additional client information. These items are collected by other methods and may include
other types of information or assessments such as physician orders, the Health Report form for
LTC homes, consent and capacity evaluations, and identification of a SDM. (For information
on health assessment, see chapter #11 in this manual. For information on consent and capacity
evaluation and SDM, see chapter #4 in this manual.)
The CCAC may have agreements to provide assessment on behalf of community service
agencies such as adult day services (see subsection #3.9 in this manual), or programs funded by
the Ministry of Children and Youth Services (MCYS).
The RAI-HC Assessment Instrument
The Resident Assessment Instrument-Home Care (RAI-HC) has been adopted as the
comprehensive standardized instrument for evaluating the needs, strengths and preferences of
adult long-stay individuals in the community, including individuals requesting admission to
LTC homes. The RAI-HC has been implemented in all 42 CCACs.
The longer-term objective is to implement a standardized assessment process, which will
include all CCAC client populations. Standard assessment instruments for intake and shortstay, palliative and other specialized client groups are under development.
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Policies and guidelines have been drafted to assist the CCAC in the introduction of the RAIHC. The policies and guidelines described below will be reviewed, and if necessary, modified
based on past experience.
Policies for Assessment of the Adult Long-Stay Client in the Community
All RAI-HC1 assessments must be administered by CCAC case managers who are
regulated health or social work professionals and have been trained (two-day education
program) to administer the tool. This includes, but is not limited to, a registered nurse,
physiotherapist, occupational therapist, speech-language pathologist, social worker,
dietitian and psychologist. These professionals are required to be members in good
standing of their regulatory body.
The CCAC case manager must:
•
•
•
•
•
•
•
Use the RAI-HC assessment tool and related assessment process to assess and reassess
all CCAC adult long-stay clients for both CCAC services and LTC home placement.
An adult long-stay client is defined as an adult who requires more than 60 uninterrupted
days of service through a CCAC, or a client who requires admission to a LTC home,
including crisis situations.
Conduct all RAI-HC assessments in face-to-face interviews with the client.
Complete all sections of the RAI-HC assessment tool.
Complete the RAI-HC assessment within 14 calendar days following the date that the
client is identified as long-stay, according to the priority for assessment parameters.
This refers to the time frame that is allowed for the initiation of the face-to-face
assessment.
Complete the RAI-HC at the time of the initial visit. In exceptional circumstances only,
when the RAI-HC assessment cannot be completed on a single visit, the CCAC case
manager must complete the assessment within three days of the initial visit. If on the
second visit the case manager determines that the client’s condition has changed
significantly, the CCAC case manager must complete a new RAI-HC.
Maintain proficiency in administering the RAI-HC by completing an average of eight
to 10 assessments/reassessments per month.
If this level of activity is not maintained, the CCAC must develop and implement
protocols to ensure that assessors who have not been using the tool for a significant
period of time are proficient.
Policies for Assessment of the Adult Long-Stay Client in the Hospital
The CCAC case manager must conduct the RAI-HC assessment at home according to the
priority for assessment parameters or within 14 days following hospital discharge
according to the professional judgement of the case manager.
1
See RAI-HC guidelines provided to CCACs by the MOHLTC Priority Project.
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Note: A long-stay client may be discharged home from hospital with a short-term plan of
service following initial triage in the hospital setting.
The CCAC case manager must conduct the Minimum Data Set for Home Care (MDS-HC)
(hospital version) in the hospital setting for a client who is ineligible for home care services
and unable to return to the community and is therefore applying for admission to a LTC
home.
6.2.2 Eligibility Determination
Eligibility determination requirements are set out in the LTCA:
Plan of service
of service.
There are regulations under the LTCA relating to eligibility for homemaking, personal support
and school services and regulations under the Health Insurance Act (HIA) relating to eligibility
for professional services (see chapter #3 in this manual).
The CCAC case manager must determine and document a client’s eligibility for CCAC
services and/or for admission to a LTC home based on the regulated eligibility criteria (see
chapter #3 in this manual). The CCAC has no authority to provide services to clients who do
not meet these eligibility criteria.
The CCAC case manager must ensure that services are provided to eligible persons in keeping
with their assessed needs and the resources available, and in accordance with the Bill of Rights
(see subsection #2.2.1 in this manual).
The case manager must also consider the respite care needs of the client’s caregiver.
The CCAC case manager must also refer persons to the appropriate health, social service or
community resources that can address their needs. These persons would include, for example,
persons determined ineligible for CCAC services, persons whose CCAC services have
terminated and persons who do not consent to CCAC services. The case manager’s judgement
will determine the duration of the provision of case management service to the individual (e.g.,
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families requiring ongoing assistance with end of life care to a loved one who does not have
Ontario Health Insurance Plan (OHIP) coverage, may receive case management services).
6.2.3 Service Planning
The requirements relating to the development of a plan of service are set out in the LTCA:
Plan of service
of service.
There are currently no regulations relating to the development, evaluation and revising of a
plan of service.
Service planning involves the following processes:
•
•
•
•
determine and authorize the services to be provided to eligible clients based on assessed
requirements;
determine the frequency and duration of the services;
set out in the plan of service, the services to be provided to the client;
determine whether the services are immediately available;
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•
•
•
•
•
Chapter 6
discuss the proposed plan of service with the client, including the need, if any, to be placed
on any waiting list;
if any of the CCAC services are not immediately available, place the client on a waiting list
for these services based on priority of need2 as determined according to local policy;
provide or ensure the provision of services in the plan of service that are available;
monitor the waiting list and provide or ensure the provision of services in the plan of
service once they become available; and
co-ordinate these services.
The CCAC case manager must develop and authorize a plan of service for each person who is
determined eligible for CCAC services. The plan of service must set out the amount of each
service to be provided to the person by the CCAC. Some elements of the plan of service may
be short-term and others long-term. The plan of service should also refer to the community
services to which the client has been referred by the CCAC as well as other supports and
services, including family support or self-paid or privately insured services.
The CCAC case manager must work closely with clients and others on the care team and take
into account the person’s preferences, including preferences based on ethnic, spiritual,
linguistic, familial and cultural factors when developing the plan of service.
Provision of Services
The LTCA states:
Waiting list
Under section 23(1) of the LTCA, the CCAC must provide the services set out in the client’s
plan of services “within a time that is reasonable in the circumstances.” These circumstances
could include, for example, the financial circumstances of the CCAC as well as availability of
contracted service providers. If services set out in the client’s plan of service are not
immediately available, the CCAC must place the person on a waiting list.
With respect to the financial circumstances of the CCAC, the CCAC must optimize the use of
CCAC services by using a resource allocation methodology. Case managers who carry a
caseload must have a service envelope. This envelope must be made up of service units based
on the allocation by the CCAC of approved service units (i.e., for personal support and
homemaking and shift nursing, one unit is one hour; for nursing and therapy services, one unit
2
Priority of need must be re-established and kept current.
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is one visit). Case managers who have a service envelope must be accountable for their service
envelope and receive timely, regular reports about the availability of CCAC resources. In
addition to each case manager’s envelope, the CCAC must also develop a type of “team”
envelope for exceptional circumstances.
6.2.4 Service Co-ordination
The CCAC’s responsibility to co-ordinate services is set out in the LTCA:
Co-ordination of services
s. 23(3) If a person is receiving more than one community service provided or arranged by an
approved agency, the agency shall assist the person in co-ordinating the services he or she
receives, in accordance with the person’s wishes.
Case managers must provide support to the client and the caregiver by:
•
•
coordinating services provided by the CCAC; and
working collaboratively with the client, staff of other approved agencies (e.g., attendant
outreach services, community support services, assisted living services in supportive
housing), the family physician and contracted service providers to:
• develop integrated plans of service for persons whose needs transcend the service
mandates of any one approved agency or service provider; and
• develop area-wide service delivery strategies for persons who are vulnerable, at risk of
abuse or being abused, or living at risk in the community, or persons who are at risk of
not being served by the existing system (e.g., outreach services specifically designed for
persons with mental illnesses or cognitive impairments, the socially isolated and those
who may experience cultural and language barriers to service).
Service co-ordination involves co-ordinating all elements of client care, including CCAC
services with other services and resources supporting the client. Effective co-ordination
includes regular and ongoing communication with clients, family members, physicians,
caregivers, and contracted service providers, and discussions with community services and
community health care partners relating to provision of service. It may also involve planning
for future health care needs and establishing linkages to other services to help ensure continuity
of care for the client.
The case manager must:
•
•
•
co-ordinate all CCAC services identified in the plan of service;
ensure that individual clients receive services within available resources; and
co-ordinate services from a number of contracted service providers and community
agencies in order to meet the individual client’s needs and respect the client’s preferences
for service delivery.
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6.2.5 Reassessment
The CCAC’s responsibility to reassess clients’ requirements is set out in the LTCA:
(b) evaluate the person’s plan of service and revise it as necessary when the person’s
s. 22(5) In assessing a person’s requirements under clause (1) (a) and in reviewing a person’s
of service.
There are currently no regulations relating to the reassessment of clients’ requirements.
The CCAC must reassess client needs to:
•
•
•
determine the client’s continuing eligibility and need for CCAC services;
monitor types and levels of services required, and appropriateness of supplies and
equipment used;
adjust service levels if client requirements change;
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•
•
Chapter 6
adjust goals; and
as necessary, arrange for new services or the termination of service.
The CCAC must reassess adult long-stay clients using the RAI-HC as follows:
•
•
at a minimum of every six months; or
when there is a significant change in a client’s clinical condition, functional level or living
circumstances. This may include the following: new diagnosis, progression of the disease
process, functional decline or improvement, return from a stay in hospital, change in
caregiver status and/or change in the plan of service.
The CCAC must reassess pediatric long-stay clients, palliative clients and rehabilitation
clients as follows:
•
•
at a minimum of every six months; and
when there is a significant change in a client’s clinical condition, functional level or living
circumstances. This may include the following: new diagnosis, progression of the disease
process, functional decline or improvement, return from a stay in hospital, change in
caregiver status and/or change in the plan of service.
The CCAC must reassess short-stay clients when there is a significant change in a client’s
clinical condition, functional level or living circumstances. This may include the following:
new diagnosis, progression of the disease process, functional decline or improvement, return
from a stay in hospital, change in caregiver status and/or change in the plan of service.
6.2.6 Monitoring and Revision of Plan of Service
The CCAC’s responsibility to revise the plan of service is set out in the LTCA:
(c) evaluate the person’s plan of service and revise it as necessary when the person’s
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of service.
There are currently no regulations relating to the evaluation and revision of a plan of service.
However, the plan of service can only be changed if the client’s requirement’s change.
Service monitoring, like service planning, is a dynamic process. Depending on the person’s
condition or circumstances, the client and/or caregiver, the case manager, and contracted
service providers and physicians as appropriate must:
•
•
•
interactively and regularly review the client’s requirements;
evaluate the plan of service in consideration of the changing needs of the client; and
measure client outcomes against previously agreed upon goals and commitments.
The case manager must monitor and revise the plan of service as necessary when the client’s
requirements change. The CCAC does not have the authority to revise a client’s plan of service
unless the client’s requirements change.
To monitor service allocation for each client, the case manager must solicit and review
information including the following:
•
•
•
•
contracted service provider reports;
client and/or caregiver and physician input;
client and/or caregiver, contracted service provider and case manager conferences, and
telephone calls; and
case manager reassessment of client needs.
6.2.7 Service Termination
The CCAC case manager must begin service termination planning when the client is admitted
and continue the process throughout the time services are being provided. Service termination
planning may focus on terminating all services or on terminating a single service among the
range of services the client is receiving.
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The case manager must:
•
•
•
work with the client to plan for service termination when planning goals, developing a plan
of service to meet these goals, and monitoring the client’s progress towards the goals;
collaborate with the client, caregivers and contracted service providers throughout the
client’s service to identify and link the client with ongoing supports that may be required by
the client when the CCAC services are no longer required or appropriate to meet the
client’s service needs; and
determine when to discharge a client.
The CCAC must terminate services when the client no longer requires services, the client is no
longer eligible for services, the client withdraws his or her consent, or the client is no longer
available to receive services. For example:
•
•
•
•
The client has reached the service and treatment care goals and no longer requires service.
The client and/or caregiver have been trained to provide the necessary care and can carry
out the care without further supervision and support.
Other available resources outside the home setting may meet the client’s care requirements.
The client’s needs cannot be met in the home setting.
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6.3 Case Management Staff Qualifications
6.3.1 Position Requirements for the Case Manager
CCAC clients often have health conditions that require multi-dimensional assessments to be
provided by a health or social work professional whose scope of practice includes
comprehensive assessments.
A case manager must be qualified to undertake the core functions of: assessment; eligibility
determination; service planning (plan of service development and resource allocation); service
co-ordination; reassessment; monitoring and revision of plan of service; and service
termination (discharge).
The minimum qualification for persons that undertake these core functions in a CCAC is that
the person be a registered health or social work professional. This includes, but is not limited
to, a registered nurse, physiotherapist, occupational therapist, speech-language pathologist,
social worker, dietitian and psychologist. These professionals are required to be members in
good standing of their regulatory body.
Case managers should be trained as capacity evaluators to assess a person’s capacity to consent
to admission to a long-term care (LTC) home. Not all health and social work professionals may
act as evaluators of capacity to consent to admission to a LTC home. For example, dietitians
are not evaluators of capacity for this purpose.
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6.4 Supports to the Case Management Function
The Community Care Access Centre (CCAC) must ensure that an efficient and cost effective
staffing model is in place to support the case management functions.
Staff who do not have professional qualifications to carry out core case management functions
may support the case management process by performing administrative tasks; however, these
staff will still require decision-making skills and a sound understanding of the case manager
role.
Examples of activities that may be undertaken by other staff include, but are not limited to:
•
•
•
•
•
•
•
•
•
•
•
•
directing calls received to the appropriate case manager or contracted service provider;
obtaining basic information on intake to assist case managers to determine eligibility and
facilitate access to program and community resources;
ordering prescribed services, equipment and supplies approved by the case manager;
scheduling services;
cancelling drug benefit authorizations;
notifying contracted service providers of changes to plans of service;
handling communications of a non-urgent, non-case management nature;
documenting receipt of reports;
flagging reports requiring review by the case manager;
assisting to maintain the client’s record;
undertaking follow-up calls to identified persons at the request of the case manager; and
researching community options on request.
The above are examples of tasks that the CCAC may reasonably delegate to other staff and
should not be considered responsibilities that must be undertaken by staff with professional
qualifications. The delegation of these tasks will enable case managers to concentrate on
activities that require their professional expertise.
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Chapter 7
This chapter describes the community services available to Community Care Access Centre
(CCAC) clients including professional, personal support and homemaking services.
7.1 Professional Services
The Long-Term Care Act, 1994 (LTCA) states:
s. 2(7) For the purpose of this Act, the following are professional services:
1. Nursing services.
2. Occupational therapy services.
3. Physiotherapy services.
4. Social work services.
5. Speech-language pathology services.
6. Dietetics services.
7. Training a person to provide any of the services referred to in paragraphs 1 to 6.
8. Providing prescribed equipment, supplies or other goods.
9. Services prescribed as professional services.
Professional services includes the direct provision of the listed professional services as well as,
where appropriate, the training of a person to provide any of these professional services.
There are currently no regulations relating to equipment, supplies or goods prescribed under
paragraph 8 and no additional services prescribed under paragraph 9 of subsection 2(7).
7.1.1 Eligibility for Professional Services
Regulation 552 of the Health Insurance Act (HIA) states:
s. 13 (1) In this section
"home care facility" means,
(a) a local board of health of a municipality or a health unit, or
(b) an agency,
approved by the Minister to provide home care services;
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"home care services" means,
(a) the services that are provided, on a visitation basis, by a nurse or a nursing assistant,
(b) the services provided, on a visiting basis, by a physiotherapist, occupational therapist,
speech therapist, social worker or nutritionist,
(c) the provision of dressings and medical supplies,
(d) the provision of diagnostic and laboratory services,
(e) the provision of hospital and sickroom equipment,
(f) the provision of transportation services to and from the home to a hospital, health facility or
the attending physician's office, as the case may be;
"nurse" means a nurse who holds a certificate of registration under Part IV of the Health
Disciplines Act;
"nursing assistant" means a nursing assistant who holds a certificate of registration under Part
IV of the Health Disciplines Act;
"professional service" means nursing, physiotherapy, occupational therapy and speech therapy
services.
(2) Each home care facility is prescribed as a health facility under the Act and is designated as
a health facility for the purpose of section 34.
(3) Home care services provided by a home care facility to an insured person in his or her
(4) It is a condition of payment for insured services under subsection (3) that,
(a) Revoked;
institution;
services" in subsection (1);
(e) the services are provided in the insured person's home where such has been approved by
the Minister as being suitable to enable the required care to be given;
(f) the services are available in the area where the insured person resides; and
(g) the services are reasonably expected to result in progress towards rehabilitation.
(5) Physiotherapy, occupational therapy and speech therapy provided by a home care facility
to an insured person who,
(a) is a resident in a nursing home;
(b) is a resident in a home for the aged, established and maintained under the Homes for the
Aged and Rest Homes Act; or
(c) is a resident in a charitable institution approved under the Charitable Institutions Act,
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are prescribed as insured services.
(6) It is a condition of payment for insured services under subsection (5) that,
(a) Revoked;
(b) Revoked;
(d) the services are available in the area of the facility in which the insured person is a
resident; and
(e) the services are reasonably expected to result in progress toward rehabilitation.
Pursuant to the above provisions, the CCAC only has authority to provide professional services
to persons who are insured under the Health Insurance Act (HIA) (i.e., have Ontario Health
Insurance Plan (OHIP) coverage) and meet the criteria set out above in subsection 13(4). The
CCAC must provide these services on a visitation basis in the person’s home, including group
homes, supportive housing settings and retirement homes.
The CCAC only has authority to provide the supplies, diagnostic and laboratory services,
equipment and transportation as set out in the definition of “home care services” above if the
person also needs at least one professional in-home service (i.e., nursing, physiotherapy,
occupational therapy and speech therapy. Note that social workers and dieticians are excluded
from the definition of professional services for this purpose.)
In addition, the CCAC only has authority to provide physiotherapy, occupational therapy and
speech therapy to residents in a long-term care (LTC) home who meet the eligibility criteria set
out in subsection 13(6) above.
The CCAC has no authority to provide LTC home residents with nursing, social work or
nutrition services.
(See section #7.5 in this manual for information on drug benefits for CCAC clients.)
7.1.2 Service Maximums for the Provision of Nursing Services
Regulation 386/99 of the LTCA states:
s. 4(1) A community care access centre shall not provide a person with more than the lesser of
the following amounts of nursing services:
1. 28 visits from a registered nurse or a registered practical nurse in a seven-day period.
2. The following number of hours of service in a seven-day period:
i. if services are provided by registered nurses, 43 hours of service,
ii. if services are provided by registered practical nurses, 53 hours of service, or
iii. if the services are provided by both registered nurses and registered practical nurses,
48 hours of service.
Note: There are no regulated service maximums for the other professional health services
provided by the CCAC.
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7.1.3 Description of Professional Services
Notes:
•
•
•
All regulated health professions governed under the Regulated Health Professions Act,
1991 (RHPA) have a scope of practice statement within their profession specific act that
broadly defines the practice of the profession. While the RHPA sets out activities that are
authorized to certain professions, there is an exemption that will allow anyone to perform
these activities if they are provided in the course of assisting a person with routine activities
of living.
Social work is regulated under the Social Work and Social Services Work Act, 1998
(SWSSWA) and not by the RHPA. The SWSSWA provides for a self-governing and selffunding regulatory college to govern both social workers and social service workers.
College membership is required from any person in Ontario who uses the titles of "social
worker" or "social service worker."
Further information on each professional service can be found in the service schedule in the
provincial CCAC procurement documents (posted on the Ontario Association of
Community Care Access Centres (OACCAC) web site).
Nursing: The scope of practice for nursing is the promotion of health and the assessment of the
provision of care for, and the treatment of, health conditions by supportive, preventive,
therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function.
Dietetics: The scope of practice of dietetics is the assessment of nutrition and nutritional
conditions, and the treatment and prevention of nutrition-related disorders by nutritional means.
Occupational Therapy: The scope of practice of occupational therapy is the assessment of
function and adaptive behaviour and the treatment and prevention of disorders that affect
function or adaptive behaviour to develop, maintain, rehabilitate or augment function in the
areas of self-care, productivity and leisure.
Physiotherapy: The scope of practice of physiotherapy is the assessment of physical function
and the treatment, rehabilitation and prevention of physical dysfunction, injury or pain to
develop, maintain, rehabilitate or augment function or to relieve pain.
Social Work Services: The social work profession enables individuals, families and
communities to develop the skills and abilities necessary to optimize their functioning and thus
reduce the risk of psychosocial breakdown.
Social work services arranged or provided through the CCAC may include but are not limited
to the following situations:
•
•
adjustment to altered health or social status;
support and counselling to care providers;
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•
•
•
Chapter 7
crisis intervention;
behaviour problems; and
domestic elder abuse.
Speech-Language Pathology: The scope of practice of speech-language pathology is the
assessment of speech and language functions, and the treatment and prevention of speech and
language dysfunctions or disorders to develop, maintain, rehabilitate or augment oral motor or
communicative functions. The provision of speech-language pathology services for children in
publicly funded schools is a shared responsibility with the Board of Education. (See subsection
#9.1 in this manual for an overview of CCAC school services.)
Note: The scope of practice of each professional service includes training a person to provide
any of those services.
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7.2 Personal Support and Homemaking Services
7.2.1 Personal Support Services
s. 2(6) For the purpose of this Act, the following are personal support services:
1. Personal hygiene activities.
2. Routine personal activities of living.
3. Assisting a person with any of the activities referred to in paragraphs 1 and 2.
4. Training a person to carry out or assist with any of the activities referred to in paragraphs 1
and 2.
6. Services prescribed as personal support services.
There are currently no equipment, supplies or other goods prescribed under paragraph 5 and no
additional services prescribed under paragraph 6 of subsection 2(6).
Description of Personal Support Services
Personal Hygiene Activities
Personal hygiene activities include but are not limited to:
•
•
•
•
•
•
•
•
washing/bathing/showering/bed bath;
dressing/undressing;
assistance with grooming;
mouth care;
hair care;
preventive skin care;
changing simple dry dressings; and
routine hand/foot care.
Note: Routine foot care consists of the non-invasive procedures of clipping and filing nails,
bathing and massaging the feet, and monitoring the condition of the feet. Only attendants or
personal support workers with the appropriate training may undertake this function.
Advanced foot care (e.g., scaling calluses or surgical procedures) is not provided as a
personal support service but only as a professional service.
Routine Personal Activities of Living
Routine personal activities of living include but are not limited to:
September 2006
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•
•
•
•
•
•
•
•
•
•
•
Chapter 7
assistance with eating;
assistance with mobility;
transferring/positioning/turning;
assistance with toileting;
supervision/bedside care and monitoring;
bladder routines (including empty/change leg bag, clean intermittent catheterization);
bowel routines;
assisting the person to take pre-measured medications;
exercising;
tracheostomy care (e.g., shallow suctioning) where the needs of the person are stable;
and
assisting with essential communication, for example Bliss boards, augmentative
communication.
A procedure is considered to be a routine personal activity of living when the need for the
procedure, the response to the procedure, and the outcome of performing the procedure are
established over time and, as a result, are predictable. The same procedure may be a routine
activity of living in one set of circumstances and part of a therapeutic plan of care in
another.1
The following procedures are considered routine personal activities of living. Each client
situation must be reviewed by a health professional to determine if it is appropriate for a
personal support worker to perform any of the following tasks. The personal support worker
must be trained to carry out the procedure for the specific client regardless of how
straightforward it appears to be.2
•
•
•
•
•
•
•
•
shallow suctioning;
medications;
oxygen;
clean intermittent catheterization;
enemas and suppositories;
G, G/J tube feedings;
changing simple dry dressings; and
augmentative communication.
Note: The Community Care Access Centre (CCAC) and the professional contracted service
provider must develop local guidelines for transferring routine activities of living to
personal support workers. Guidelines must comply with the requirements of the health
professional regulatory colleges and be included in the contractual agreement between the
CCAC and the contracted service provider.
1
2
Utilization of Unregulated Care Providers (UCPs): A Guide to Making Decisions, College of Nurses, March 2001, p. 4.
Guidelines for RNs and RPNs Working with Unregulated Care Providers, College of Nurses of Ontario, May 1996, p. 5.
September 2006
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Further information on personal support and homemaking services can be found in the service
schedule in the provincial CCAC procurement documents (posted on the Ontario Association
of Community Care Access Centres (OACCAC) web site).
Eligibility for Personal Support Services
s. 2.1 A community care access centre shall not provide personal support services to a person
unless the community care access centre determines that the person is an insured person under
the Health Insurance Act.
A CCAC does not have the authority to provide personal support services to a person unless the
person is an insured person under the Health Insurance Act (HIA) (i.e., has an Ontario health
card). The CCAC is required to provide personal support services to retirement home residents
beyond what the operator provides through his or her agreement with the resident. The CCAC
must assess whether persons residing in supportive housing require these services if assisted
living services in supportive housing (ALSSH) are available. 3
Service Maximums for Homemaking and Personal Support Services
s. 3(1) A community care access centre shall not provide a person with more than the following
number of hours of homemaking and personal support services:
1. 80 hours, in the first 30 days that follow the first day of service.
2. 60 hours, in any subsequent 30-day period.
(2) The maximum amounts referred to in subsection (1) apply only with respect to homemaking
services and personal support services that,
(a) are provided by or arranged by a community care access centre; and
(b) are provided to a person at his or her place of residence.
Provision of Additional Personal Support and Homemaking Services in Extraordinary
Circumstances
s. 3(3) Despite subsection (1), a community care access centre may provide more than the
maximum number of hours of homemaking and personal support services set out in that
subsection for a period of up to 30 days if the community care access centre determines that
there exists extraordinary circumstances that justify the provision of additional services.
3
A CCAC case manager cannot assume that all clients living at a particular address would be assisted living services in
supportive housing clients.
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A situation is deemed to be extraordinary when the client’s service requirements exceed the
allowable service maximums, all other service options have been exhausted, and the higher
level of service is necessary to support the person until alternative arrangements are made.
Situations where this might apply include but are not limited to the following:
•
•
•
•
palliative care clients who require a more intensive level of service to support them to
remain at home for end of life care;
clients who require additional services on a short-term basis until they are stabilized or
alternative arrangements for care can be made;
clients awaiting an emergency admission into a long-term care home; and
crisis situations where the client’s caregiver is ill and the client cannot be left alone.
7.2.2 Homemaking Services
The LTCA states:
s. 2(5) For the purpose of this Act, the following are homemaking services:
1. Housecleaning.
2. Doing laundry.
3. Ironing.
4. Mending.
5. Shopping.
6. Banking.
7. Paying bills.
8. Planning menus.
9. Preparing meals.
10. Caring for children.
11. Assisting a person with any of the activities referred to in paragraphs 1 to 10.
12. Training a person to carry out or assist with any of the activities referred to in paragraphs
1 to 10.
14. Services prescribed as homemaking services.
Note: Regulation 33/02 of the Community Care Access Corporations Act, 2001 (CCACA)
provides that the CCAC no longer has the authority to provide ironing and mending.
There are currently no equipment, supplies or other goods prescribed under subsection 2(5)13
and no additional homemaking services prescribed under subsection 2(5)14.
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Chapter 7
Description of Homemaking Services3
•
Housecleaning: Housecleaning refers to light cleaning only. Heavy housecleaning may be
provided only in exceptional situations where conditions in the person’s setting pose a
severe risk to health or safety (e.g., where months of neglect have resulted in the presence
of animal/human waste or physically unsafe surroundings). In cases in which the required
cleaning and disinfecting are beyond the scope of services provided by homemaking
agencies, the services of a company that specializes in industrial/residential cleaning may
be required.
In these situations, a preliminary heavy cleaning may be required prior to initiating
homemaking services. The CCAC must only provide heavy cleaning in exceptional
circumstances.
•
Banking, paying bills, planning menus and preparing meals: In situations where the
client or caregiver cannot perform these services, the CCAC may arrange for these services
to encourage the independence of the client.
•
Caring for children: Caring for children refers to the support and assistance provided to a
child when the parent/guardian cannot undertake the physical care associated with the child
because of the parent’s/guardian’s health care requirements (e.g., due to the parent’s
physical disability, illness, or specific post-surgical condition). The parent/guardian may be
at home and capable of directing the child’s care, or the parent/guardian may be absent
from the home for a medical reason or because of an emergency of a short-term duration.4
Short-term in this context means a period not exceeding 12 hours. However, the time
period may be extended in crisis situations and in accordance with service maximums. (See
service maximums in subsection #7.2.1 in this manual.) The parent/guardian does not have
to be receiving other services through a CCAC in order to be eligible for child care services
in the home.
In general, caring for children as a homemaking service involves the tasks that
parents/guardians would undertake on a day-to-day basis if they were physically able to do
so. It does not involve carrying out the early childhood education activities. Child care
services include but are not confined to the following tasks:
•
•
•
•
3
4
infant care;
bathing, dressing and feeding (toileting, transferring);
assisting the children to get ready for school; and
preparing school lunches.
While there are no regulations relating to these matters, this section provides policy direction on these services.
If the parent/guardian leaves the home, he or she must designate a substitute decision-maker.
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Child care services in this context should not be confused with a service to a child who is
ill or disabled and who may require direct service in his or her own right.
Child care services provided or arranged by the CCAC may not be used as a substitute for
private child minding or professional day care or child care services. All other options must
be exhausted before providing child care services (e.g., partner, spouse or other relative is
not able to provide child care, no other child care service is available in the community,
nursing infant must be close to the ailing parent).
Eligibility for Homemaking Services
When determining eligibility for homemaking services, the CCAC must comply with the
regulations under the LTCA. The LTCA states:
s. 2(2) A person is eligible to receive homemaking services if,
(a) the person requires personal support services along with the homemaking services;
(b) the person receives personal support and homemaking services from a caregiver who
requires assistance with the homemaking services in order to continue providing the person
with all the required care; or
(c) the person requires constant supervision as a result of a cognitive impairment or acquired
brain injury and the person's caregiver requires assistance with the homemaking services.
"caregiver" means a family member, friend or other person who,
(a) has primary responsibility for the care of an applicant for homemaking or personal support
services or of a person who receives such services, and
(b) provides that care without remuneration.
Personal Support Required for Homemaking Services
A person who is assessed to require assistance with personal support will be eligible to receive
homemaking services if:
•
•
•
•
the CCAC provides the personal support services; or
the person’s caregiver provides the personal support services; or
another agency provides the personal support services; or
despite having been assessed as eligible for personal support services, and despite
experiencing great difficulty in doing so, the person insists on managing his or her own
personal support. This recognizes that some CCAC clients may decline assistance with
personal support because of concerns about loss of control, dignity or privacy.
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Limitations on Eligibility
A person receiving homemaking services must have an Ontario health card in order to prove
that he or she is insured under the Ontario Health Insurance Plan (OHIP). Regulation 386/99 of
the LTCA states:
Eligibility for homemaking services
s. 2(1) A community care access centre shall not provide homemaking services to a person
unless the community care access centre determines that the person is an insured person under
the Health Insurance Act and is eligible under this section to receive homemaking services.
(See chapter #3 in this manual for OHIP eligibility criteria.)
Persons residing in some settings are not eligible for homemaking services. Regulation 386/99
of the LTCA states:
s. 2(4) A person is not eligible to receive homemaking services if the person is a tenant in a
care home within the meaning of the Tenant Protection Act, 1997 or is a resident in a nursing
home under the Nursing Homes Act, an approved charitable home for the aged under the
Charitable Institutions Act or a home under the Homes for the Aged and Rest Homes Act.
This provision ensures that the CCAC does not replicate services that a care home or long-term
care (LTC) home provides as part of their agreement with the tenant or resident.
A CCAC has no authority to provide homemaking services to residents in retirement homes or
tenants in supportive housing sites.
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Chapter 7
7.3 Management of Waiting Lists for CCAC Services
Waiting list
Waiting lists are a method of allocating resources in a prioritized manner when resources are
not immediately available to a client that has been assessed to require the service(s).
The Community Care Access Centre (CCAC) must establish and maintain waiting lists for the
services they provide in accordance with section 23 of the LTCA. The CCAC must also
establish and maintain waiting lists for long-term care (LTC) homes admission based on
priorities established in legislation. (See chapter #12 in this manual for management of waiting
lists for LTC homes.)
The CCAC must prioritize clients on the waiting list based on the following:
•
•
•
•
the client’s condition;
the client’s support system;
the availability of other community resources; and
the CCAC’s prioritization system.
The CCAC must maintain a separate waiting list for each service and monitor the waiting list to
address changes in priority needs.
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Chapter 7
7.4 Ambulance Services for CCAC Clients
7.4.1 Eligibility Criteria
Ambulance services are insured services under section 15 of Regulation 552, made under the
Health Insurance Act (HIA), where the following conditions are met:
•
•
•
•
•
the person to whom the ambulance services are provided is an insured person under the
Health Insurance Act;
the services are medically necessary;
the services are provided by an ambulance service operator listed in Schedule 7 of
Regulation 552, which includes a number of ambulance service operators in communities
throughout Ontario;
the hospital to or from which the services are required is listed in Schedule 1 of 4 of
Regulation 552 or is graded under the Public Hospitals Act as a Group A, B, C, E, F, G, J or
R hospital, which categories include many hospitals throughout Ontario; and
the person to whom the services are provided pays the applicable co-payment for the
service, set out in Regulation 552, if any (the exceptions are described in section 15(6)).
Notes:
•
•
•
Ambulance service is not an insured service if it is not medically necessary, as determined
by a physician.
In emergency situations, the choice of the destination health care facility is determined by
the ambulance communications officer (dispatcher) in accordance with the needs of the
patient. In the absence of such a determination by dispatch, the patient will be transported
to the closest health care facility that can provide the care apparently required by the
patient.
While the primary purpose and function of ambulances are to respond to emergencies,
ambulances are also used for non-emergency purposes, e.g., transportation to and from
scheduled hospital appointments/long term care homes for a patient who needs a stretcher.
There are many private medical transportation services in the province that are used by
patients for non-emergency transfers on a fee for service basis.
7.4.2 Role of the CCAC Case Manager
The case manager must assess the client’s transportation needs and if the client requires
ambulance transportation, the case manager must determine if the client meets the ambulance
eligibility criteria, authorize the ambulance transport and ensure the service is ordered. If the
client does not require ambulance transportation, the case manager must discuss with the client
other modes of transportation (e.g., accessible taxis, stretcher-capable private medical transport
service and medical transportation services operated by volunteer agencies) and payment
options.
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The Community Care Access Centre (CCAC) must develop local procedures for authorizing
and ordering ambulances. The procedures must include emergency measures.
7.4.3 Co-payment Exemption
A number of people are exempt from the co-payment (i.e., invoice) for ambulance services,
including people who are:
•
•
•
•
•
•
•
CCAC clients (receiving home care services);
transferred from a hospital to another hospital;
transferred from a hospital to a medical laboratory or public health laboratory;
transferred from a hospital to a facility registered under the Healing Arts Radiation
Protection Act (HARPA) for the purpose of radiological examination or treatment;
transferred from a hospital to a centre (as per the HIA);
receiving provincial social assistance; and
residents in a long-term care (LTC) home.
7.4.4 Important Information for the CCAC
The Medical Air Transport Centre for air ambulance will determine whether clients should
travel on chartered services or scheduled airlines.
For up-to-date telephone number and fax number for the Medical Air Transport Centre, see the
Ministry of Health and Long-Term Care (MOHLTC) website at:
[http://www.gov.on.ca/MOH/english/program/ambul/airamb.html]
For further details on criteria for selection of air versus land transport, see the document
entitled A Guide to Choosing Appropriate Patient Transportation, available through the
Emergency Health Services Branch of the MOHLTC, and through the ambulance transition
website at: [http://www.ambulance-transition.com].
7.4.5 Criteria for Selecting Air Rather than Land Ambulance
Air ambulance may be selected when one or more of the following criteria are met:
•
•
•
the transfer involves a one way travel distance greater than 240 kilometres (150 miles);
all land alternatives have been exhausted and it is not feasible to assign a land ambulance;
and/or
specialized equipment and/or escorts or paramedical staff are required.
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Chapter 7
7.5 Drug Benefits for CCAC Clients
Persons receiving home care services which are insured under the Health Insurance Act (HIA)
are eligible to receive drug benefits under the Ontario Drug Benefit (ODB) Program. The ODB
Program covers over 3,200 quality-assured drug products which are listed in the Ontario Drug
Benefit Formulary/Comparative Drug Index (Formulary/CDI) which can be accessed at:
[http://www.health.gov.on.ca/english/providers/program/drugs/odbf_eformulary.html].
Community Care Access Centre (CCAC) clients are only required to pay a $2 co-payment
charge for prescription drug products covered under the ODB Program.
7.5.1 Role of the Case Manager
The role of the case manager is to explain the ODB Program to appropriate clients, determine
eligibility, authorize ODB coverage if the client is eligible, and terminate coverage when the
client is no longer eligible. The case manager may also explore payment options for drugs not
listed in the Formulary/CDI for ODB-eligible persons under the individual review mechanism
provided for in section 8 of the Ontario Drug Benefit Act (ODBA).
7.5.2 Benefit Coverage
A person must need at least one professional service in the home in order to be eligible for a
drug card.
Drug coverage remains in place for the duration of the treatment period. Coverage may be
renewed if the client is still receiving professional services after the original coverage expires
and it is terminated when eligibility/assessed need for the professional service ends.
The CCAC case manager completes the Drug Benefit Eligibility card (form #2654-87(97/10))
in triplicate:
•
•
•
Copy 1 is provided to the client and retained by the pharmacy.
Copy 2 is forwarded by the CCAC to the Ministry of Health and Long-Term Care
(MOHLTC).
Copy 3 is attached to the client’s file.
All hard copies of drug cards are numbered sequentially and must be accounted for by the
CCAC. A record should be kept of the numbers on drug cards received from the ODB Program
and of every card issued. The CCAC should also provide regular updates to local pharmacies
regarding clients’ ODB status (i.e., inform pharmacies of drug card expiries). Pharmacies must
keep the Drug Benefit Eligibility card on file for a period of two years.
Another way of authorizing coverage is through the CCAC’s local automated system. Through
the local automated system the pharmacy receives notification by autofax.
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Chapter 7
The CCAC must inform the client’s pharmacy as soon as coverage is discontinued. This is
particularly important when the termination occurs prior to the expiry date of the benefit
period.
7.5.3 Ontario Residents Aged 65 Years and Over
All Ontario residents who have a valid Ontario health card are eligible for ODB coverage on
the first day of the month following their 65th birthday. The ODB Program uses the Health
Network System, an online information system which links all Ontario pharmacies and
dispensaries to the MOHLTC for the real-time processing and adjudication of claims.
7.5.4 Senior Co-payment
Seniors aged 65 years and over may pay a $2 or a $6.11 co-payment. The co-payment amount
is based on the individual’s or couple’s net income, which is based on the most recent taxation
year.
If a person aged 65 years and older has an annual net income of less than $16,018.00 or if the
combined income of the eligible person and his or her spouse or partner is less than $24,175.00,
they may be charged a co-payment of up to $2 per prescription.
Notes:
•
•
The minimum co-payment is not automatic for low-income seniors or senior couples.
Seniors with incomes below the income threshold must apply to become eligible for the $2
co-payment by submitting a co-payment form to the MOHLTC.
A person residing in a long-term care (LTC) home or home for special care (defined in the
Homes for Special Care Act (HSCA)) automatically qualifies for the $2 co-payment.
Seniors who have an income greater than the above income thresholds pay the first $100 of the
cost of prescription drugs (combined total of the cost of the drug product and the dispensing
fee) in every 12-month period, commencing August 1 of each year. Only allowable drug
expenses can count towards the $100 deductible, namely, prescriptions for drug products listed
in Part III of the Formulary/CDI, prescriptions for nutrition products and diabetic testing agents
approved as benefits under the ODB Program, as well as extemporaneous products that are
designated pharmaceutical products under the ODBA regulations. The ODB deductible and copayment are tracked through the Health Network System according to the ODB benefit year.
For the balance of the ODB benefit year, these seniors pay a maximum of $6.11 toward the
ODB dispensing fee on each prescription.
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Chapter 7
7.5.5 Requests Under Section 8 of the Ontario Drug Benefit Act
Requests from ODB eligible persons for coverage of drug products that are not listed in the
Formulary/CDI may be considered by the MOHLTC under the individual clinical review
mechanism provided for in section 8 of the ODBA.
The CCAC case manager will inform the referring physician that the client’s drugs are not
listed in the Formulary/CDI and discuss options (e.g., the physician could provide alternate
medication or, if appropriate, the physician could apply for coverage under section 8 of the
ODBA).
The individual clinical review (or section 8) mechanism of the ODBA is reserved for situations
where:
•
•
the drug is not covered under another government program; and
there are no Formulary/CDI alternatives to treat severe life-threatening, organ-threatening
conditions or diseases that would otherwise cause severe debilitating effects.
The individual clinical review (or section 8) mechanism of the ODBA is not intended to be
used:
•
•
•
to request drugs that treat self-limiting conditions/symptoms;
for patient “convenience”; or
to continue clients previously enrolled in clinical trials of new drugs once these drugs are
approved for marketing.
To apply for special coverage under section 8 of the ODBA, the client’s physician must send a
written request to the Drug Programs Branch, including a concise clinical description and
therapeutic plan.
7.5.6 Trillium Drug Program
CCAC clients who are not eligible for the ODB Program (e.g., children only receiving CCAC
school services), but who have high drug expenses in relation to their income may be eligible
for coverage under the Trillium Drug Program. Each year starting August 1, drug costs must be
paid up to the deductible level before eligibility for coverage begins. The Trillium Drug
Program recipients may pay up to a $2 co-payment towards the dispensing fee of an ODBcovered drug product once the deductible has been met.
Additional information about the Trillium Drug Program is available at 1-800-575-5386.
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Chapter 7
7.6 Influenza Services
Community Care Access Centres (CCACs) may provide influenza vaccinations to a current
CCAC client who has a physician's prescription. In addition, the CCAC may pay for on-site
vaccinations of staff.
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Chapter 7
7.7 Residential Hospices
In October 2005 the government announced Ontario’s End-of-Life (EOL) Care Strategy to
improve end-of-life care services at home and in the community. One objective of the EOL
Care Strategy is to shift care of the dying from the acute setting to appropriate alternate settings
of individual choice. Although many individuals would prefer to receive end-of-life care at
home, for some this is not possible. Therefore, the EOL Care Strategy includes funding support
for residential hospices in over 30 communities by 2007-2008. The approved hospices and
communities were identified in the Residential Hospice Backgrounder of the Ministry of
Health and Long-Term Care (MOHLTC) News Release for the End-of-Life Care Strategy,
October 4, 2005 at:
[http://www.health.gov.on.ca/english/media/news_releases/archives/nr_05/bg_100405b.pdf].
A residential hospice is a home-like environment where adults and children with lifethreatening illnesses receive end-of-life care services. The current priority is given to free
standing residential hospices and does not include beds in long-term care (LTC) homes,
supportive housing, homeless shelters or hospitals.
The funding support for residential hospices approved by the MOHLTC is being provided
through the Community Care Access Centres (CCACs). Residential hospices have the option of
either:
1. receiving a funding envelope to independently employ nursing and personal support
services, with an accountability agreement through the CCAC; or
2. receiving enhanced hours of service of nursing and personal support through the CCAC.
Access to all other CCAC services is based on the individual’s needs and are outside of any
direct funding relationship with the residential hospice. Services provided through the CCAC
are governed under the Long-Term Care Act, 1994 (LTCA).
If the residential hospice chooses the first option of receiving the funding envelope:
•
•
•
•
•
The CCAC must negotiate an accountability agreement with the residential hospice using the
template developed by the Ontario Association of Community Care Access Centres
(OACCAC) and provide the designated funding envelope from the MOHLTC to the
residential hospice.
The funding can only be used for nursing and personal support services to support clients in
residential hospice beds. Staffing must include 24/7 Registered Nursing (RN) coverage.
The purchase of nursing and personal support services is exempt from the Client Services
Procurement Policy for Community Care Access Centres, July 2003.
Residential hospice resident days and expenditures are reconciled annually. The residential
hospice is permitted to retain 100% of the funding provided the hospice maintains a
minimum of 80% occupancy.
When the hospice initially begins admitting clients the need to maintain a minimum
occupancy level of 80% is waived for the first three months.
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Chapter 7
The equivalency of one and a half months of funding is available prior to admitting clients to
support recruiting, hiring and training of nursing and personal support staff.
If occupancy is less than 80%, the amount of subsidy the residential hospice is permitted to
retain is reconciled based on actual bed resident days.
If the residential hospice chooses the second option:
•
The CCAC must use the designated funding from the MOHLTC to provide nursing and
personal support services in the residential hospice through CCAC contracted service
provider(s).
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Chapter 8
8.1 Home Oxygen Program
The Assistive Devices Program (ADP) of the Ministry of Health and Long-Term Care
(MOHLTC) administers the Home Oxygen Program (HOP). Oxygen is not included as a
benefit under the Ontario Drug Benefit (ODB) Program.
The Community Care Access Centre (CCAC) is not responsible for the provision of oxygen
and related equipment.
The CCAC case manager may help CCAC clients to access information about HOP, may assist
clients to obtain the application forms and to complete necessary documentation to apply for
the program.
8.1.2 Eligibility
The HOP pays for oxygen and related equipment for eligible Ontario residents. Residents who
have an illness resulting in the need for oxygen therapy may apply. Applicants must have a
valid Ontario health card and meet the medical criteria (see subsection #8.1.4 in this manual).
Eligibility for Long-Term Oxygen Funding
The person’s medical condition must be stabilized and treatment regimen optimized before
long-term oxygen therapy is considered. The person must have chronic hypoxemia on room air
at rest – PaO2 of 55mmHg or less or SaO2 of 88% or less.
Some applicants with a persistent PaO2 in the range of 56 to 60mmHg may be considered
candidates for long-term oxygen therapy if the following medical conditions are present:
•
•
•
cor pulmonale;
pulmonary hypertension; or
persistent erthrocytosis.
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Also some persons with a persistent PaO2 in the range of 56 to 60mmHg may be candidates for
long-term oxygen if the following occurs:
•
•
exercise limited by hypoxemia and documented to improve with supplemental oxygen; or
nocturnal hypoxemia.
Eligibility for Funding for Oxygen for Palliative Care
Special consideration is given to persons at the end stage of a terminal disease receiving
palliative care who do not meet the medical criteria. Persons who are identified as receiving
palliative care may receive funding assistance for a maximum of 90 days. If oxygen is required
after the 90-day period, the medical criteria must be met. In this instance, oximetry tests are
acceptable.
The vendor bills the MOHLTC.
8.1.3 Persons Not Eligible
The following are not eligible for funding assistance from the HOP:
•
•
•
people who require oxygen due to work related injuries; or
people who are eligible for benefits through the Department of Veteran Affairs (DVA)
Group “A”; or
people who are in acute, chronic or rehabilitation hospitals.
8.1.4 Funding
For eligible Ontario residents, the HOP may fund 100% of the monthly cost of a basic oxygen
system. Vendors can supply a liquid system or concentrator and/or cylinders. The ADP pays a
flat monthly rate regardless of the system supplied except for cylinders which get a per cylinder
rate according to the person’s oxygen needs. To qualify for 100% coverage, a person must meet
the medical criteria and be:
•
•
•
•
receiving in-home professional services through the CCAC; or
65 years or older; or
a social assistance recipient; or
a resident in a long-term care (LTC) home.
The HOP may fund 75% of the monthly cost of a basic oxygen system according to the
person’s oxygen needs. To qualify for 75% coverage a person must be 64 years or younger and
must meet the medical criteria, and should not fall into any of the categories listed immediately
above.
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8.1.5 Application Procedure for Home Oxygen Program Funding
The HOP application form is available from oxygen vendors and must be completed by the
physician and a registered oxygen vendor. New HOP applicants must submit arterial blood gas
results with the first application. Applicants who meet medical eligibility criteria receive
approval for 90 days. To continue HOP funding, an oximetry test must be submitted at the end
of the 90-day period. HOP clients who continue to meet the medical eligibility criteria receive
funding for an additional 12 months. A final oximetry test must be submitted at the end of the
12-month period confirming eligibility. At that time, ongoing funding is approved and
continues until HOP is notified that oxygen therapy has been discontinued.
8.1.6 Registered Vendor
A registered oxygen vendor supplies and monitors the oxygen equipment. A list of registered
vendors can be obtained from the HOP. Registered vendors agree to follow HOP policies and
must not charge more than the program-approved price for oxygen and approved equipment.
They may charge less if they choose.
8.1.7 Hospital Replacement Program Pilot Project – Short Term Oxygen Therapy
Effective August 1, 2005, the ADP introduced the Hospital Replacement Program (HRP) Pilot
Project, which will be part of the HOP. The pilot project will run for two years, beginning in
2005 and concluding in 2007.
The intent of the HRP is to prevent a person with an acute respiratory condition from being
admitted to hospital or, in the case of hospitalization, allows the individual to be discharged
earlier by providing funding assistance for short term oxygen therapy.
To receive funding assistance through the HRP, the individual’s condition must be such that
early discharge from hospital or avoiding hospitalization with short-term home oxygen therapy
and other appropriate support services is recommended by the prescribing physician.
An applicant with an acute respiratory condition such as, but not restricted to, an acute
exacerbation of COPD, pneumonia, pulmonary emboli or post-operative lung surgery is
eligible to apply for funding assistance if the individual exhibits hypoxemia at rest. For the
HRP, hypoxemia at rest is defined as PaO2 less than or equal to 60mmHg. If the individual
meets the general and medical eligibility criteria funding assistance is provided for up to 60
days.
Access to the HRP occurs through one of four methods:
1. Emergency room physicians, who have diagnosed their patient with an acute respiratory
condition and have determined that the use of short-term home oxygen therapy, along with
appropriate support services, will result in an early discharge from the hospital or avoid
hospitalization.
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2. Attending physicians, who have diagnosed their patient with an acute respiratory condition
and have determined that the use of short-term home oxygen therapy, along with
appropriate support services, will result in an early discharge from the hospital.
3. CCAC case managers, located in the hospital or discharge planners who have identified a
patient with an acute respiratory condition that could potentially be discharged from the
hospital. The attending physician would then determine if short-term home oxygen therapy,
along with appropriate support services, would result in an early discharge from the
hospital.
4. Family physicians, who have diagnosed their patient with an acute respiratory condition
and have determined that the use of short-term oxygen therapy, along with appropriate
support services, will avoid hospitalization.
8.1.8 HRP Application Process
1. Applicants to the HRP use the regular HOP application form that is used by all HOP
clients.
2. The prescribing physician must complete section 2 of the HOP application form, clearly
indicating in section 2, that the applicant is applying to the HRP. The physician can do this
by recording the phrase “Hospital Replacement Program” directly on the application form.
The home oxygen service provider cannot complete this section.
3. When applying to the HRP, arterial blood gas results must be provided. The arterial blood
gas results must be within one day of the physician’s prescription date.
4. A separate HRP questionnaire must be completed for all applicants to the HRP. The
questionnaire can be completed by the health care professional from the home oxygen
service provider. Data collected from the questionnaire will be used to evaluate the program
at the end of the two-year period. Copies of the Hospital Replacement Program
Questionnaire have been provided to all ADP registered home oxygen service providers
and can be printed from the MOHLTC website at:
[http://www.health.gov.on.ca/english/providers/program/adp/hrp/questionnaire.pdf].
5. The completed questionnaire should be attached to the application and submitted to the
ADP.
6. Funding assistance is provided for up to 60 days. If funding assistance is required beyond
the 60-day funding period, the client must apply to the regular HOP and must meet the
general and medical eligibility criteria and submit arterial blood gases.
CCACs will be notified when the pilot project is completed.
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8.2 Northern Health Travel Grant Program
The Ministry of Health and Long-Term Care (MOHLTC) provides travel grants to help defray
the cost of transportation for eligible residents of northern Ontario who must travel a long
distance to receive medical specialist services that are not available locally. Unless advance
funding is provided through Northern Health Travel Grant Program designated third party
agencies, the person incurs the cost of transportation and is later reimbursed, if eligible. Travel
grants are paid based on the two-way road distance a client travels, less a 100 kilometre
deductible. The grants do not cover all of the client’s travel costs, such as meals or
accommodation. In the event a designated third party agency advances funds to an eligible
client, the third party agency claims the grant on behalf of the client.
The Community Care Access Centre (CCAC) case manager may help CCAC clients to access
information about the Northern Health Travel Grant Program and may assist clients to obtain
the application forms. The case manager may refer clients to social workers when clients
require assistance to complete the forms.
8.2.2 Eligibility
A person is eligible for the Northern Health Travel Grant if:
•
•
•
•
•
•
the person lives in the territorial Districts of Algoma, Cochrane, Kenora, Manitoulin,
Nipissing, Parry Sound, Rainy River, Sudbury, Thunder Bay or Timiskaming;
the person has a valid Ontario health card;
the person is referred for specialty health care that is an insured service under the Health
Insurance Act (HIA);
a northern Ontario physician, dentist, optometrist, chiropractor, midwife or nurse
practitioner has referred the person before the travel takes place;
the person has been referred to a dental or medical specialist who is certified by the Royal
College of Physicians and Surgeons of Canada, or to a designated health facility; and
the nearest specialist or designated health facility in Ontario or Manitoba is at least 100
kilometres from the person’s area of residence.
8.2.3 Additional Conditions
The amount of the grant is based on the two-way road distance to the nearest specialist or
health facility that can provide the required service and not necessarily the one the person
chooses to visit. A deductible of 100 kilometres on the trip is applied. If it is necessary to travel
to a specialist other than the nearest one, the referring practitioner must provide written
information on the application, explaining why this is medically necessary.
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Chapter 8
A companion grant may be paid if:
•
•
the applicant is under 16 years of age; or
the referring health care practitioner indicates in section 3 of the grant application form,
before the travel takes place, that a companion for the individual is necessary because the
individual is under 16 years old, or for health and safety reasons (e.g., the person is in a
wheelchair or is cognitively impaired).
If the individual is transported one way by ambulance, the person is eligible for a one-way
grant.
If travel is by plane, train or bus, and both the person and the escort have paid a fare, both the
person and the escort may receive a grant. If travel is by car, the person and the escort can
apply for an equal share of one grant.
8.2.4 Exclusions
An individual does not qualify for the grant if:
•
•
•
•
•
•
the care is related to a Workplace Safety and Insurance Board claim;
another government program or organization pays for the individual’s travel;
the service is covered by an insurance company;
the person travels round trip by ambulance;
the services are not provided by a certified medical or dental specialist; or
the nearest specialist is within 100 kilometres of the person’s area of residence.
8.2.5 Obtaining Application Forms
The MOHLTC Application for Northern Health Travel Grant form (#014-0327-88) can be
printed from the MOHLTC website at:
[http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?openform&ENV=W
WE&NO=014-0327-88]. Northern Ontario general practitioners, specialists, dentists,
optometrists, chiropractors, and the CCAC or local MOHLTC office may also have printed
versions of the application form.
8.2.6 Completing the Application Forms and Deadline for Submission
The application form must be completed by:
•
•
•
•
the applicant;
the referring health practitioner, specialist, or technician if a procedure is performed within
a health care facility;
a third party agency, if applicable; and
a travelling companion, if involved.
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Applications must be received by the MOHLTC office within 12 months from the date the
person receives health care services from the specialist or designated health care facility. For
more information, visit the MOHLTC website at:
[http://www.health.gov.on.ca/english/public/pub/pub_menus/pub_ohip/.html], or contact the
Northern Health Travel Grant Program at 1-800-461-4006 (English), or 1-800-461-1149
(French).
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Chapter 9
CCAC School Services*
9.1 Overview of CCAC School Services
Community Care Access Centre (CCAC) school services are provided to children/youths in
publicly funded and private schools and to children/youths who are being home schooled to
assist them in pursuing their education. The student must require the services in order to be able
to attend school, participate in school routines and receive instruction, including receiving
satisfactory instruction at home. In other words, in the absence of school services, the
child’s/youth’s school attendance, instruction or participation would be significantly disrupted.
CCAC school services include professional school services and personal support school
services. Professional school services are provided to children/youths in publicly funded and
private schools and to children/youths who are being home schooled. CCAC personal support
school services are only provided to children/youths in private schools and to children/youths
who are being home schooled
9.1.1 Children/Youths in Publicly Funded Schools
Children/youths enrolled in publicly funded schools have access to a range of professional
school services: nursing, physiotherapy, occupational therapy, speech-language pathology and
dietetics. These services are provided through CCAC contracted service providers and include
the training of school personnel and provision of necessary medical supplies, dressings and
treatment equipment.
The CCAC provides access to these professional school services for children/youths with
medical and/or rehabilitation needs to enable them to attend school, participate in school
routines and receive instruction.
Personal support school services are not provided by the CCAC to students in publicly funded
schools. School boards are responsible for accommodating the needs of public school students
for assistance with routine personal activities of living. Social work services are not provided
through the CCAC in publicly funded school settings. Public school resources deal with
psycho-social needs of students that need to be addressed while attending public school.
* Note: Current regulations under the Long-Term Care Act, 1994 distinguish between “school services” (which are
professional services (i.e., nursing, therapies, etc.) and “personal support school services.” To provide clarity in this manual
“school services” are referred to as “professional school services” and “personal support school services” are referred to as
“personal support school services.” When referring to both these services, the term “school services” is used.
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CCAC professional school services are provided in publicly funded schools by the Ministry of
Health and Long-Term Care (MOHLTC), the Ministry of Education and Training (EDU), and
the Ministry of Community and Social Services (MCSS), pursuant to the following:
1. Policy/Program Memorandum No. 81 (PPM81), July 19, 1984, available at:
[http://www.edu.gov.on.ca/extra/eng/ppm/81.html]. This policy memorandum sets out the
responsibility of the MOHLTC for funding the provision of health services for
children/youths with special needs who would have difficulty attending school, if at all,
were they not to receive these services. The policy also addresses joint responsibilities of
the MOHLTC and school boards for medications, lifting, positioning, general maintenance
exercises, feeding and toileting.
2. Memorandum regarding Catheterization and Suctioning, August 14, 1989; Clarification of
Policy/Program Memorandum No. 81. This memorandum was issued in response to
questions raised about PPM81, in order to clarify the responsibilities for different types of
catheterization and suctioning, as follows:
•
•
Clean catheterization and shallow surface suctioning are recognized as part of a child’s
normal toileting and oral hygiene needs and can be administered by the child or school
board staff. Training and direction for these procedures may be provided by the parent
or the CCAC.
Sterile intermittent catheterization and deep suctioning are administered by a health
professional provided by the CCAC.
3. Interministerial Guidelines for the Provision of Speech and Language Services 1988
(MCYS, EDU, MOHLTC), available at:
[http://www.edu.gov.on.ca/extra/eng/ppm/81.html]. This memorandum clarifies the shared
responsibilities of CCACs and school boards relating to the provision of speech therapy, as
follows:
•
•
•
1
The school board is responsible for the initial assessment to determine if the primary
concern is speech production or a language disorder.
The CCAC is responsible for children/youths who have problems because speech
production is difficult.
The Interministerial Guidelines for the Provision of Speech and Language Services
were developed in 1985 and revised in 1988 to provide direction to public schools and
home care programs1about their responsibilities in the provision of speech and language
services. This 1988 version also supercedes references to speech and speech
pathology/therapy in PPM81.
Precursors to the CCAC.
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•
Medical disorders that the CCAC manages fall primarily under the following diagnostic
areas:
•
•
•
•
•
•
Chapter 9
articulation/speech sound production problems caused by motor speech disorders
including dyspraxias and dysarthrias;
non-speech communication (assessment for and prescription of and orientation to
augmentative and alternative methods of communication);
fluency disorders such as stuttering;
voice disorders (e.g., hoarseness and/or nasal speech due to vocal nodules and cleft
lip palate); and
swallowing disorders.
CCACs do not provide speech therapy for children/youths who primarily have a
language disorder. School boards are responsible for providing these services to
children/youths who have a language disorder (i.e., do not have the ability to translate
thoughts into verbal expression and to understand others, and do not have reading and
spelling skills that are prerequisite for acquiring literacy skills).
CCACs must provide professional school services in accordance with PPM81 and all other
relevant memoranda and guidelines. CCACs must not assume any of the responsibilities of
school boards as outlined in PPM81 and all other relevant memoranda and guidelines.
9.1.2 Children/Youths in Private Schools and Home Schooling Situations
Children/youths enrolled in private schools or receiving instruction at home have access to a
range of professional school services and personal support school services: nursing,
physiotherapy, occupational therapy, speech-language pathology, dietetics, and personal
support services such as personal hygiene activities and routine activities of living. These
school services can be purchased directly2 or accessed through CCAC contracted service
providers.
Social work services are not provided through the CCAC in private schools and home
schooling situations.
The CCAC provides access to these professional school services and personal support school
services to children/youths with medical and/or rehabilitation needs to enable them to attend
school, participate in school routines and receive satisfactory instruction at home. In other
2
Purchased services means that the CCAC provides funding directly to a transfer payment agency. The agency in turn
provides funding to the private school or the parent/guardian in home schooling situations, who is then responsible for
locating and hiring the service provider.
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Chapter 9
words, in the absence of school services, the child’s/youth’s school attendance, instruction or
participation would be significantly disrupted.
CCACs are required to provide the initial assessment for speech-language pathology for
children/youths in private schools or receiving home schooling. The CCAC funds private
schools and parents/guardians providing home schooling (through an agency) for the treatment
of speech disorders primarily in the diagnostic areas listed above in subsection #9.1.1, point “3”
in this manual.
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9.2 Eligibility for CCAC School Services
Community Care Access Centre (CCAC) school services are governed by the Long-Term Care
Act, 1994 (LTCA). The regulations under the LTCA refer to the terms “school” and “private
school” as they are defined under the Education Act (EA). The following are the definitions of
these terms under the EA:
s. 1(1)“school” means,
(a) the body of elementary school pupils or secondary school pupils that is organized as a unit
for educational purposes under the jurisdiction of the appropriate board, or
(b) the body of pupils enrolled in any of the elementary or secondary school courses of study in
an educational institution operated by the Government of Ontario,
and includes the teachers and other staff members associated with the unit or institution and
the lands and premises used in connection with the unit or institution;
“private school” means an institution at which instruction is provided at any time between the
hours of 9 a.m. and 4 p.m. on any school day for five or more pupils who are of or over
compulsory school age in any of the subjects of the elementary or secondary school courses of
study and that is not a school as defined in this section;
In addition, the regulations under the LTCA refer to subsection 21(1)(a) of the EA relating to
home schooling. Subsection 21(1)(a) of the EA states:
s. 2(2) A child is excused from attendance at school if,
(a) the child is receiving satisfactory instruction at home or elsewhere; …
9.2.1 Eligibility for Professional School Services
Section 5 of regulation 386/99 of the LTCA states:
s. 5(1) “school” means a school as defined in subsection 1 (1) of the Education Act and
includes a private school as defined in subsection 1 (1) of that Act.
“school services” means the following professional services that are provided to a person who
is enrolled as a pupil at a school on the school premises or while the pupil is being transported
to or from the school on a school bus or other school vehicle or participating in a school trip
or activity outside the school premises or that are provided to a person who is receiving
satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act and
are necessary in order for the person to be able to receive instruction:
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Chapter 9
1. Nursing services.
2. Occupational therapy services.
3. Physiotherapy services.
4. Speech-language pathology services.
5. Dietetics services.
6. Training of school personnel to provide the services referred to in paragraphs 1 to 5 to
persons enrolled as a pupil at the school.
7. The provision of medical supplies, dressings and treatment equipment necessary to the
provision of the services referred to in paragraphs 1 to 5.
Clarification: Professional school services are defined in regulation 386/99 of the LTCA as
nursing services, occupational therapy services, physiotherapy services, speech-language
services and dietetics services. These services include the training of school personnel and
provision of necessary medical supplies, dressings and treatment equipment.
s. 5(2) A community care access centre shall not provide school services to a person unless the
person meets the following eligibility criteria:
Clarification: A CCAC does not have the authority to provide professional school services to a
person unless the person meets the following eligibility criteria:
s. 5(2)1. The person must be enrolled as a pupil at a school or be receiving satisfactory
instruction at home in accordance with clause 21 (2) (a) of the Education Act.
Clarification: A child/youth up to the age of 21 must be either enrolled in a publicly funded
school or private school or receiving satisfactory instruction at home in order to be eligible for
these professional school services. More information is available on the Ministry of Education
and Training (EDU) website at: [http://www.edu.gov.on.ca/eng/funding/].
s. 5(2)2 The person must require the services,
i. in order to be able to attend school, participate in school routines and receive instruction, or
ii. in order to be able to receive satisfactory instruction at home in accordance with clause 21
(2) (a) of the Education Act.
Clarifications:
•
3
The CCAC may provide professional school services at the school or while the pupil is
being transported to or from publicly funded school or private school or participating in
publicly funded school or private school related activities (see subsection #9.5 in this
manual for additional information) in other locations3. The professional school services
For example, early screening may be done in a clinic setting.
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•
Chapter 9
must be necessary in order for the child/youth to be able to attend publicly funded school or
private school, participate in publicly funded school or private school routines and receive
instruction. In other words, in the absence of professional school services, the
child’s/youth’s publicly funded school or private school attendance, instruction or
participation would be significantly disrupted.
The CCAC must not assume responsibility for determining what constitutes “satisfactory
instruction at home.” In order for a child/youth who is receiving home schooling to be
eligible for professional school services, the parent/guardian must provide the CCAC with a
letter from the relevant school board indicating that the child/youth is excused from
attendance at school because he or she is receiving “satisfactory instruction at home.”
Policy/Program Memorandum No. 131 (PPM131), dated June 17, 2002, addresses the
services offered by the MOHTLC and sets out the process a parent/guardian should follow
in order to obtain the appropriate documentation, including a sample letter. PPM131 and
the sample letter are available on the EDU website at:
[http://www.edu.gov.on.ca/extra/eng/ppm/131.html].
s. 5(2)3 The person must be an insured person under the Health Insurance Act.
(See chapter #3 in this manual for Ontario Health Insurance Program (OHIP) eligibility
criteria.)
s. 5(2)4 The school or home in which the service is to be provided must have the physical
features necessary to enable the service to be provided.
Clarifications:
•
•
The setting in which the professional school services are to be provided must be conducive
to providing the service such as having enough space to allow the use of necessary
equipment and supplies, and privacy to allow appropriate treatment to be given.
The CCAC must use their best efforts to adapt their service provision to the available
surroundings. However, when such adaptations cannot be made, the CCAC must discuss
alternative courses of action with the child/youth/parent/guardian and/or publicly funded or
private school in order to avoid declaring a child/youth ineligible for professional school
services on this basis.
s. 5(2)5 The risk that a service provider who provides the school service to the person who
requires the service will suffer serious physical harm while providing the service,
i. must not be significant, or
ii. if it is significant, the service provider must be able to take reasonable steps to reduce the
risk so that it is no longer significant.
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Clarification: The CCAC must use their best efforts to mitigate any risk to the point where it is
no longer a serious risk to the contracted service provider in order to avoid declaring a
child/youth ineligible for professional school services on this basis.
9.2.2 Eligibility for Personal Support School Services
Section 7 of regulation 386/99 of the LTCA states:
s. 7(1) “school” means a private school as defined in subsection 1 (1) of the Education Act;
s. 7(1) “personal support school services” means the following personal support services that
are provided to a person who is enrolled as a pupil at a school on the school premises or
during a school trip or activity outside the school premises or that are provided to a person
who is receiving satisfactory instruction at home in accordance with clause 21 (2) (a) of the
Education Act and are necessary in order for the person to be able to receive instruction:
1. Personal hygiene activities.
2. Routine personal activities of living.
3. Training of school personnel to provide the services referred to in paragraphs 1 and 2 to
persons enrolled as pupils at the school and assisting the personnel in providing them.
4. The provision of medical and personal equipment necessary to the provision of the services
referred to in paragraphs 1 and 2.
Clarification: Personal support school services are defined in regulation 386/99 as personal
hygiene activities and routine personal activities of living. These services include the training
of school personnel and provision of treatment equipment necessary to the provision of the
services. Personal hygiene activities and routine personal activities of living in the context of
private and home schools include assistance with eating, dressing and toileting (including clean
catheterization), personal hygiene (including shallow suctioning), mobility, transferring,
positioning, and routine exercises taught by a therapist (physiotherapist, occupational therapist,
speech-language pathologist).4
s. 7(2) A community care access centre shall not provide personal support school services to a
person unless the person meets the following eligibility criteria:
Clarification: A CCAC does not have the authority to provide personal support school services
to a person unless the person meets the following eligibility criteria:
s. 7(2)1 The person must be enrolled as a pupil at a school or be receiving satisfactory
instruction at home in accordance with clause 21 (2) (a) of the Education Act.
4
MOHLTC Memorandum regarding Personal Support Services and Equipment in Private and Home Schools, January 8,
2001.
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Chapter 9
Clarification: A child/youth up to the age of 21 must be either enrolled in a private school or
receiving satisfactory instruction at home in order to be eligible for these personal support
school services. More information is available on the EDU website at:
[http://www.edu.gov.on.ca/eng/funding/].
s. 7(2)2 The person must require the services,
i. in order to be able to attend school, participate in school routines and receive instruction, or
ii. in order to be able to receive satisfactory instruction at home in accordance with clause 21
(2) (a) of the Education Act.
Clarifications:
•
•
The CCAC may provide personal support school services at the private school or while the
pupil is being transported to or from private school or participating in private school related
activities (see subsection #9.5 in this manual for additional information) in other locations5.
The personal support school services must be necessary in order for the child/youth to be
able to attend private school, participate in private school routines and receive instruction.
In other words, in the absence of personal support school services, the child’s/youth’s
private school attendance, instruction or participation would be significantly disrupted.
The CCAC must not assume responsibility for determining what constitutes “satisfactory
instruction at home.” In order for a child/youth who is receiving home schooling to be
eligible for personal support school services, the parent/guardian must provide the CCAC
with a letter from the relevant school board indicating that the child/youth is excused from
attendance at school because he or she is receiving “satisfactory instruction at home.”
Policy/Program Memorandum No. 131 (PPM131), dated June 17, 2002, addresses the
services offered by the MOHTLC and sets out the process a parent/guardian should follow
in order to obtain the appropriate documentation, including a sample letter. PPM131 and
the sample letter are available on the EDU website at:
[http://www.edu.gov.on.ca/extra/eng/ppm/131.html].
s. 7(2)3 The person must be an insured person under the Health Insurance Act.
(See chapter #3 in this manual for Ontario Health Insurance Program (OHIP) eligibility
criteria.)
s. 7(2)4 The school or home in which the service is to be provided must have the physical
features necessary to enable the service to be provided.
5
For example, early screening may be done in a clinic setting.
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Clarifications:
•
•
The setting in which the personal support school services are to be provided must be
conducive to providing the service such as having enough space to allow the use of
necessary equipment and supplies, and privacy to allow appropriate treatment to be given.
The CCAC must use their best efforts to adapt their service provision to the available
surroundings. However, when such adaptations cannot be made, the CCAC must discuss
alternative courses of action with the child/youth/parent/guardian and/or private school in
order to avoid declaring a child/youth ineligible for personal support school services on this
basis.
s. 7(2)5 The risk that a service provider who provides the service to the person who requires it
will suffer serious physical harm while providing the service,
i. must not be significant, or
ii. if it is significant, the service provider must be able to take reasonable steps to reduce the
risk so that it is no longer significant.
Clarification: The CCAC must use their best efforts to mitigate any risk to the point where it is
no longer a serious risk to the contracted service provider in order to avoid declaring a
child/youth ineligible for personal support school services on this basis.
9.2.3 Overview of Services Offered by CCAC
Publicly Funded Schools
Private Schools
Home Schooling
Situations
Nursing, physiotherapy,
occupational therapy,
specified speech-language
pathology after school board
provides initial assessment,
dietetics
pathology (including initial
assessment), dietetics
pathology (including initial
assessment), dietetics
Personal support services
Personal support services
Training of school personnel
Training of school personnel
Training of parent/guardian
The provision of medical
supplies, dressings and
treatment equipment relating
to professional school services
treatment equipment relating
to professional school services
as well as the provision of
medical and personal
treatment equipment
relating to professional
school services as well as
the provision of medical
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Publicly Funded Schools
Chapter 9
Private Schools
Home Schooling
Situations
equipment relating to personal
support school services
and personal equipment
relating to personal support
school services
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9.3 Service Maximums
Service maximums for CCAC school services are regulated under the Long-Term Care Act,
1994 (LTCA).
9.3.1 Private and Publicly Funded Schools – No Service Maximums
There are no service maximums for Community Care Access Centre (CCAC) school services
provided in public and private schools. However, subsection 4(3) of regulation 386/99 of the
LTCA states:
s. 4(3) In determining the maximum amount of nursing services that may be provided to a
person under this section, a community care access centre shall not include any nursing
services that are provided as school services under sections 5 and 6.
Clarification: Subsection 4(3) of regulation 386/99 provides that the CCAC must not include
the hours of nursing services provided to a child/youth in a publicly funded school, private
school or in a home schooling situation through CCAC school services when determining the
maximum amount of nursing services that can be provided to a child/youth as part of in-home
nursing services. Children/youths who receive CCAC school services may also receive
professional services at home.
9.3.2 Home Schooling Situations – Service Maximums
There are service maximums for children/youths receiving professional school services and
personal support school services while being home schooled. regulation 386/99 of the LTCA
states:
s. 6 A community care access centre that provides school services to a person who is receiving
satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act shall
not provide more than six hours of school services a day to that person, five days a week.
s. 7(3) A community care access centre that provides personal support school services under
this section to a person who is receiving satisfactory instruction at home in accordance with
clause 21 (2) (a) of the Education Act shall not provide more than six hours of those services a
day to that person, five days a week.
Clarification: The CCAC must not provide more than six hours of professional school services
or personal support school services a day, five days a week to a child/youth who receives home
schooling. However, regulation 386/99 of the LTCA states:
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s. 3(4) In determining the maximum amount of personal support services that may be provided
to a person under this section, a community care access centre shall not include any personal
support school services provided under section 7.
Clarification: Subsection 3(4) of regulation 386/99 provides that the CCAC must not include
the hours of personal support school services provided to a child/youth in a private school or in
a home schooling situation through CCAC school services when determining the maximum
amount of personal support services that can be provided to a child/youth as part of in-home
personal support services.
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9.4 Equipment Relating to School Services
9.4.1 Medical Supplies, Dressings and Treatment Equipment Relating to
Professional School Services
Professional school services include the provision of medical supplies, dressings and treatment
equipment necessary to the provision of nursing services, occupational therapy services,
physiotherapy services, speech-language pathology services, and dietetics services to eligible
children/youths. Subsection 5(1)7 of regulation 386/99 of the Long-Term Care Act, 1994
(LTCA) states that “school services” include “the provision of medical supplies, dressings and
treatment equipment necessary to the provision of the services referred to in paragraphs 1 to
5.” The eligibility criteria and case management functions set out in subsection #9.2.1 in this
manual apply to these medical supplies, dressings and treatment equipment.
Clarification: The child/youth or his or her parent/guardian is responsible for the provision and
transportation of any specialized long-term treatment equipment required for the child/youth to
participate in school which is not related to the provision of school services, for example, a
wheelchair.6
The Community Care Access Centre (CCAC) case manager may authorize the provision of
treatment equipment to an eligible child/youth through the CCAC school services when one of
the following conditions applies:
•
•
•
the treatment equipment is required for a trial period prior to purchase and requires
monitoring and evaluation by an Assistive Devices Program (ADP) authorizing
professional;
the treatment equipment is not available through ADP and is essential to support the
child’s/youth’s medical treatment/rehabilitation needs (as opposed to education related
needs, such as a communication device or customized desk, which is the responsibility of
the school board); or
the child/youth has a short-term need for the treatment equipment.
Note: The CCAC does not provide Ontario Drug Benefits (ODBs) to children who are only
receiving school services.
Treatment Equipment Selection
To facilitate the provision of treatment equipment, the CCAC case manager must:
6
A child/youth may be eligible to receive assistance to obtain equipment for long-term use from the Ministry of Health and
Long-Term Care (MOHLTC) as per Assistive Devices Program (ADP) requirements.
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•
•
•
•
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assess a child’s/youth’s need for equipment or request a therapist to do the assessment for
this equipment;
select the most cost effective equipment;
authorize the price of equipment which may include applicable taxes and delivery charges
or monthly rental charges; and
reassess the child/youth if different equipment is subsequently required.
Purchase, Maintenance and Disposal of Treatment Equipment
The purchase, disposal and maintenance of treatment equipment are the responsibility of the
school or the home schooling parent. When the child/youth no longer requires the treatment
equipment, it is the responsibility of the school or parent to determine the best use of the
equipment (e.g., donate to charity).
9.4.2 Medical and Personal Equipment Relating to Personal Support School
Services
Personal support school services include the provision of medical and personal equipment
necessary to the provision of routine hygiene activities and routine personal activities of daily
living. Subsection 7(1)4 of regulation 386/99 of the LTCA states that “personal support school
services” include “the provision of medical and personal equipment necessary to the provision
of the services referred to in paragraphs 1 and 2”. The eligibility criteria and case management
functions set out in subsections #9.2.1 and #9.2.2 in this manual, respectively apply to these
medical supplies, dressings and treatment equipment.
The medical and personal equipment required must be necessary to the provision of personal
support school services. Examples include standers, grab bars, lifts, adaptive seating equipment
(e.g., wedges, wrist weights and weighted vests), commode chairs, change tables, suction
machines, adaptive feeding equipment, lifts and wheelchair tables.
The CCAC case manager must authorize the purchase of the following medical and personal
equipment:
•
equipment that is covered by the Ministry of Health and Long-Term Care (MOHLTC) ADP
required for the home and the school setting and problematic to transport, (e.g., suction
machine)7; and
7
In this case, a second piece of equipment may be necessary. The second piece of equipment does not have to be identical
to the original piece but must be functionally appropriate for the purpose for which it is required, e.g., more conducive to
travel or accommodated to functioning in a smaller space.
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•
Chapter 9
equipment that is not covered by the ADP but is needed to support the provision of personal
support school services as determined by a professional assessment (e.g., transfer boards).
Medical and Personal Equipment Not Provided
The CCAC does not provide the following medical and personal equipment:
•
•
educational equipment that allows the child/youth to access the curriculum (e.g., frequency
modulation (FM) systems for children/youths who are hard of hearing, Braille printers and
custom designed desks); and
equipment associated with modifying the school or home infrastructure. This may include,
elevators, stair glides, special toilets, handrails for stairs, ramps, locked medication
cupboard and cardio-pulmonary equipment.
Medical and Personal Equipment Selection
To facilitate the provision of medical and personal equipment, the case manager must:
•
•
•
•
assess a child’s need for equipment or request a therapist to do the assessment for
equipment;
select the most cost effective equipment;
authorize the price of equipment which may include applicable taxes and delivery charges
or monthly rental charges; and
reassess the child/youth if different equipment is subsequently required.
Purchase, Disposal and Maintenance of Medical and Personal Equipment
The purchase, disposal and maintenance of medical and personal equipment are the
responsibility of the school or the home schooling parent/guardian. When the child/youth no
longer requires the equipment, it is the responsibility of the school or parent/guardian to
determine the best use of the equipment (e.g., donate to charity).
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9.5 Transportation Relating to School Services
It is the not the responsibility of the Community Care Access Centre (CCAC) to transport
children/youths to publicly funded or private school. The CCAC provides school services to
eligible children/youths while they are being transported to or from school on a school bus or
other school vehicle or are participating in a school trip or activity outside the school premises.
The CCAC may only provide school services when the child/youth being transported:
•
•
is at risk of significant physical injury during transportation; and
the skills of a nursing professional are required within scope of practice.
A child/youth who is home schooled is also eligible for nursing services while being
transported in a private vehicle to attend an organized activity directly related to the education
of the child/youth as long as the child/youth meets the above criteria. The CCAC does not
provide school services in relation to casual activities that are not related to the child’s/youth’s
education.
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9.6 Case Management Function Relating to the Provision of
The Community Care Access Centre (CCAC) case manager must assess the child’s/youth’s
requirements, determine eligibility for school services and for each eligible child/youth,
develop and authorize a plan of service that sets out the amount of service to be provided in
accordance with the Long-Term Care Act, 1994 (LTCA).
When required by the school board, the CCAC is responsible to ensure that case managers have
police clearance/criminal checks in order to be able to access schools/school property.
The CCAC case manager must manage the plan of service between the child/youth, the
parent/guardian, the school and the contracted service provider as well as:
•
•
•
•
•
interpret CCAC school service policies and guidelines;
collaborate in planning for the integration of school services to complement existing school
programs;
make recommendations about specific supplies and dressings and facilitate access to certain
specialized equipment to meet the program goals;
track units of service for these services, as required by the Management Information System
(MIS); and
facilitate harmonious relationships among the parties.
The CCAC case manager must review the child’s/youth’s requirements when appropriate.
Depending on the child’s condition and circumstances, the review can be in consultation with
the contracted service provider, parent/guardian and school personnel as appropriate. It is
recommended that the CCAC conduct a review at least once a year. During the course of the
review, the CCAC must evaluate the child’s/youth’s plan of service (outcomes, goals and
timeframes) and revise the plan of service as necessary when the child’s/youth’s requirements
change.
9.6.1 Specific Processes Relating to Provision of CCAC Professional School
Services to Children/Youths Enrolled in Publicly Funded Schools
•
•
For a child/youth enrolled in a publicly funded school, the child’s/youth’s parent and/or an
outside health care professional, if one is involved, should first discuss any need for
professional school services with the principal of the school.
If it is agreed that CCAC professional school services would be appropriate in the situation,
the parties should designate one person to contact the CCAC.
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•
•
•
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The CCAC case manager must contact the school for an appointment to see and assess the
child, with the parent’s consent.
The CCAC must then assess the child’s/youth’s needs, determine whether the child/youth is
eligible for professional school services and if so, develop and authorize a plan of service.
The CCAC provides the professional school services to children/youths in publicly funded
schools through their service providers.
9.6.2 Specific Processes Relating to the Provision of CCAC Professional School
Services and Personal Support School Services to Children/Youths Enrolled
in Private Schools
•
•
•
•
•
•
For a child/youth enrolled in a private school, the parent/guardian should first discuss with
the principal of the school:
• the need for professional school services or personal support school services; and
• the request for a referral.
If it is agreed that CCAC professional school services or personal support school services
would be appropriate in the situation, the principal or parent should then contact the CCAC.
The principal must provide express permission to the CCAC to provide service on school
property.
The CCAC case manager must contact the school for an appointment to see and assess the
child, with the parent’s consent.
The CCAC must then assess the child’s/youth’s needs, determine whether the child/youth is
eligible for either professional school services or personal support school services, or both,
and if so, develop and authorize a plan of service.
The private school may:
• receive funding directly from the CCAC and hire the service provider itself; or
• request in writing that the CCAC arrange the professional school services or personal
support school services on the school’s behalf. The CCAC then refers the matter to the
appropriate contracted service provider.
Where the private school receives funding directly from the CCAC, the following
responsibilities arise:
•
•
enter into a memorandum of understanding with the principal/chief administrator of the
private school;
receive quarterly reports from the private schools and include this information in the
quarterly reports submitted to the Ministry of Health and Long-Term Care (MOHLTC);
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•
•
•
ensure the private school’s quarterly reports identify all expenditures related to the
provision of professional school services and personal support school services (Private
schools may charge the CCAC up to 3% as an administration fee.);
receive annual reconciliation reports from the private schools and provide this information
in the annual reconciliation reports (ARRs) submitted to the MOHLTC (When the amount
of funding is limited, the CCAC may use its discretion regarding the requirement for an
ARR. In these cases, the submission of invoices with the quarterly report may be a less
expensive and a more reasonable accountability mechanism.); and
monitor and be satisfied based on the claims and reports submitted by the CCAC that the
private school has spent the funding provided by the CCAC for approved services,
including the purchase of services and equipment in accordance with the plans of service
for the children/youths enrolled in the private school.
The private school must:
•
•
•
•
•
•
•
enter into a memorandum of understanding with the CCAC;
use the funding provided by CCAC only for approved services, including the purchase of
services and equipment in accordance with the plans of service for the children/youths
enrolled in the private school;
assume all liability related to the provision of services;
hire service providers (When the private school hires staff to provide the approved services,
the private school must use a standard job description and have policies for screening and
supervision of staff. Any staff hired must comply with the requirements set in the Regulated
Health Professions Act, 1991 (RHPA).);
provide a quarterly report to the CCAC;
provide an annual audited reconciliation report at year-end that indicates how their funding
was spent for the provision of approved services in accordance with the plans of service for
the eligible children/youths; and
return any unspent funds to the CCAC.
9.6.3 Specific Processes Relating to the Provision of CCAC Professional School
Services and Personal Support School Services to Children/Youths in Home
Schooling Situations
•
•
For a child/youth in home schooling, the parent/guardian should contact the CCAC directly.
Once the CCAC has assessed a child’s/youth’s needs, determined his or her eligibility and
developed and authorized a plan of service, the CCAC must flow funds for children/youths
schooled at home through a local community agency that is a transfer payment agency of
either the MOHLTC or Ministry of Community and Social Services (MCSS). The CCAC
must flow funding directly to the agency and the agency must agree to act as a banker and
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Chapter 9
flow funds to the parent/guardian who will then purchase the approved services. The CCAC
is responsible for the reconciliation process.
Where the parent/guardian receives funding from the agency, the following responsibilities
arise:
•
•
•
•
•
enter into a memorandum of understanding with the parent/guardian;
enter into a memorandum of understanding with the agency;
receive quarterly receipts from the parent/guardian and include this information in the
quarterly reports submitted to the MOHLTC;
ensure the quarterly reports identify all expenditures related to the provision of professional
school services and personal support school services approved by the CCAC
(Parents/guardians are not permitted to charge an administration fee.); and
monitor and be satisfied based on the claims and reports submitted by the parent/guardian
that the parent/guardian has spent the funding provided by the agency for professional
school services or personal support school services approved by the CCAC, including the
purchase of services and equipment in accordance with the plan of service for the
children/youths being home schooled.
The parent/guardian must:
•
•
•
•
•
•
enter into a memorandum of understanding with the CCAC;
use the funding provided by the agency only for professional school services and personal
support school services approved by the CCAC, including the purchase of services and
equipment in accordance with the plan of service for the child/youth being home schooled;
assume all liability related to the provision of services;
directly hire appropriate and competent service providers (non-family members only) or
contract with an appropriate service provider;
provide quarterly reports identifying all expenditures related to the provision of
professional school services and personal support school services approved by the CCAC
for the child/youth being home schooled; and
return any unspent funds to the CCAC.
The agency must:
•
flow the funds provided to the agency by the CCAC to the parent/guardian.
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9.7 CCAC Approaches to Service Delivery for School Services
Since the introduction of Community Care Access Centre (CCAC) school services, there has
been a dramatic increase in the demand for these services. School children/youths are a unique
client group because of the settings in which they receive school services and the need for their
treatment and care to be integrated into their academic program. These factors have prompted
each CCAC to pursue different approaches to service delivery in order to efficiently serve as
many children/youths as possible. Regardless of the method of intervention or the type of
therapist employed, the CCAC must ensure that:
•
•
•
all procedures are within the scope of practice outlined under the Regulated Health
Professions Act, 1991 (RHPA);
all contracted service providers are trained and competent in the procedures used; and
the procedures offered are in keeping with any site restrictions.
9.7.1 Acceptable Approaches to Service Delivery
The following approaches are acceptable only when deemed to be appropriate by the CCAC
and the school principal (where applicable):
1. Mediator Training: involves demonstrating and teaching tasks to school staff and
volunteers (including the home schooling instructor). Teachers can assist in the supervision
of students in regards to tasks that support the learning process. 8(The role or involvement
of school staff may depend on school policies.)
2. Group Treatment: involves treating children/youths with similar therapy needs in a group.
For example, children/youths requiring life skills teaching can be taught in a group setting
by therapists. Children/youths with similar difficulties may benefit from intensive treatment
programs such as a writing program held in the summer months or a dysfluency treatment
group.
3. Block Treatment/Cycling Model: involves use of a scheduling model based on a cycle of
time when therapy is provided and not provided. Lengths of the interval can also be varied
by cycling the variations (staggering cycle blocks, or staggering the length of blocks or
intervals). After the initial block of treatments, teachers and parents/guardians are trained
on a remedial program for the child/youth. The model can be used for individual or group
treatments.
8
For example, the CCAC may agree to provide some training to teachers so that they would become more adept in
recognizing the level of handwriting/printing difficulties which would benefit from a therapist’s assessment.
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4. Periodic Sessions: involve scheduling of individual treatments at appropriate intervals
(e.g., monthly, every three months). Treatment programs are designed for use at school and
home.
5. Direct Service: involves treatment on a one-to-one basis.
6. Consultation: to exchange knowledge or information in a general, informative way
between the CCAC and the school staff/instructor, as appropriate, i.e., a service care plan
cannot be developed solely based on consultations.
7. Sharing Resources/Cost Sharing Staffing: where the health professional and educational
assistant are working with the same child/youth and it is possible for one person to provide
all the assistance, in cases where appropriate. This promotes continuity of care for the
child/youth.
Once the CCAC and the school principal have agreed on the split responsibilities, the cost
of providing both services by one staff person must be shared between the CCAC and the
public or private school. For example, a medically fragile child/youth with gastric tube
feeds who has an educational assistant for educational needs and a nurse for tube feeds
could have one dually-trained professional to provide both services.
8. Conferences: where case managers and/or contracted service providers may be required to
attend case conferences or meetings to develop or explain plans of service. This is a normal
expectation for the effective delivery of service. The case manager authorizes who attends
case conferences, especially if the CCAC is paying for a contracted service provider to
attend these meetings. Attendance at case conferences may be a service provider contractual
obligation.
9. Service Sites: where the primary service site for the child/youth attending a public or
private school is the school, the child/youth receiving instruction at home has home visits.
Occasionally, a contracted service provider may need to visit a child/youth in locations
other than the school setting. For example, a contracted service provider may be required
to:
•
•
•
•
participate in school day trips;
attend case conferences and meetings not on school property;
attend a specialized assessment requiring the presence of the student’s CCAC therapist
or other contracted service provider;
access specialized equipment not available in the school;
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•
•
•
Chapter 9
provide specialized support during the student’s transportation to and from school or a
school-related activity;
attend co-op placement sites; and/or
conduct assessments in the child’s/youth’s home.
Off-site service would be provided in accordance with the goals of CCAC professional
school services and personal support school services.
10. General Training: while not a primary function of CCAC school services, the CCAC may
authorize training and consultation to parents/guardians, and groups of school staff
regarding provision of school services for eligible children/youths. Examples are training
sessions on proper body mechanics for lifting, positioning and transferring.
Many children have fine motor difficulties that affect their printing skills. CCACs could
provide information to teachers on their professional development days or CCACs could
approach school boards to ask whether they would like information sessions on
professional activity days. While school services may include training on some occasions,
schools have the primary responsibility to teach printing/handwriting skills to their
students. The CCAC may agree to provide some training to teachers so that they would
become more adept in recognizing the level of handwriting/printing difficulties which
would benefit from a therapist’s assessment.
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Chapter 9
9.8 Service Termination in Public, Private and Home Schools
The Community Care Access Centre (CCAC) may terminate a child’s professional school
services or personal support school services if:
•
•
the child/youth and/or parent/guardian are repeatedly not available for scheduled
appointments; or
the provision of continued therapy will not further clinical progress.
The CCAC must terminate professional school services and personal support school services if:
•
•
•
•
the child/youth moves from Ontario;
any of the eligibility criteria cease to be met (for example, if the child/youth receiving
services is no longer an insured person under the Health Insurance Act (HIA);
the child is not enrolled in a publicly funded school or private school or is not being home
schooled; or
the child/youth has reached the age of 21.
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Chapter 9
9.9 CCAC Liaison Activities
The Community Care Access Centre (CCAC) must liaise with publicly funded schools, private
schools and community service agencies to ensure that these groups are fully informed about
the professional school services and personal support school services provided by the CCAC.
During the course of these liaison activities, the CCAC must ensure that they comply with the
laws governing the confidentiality of personal health information.
9.9.1 Publicly Funded Schools and Private Schools
The CCAC, schools and contracted service providers should have regular meetings to discuss
the roles of CCAC staff, school staff and contracted service providers relating to the provision
of services to pupils in schools (e.g., private treatment space, record keeping and information
sharing) and other issues of mutual concern.
Note: Every publicly funded school board must establish a Special Education Advisory
Committee (SEAC) that advises the school board on special education issues. It is important for
the CCAC case manager to liaise with this Committee for information sharing and planning
purposes.
School principals should be aware of service issues and the needs of children/youths in order to
be partners in the provision of CCAC school services and personal support school services.
Parents/guardians and teachers must be aware of these issues as there may be times when they
are directly/indirectly involved with service provision or act as mediators on behalf of the
pupil.
9.9.2 Agencies Providing Service to Preschoolers
Preschool-aged children with special needs may be clients of early intervention programs,
Easter Seal Society, day care centres, public health units, specialty clinics, hospitals or others.
The CCAC and their contracted service providers must liaise with these organizations in order
to ensure a smooth transition from the pre-school agency to CCAC school services when the
child becomes school-aged and to avoid duplication of services.
Note: Children attending day care or nursery schools are not eligible for the provision of
CCAC school services in the day care or nursery school settings as these are not “schools” as
defined under the Education Act (EA).
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Chapter 9
Community Groups
CCAC staff must liaise with community groups in order to promote a comprehensive range of
school services. For example, the CCAC in conjunction with local school boards, children’s
services planning bodies, and parent groups could work together to ensure that available
resources are being efficiently utilized and services are working well together as well as to
develop service priorities and plans based on local needs.
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Chapter 9
9.10 Other Service Delivery Models
Children/youths with health needs may also receive services in the school setting from four
other agencies
9.10.1 Children’s Care and Treatment Facilities and Correctional Facilities
Some children/youths are unable to attend school because of their need for treatment or the fact
that they are incarcerated. Services in children’s mental health treatment programs and
correctional service programs for young offenders are provided by the Ministry of Children and
Youth Services (MCYS). Where the child/youth resident in any of these types of facilities are
unable to attend school, the facilities provide space for an education program to be provided by
a local school board. Children/youths in these facilities are not eligible for Community Care
Access Centre (CCAC) professional school services or personal support school services.
9.10.2 Children’s Treatment Centres
There are six children’s treatment centres (CTCs) with school boards attached in Ontario.
These centres have their own volunteer school boards and provide education programs for the
children who attend the centres. The CCAC may provide specialized nursing services in these
settings. Other health services are provided by the CTC.
9.10.3 First Nations Schools
The federal government, through Indian and Inuit Affairs Canada, funds special education
programs for First Nations children/youths living on reserves. Health Canada may fund the
provision of health services in school for children/youths attending schools on First Nations
reserves.
Children/youths residing in First Nations communities are eligible for CCAC services. The
CCAC must first assess whether these individuals require CCAC services if similar services are
provided through the First Nations community. CCAC services should co-ordinate with and
complement services available in the First Nations community rather than duplicate those
services. To achieve this goal, CCAC staff need to be aware of the services available in First
Nations communities within their service area.
First Nations may purchase services from the CCAC or contracted service providers. In remote
northern areas, First Nations may also purchase services from Integrated Services for Northern
Children (ISNC), a program administered by the MCYS.
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Chapter 9
Note: First Nations children/youths attending public schools off reserves may receive CCAC
school services if they meet the eligibility criteria. The CCAC must assess requirements and
determine eligibility for services on the same basis as any other Ontario resident. The
MOHLTC provides funding to some aboriginal organizations to provide home and community
care services to aboriginal people both on and off reserve. The types and availability of services
vary across the province.
9.10.4 Integrated Services for Northern Children (ISNC)
The ISNC program is a commitment made by the MCYS, the MOHLTC, the Ministry of
Education and Training (EDU), and the Ministry of Northern Development and Mines to
provide a range of health, mental health and education services to children/youths living in
rural and remote areas across northern Ontario.
Since ISNC provides services similar to CCAC professional school services and personal
support school services, the CCAC and ISNC must negotiate roles and responsibilities locally.
For additional information, visit the ISNC website at:
[http://www.children.gov.on.ca/CS/en/programs/SpecialNeeds/integratedServicesforNorthernC
hildren.htm] or call (705) 474-3540 ext. 218 or (705) 564-8153 ext. 341.
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Chapter 9
9.11 Responsibilities in Emergencies
As the management of an emergency situation while a child/youth is attending school or a
school-related activity is the responsibility of the school or home school instructor, it is the
responsibility of the school or home school instructor to arrange any required ambulance
service or any other response to an emergency.
In regards to the payment of ambulance service, a child/youth receiving in-home services as
well as school services is eligible for a fee waiver relating to ambulance services. A child/youth
receiving school services only is not eligible for a fee waiver.
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Chapter 10
This section describes the complaint and appeal processes to be followed by the Community
Care Access Centre (CCAC) with respect to decisions regarding the provision of community
services and admission to a long-term care (LTC) home.
10.1 Complaint Resolution – Community Services
The Long Term Care Act, 1994 (LTCA) provides that the CCAC must establish a process for
reviewing complaints regarding the provision of community services. Section 39 of the LTCA
states:
s. 39(1) An approved agency shall establish a process for reviewing complaints made to it by a
person about any of the following matters:
1. A decision by the approved agency that the person is not eligible to receive a particular
community service.
2. A decision by the approved agency to exclude a particular community service from the
person’s plan of service.
3. A decision by the approved agency respecting the amount of any particular community
service to be included in the person’s plan of service.
4. A decision by the approved agency to terminate the provision of a community service to the
person.
5. The quality of a community service provided to the person or arranged for the person by the
approved agency.
6. An alleged violation by the approved agency of any of the person’s rights set out in
subsection 3 (1).
Complaint under par. 5 or 6 of subs. (1)
s. 39(2) Within 60 days after a complaint is made to an approved agency about a matter
referred to in paragraph 5 or 6 of subsection (1), the approved agency shall review the
complaint and respond to the person who made the complaint.
Complaint under par. 1, 2, 3 or 4 of subs. (1)
s. 39(3) Within 60 days after a complaint is made to an approved agency about a decision
referred to in paragraph 1, 2, 3 or 4 of subsection (1), the approved agency shall,
(a) affirm the decision and give a written notice of the affirmation to the persons referred to in
subsection (4);
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(b) rescind the decision and give a written notice of the rescission to the persons referred to in
subsection (4); or
(c) rescind the decision, substitute a new decision in its place and give a copy of the new
decision to the persons referred to in subsection (4).
Who must be given notice
s. 39(4) A notice under clause (3) (a) or (b) or a copy of a decision under clause (3) (c) shall be
given,
(a) to the person to whom the decision relates; and
(b) if the person to whom the decision relates is mentally incapable, to the person who is
lawfully authorized to make a decision on his or her behalf concerning the community service.
The CCAC must have a formal written process, approved by the board of directors, for
receiving, reviewing and responding to complaints regarding community. The CCAC must
review all complaints in accordance with section 39 of the LTCA.
A complaint may be made to the CCAC by the person affected by the CCAC’s decision or their
substitute decision-maker. Complaints may also be made regarding CCAC services directly to
the Ministry of Health and Long-Term Care (MOHLTC).
10.1.1 Decisions for Which the CCAC Must Have a Complaint Review Process
Pursuant to subsection 39(1) of the LTCA, the CCAC must establish a process for reviewing
complaints made to it by a person about any of the following matters:
•
•
•
•
•
•
a decision by the CCAC that the person is not eligible to receive a particular community
service;
a decision by the CCAC to exclude a particular community service from the person's plan
of service;
a decision by the CCAC respecting the amount of any particular community service to be
included in the person's plan of service;
a decision by the CCAC to terminate the provision of a community service to the person;
the quality of a community service provided to the person or arranged for the person by the
CCAC; or
an alleged violation by the CCAC of any of the person's rights set out in subsection 3(1).
(See the Bill of Rights for people receiving community services in subsection 3(1) of the LTCA
or subsection #2.2.1 in this manual.)
10.1.2 Documentation Relating to Complaints
The CCAC must maintain a written record of all complaints concerning the above matters
including the following information:
•
name of the person who is the subject of the complaint;
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•
•
•
•
•
•
•
•
•
•
•
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name of the person who is making the complaint, if it is different than the person who is the
subject of the complaint;
date of the complaint;
substance of the complaint;
review taken;
outcome of the review;
decision made and/or action taken;
date of the decision and/or action taken;
date feedback was provided to the person or his or her substitute decision-maker;
reaction to the feedback;
any follow-up action required; and
monitoring plan if required.
10.1.3 Steps to Review a Complaint
The CCAC must implement a complaint review process which includes, but is not limited to,
the following steps:
Clarifying the Complaint
The CCAC must listen to the person’s concerns, asking questions to obtain details (What
happened? When and where did it happen? Who was involved?) and attempt to bring all parties
to a consensus on the exact identification of the problem.
Early Resolution Through Information Exchange
It is possible that a complaint has been made as one or both parties have not clearly understood
a particular situation. In addition, the complainant or the CCAC may have additional
information that may affect the outcome of the complaint. The CCAC must attempt to solicit all
relevant and appropriate information that may result in the resolution of the complaint.
Clarifying the Process
If the complaint is not resolved at an early stage, the CCAC must:
•
•
•
determine whether the complainant wishes to pursue the complaint further;
explain the next steps in the complaints process; and
advise the complainant when he or she may expect a response.
Information Gathering
The CCAC must interview staff and the affected person (where appropriate), the contracted
service provider (where appropriate), and review documentation about the situation, such as
application forms, client files, daily logs and incident reports. The CCAC must also review
relevant legislation and agency/government policies.
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Action
Based on the above information, the CCAC must decide whether or not to support the CCAC’s
original decision or action.
If any complaint suggests there is a systemic rather than an individual problem relating to the
provision of community service by the CCAC, the CCAC must review its policies and
procedures and determine whether any changes are necessary. Where system changes are
necessary, the CCAC must make the changes and communicate them to staff to prevent
reoccurrences and, if required, the CCAC must monitor to ensure that new policies and/or
procedures are fully implemented in a timely fashion.
Feedback
Pursuant to subsection 39(2) of the LTCA, the CCAC must review any complaint relating to
quality of service or alleged violation of the Bill of Rights and respond within 60 days to the
person who made the complaint.
Pursuant to subsections 39(3) and (4) of the LTCA, within 60 days after a complaint is made
relating to eligibility, exclusion of a particular community service from the plan of service,
amount of service or termination of service, CCAC must do one of the following:
•
•
•
affirm the decision and give a written notice of the affirmation;
rescind the decision and give a written notice of the rescission; or
rescind the decision, substitute a new decision and provide a copy of the new decision.
The CCAC must provide the notice or copy of the decision to the person to whom the decision
relates or his or her substitute decision-maker.
10.1.4 Reporting Complaints to the MOHLTC
The MOHLTC has implemented a complaint reporting policy for the CCAC. The CCAC must
report all client complaints to the MOHLTC’s regional offices at the time the CCAC submits
its Annual Performance Report. The CCAC must report client complaints based on two
categories:
•
•
client complaints about CCAC decisions, (see subsection #10.1.1 in this manual); and
client complaints about the quality of service by the CCAC and contracted service provider
agencies.
For the purpose of reporting, a complaint is defined as any concern brought forward by a client
or caregiver (or substitute decision-maker) concerning the services provided by the CCAC or
any contracted service provider agency that is not resolved at the level of the case manager (i.e.,
the client/caregiver is referred to the manager/executive director for follow up). A complaint
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can relate to any component of the services provided through the CCAC (e.g., placement, inhome services, medical supplies and equipment).
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10.2 Appeal of CCAC Decisions – Community Services
Section 40 of the Long-Term Care Act, 1994 (LTCA) states:
Appeal of original decision
s. 40(1) A person to whom a decision referred to in paragraph 1, 2, 3 or 4 of subsection 39 (1)
relates and who has made a complaint to the approved agency about the decision may appeal
the decision to the Appeal Board if,
(a) either of the persons referred to in subsection 39 (4) receives a notice of the affirmation of
the decision under clause 39 (3) (a); or
(b) neither of the persons referred to in subsection 39 (4) receives a notice under clause 39 (3)
(a) or (b) or a copy of a decision under clause 39 (3) (c) within 60 days after the complaint is
made.
Appeal of new decision
s. 40(2) A person to whom a decision referred to in paragraph 1, 2, 3 or 4 of subsection 39 (1)
relates and who has made a complaint to the approved agency about the decision may, if either
of the persons referred to in subsection 39 (4) receives a copy of the approved agency’s new
decision under clause 39 (3) (c), appeal the new decision to the Appeal Board.
Notice
s. 40(3) To appeal the decision of the approved agency to the Appeal Board under subsection
(1) or (2), the person shall give the Appeal Board a notice requiring a hearing.
Only decisions concerning matters referred to in paragraphs 1, 2, 3 and 4 of section 39 (1) of
the LTCA can be appealed. These decisions are:
•
•
•
•
a decision by the CCAC that the person is not eligible to receive a particular community
service;
a decision by the CCAC to exclude a particular community service from the person’s plan
of service;
a decision by the CCAC respecting the amount of any particular community service to be
included in the person’s plan of service; and
a decision by the CCAC to terminate the provision of a community service to the person.
10.2.1 Right to Appeal
Pursuant to section 40 of the LTCA, a complainant or the complainant’s substitute decisionmaker has the right to appeal to the Health Services Appeal and Review Board (HSARB) a
decision made by the CCAC in response to a complaint if:
•
the decision of the CCAC affirms the original decision, and the complainant or substitute
decision-maker continues to disagree with that decision;
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•
•
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the complainant or substitute decision-maker has not had a written notice of a response to
his or her complaint within 60 days; or
the complaint has resulted in a new CCAC decision with which the complainant or the
substitute decision-maker disagrees.
In order to commence the appeal, the complainant or substitute decision-maker must give a
notice to the HSARB requiring a hearing.
The HSARB is created under the Ministry of Health Appeal and Review Boards Act, 1998
(MHARBA). Pursuant to subsection 6(1) of this legislation, the HSARB has the duty to
conduct hearings under, amongst others, the LTCA. The HSARB is required to interpret and
apply all laws, including the LTCA. The HSARB has no jurisdiction to override the provisions
of the LTCA, including its regulations. For example, eligibility criteria and service maximums
have been established in the regulations under the LTCA. The HSARB has no authority to
require a CCAC to provide more services than permitted under the regulations. The HSARB is
not bound by Ministry of Health and Long-Term Care (MOHLTC) or CCAC policies or
guidelines.
10.2.2 The Appeal Process
Step 1: Notice by Complainant
As referred to above, pursuant to subsection 40(3) of the LTCA, the complainant or
complainant’s substitute decision-maker must provide a notice to the HSARB requiring the
hearing. The request for an appeal must be submitted in writing to:
Health Services Appeal and Review Board
Health Boards Secretariat
151 Bloor Street West, 9th floor
Toronto, ON M5S 2T5
Fax: (416) 327-8524
Step 2: Arranging a Time and a Place for a Hearing
Subsections 41(1) and (2) of the LTCA state:
Hearing
s. 41(1) If a person appeals a decision of an approved agency to the Appeal Board in
accordance with section 40, the Appeal Board shall promptly appoint a time and place for a
hearing.
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When hearing to begin
s. 41(2) The hearing shall begin within 30 days after the day the Appeal Board receives the
notice requiring the hearing, unless the parties agree to a postponement.
The HSARB usually conducts pre-hearings prior to the hearing and these pre-hearings are
scheduled within 30 days after the HSARB receives notice of the appeal.
Step 3: Notice of Hearing
Subsection 41(3) of the LTCA states:
Notice of hearing
s. 41(3) The Appeal Board shall give each of the parties and the Minister at least seven days
notice of the time and place of the hearing.
Step 4: The Hearing
Parties to the Hearing
Sections 42 and 43 of the LTCA state:
Parties
s. 42 The parties to a proceeding before the Appeal Board under this Act are the person
appealing the approved agency’s decision, the approved agency whose decision is being
appealed and any other persons specified by the Appeal Board.
Minister entitled to be heard
s. 43 The Minister is entitled to be heard by counsel or otherwise in a proceeding before
the Appeal Board under this Act.
The parties to an HSARB hearing are:
•
•
•
•
the person appealing the CCAC decision;
the CCAC;
any other persons specified by the HSARB; and
the Minister of Health and Long-Term Care if the minister makes a decision to
intervene.
Other Procedural Matters
Sections 46 and 47 of the LTCA state:
Evidence of person unable to attend
s. 46(1) If a party to a proceeding before the Appeal Board under this Act wishes to give
evidence in the proceeding or wishes to call another person as a witness to give evidence in
the proceeding but the party or other person is unable to attend the hearing by reason of
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age, infirmity or physical disability, the Appeal Board members holding the hearing may,
at the request of the party, attend upon the party or the other person, as the case may be,
and take his or her evidence.
Medical report proves inability
s. 46(2) A medical report signed by a legally qualified medical practitioner stating that the
practitioner believes that the person is unable to attend the hearing by reason of age,
infirmity or physical disability is proof, in the absence of evidence to the contrary, of the
inability of the person to attend the hearing.
Notice to all parties
s.46(3) No Appeal Board member shall take evidence from anyone under subsection (1)
unless reasonable notice of the time and place for taking the evidence is given to all parties
to the proceeding and each party attending is given an opportunity to examine or crossexamine the person giving the evidence.
Health Insurance Act applies
s. 47 Subsections 23 (1), (2), (4) and (6) of the Health Insurance Act apply to the
proceedings and decisions of the Appeal Board under this Act.
Subsections 23 (1), (2), (4) and (6) of the Health Insurance Act (HIA) state:
Examination of documentary evidence
s. 23(1) A person who is a party to proceedings before the Appeal Board shall be afforded
an opportunity to examine before the hearing any written or documentary evidence that
will be produced or any report the contents of which will be given in evidence at the
hearing.
Board members not to have investigated prior to hearing
s. 23(2) Members of the Appeal Board holding a hearing shall not have taken part, before
the hearing, in any investigation or consideration of the subject-matter of the hearing and
shall not communicate directly or indirectly in relation to the subject-matter of the hearing
with any person or with any party or representative of the party except upon notice to and
with opportunity for all parties to participate, but the Appeal Board may seek legal advice
from an adviser independent from the parties and in such case the nature of the advice
should be made known to the parties in order that they may make submissions as to the
law.
Findings of fact
s. 23(4) The findings of fact of the Appeal Board pursuant to a hearing shall be based
exclusively on evidence admissible or matters that may be noticed under section 15 or 16
of the Statutory Powers Procedure Act.
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Release of documents, etc.
s. 23(6) Documents and things put in evidence at the hearing shall, upon the request of the
person who produced them, be released to the person by the Appeal Board within a
reasonable time after the matter in issue has been finally determined.
Step 5: Decision of the HSARB
Section 48 of the LTCA states:
Decision of Appeal Board
s. 48(1) After a hearing by the Appeal Board under this Act, the Appeal Board may,
(a) affirm the decision of the approved agency;
(b) rescind the decision of the approved agency and refer the matter back to the approved
agency for a new decision in accordance with such directions as the Appeal Board considers
appropriate; or
(c) rescind the decision of the approved agency, substitute its opinion for that of the approved
agency and direct the approved agency to implement the decision of the Appeal Board in
accordance with such directions as the Appeal Board considers appropriate.
(2) Repealed.
Decision and reasons
s. 48(3) The Appeal Board shall render its decision within three days after the end of the
hearing and shall provide written reasons to the parties as soon as possible after rendering the
decision.
Decision to Minister
s. 48(4) The Appeal Board shall give the Minister a copy of its decision and reasons.
Decision final
s. 48(5) A decision of the Appeal Board under this Act is final and binding and is not subject to
appeal.
Pursuant to subsection 48(1), after a hearing the HSARB may do one of the following:
•
•
•
affirm the decision of the CCAC;
rescind the decision of the CCAC and refer the matter back to the CCAC for a new decision
in accordance with the HSARB’s directions; or
rescind the decision of the CCAC, substitute its own decision and direct the CCAC to
implement the decision in accordance with the HSARB’s directions.
Pursuant to subsection 48(5), the decision of the HSARB is final and not subject to appeal.
However, this provision does not preclude any party, including the Attorney General, from
bringing an application for a judicial review to the Divisional Court of Ontario (see subsection
#10.3.4 in this manual).
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10.3 Appeal Process Relating to Admission to a Long-Term
Care Home
A person may apply for admission to a long-term care (LTC) home as a long-stay resident or a
short-stay resident (respite or supportive care). The applicant for admission has the right to
appeal determination of the Community Care Access Centre (CCAC) that the person is
ineligible for admission.
Although the CCAC should attempt to resolve any complaints relating to these types of
determinations through an internal complaints process, the applicant may commence the appeal
as soon as the determination is made. The applicant may appeal the decision to the Health
Services Appeal and Review Board (HSARB). If the applicant is not satisfied with the decision
of the HSARB, the applicant has a further right of appeal to the Divisional Court of Ontario.
The following long-term care home legislation governs the appeal process relating to admission
to homes:
•
•
•
The Nursing Homes Act (NHA);
The Charitable Institutions Act (CIA); and
The Homes for the Aged and Rest Homes Act (HARHA).
The provisions in these statutes are similar and therefore only the provisions of the NHA will
be incorporated into this section. The equivalent sections in the CIA and HARHA will be crossreferenced.
10.3.1 Decisions that Can be Appealed
Section 20.5 of the NHA (see also section 9.10 of the CIA and section 19.1 of the HARHA)
states:
Notice of determination
s. 20.5(1) If a placement co-ordinator determines that an applicant for a determination
respecting eligibility for admission to a nursing home is not eligible, the placement coordinator shall ensure that the applicant and the person, if any, who applied for the
determination on behalf of the applicant are notified of,
(a) the determination of ineligibility;
(b) the reasons for the determination; and
(c) the applicant’s right to apply to the Appeal Board for a review of the determination.
Application to Appeal Board
s. 20.5(2) The applicant may apply to the Appeal Board for a review of the determination of
ineligibility made by the placement co-ordinator.
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Pursuant to the above provisions, a person or substitute decision-maker may appeal a decision
of the CCAC that the person has been determined ineligible for admission to a LTC home.
Other decisions relating to admission, for example decisions relating to waiting list
management, are not subject to appeal. The CCAC must advise the person of the determination,
the reasons for the determination and the right to appeal.
The term “Appeal Board” is defined in the LTC home legislation as meaning the “Health
Services Appeal and Review Board under the Ministry of Health Appeal and Review Boards
Act, 1998”. Pursuant to subsection 6(1) of this legislation, the HSARB has the duty to conduct
hearings under, amongst others, the NHA, CIA and HARHA. The HSARB is required to
interpret and apply all laws, including these statutes. The HSARB has no jurisdiction to
override the provisions of these statutes, including their regulations. For example, eligibility
criteria have been established in the regulations under these statutes. The HSARB has no
authority to require a CCAC to determine that a person is eligible for admission if the person
does not meet the eligibility criteria established under the regulations. The HSARB is not
bound by Ministry of Health and Long-Term Care (MOHLTC) or CCAC policies or guidelines.
10.3.2 Further Determinations of Eligibility
The fact that a person has appealed a determination of ineligibility does not preclude the person
from applying for a new eligibility determination or the CCAC from initiating a new
assessment of eligibility. For example, there may be gap in time between the date of the
original determination of ineligibility and the date of the hearing. Depending on the
circumstances, the CCAC may wish to contact the person to ask whether the person’s condition
has changed. If the person indicates that his or her condition has changed and the person wants
a further assessment of eligibility, the CCAC may conduct the assessment. If the person is
determined eligible at this point in time, it is likely that the person will withdraw the appeal. If
the person is still determined to be ineligible, the person may appeal the second determination
of ineligibility as well.
10.3.3 The Appeal Process
Step 1: Notice by Applicant
As referred to above, pursuant to subsection 20.5(2) of the NHA (see also subsection 9.10(2) of
the CIA and subsection 19.1(2) of the HARHA) the applicant or substitute decision-maker must
provide a notice to the HSARB requiring the hearing. The request for an appeal must be
submitted in writing to:
Health Services Appeal and Review Board
Health Boards Secretariat
151 Bloor Street West, 9th floor
Toronto, ON M5S 2T5
Fax: (416) 327-8524
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Step 2: Arranging a Time and a Place for a Hearing
Subsections 20.6(1) and (2) of the NHA (see also subsections 9.11(1) and (2) of the CIA and
subsections 19.2(1) and (2) of the HARHA) state:
Hearing
s. 20.6(1) When the Appeal Board receives an application for a review of a determination of
ineligibility, it shall promptly appoint a time and place for a hearing.
Same
s. 20.6(2) The hearing shall begin within twenty-one days after the day the Appeal Board
receives the application for the hearing, unless the parties agree to a postponement.
The HSARB usually conducts pre-hearings prior to the hearing and these pre-hearings are
scheduled within 21 days after the HSARB receives notice of the appeal.
Step 3: Notice of Hearing by the HSARB and CCAC
Subsection 20.6(3) of the NHA (see also subsection 9.11(3) of the CIA and subsection 19.2(3)
of the HARHA) states:
Notice to parties
s. 20.6(3) The Appeal Board shall notify each of the parties of the time and place of the hearing
at least seven days before the hearing begins.
In addition, subsection 20.6(5) of the NHA (see also subsection 9.11(5) of the CIA and
subsection 19.2(5) of the HARHA) states:
Notice to Minister
s. 20.6(5) When a placement co-ordinator is notified by the Appeal Board of a hearing, the
placement co-ordinator shall promptly give the Minister written notice of the hearing together
with written reasons for the determination of ineligibility made by the placement co-ordinator.
When the CCAC is notified by the HSARB of a hearing, the CCAC must give the following to
the Minister of Health and Long-Term Care:
•
•
notice of the hearing; and
the CCAC’s written reasons for the determination of ineligibility.
Step 4: The Hearing
Parties to the hearing
Subsections 20.6(4) and (6) of the NHA (see also subsection 9.11(4) and (6) of the CIA and
subsection 19.2(4) and (6) of the HARHA) state:
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Parties
s. 20.6(4) The parties to the proceeding before the Appeal Board are the applicant who
was determined to be ineligible for admission, the placement co-ordinator who made the
determination and such other parties as the Appeal Board specifies.
Minister entitled to be heard
s. 20.6(6) The Minister is entitled to be heard by counsel or otherwise in a proceeding
before the Appeal Board under this section.
Parties to the HSARB hearing are:
•
•
•
•
the person appealing the CCAC decision;
the CCAC;
any other persons specified by the Appeal Board; and
the Minister of Health and Long-Term Care if the minister makes a decision to
intervene.
Other Procedural Matters
Subsections 20.6 (9 through 13) of the NHA (see also subsections 9.11 (9 through 13) of
the CIA and subsections 19.2 (9 through 13) of the HARHA) state:
Evidence of disabled person
s. 20.6(9) If a party to a proceeding before the Appeal Board under this Act wishes to give
evidence in the proceeding or wishes to call another person as a witness to give evidence in
the proceeding but the party or other person is unable to attend the hearing by reason of
age, infirmity or physical disability, the Appeal Board members holding the hearing may,
at the request of the party, attend upon the party or the other person, as the case may be,
and take his or her evidence.
Medical report proves inability
s. 20.6(10) A medical report signed by a legally qualified medical practitioner stating that
the practitioner believes that the person is unable to attend the hearing by reason of age,
infirmity or physical disability is proof, in the absence of evidence to the contrary, of the
inability of the person to attend the hearing.
Opportunity for all parties
s. 20.6(11) No Appeal Board member shall take evidence from a party or other person
under subsection (9) unless reasonable notice of the time and place for taking the evidence
is given to all parties to the proceeding and each party attending is given an opportunity to
examine or cross-examine the party or other person, as the case may be.
Recording of evidence
s. 20.6(12) The oral evidence taken before the Appeal Board at a hearing and the oral
evidence taken from a party or other person under subsection (9) shall be recorded and, if
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required, copies of a transcript of the evidence shall be furnished on the same terms as in
the Ontario Court (General Division).
Health Insurance Act
s. 20.6(13) Subsections 23 (1), (2), (4) and (6) of the Health Insurance Act apply to the
proceedings and decisions of the Appeal Board under this Act.
Subsections 23 (1), (2), (4) and (6) of the Health Insurance Act (HIA) state:
Examination of documentary evidence
s. 23(1) A person who is a party to proceedings before the Appeal Board shall be afforded
an opportunity to examine before the hearing any written or documentary evidence that
will be produced or any report the contents of which will be given in evidence at the
hearing.
Board members not to have investigated prior to hearing
s. 23(2) Members of the Appeal Board holding a hearing shall not have taken part, before
the hearing, in any investigation or consideration of the subject-matter of the hearing and
shall not communicate directly or indirectly in relation to the subject-matter of the hearing
with any person or with any party or representative of the party except upon notice to and
with opportunity for all parties to participate, but the Appeal Board may seek legal advice
from an adviser independent from the parties and in such case the nature of the advice
should be made known to the parties in order that they may make submissions as to the
law.
Findings of fact
s.23(4) The findings of fact of the Appeal Board pursuant to a hearing shall be based
exclusively on evidence admissible or matters that may be noticed under section 15 or 16
of the Statutory Powers Procedure Act.
Release of documents, etc.
s. 23(6) Documents and things put in evidence at the hearing shall, upon the request of the
person who produced them, be released to the person by the Appeal Board within a
reasonable time after the matter in issue has been finally determined.
Step 5: Decision of the Appeal Board
Subsections 20.6(14) through (16) of the NHA (see also subsections 9.11(14) through (16) of
the CIA and subsections 19.2(14) through (16) of the HARHA) state:
Powers of Appeal Board
s. 20.6(14) After a hearing by the Appeal Board, the Appeal Board may,
(a) affirm the determination of ineligibility made by the placement co-ordinator;
(b) rescind the determination of ineligibility made by the placement co-ordinator and refer the
matter back to the placement co-ordinator for re-determination in accordance with such
directions as the Appeal Board considers proper; or
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(c) rescind the determination of ineligibility made by the placement co-ordinator, substitute its
opinion for the opinion of the placement co-ordinator and direct the placement co-ordinator to
determine that the applicant is eligible for admission to a nursing home.
Decision and reasons
s. 20.6(15) The Appeal Board shall render its decision within one day after the end of the
hearing and shall provide written reasons to the parties within seven days after rendering the
decision.
s. 20.6(16) The placement co-ordinator shall furnish the Minister with a copy of the decision
and reasons of the Appeal Board.
After a hearing the HSARB may do one of the following:
•
•
•
affirm the determination of ineligibility;
rescind the determination of ineligibility made by the CCAC and refer the matter back to
the CCAC for re-determination in accordance with the HSARB’s directions; or
rescind the determination of ineligibility made by the CCAC, substitute its own decision
and direct the CCAC to determine that the applicant is eligible for admission.
10.3.4 Appeal to the Divisional Court
Appeal to Divisional Court
s. 20.8(1) A party to a review of the determination of ineligibility by the Appeal Board may
appeal its decision to the Divisional Court on a question of law or fact or both, in accordance
with the rules of court.
Any party to the HSARB appeal may appeal the decision of the HSARB to the Divisional
Court on a question of fact or law, or both. The appellant may raise issues relating to the
determination of fact or interpretation of the law, or both, made by the HSARB.
Record
s. 20.8(2) If a party appeals a decision of the Appeal Board to the Divisional Court under this
section, the Appeal Board shall promptly file with the Divisional Court the record of the
proceeding before the Appeal Board and the transcript of the evidence taken before the Appeal
Board, which together constitute the record in the appeal.
Subsection 20.8(3) of the NHA (see also subsection 9.13 of the CIA and subsection 19.4(3) of
the HARHA) states:
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Minister to be heard
s. 20.8(3) The Minister is entitled to be heard by counsel or otherwise on the argument of an
appeal under this section.
Powers of court on appeal
s. 20.8(4) On an appeal under this section, the Divisional Court,
(a) may affirm or rescind the decision of the Appeal Board;
(b) may refer the matter back to the Appeal Board for rehearing in whole or in part in
accordance with such directions as the court considers proper;
(c) may refer the matter back to the placement co-ordinator for re-determination in accordance
with such directions as the court considers proper;
(d) may substitute its opinion for that of the placement co-ordinator or the Appeal Board; and
(e) may direct the placement co-ordinator to determine that the applicant is eligible for
admission to a nursing home.
On an appeal the Divisional Court may do the following:
•
•
•
•
•
affirm or rescind the decision of the HSARB;
refer the matter back to the HSARB for rehearing in whole or in part in accordance with the
Divisional Court’s directions;
refer the matter back to the CCAC for re-determination in accordance with the Divisional
Court’s directions;
substitute its opinion for that of the CCAC or the HSARB; and
direct the CCAC to determine that the applicant is eligible for admission.
s. 20.8(5) The placement co-ordinator shall furnish the Minister with a copy of the decision and
reasons of the Divisional Court.
10.3.5 Impact of Appeals on Waiting List Management – Date of Ranking
Subsection 150(3) of Regulation 832 under the NHA (see also subsection 81(3) of Regulation
69 under the CIA and subsection 12.16(3) of Regulation 637 under the HARHA) states:
s. 150(3) If a person who was determined by a placement co-ordinator to be ineligible for
admission to a nursing home as a long-stay resident is determined to be eligible for admission
as a long-stay resident as a result of an application to the Appeal Board under subsection 20.5
(2) of the Act or an appeal to the Divisional Court under subsection 20.8 (1) of the Act, and if
the person then makes an application for authorization of his or her admission to one or more
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nursing homes, homes under the Homes for the Aged and Rest Homes Act or approved
charitable homes for the aged under the Charitable Institutions Act as a long-stay resident,
(a) that application for authorization shall, for the purposes of Table 5, be deemed to have been
made at the time that the placement co-ordinator determined that the person was ineligible for
admission; and
(b) all additional applications for authorization of admission to one or more nursing homes as
a long-stay resident, made by the person within six weeks after making the first application and
before being admitted to one of such facilities shall, for the purpose of Table 5, be deemed to
have been made at the time that the first application is deemed under clause (a) to have been
made.
If a person who was originally determined by the CCAC to be ineligible for admission is later
determined to be eligible as a result of an appeal before the HSARB or Divisional Court and
the person applies for authorization of admission, the application for authorization is deemed to
have been made at the time the CCAC determined the person ineligible. In addition, all
additional applications submitted by the person within six weeks after making the first
application for authorization are deemed to have been made at the same time as the original
application for authorization. The date of the application for authorization has an impact on the
ranking of the person within the waiting list category as set out in Table 5 in the NHA
regulation at: [http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/90n07_e.htm]. Also see:
•
•
•
Table 4, Ranking of Waiting List Categories (subsection #12.8.1 in this manual).
Table 5, Rules for Ranking within Categories (subsection #12.8.2 in this manual).
Table 6 in the CIA regulation at: [http://www.elaws.gov.on.ca/DBLaws/Statutes/English/90c09_e.htm ].
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11.1 Introduction
Community Care Access Centres (CCACs) are the designated placement co-ordinators under
the Nursing Homes Act (NHA), Charitable Institutions Act (CIA) and Homes for the Aged and
Rest Homes Act (HARHA), and are therefore required to comply with the relevant provisions
of these statutes and their regulations. As placement co-ordinators, management of admissions
to long-term care (LTC) homes is one of the key functions of the CCAC.
In some CCACs, case managers carry out placement co-ordination, while other CCACs have
dedicated placement co-ordinators. The terms case manager and placement co-ordinator are
often used interchangeably in reference to the persons carrying out the placement function. The
term placement co-ordinator is used throughout this chapter for purposes of consistency.
This chapter sets out the requirements that the CCAC must adhere to in order to determine a
person’s eligibility for admission to a LTC home, and for those determined eligible, authorizing
their admission to the LTC home of their choice. The requirements for short-stay and long-stay
clients are dealt with separately in this chapter. (See prioritization criteria and waiting list
management in chapter #12 in this manual.)
All legislative references in this chapter, unless stated otherwise, are to the NHA and regulation
832 of the NHA. However, similar provisions can be found in the CIA and HARHA, and their
regulations.
It should be noted that the CCAC does not determine eligibility or authorize admissions to
group homes, rest homes and retirement homes, or to acute, complex continuing care and
psychiatric hospitals.
11.1.1 Responsibilities of the CCAC with Respect to LTC Home Admissions
All persons seeking admission to a LTC home must contact the placement co-ordination
service (PCS) of the CCAC in the person’s area. The CCAC, through its placement function, is
responsible for:
• determining eligibility for admission to LTC homes;
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• for those persons determined eligible, requesting the LTC home’s approval for admission to
the home;
• determining priority for admission and placing all eligible applicants in the appropriate
prioritization categories on the waiting lists when beds are not immediately available;
• keeping and managing the waiting lists for admission to LTC homes; and
• authorizing admissions to LTC homes.
If an application is made for a LTC home in another area of the province, the local CCAC
where the person is living at the time of application is responsible for the determination of
eligibility, but will transfer the assessment and eligibility information to the out-of-area CCAC
where the LTC home is located. In this situation, the two CCACs co-ordinate their activities
and the local CCAC acts as liaison with the person.
When a person requests admission to a LTC home, the CCAC will conduct an interview with
the applicant or if the applicant is incapable of making the admission decision, with his or her
authorized substitute decision-maker (SDM). Here the CCAC will explain the assessment and
admission processes and will gather information to determine the applicant’s needs and
whether the needs can be met through CCAC in-home services or community services or
whether the applicant requires LTC home admission.
The CCAC must have detailed information about the LTC homes, publicly-funded community
services, retirement homes and other alternative services in its area. The information for each
home should include programming available, unique features, in-house staffing, number of
beds, and compliance with standards, policies, criteria, regulations and legislation. This
information is necessary because the placement co-ordinator must consider the following:
•
•
•
whether the person’s care requirements can be met in a LTC home (rather than in the
person’s home or in the community);
the person’s care expectations and personal preferences; and
the person’s ethnic, spiritual, linguistic, familial and cultural preferences.
The placement co-ordinator must also assess the person’s ability to understand the service
options that are available and appropriate to address the person’s needs, and assist the person or
if the person is incapable of making the admission decision, the SDM’s ability to access these
services.
11.1.2 History
PCSs were initially pilot tested in Ontario in the1970s. In 1993 the Long-Term Care Statute
Law Amendment Act, 1993 (LTCSLAA) made amendments to the NHA, CIA and HARHA.
These amendments enabled the Ministry of Health and Long-Term Care (MOHLTC) to
designate one or more persons, classes of persons, or other entities as placement co-ordinators.
By 1994, PCSs were fully implemented across the province. Between 1996 and 1998, PCSs
and Home Care Programs were consolidated to form the new CCACs with the purpose of
providing simplified access for persons seeking in-home services or placement in LTC homes.
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This manual supersedes the previous Placement Coordination Services Manual issued in 1994
and its subsequent updates. Further information about MOHLTC policies with respect to LTC
homes can be found in the Long-Term Care Facilities Program Manual, 1993, Revisions 1995,
1998 available from the MOHLTC Long-Term Care Homes Branch or any regional office of
MOHLTC.
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11.2 Eligibility Criteria
11.2.1 Eligibility Criteria for Long-Stay Applicants
Section 130 of the Nursing Homes Act (NHA) regulation outlines eligibility criteria for a
person seeking long-stay placement in a long-term care (LTC) home:
s. 130(1) An applicant shall be determined to be eligible for admission to a nursing home if,
and only if,
(a) the applicant is at least 18 years old;
(b) the applicant is an insured person under the Health Insurance Act;
(c) the applicant meets at least one of the conditions set out in subsection (2);
(d) the applicant meets at least one of the conditions set out in subsection (3); and
(e) the applicant's care requirements can be met in a nursing home.
(2) The following are the conditions referred to in clause (1) (c):
1. The applicant requires that nursing care be available on-site 24 hours a day.
2. The applicant requires assistance each day with activities of daily living.
3. The applicant requires, at frequent intervals throughout the day, on-site supervision or onsite monitoring to ensure his or her safety or well-being.
4. The applicant is at risk of being financially, emotionally or physically harmed if the
applicant lives in his or her residence.
5. The applicant is at risk of suffering harm due to environmental conditions that cannot be
resolved if the applicant lives in his or her residence.
6. The applicant may harm someone if the applicant lives in his or her residence.
(3) The following are the conditions referred to in clause (1) (d):
1. None of the publicly-funded community-based services available to the applicant while the
applicant lives in his or her residence and none of the other caregiving, support or
companionship arrangements available to the applicant while the applicant lives in his or her
residence are sufficient, in any combination, to meet the applicant's requirements.
2. None of the publicly-funded community-based services available to the applicant in the area
to which the applicant plans to move and none of the other caregiving, support or
companionship arrangements available to the applicant in the area to which the applicant
plans to move are sufficient, in any combination, to meet the applicant's requirements.
(4) Revoked: O. Reg. 121/02, s. 7.
(5) Revoked: O. Reg. 121/02, s. 7.
(6) This section does not apply to an applicant who is applying for a determination respecting
his or her eligibility for admission to a nursing home as a short-stay resident in the respite care
or supportive care program.
11.2.2 Discussion of the Eligibility Criteria for Long-Stay Applicants
As indicated in the regulatory provisions of the NHA referenced above, the criteria for
determining an applicant’s eligibility for admission to a LTC home are:
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1. the applicant must be at least 18 years old;
2. the applicant must be an insured person under the Health Insurance Act (HIA);
3. the applicant must meet at least one of the following criteria:
• requires nursing care be available on-site 24 hours a day;
• requires assistance each day with activities of daily living;
• requires, at frequent intervals throughout the day, on-site supervision and monitoring to
ensure his or her safety or well-being;
• at risk of being financially, emotionally or physically harmed if the applicant lives in his
or her residence;
• at risk of suffering harm due to environmental conditions that cannot be resolved if the
applicant lives in his or her residence; or
• applicant may harm someone if the applicant lives in his or her residence;
4. publicly-funded community-based services available to the applicant and caregiving,
support or companionship arrangements available where the applicant lives or intends to
live are insufficient to meet the applicant’s requirements; and
5. applicant’s care requirements can be met in a LTC home.
For greater clarity, additional information and discussion of each of these requirements is
provided below.
1. The applicant is at least 18 years old.
Persons under the age of 18 years cannot be admitted to LTC homes on either a short or
long-term basis. Persons aged 18 years and over may be served in a LTC home. Of course,
all community-based service options should be explored with all applicants. Some younger
persons may prefer community-based services over placement in a LTC home, as the
majority of persons who seek admission to LTC homes are seniors.
2. The applicant is an insured person under the HIA.
The Community Care Access Centre (CCAC) must ensure that the applicant has valid
Ontario Health Insurance Plan (OHIP) coverage. (For additional information on OHIP
coverage, see chapter #3 in this manual.)
3. The applicant meets at least one of the following criteria.
s. 130(2)1 The applicant requires that nursing care be available on-site 24 hours a day.
People seeking admission to LTC homes should not require the constant presence of
registered nursing staff: this level of care is only available in a hospital. However, the
applicant who requires frequent intervention and monitoring of a condition by a nurse
throughout the day, which would be difficult to provide in a community-based setting,
would meet this criterion.
s. 130(2)2 The applicant requires assistance each day with activities of daily living.
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The applicant requires assistance with some or all of the following activities each day that
would be difficult to provide in a community-based setting. These activities include but are
not limited to the following:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
washing/bathing/showering/bed bath;
mouth care;
hair care;
preventive skin care;
routine hand/foot care;
menstrual care;
transferring/positioning/turning;
exercises (rehabilitation/ambulation);
dressing/undressing;
assistance with eating;
toileting (including empty/change leg bag, catheterization);
bowel routines;
assistance with taking pre-measured medications;
changing non-sterile dressings; and
care and maintenance of equipment.
In addition, an applicant who is of such frailty that he or she requires ongoing assistance
with a number of activities of daily living such as meal preparation, ordinary housework,
managing finances, managing medications and shopping on a daily basis may be in need of
admission to a LTC home.
s. 130(2)3 The applicant requires, at frequent intervals throughout the day, on-site
supervision and monitoring to ensure his or her safety or well-being.
The need for a supervised, safe physical environment is the reason for admission in this
case as opposed to the applicant’s need for nursing or personal care. The applicant requires
frequent monitoring or on-site supervision to ensure his or her safety and well-being
throughout the day.
For example, a secure setting may be required to prevent wandering, or for applicants who
experience considerable agitation and distress living in an environment where they would
be alone for long periods of time.
s. 130(2)4 The applicant is at risk of being financially, emotionally or physically harmed if
the applicant lives in his her residence.
There is reason to believe that the applicant is at risk of harm or abuse if he or she is left in
his or her existing living situation. In the case of abuse, it could be physical, psychological
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or emotional, financial abuse or exploitation, sexual abuse, medication abuse, violation of
civil/human rights or neglect/self-neglect.1
Another example of where an individual may be at risk for financial or emotional harm
occasionally occurs when a person is left on his or her own as a result of his or her
spouse’s/partner’s admission to a LTC care home.
s. 130(2)5 The applicant is at risk of suffering harm due to environmental conditions that
cannot be resolved if the applicant lives in his or her residence.
The applicant may be living in a home that is no longer fit for habitation or living in a
remote area where there are limited health and community services to assist the applicant to
remain in his or her current setting.
s. 130(2)6 The applicant may harm someone if the applicant lives in his or her residence.
Family members, caregivers or neighbours may be at risk if the applicant is prone to
assaultive behaviour because of an illness or a cognitive impairment.
4. The community-based services, caregiving, support or companionship arrangements
available where the applicant lives or intends to live are insufficient to meet the
applicant’s requirements.
s. 130(1)(d) The applicant meets at least one of the conditions set out in subsection (3):
(3) 1. None of the publicly funded community-based services available to the applicant
while the applicant lives in his or her residence and none of the other caregiving, support
or companionship arrangements available to the applicant while the applicant lives in his
or her residence are sufficient, in any combination, to meet the applicant’s requirements.
2. None of the publicly-funded community-based services available to the applicant in the
area to which the applicant plans to move and none of the other caregiving, support or
companionship arrangements available to the applicant in the area to which the applicant
plans to move are sufficient, in any combination, to meet the applicant’s requirements.
If the applicant’s needs can be met through the community-based services described above,
the applicant is not eligible for admission to a LTC home. The CCAC may declare
an applicant ineligible if the CCAC placement co-ordinator believes that the communitybased services the applicant is receiving or could receive are adequate to meet his or her
needs.
The CCAC may not, however, declare an applicant ineligible on the grounds that the
applicant has the financial resources to live in a retirement home or to make private care
arrangements that exceed the amount of service available through publicly-funded or
voluntary community-based services.
1
British Columbia Coalition to Eliminate Abuse of Seniors Fact Sheet #1.
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If an applicant refuses to accept community-based services that have been determined by
the CCAC to be available and appropriate to meet the applicant’s needs, the applicant is not
eligible for LTC home admission.
5. The applicant’s care requirements can be met in a LTC home.
The CCAC must ensure that the applicant’s assessed care needs:
•
•
•
may be reasonably met within the LTC home;
are within the scope of what a LTC home provides; or
can be provided by a LTC home with the support and assistance of other institutional or
home resources in the community.
11.2.3 Determination of Ineligibility
Pursuant to LTC home legislation, if an applicant is determined ineligible for admission to a
LTC home, the CCAC must provide the applicant and the person, if any, who applied for the
determination on behalf of the applicant, with written notice outlining:
s. 20.5(1)the determination of ineligibility;
the reasons for the determination, and
the applicant’s right to apply to the Health Services Appeal and Review Board (Appeal Board)
for a review of the determination.
The CCAC should advise applicants to contact the CCAC for a re-determination of eligibility
should their condition or circumstances change.
If the applicant is a hospital inpatient, the CCAC may advise the hospital of the CCAC’s
determination of ineligibility, subject to the provisions of the Personal Health Information
Protection Act, 2004 (PHIPA).
11.2.4 Other Alternatives
Subsection 20.1(16) of the NHA provides that the CCAC placement co-ordinator must suggest
alternative services or make appropriate referrals on behalf of an applicant if it is determined
that the applicant is either not eligible for admission to a LTC home or is determined eligible
for admission to a LTC home but not authorized for immediate admission.
11.2.5 Spousal/Partner Accompaniment by a “Well Spouse/Partner”
A spouse/partner who does not have care requirements of his or her own, but who wishes to
enter a LTC home to be with his or her spouse/partner who has been determined eligible as a
result of care needs, or who is already residing in a LTC home, may be admitted to a LTC
home as long as he or she meets the following criteria:
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s. 132 Despite section 130, an applicant shall be determined to be eligible for admission to a
nursing home as a long-stay resident if,
(a) the applicant's spouse or partner is,
(i) a long-stay resident, or
(ii) a person who has been determined by a placement co-ordinator to be eligible for
admission to a nursing home as a long-stay resident;
(b) the applicant is at least 18 years old;
(c) the applicant is an insured person under the Health Insurance Act; and
(d) the applicant's care requirements can be met in a nursing home.
Notes:
•
•
•
•
•
•
The term spouse is defined in subsection 1(1) of the NHA regulation as:
s. 1(2) a person,
(a) to whom the person is married, or
(b) with whom the person is living, or was living immediately before one of them was
admitted to a nursing home, in a conjugal relationship outside marriage, if the two
persons,
(iii) have together entered into a cohabitation agreement under section 53 of the
Family Law Act.
The term partners is defined in subsection 1(2) of the NHA regulation as:
s. 1(2) Two persons are partners for the purpose of this Regulation if they have lived
together for at least one year and have a close personal relationship that is of primary
importance in both persons' lives.
A spouse/partner entering a LTC home to join his or her spouse/partner must provide the
same assessment and personal information required for any applicant.
An accompanying spouse/partner who is admitted to a LTC home may continue to reside in
the LTC home after the death of his or her spouse/partner even if the surviving person does
not require LTC home services. The rationale for allowing this person to remain in the
home is that the survivor is unlikely to have a home in the community to which he or she
can return.
If the spouse/partner in the LTC home dies while the accompanying person is on a waiting
list, the CCAC must reassess the eligibility of the person. If the person does not meet the
eligibility criteria for admission set out in section 130(1) of the NHA regulation, the person
must be removed from the waiting list. The CCAC should explain this situation to
prospective applicants who wish to join a spouse/partner in a LTC home and are not
eligible for home admission on the basis of their own care and support requirements.
If there is a strong indication that a well spouse/partner will want to accompany his or her
spouse/partner into a LTC home, the CCAC should strongly encourage the well
spouse/partner to apply for admission at the same time as his or her spouse/partner. This
will ensure the earliest possible date for ranking of the well spouse within prioritization
category 2 of the waiting list. (The spouse with the care needs will receive higher
prioritization in category 1A1. See subsection #12.3 in this manual for additional
information on prioritization criteria in category 1A1.)
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11.2.6 Eligibility of Individuals Already Resident in a LTC Home
Section 133 of the NHA regulation exempts existing residents of LTC homes from a redetermination of their eligibility for admission to another LTC home by stating:
s. 133 Despite section 130, the following applicants shall be determined to be eligible for
admission to a nursing home as long-stay residents:
1. A long-stay resident requesting a transfer to another nursing home as a long-stay resident.
2. A long-stay resident under the Homes for the Aged and Rest Homes Act or the Charitable
Institutions Act requesting a transfer to a nursing home as a long-stay resident.
Note: This exemption extends only to the eligibility requirements in section 130 of the NHA
regulation. It does not exempt the CCAC from obtaining an applicant’s consent for admission
to another LTC home, which is required for authorization of admission. The requirement for
consent is contained in subsection 20.1(13) of the NHA. (See subsection #11.4 in this manual
for additional information on the requirement for consent.)
Although the eligibility for admission of a person who is seeking a transfer to another LTC
home cannot be re-determined, there may be situations where a transfer is being requested
because the person’s needs can no longer be met in a LTC home. In these cases, it is imperative
that the LTC homes to which the person is seeking a transfer receive comprehensive and up-todate information about the person’s condition, including physical and mental health, functional
status and behaviours in order to determine whether to grant or refuse admission. In some
instances new assessments may be appropriate when an applicant is transferring from one home
to another.
11.2.7 Eligibility of Veterans
With the exception of the requirement that they be an insured person under the HIA, veterans
are also exempt from the eligibility criteria set out in section 130 of the NHA regulation.
Section 133.1 provides for the eligibility of veterans as follows:
s. 133.1 Despite section 130, an applicant who is a veteran shall be determined eligible for
admission to a nursing home as a long-stay resident if the applicant is an insured person under
the Health Insurance Act.
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11.3 Application Process for Long-Stay Eligibility
Determination
Section 134 of the Nursing Homes Act (NHA) regulation sets out the application process for a
determination of eligibility:
s. 134(1) To apply for a determination respecting his or her eligibility for admission to a
nursing home, a person shall establish that he or she is at least 18 years old and shall provide
to a placement co-ordinator,
(a) a request by the person for a determination of his or her eligibility, in the form provided by
the Minister;
(b) proof that the person is an insured person under the Health Insurance Act;
(c) an up-to-date health assessment of the person, in the form provided by the Minister, signed
by,
(i) a member of the College of Physicians and Surgeons of Ontario, or
(ii) a registered nurse who holds a general certificate of registration or an extended
certificate of registration in accordance with the regulations made under the Nursing Act,
1991;
(d) an up-to-date functional assessment of the person conducted by a health or social service
provider approved by the placement co-ordinator; and
(e) such additional information and documentation as is necessary to enable the placement coordinator to determine whether the person meets the eligibility requirements set out in this
Regulation.
(1.1) Despite subsection (1), a veteran who wishes to apply for a determination of his or her
eligibility for admission to a nursing home is not required to establish that he or she is 18 years
old or to provide his or her request for a determination respecting his or her eligibility in the
form provided by the Minister.
(2) Despite subsection (1), the following persons are not required to establish that they are at
least 18 years old and are not required to comply with clauses (1) (b), (c) and (d):
1. A long-stay resident applying for a determination of eligibility for the purpose of
transferring to another nursing home as a long-stay resident.
2. A long-stay resident under the Homes for the Aged and Rest Homes Act or the
Charitable Institutions Act applying for a determination of eligibility for the purpose of
transferring to a nursing home as a long-stay resident.
(3) Despite subsection (1), a person described in a paragraph of subsection (2) who is applying
for a determination of eligibility for the purpose of transferring to a related temporary nursing
home, a re-opened nursing home or a replacement nursing home as a long-stay resident is not
required to provide his or her request for a determination respecting his or her eligibility in the
form provided by the Minister, if he or she is a long-stay resident of the original nursing home
or was a long-stay resident of the original nursing home immediately before the closure of his
or her bed in the home.
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(4) If a person applying for a determination of eligibility is going to be placed in category 1A
under section 143, the person is not required to comply with clauses (1) (c) and (d) if there is
insufficient time to comply with them.
(5) The placement co-ordinator shall assist the person in obtaining the information and
documentation that the person is required to provide to the placement co-ordinator under this
section.
11.3.1 Discussion of the Application Process for Determination of Eligibility
The application process begins when a person requests admission to a long-term care (LTC)
home. The placement co-ordinator conducts an interview with the applicant or if the applicant
is incapable of the admission decision, with his or her authorized substitute decision-maker
(SDM). (For information on identifying the SDM, see subsection #4.5.3 in this manual.) In the
interview, the placement co-ordinator will explain the assessment and admission processes and
will gather information to determine the applicant’s needs, whether the needs can be met
through Community Care Access Centre (CCAC) in-home services or community services.
If the client’s needs cannot be met by in-home services or community services, then the
assessment continues to determine whether the client’s needs can be met by LTC home
services.
The placement co-ordinator will review the following information with the applicant or the
SDM:
•
•
•
•
•
•
the criteria for determining eligibility;
the type of information that is collected during the eligibility determination process,
including personal information;
the process for admission to a LTC home, which includes authorizing admission to a LTC
home and the LTC home’s ability to withhold approval for the person’s admission under
certain circumstances; (i.e., the home lacks the physical facilities or nursing expertise
necessary to meet the person’s care requirements);
the process for determining a person’s priority for admission and what the waiting list
involves;
the person’s rights to appeal any determination of being incapable of making an admission
decision and the right to appeal a determination of ineligibility for admission to a LTC
home; and
resident charges in a LTC home.
If the person agrees to proceed with the determination of eligibility, the placement co-ordinator
works with the person and/or the person’s SDM in obtaining the information and
documentation required by the regulation under subsection 134(5) of the NHA. In all cases, the
outcome of this interview must be documented and retained for future reference.
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Establishing that an Applicant is at Least 18 Years Old
Subsection 134(1) of the NHA provides that to apply for admission to a LTC home, a person
must establish that he or she is at least 18 years old.
Since many individuals seeking admission to LTC homes are seniors, specific verification of
age through the provision of identification that includes a date of birth is generally not required.
If a situation arises where a placement co-ordinator is in doubt that a prospective applicant is at
least 18 years old, the placement co-ordinator must request proof of age. This proof could
include a birth certificate, passport, or any other government identification that provides date of
birth.
Exemptions: Under subsections 134 (1.1), (2) and (3) of the NHA regulation, veterans and
persons already resident in a LTC home who are transferring to another LTC home are not
required to establish that they are at least 18 years old. (For long-stay residents of a LTC home
applying for a determination of eligibility in order to transfer to a related temporary, re-opened
or replacement LTC home, see “Streamlined Admission Process” in subsection #12.7.3 in this
manual.)
A Written Request for Determination of Eligibility for Admission to a LTC Home
A further requirement, in subsection 134(1)(a) of the NHA, is the provision of a written request
for determination of eligibility for admission to a LTC home, which is contained in the
Ministry of Health and Long-Term Care (MOHLTC) consent form, Consent for Placement
Coordination Services to Collect, Keep on File, and Release Information form (#014-2747-69),
available at:
[http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=R
DR&TAB=PROFILE&ENV=WWE&NO=014-2747-69].
When completed and signed, this form provides the written request for eligibility
determination.
Exemptions:
•
•
Under subsections 134 (1.1) and (3) of the NHA regulation, veterans and long-stay
residents of a LTC home applying for a determination of eligibility in order to transfer to a
related temporary, re-opened or replacement nursing home are not required to provide their
requests for eligibility determination in the form provided by the MOHLTC. (In the latter
case, see “Streamlined Admission Process” in subsection #12.7.3 in this manual.)
This does not mean that these applicants are exempt from making the request, but rather
that the request does not have to be in the form provided by the MOHLTC (i.e., the request
can take another form such as an oral request).
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Proof that the Person is an Insured Person Under the Health Insurance Act
A person seeking admission to a LTC home must provide proof that he or she is an insured
person under the HIA. The CCAC must ensure that the applicant’s Ontario Health Insurance
Plan (OHIP) coverage is valid by verifying coverage through the OHIP validation systems. (For
information on the verification process, see subsection #3.2 in this manual.)
Exemptions:
•
•
Under subsections 134(2) and (3) of the NHA regulation, persons who are already residents
in a LTC home who are transferring to another LTC home are not required to provide proof
of OHIP coverage. (For long-stay residents of a LTC home applying for a determination of
eligibility in order to transfer to a related temporary, re-opened or replacement LTC home,
see “Streamlined Admission Process” in subsection #12.7.3 in this manual.)
Also see “Residency Requirements for OHIP Coverage” in subsection #3.3 in this manual.
Up-to-date Health and Functional Assessments
A further requirement for a determination of eligibility for LTC home admission is the
provision of an up-to-date health assessment and an up-to-date functional assessment of the
applicant in all cases, including crisis situations.
Purpose of Assessments
The purpose of the assessments is to:
•
•
•
•
identify and evaluate the person’s needs, strengths and preferences;
identify potential risks;
determine the person’s eligibility; and
determine the most appropriate level of care to address the person’s requirements.
Health Assessment
An up-to-date health assessment of the person is required in all cases, including crisis
situations. The information for the health assessment is provided in the MOHLTC Health
Report form (#014-2734-69) which is available at:
[http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&AC
T=RDR&TAB=PROFILE&ENV=WWE&NO=014-2734-69]. This form seeks information
about the person’s medical diagnosis, health history, special needs, treatment and
medication requirements.
The form must be signed by a member of the College of Physicians and Surgeons of
Ontario, or a registered nurse who holds a general certificate of registration or an extended
certificate of registration, as required by section 134(1)(c) of the NHA regulation.
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Applicants cannot be charged for completion of this form by a physician if the completion
of the form is a common element of an insured service provided by the physician (under
the OHIP Schedule of Benefits).
Functional Assessment
Under subsection 134(1)(d) of the NHA regulation, an up-to-date functional assessment
carried out by a health or social services provider approved by the CCAC is required in all
cases, including crisis situations. Since March 2004, functional assessments are carried out
using the Resident Assessment Instrument-Home Care (RAI-HC) assessment tool, the use
of which the MOHLTC has mandated.
In the past, functional assessments were frequently contracted out to hospitals and service
providers; however, since the introduction of the RAI-HC in all CCACs, these assessments
are now carried out almost exclusively by CCAC case managers or placement coordinators who are either healthcare or social work professionals. This assessment has
become an activity internal to the CCAC as a result of the proficiency requirements
associated with the assessment tool. However, there is nothing to preclude the CCAC from
contracting out the provision of this assessment so long as the health or social service
providers they select are, and remain, proficient in the use of the RAI-HC.
Note: Subsection 134(1)(d) of the NHA regulation provides that although the functional
assessment that contributes to the eligibility determination may be delegated to a health or
social services professional in the employ of a service provider or service agency, an
applicant’s eligibility for admission to a LTC home shall be determined only by the CCAC
as provided by subsection 20.1(9) of the NHA.
The RAI-HC provides for a standardized assessment process and terminology that is
applicable throughout the province. Standardized assessments ensure greater consistency in
outcomes based on data collected from applicants. It also ensures LTC homes throughout
the province receive the same type of reports and information for consideration when
deciding on admission of an applicant.
The RAI-HC assessment tool consists of the Minimum Data Set for Home Care (MDS-HC)
and Client Assessment Protocols. The MDS-HC is the screening component that enables a
home care provider to assess multiple key areas of a client’s function, health, social
support, and service use. The RAI-HC report function known as the Personal Health Profile
provides a standard summary document of the information generated by the RAI-HC tool
that homes use to help decide whether to approve an application for admission.
Exemptions:
•
September 2006
Under subsections 134(2) and (3) of the NHA regulation, persons who are already longstay residents in a LTC home who are transferring to another LTC home are exempt
from the requirements for an up-to-date health assessment and up-to-date functional
assessment. (For long-stay residents of a LTC home applying for a determination of
15
•
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eligibility in order to transfer to a related temporary, re-opened or replacement nursing
home, see “Streamlined Admission Process” in subsection #12.7.3 in this manual.)
Additionally under subsection 134(4) of the NHA regulation, applicants who are going
to be placed in category 1A (crisis) of the waiting lists of their chosen LTC homes are
not required to provide up-to-date health and functional assessments at this point of the
admissions process if there is insufficient time to comply with these requirements.
Any Additional Information Necessary for the CCAC to Determine Whether the Person
Meets the Eligibility Requirements Set Out in the Regulations
Additional information and documentation may be requested if required to enable the
placement co-ordinator to determine whether an applicant meets the eligibility requirements in
the regulations.
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11.4 Consents Required for Long-Stay Placement
11.4.1 Consent for Admission
People cannot be forced to go into a long-term care (LTC) home or to choose specific homes.
The Nursing Homes Act (NHA) states:
Applications to placement co-ordinator
s. 20.1(6) A person may apply for a determination by a placement co-ordinator respecting the
person’s eligibility for admission to a nursing home and for authorization of admission with
respect to such nursing home or homes as the person selects.
Conditions of authorization
s. 20.1(13) The placement co-ordinator designated for a nursing home under subsection (3)
may authorize the admission of a person to the nursing home only if,
(a) the placement co-ordinator or another placement co-ordinator has determined, within the
six months preceding authorization, that the person is eligible for admission to a nursing
home;
(b) the licensee of the nursing home to which the person’s admission is to be authorized
approves the person’s admission to the nursing home; and
(c) the person consents to being admitted to the nursing home.
While applicants can be encouraged, they cannot be required to choose a specific number of
LTC homes or homes with short waiting lists. In addition, they cannot be required to accept a
first available bed that is not one of the person’s choices. These consumer rights have been a
well-established part of the placement co-ordination system since 1993.
In addition, the Health Care Consent Act, 1996 (HCCA) sets out a comprehensive scheme for
obtaining substitute decisions on behalf of persons who are incapable of making the decision
about admission to a LTC home. (For information on the provisions of the HCCA concerning
consent to admission to a LTC home on behalf of an incapable person, see chapter #4 in this
manual.)
11.4.2 Consent to Release Personal Information 2
LTC home legislation also requires the placement co-ordinator to obtain a person’s consent to
share information with the LTC home to which a person is to be admitted. The NHA states:
Information to licensee
s. 20.2(1) A placement co-ordinator who authorizes a person’s admission to a nursing home
shall give to the licensee of the nursing home the information mentioned in a paragraph of
subsection (2) if,
2
CCACs are health information custodians under the Personal Health Information Protection Act, 2004 (PHIPA).
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(a) the placement co-ordinator has the information mentioned in the paragraph; and
(b) consent to the disclosure of the information to the licensee is given by,
(i) the person whose admission is authorized, or
(ii) the person, if any, who was lawfully authorized to consent to admission to the nursing
home on behalf of the person whose admission is authorized.
Same
s. 20.2(2) The information referred to in subsection (1) is the following:
1. Information about assessments of the person whose admission is authorized.
2. Information about the person’s medical history.
3. Information about the person’s social and other care requirements.
4. The name and address of the person, if any, who was lawfully authorized to consent to
admission to the nursing home on behalf of the person whose admission is authorized.
Further, requirements under the Personal Health Information Protection Act, 2004 (PHIPA)
impose additional obligations on the Community Care Access Centre (CCAC) regarding the
maintenance of confidentiality of clients’ personal health information and the sharing of such
information.
Personal information gathered by the CCAC must be kept confidential. The CCAC must obtain
the consent of the applicant or the applicant’s substitute decision-maker (SDM) to collect, use
and disclose information. In some instances, PHIPA permits the CCAC to release information
without consent.
The Ministry of Health and Long-Term Care (MOHLTC) form Consent for Placement
Coordination Services to Collect, Keep on File, and Release Information form (#014-2747-69)
is used to obtain client consent for a number of purposes as described below. The placement
co-ordinator is responsible for discussing the contents of the form with the applicant, and
having the form signed and dated by the applicant or the applicant’s SDM before proceeding
with the application process.
The Consent for Placement Coordination Services to Collect, Keep on File, and Release
Information form (#014-2747-69) is available at:
[http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=R
DR&TAB=PROFILE&ENV=WWE&NO=014-2747-69].
11.4.3 Types of Consent
Different situations require different types of consents to be given by the person or his or her
SDM if the person is incapable. The types of consent are outlined below:
•
Consent for the CCAC to request and collect personal information including personal
information about the applicant from other organizations
Such personal information could include assessments by the applicant’s physicians,
community-based service providers or informal caregivers. These assessments may provide
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information that is necessary to determine the person’s eligibility for admission to a LTC
home.
•
Consent for the CCAC to disclose personal information about an individual to another
CCAC
Consent is required to share information with another CCAC when an individual wants to
reside in a LTC home outside the catchment area of the CCAC. The person must give
consent to the CCAC that will undertake the eligibility determination to disclose personal
information to the CCAC that will authorize the person’s admission to the LTC home in
another area.
•
Consent for the CCAC to disclose personal information to the LTC home(s) to which
the person has applied for admission
Information about the applicant’s medical history, social, health and functional status
enables the LTC home to determine whether the home can meet the applicant’s care
requirements.
•
Consent for the CCAC to send information to the LTC homes to which a resident of a
LTC home wishes to transfer
Before transferring a person from one LTC home to another, information from the sending
LTC home must be sent by the CCAC to the receiving LTC home to obtain the approval of
the receiving LTC home to admit the person.
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11.5 LTC Home Selection for Long-Stay Applicants
If an applicant is declared eligible for admission to a long-term care (LTC) home, the process
continues with the selection of the person’s preferred LTC home(s). The person has the right to
choose the LTC home in which he or she will seek to reside. In order for the applicant to make
an informed choice, the applicant needs information about the homes.
11.5.1 General Information About Homes
The Community Care Access Centre (CCAC) can assist a person to make choices about a LTC
home by providing information about the services and programs provided by a LTC home,
including whether the home has indoor smoking facilities (see #11.6.1, below, in this manual)
and answering any questions he or she may have about possible choices. The CCAC must
inform the person about home waiting lists so he or she knows how long the wait may be for a
specific LTC home.
The CCAC may also provide information to persons regarding the performance of the LTC
home but should not attempt to influence the person’s decision. The CCAC may share the
following information with persons interested in different LTC homes:
•
•
results of the Ministry of Health and Long-Term Care (MOHLTC) inspection of the LTC
home; and
corrective action plans, if any, that have been identified as part of the inspection.
CCACs can also refer applicants to the public reporting website so applicants can review this
information themselves (although the CCAC may have a more up-to-date inspection report than
is posted on the website).
Applicants should be advised if a LTC home has failed to take corrective actions and where
sanctions have been applied. If the applicant has additional questions, he or she should be
referred to staff of the MOHLTC regional office.
The CCAC is also required to maintain up-to-date information with a description of services
and programs offered in each LTC home and inform applicants about those services.
11.5.2 Information About Accommodation Rates
The CCAC should provide the following information to persons who are considering choices of
LTC homes:
•
•
the accommodation charges that are required to be paid by the resident;
the premium for preferred accommodation;
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•
•
•
•
Chapter 11
that the applicant will be asked by the LTC home to which he or she is admitted to sign an
agreement regarding payment of accommodation charges even though the legal requirement
for payment is set out in the LTC homes legislation;
the services for which the LTC home is responsible and cannot charge residents, and any
services the home may make available for which it does charge;
income testing procedures for rate reduction (see subsection #11.5.3 in this manual); and
reasons for and costs associated with “bed holding.”
11.5.3 Information About Rate Reduction
Under subsection 116(1) of the Nursing Homes Act (NHA) regulation, rate reduction is only
available to long-stay residents in basic accommodation. It is available when a person is unable
to pay the full amount of the accommodation fees as a result of limited income. A rate
reduction is not available to residents contracting for preferred accommodation.
If a person applies for a rate reduction, income testing will be undertaken by the LTC home at
the time the person is admitted (or later, if the application for rate reduction is made at a later
time). A person applying for a rate reduction must provide a copy of their Notice of
Assessment from the Canada Revenue Agency as proof of income for the immediately
preceding year.
Under subsection 116(2) of the NHA regulation, if the person is not required to file an income
tax return with the Canada Revenue Agency, alternative documentation provided by an
independent third party may be accepted to prove income for the immediately preceding year
(e.g., a confirmation letter from the Income Security Branch of Human Resources Development
Canada, or from the applicable social assistance program of the Ministry of Community and
Social Services (MCSS)).
For a description of the entire process for making an application for a reduction in the basic
accommodation rate, refer to section 116 of the NHA regulation.
11.5.4 Additional Rate Reduction in Basic LTC Home Accommodation Fees –
Exceptional Circumstances Application
Effective July 1, 1995, the regulations under the LTC home legislation were amended to allow
residents living in long-stay basic accommodation to apply for an additional reduction to the
basic accommodation rate in exceptional circumstances. Section 116.1 of the NHA regulation
sets out the requirements related to this additional rate reduction:
s. 116.1(1) An application may be made to the Director for a reduction in the fee payable by
any of the following persons for basic accommodation:
1. A long-stay resident for whom the maximum monthly amount is determined to be $963.16
under section 116.
2. A long-stay resident whose spouse lives outside a nursing home, a home under the Homes for
the Aged and Rest Homes Act, an approved charitable home for the aged under the Charitable
Institutions Act or a hospital or other facility that is government-funded.
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Under subsection 116.1(4) of the NHA regulation, these applications are not processed by the
LTC home, but by the MOHLTC directly (i.e., the “Director” under the LTC homes
legislation). Therefore, when a rate reduction is sought under one of these two circumstances,
the application must be filed with the MOHLTC regional office for processing. An application
may only be filed under one of the above referenced circumstances even when both
circumstances apply. An application under the second circumstance referred to above may be
made by either the resident or the resident’s spouse.
The exceptional circumstances application requires residents to provide proof of income for the
immediately preceding year. In the case of an application under the second circumstance, proof
of the income of the spouse of the resident for the immediately preceding year is also required.
Applicants may be requested to provide an explanation of any decrease in their current income
from their previous year’s income. An applicant who has had a government benefit,
entitlement, supplement, or other financial assistance reduced, due to income received or
deemed received during the previous year, would in most cases not qualify for the exceptional
circumstances rate reduction.
MOHLTC regional offices will provide additional information upon request.
11.5.5 Visits to Homes
When circumstances allow, the applicant or substitute decision-maker (SDM) and/or family
members should be encouraged to visit the LTC homes in which they have expressed interest
before they provide the CCAC with their LTC home choices. The visit to the LTC home
provides an opportunity to assess the appropriateness of the LTC home’s services and
amenities, and to pose questions to LTC home staff.
The CCAC is responsible for advising the applicant that when he or she visits the LTC home,
the applicant may request to see the following government documents or reports:
•
•
•
•
the Residents’ Bill of Rights along with information on the procedures for making
complaints about the maintenance or operation of the home, the conduct of the staff of the
home, or the treatment or care received by a resident in the home;
a copy of the service agreement between the LTC home and the MOHLTC;
a copy of the most recent inspection report relating to the LTC home (MOHLTC
inspections are conducted annually and the report should be dated within 12 months of the
date of the visit); and
copies of the most recent year-end report and most recent auditor’s report for the home.
LTC homes legislation requires these documents/reports to be posted in the LTC home or
provided by written notice to each resident (or if the resident is incapable, to the SDM).
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11.5.6 Classes of Accommodation
Section 155 of the NHA regulation sets out the classes of accommodation for which an
applicant may apply and be waitlisted:
s. 155(1) Subject to section 156, the placement co-ordinator designated for a nursing home
under subsection 20.1 (3) of the Act shall authorize the admission of a person to the home if,
and only if,
…
(c) the home has available the class of accommodation for which the person is recorded to be
waiting;
(d) there is no one on the waiting list for the home who is recorded to be waiting for the class
of accommodation that is available, who ranks ahead of the person, and whose admission may
be authorized under this section; …
(2) For the purposes of clauses (1) (c) and (d), the following are the classes of accommodation
for which a person may be recorded to be waiting:
1. Accommodation for a woman in a respite care or supportive care program.
2. Accommodation for a man in a respite care or supportive care program.
3. Basic accommodation for a woman other than in a respite care or supportive care program.
4. Basic accommodation for a man other than in a respite care or supportive care program.
5. Semi-private accommodation for a woman other than in a respite care or supportive care
program.
6. Semi-private accommodation for a man other than in a respite care or supportive care
program.
7. Private accommodation for a woman other than in a respite care or supportive care
program.
8. Private accommodation for a man other than in a respite care or supportive care program.
11.5.7 Number of Home Choices
LTC home legislation allows a person to apply to as many LTC homes as he or she wishes.
However, subject to two exceptions the regulations under LTC care home legislation restrict to
three the number of “approval requests” that the CCAC can send at any one time to LTC home
operators and the number of waiting lists upon which a CCAC may place a person at any one
time. Under subsection 137.1(3) of the NHA regulation, the two exceptions are persons who
will be placed in category 1A (crisis) or the short-stay category on the waiting list for a LTC
home.
An applicant has the right to have applications sent to three LTC homes in the same CCAC
area, or three LTC homes in different areas of the province or a combination of both, as long as
only three or less are issued and outstanding at any given point in time. The applicant also has
the right to select only one or two LTC homes if that is all the person is prepared to consider.
Once an applicant has made his or her choice(s), the CCAC will send up to a maximum of three
approval requests to the LTC homes. If the maximum of three requests is sent, they must be the
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applicant’s top three choices. If the applicant is approved by the three LTC home operators, the
CCAC must place the applicant on the waiting lists for these three LTC homes. If any of the
applications are refused by one or more of the LTC homes selected, the CCAC may send a
request to another LTC home selected by the applicant (or SDM).
Under subsections 137.1(1) and (2) of the NHA regulation, the “three LTC home” rule which
took effect on May 1, 2002, applies to approval requests sent to LTC home operators and
waiting lists for all applicants (both hospital and community-based) with the exception of those
who are ranked in category 1A (crisis) and those who are applying for short-stay programs.
Under subsection 137.1(3), persons who are ranked in category 1A (crisis) or applying for
short-stay programs may apply to an unlimited number of homes.
Under subsections 137.1(1) and (2), applicants who were placed on more than three waiting
lists prior to May 1, 2002 who are still awaiting placement may remain on the lists. However a
CCAC cannot send any approval requests or place the applicant on any additional waiting lists
unless the applicant agrees to remove his or her name from other waiting lists so that the total
number of waiting lists on which the person is placed does not exceed three.
Applicants should be encouraged to examine a range of potential LTC homes and should have
their names placed only on the waiting lists of those LTC homes that they are prepared to
accept.
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11.6 Request for Approval of Admission and Response from the
LTC Home
11.6.1 Application for Authorization of Admission
Once the applicant has been determined eligible for admission and made his or her selection(s)
of long-term care (LTC) home(s), the applicant must apply for authorization of admission. The
Community Care Access Centre (CCAC) is obliged to assist applicants with the completion of
the application. Sections 135 and 136 of the Nursing Homes Act (NHA) regulation set out the
requirements related to the application for authorization of admission:
s. 135 A person may apply for authorization of his or her admission to a nursing home only
after the person has been determined by a placement co-ordinator to be eligible for admission.
s. 136(1) To apply for authorization of his or her admission to a nursing home, a person shall
provide to the placement co-ordinator designated for the home under subsection 20.1 (3) of the
Act,
(a) a written request by the person for authorization of his or her admission to the home;
(b) the items mentioned in clauses 134 (1) (c) and (d) if,
(i) the person was not required to provide those items when the person applied for the
determination of his or her eligibility, and
(ii) in the opinion of the placement co-ordinator, the licensee of the home does not have
sufficient other information about the person to determine whether to give or withhold
approval for the person’s admission to the home; and
(c) such additional information and documentation as is necessary to enable the placement coordinator to determine the category in which to place the person under sections 142 to 148.4.
(1.1) Despite clause (1) (a), a request for authorization of admission need not be in writing if it
is a request for authorization of admission as a long-stay resident with respect to a related
temporary nursing home, a re-opened nursing home or a replacement nursing home made by a
person who is a long-stay resident of the original nursing home or was a long-stay resident of
the original nursing home immediately before the closure of his or her bed in the home.
(2) The placement co-ordinator shall assist the person in obtaining the information and
documentation that the person is required to provide to the placement co-ordinator under this
section.
Applicants provide the written request for authorization of admission to the LTC home(s) of
their choice by completing the selection form provided by the CCAC. Each CCAC has
developed its own forms for applicants to complete for selection of LTC homes. As part of this
application, the person also indicates his or her preferences for accommodation (private, semiprivate or basic). An applicant may base his or her decision on many factors including, ethnic,
spiritual, linguistic, familial and cultural preferences, the location of the home, whether the
home has indoor smoking facilities, or what he or she can afford to pay.
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If an applicant is a smoker, it is imperative that the CCAC advise the person that the provisions
of the Smoke-Free Ontario Act prohibit smoking inside a LTC home other than in a controlled
smoking area that complies with the requirements under that legislation. Furthermore, even
where a LTC home has a controlled smoking area, residents who wish to smoke in there must
be able to smoke safely without assistance from an employee. Employees are not required to
enter a controlled smoking area to assist a resident to smoke. If the person selects one or more
LTC homes that do not have a controlled smoking area, the CCAC must ensure that the person
is aware of the LTC home’s internal no smoking policy and agrees not to smoke inside the LTC
home.
If the applicant, being advised that a LTC home is non-smoking, indicates that he or she will
continue to smoke indoors, the operator may decide not to approve the admission on the basis
that the LTC home lacks the physical facilities necessary to meet the applicant’s care
requirements. The applicant must be advised of this likelihood.
As part of the process for authorization of admission, CCACs must provide applicants who are
smokers with the information referred above. CCACs must document the provision of
information to applicants and the applicant’s response and ensure that this information is
provided to the LTC home(s) as part of the application for admission.
As noted in the above referenced provision, the written request for authorization of admission
to a LTC home must be accompanied by the following documentation:
•
•
the functional and health assessment information if the applicant was not initially required
to provide this information to the CCAC when applying for the determination of eligibility
and the CCAC is of the view that the LTC home needs it to provide approval for admission;
and
any additional information and documentation that the CCAC deems necessary to
determine the applicant’s category on the waiting list.
11.6.2 Date of Application
The date and time when the CCAC received all the information for the application is
considered the “time at which the person applied for authorization of their admission”. This
date and time will be used to rank the person for admission within each category of the waiting
list, with some exceptions. (For additional information on ranking of priority categories, see
subsection #12.8 in this manual.)
11.6.3 Request for Approval of Admission by LTC Home
Once the CCAC has determined that the applicant is eligible for admission to a LTC home and
the applicant has applied for authorization of admission, the CCAC must submit the
application(s) to the LTC home(s) chosen by the applicant. This requirement is set out in
section 137 of the NHA regulation:
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s. 137 (1) Subject to sections 137.1 and 138.1, when a person who has been determined by a
placement co-ordinator to be eligible for admission to a nursing home applies for authorization
of his or her admission to a particular nursing home, the placement co-ordinator designated
for the home under subsection 20.1 (3) of the Act shall,
(a) give the licensee of the home the information possessed by the placement co-ordinator that
is relevant to the licensee’s determination of whether to give or withhold approval for the
person’s admission to the home; and
(b) request the licensee to determine whether to give or withhold approval for the person’s
admission to the home.
With the consent of the applicant or where applicable, the applicant’s substitute decision-maker
(SDM), the CCAC must provide the LTC home(s) with information that is relevant for the
operator to make the decision to give or withhold approval for the applicant’s admission to the
LTC home. This information includes:
•
•
•
the name and address of the applicant and the SDM, if any, who was lawfully authorized to
consent to the admission;
whether the person is requesting a long-stay or a short-stay respite care or supportive care
program;
assessments of the person who is seeking admission to the LTC home:
• information about the person’s medical history (The completed Ministry of Health and
Long-Term Care (MOHLTC) Health Report form requests information about a medical
diagnosis, history, current condition, current treatments required, prognosis and current
medications and diet. The Health Report form (#014-2734-69) is available at:
[http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&
ACT=RDR&TAB=PROFILE&ENV=WWE&NO=014-2734-69].);
• information about the person’s social and other care requirements including reports and
assessments that may have been undertaken and could have a bearing on the person’s
care requirements (e.g., a psychogeriatric assessment);
• type of accommodation requested by the person; and
• personal information such as:
• age;
• gender;
• ethnic, spiritual, linguistic, cultural, familial preferences;
• relevant life-style factors (e.g., smoker); and
• names of relatives or other contacts.
11.6.4 Response from the LTC Home
The LTC home is required to provide a written response to both the CCAC and the applicant
stating the applicant is either approved or not approved for admission to the home within five
days after receiving the request for approval of admission. This time frame does not include
weekends or holidays. The NHA states:
s. 137(2) A licensee of a nursing home shall, within five days after receiving the request
mentioned in subsection (1),
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(a) give the placement co-ordinator designated for the home and the person applying for
authorization of admission to the home a written notice stating that the licensee approves the
person's admission; or
(b) if the licensee is withholding approval for the person's admission, give the written notice
required under subsection 20.1 (15) of the Act to the persons mentioned in subsection 20.1 (15)
of the Act.
(3) In counting five days for the purpose of subsection (2), holidays shall not be included.
"holiday" means,
(a) Saturday,
(b) Sunday,
(c) New Year's Day,
(d) Good Friday,
(e) Victoria Day,
(f) Canada Day,
(g) Civic Holiday,
(h) Labour Day,
(i) Thanksgiving Day,
(j) Christmas Day,
(k) Boxing Day,
(l) any special holiday proclaimed by the Governor General or the Lieutenant Governor,
(m) if New Year's Day or Canada Day falls on a Saturday or Sunday, the following Monday,
(n) if Christmas Day falls on a Saturday or Sunday, the following Monday and Tuesday, and
(o) if Christmas Day falls on a Friday, the following Monday.
LTC homes are not obliged to take the full five days to respond to an applicant’s request for
approval of admission so the CCAC can try to negotiate to receive a response sooner.
11.6.5 LTC Home Approval of Admission
If a LTC home of the applicant’s choice approves admission and a bed is available for the
person, the CCAC may authorize the admission and the person may be admitted to the LTC
home immediately. If a bed is not immediately available, the CCAC must place the person on
the waiting list(s) of the person’s chosen LTC homes. The CCAC must advise the person of his
or her priority for admission. (For information on management of LTC home waiting lists, see
chapter #12 in this manual.)
11.6.6 LTC Home Withholds Approval
LTC homes legislation sets out limited grounds for a LTC home to withhold approval of a
person’s admission and the notification requirements in such situations. The NHA states:
Approval
s. 20.1(14) A licensee of a nursing home shall approve a person's admission to the nursing
home unless,
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(a) the nursing home lacks the physical facilities necessary to meet the person's care
requirements;
(b) the staff of the nursing home lack the nursing expertise necessary to meet the person's care
requirements; or
(c) circumstances exist which are prescribed by the regulations as being a ground for
withholding approval.
Written notice
s. 20.1(15) A licensee who withholds approval for the admission of a person to a nursing home
shall give to the person, the Director and the placement co- ordinator designated for the
nursing home under subsection (3), a written notice setting out the ground or grounds on which
the licensee is withholding approval and a detailed explanation of the supporting facts.
A LTC home operator must approve the admission of an applicant unless the LTC home lacks
the physical facilities necessary to meet the person’s care requirements, or the staff of the home
lack the nursing expertise necessary to meet the person’s care requirements. Currently, there
are no additional circumstances prescribed by the regulations as being grounds for a LTC home
to withhold approval under subsection 20.1(14)(c) of the NHA.
When admission is not approved, the LTC home operator must provide a written notice to the
Director (i.e., MOHLTC regional office), the CCAC and the applicant setting out the grounds
on which the approval is withheld and a detailed explanation of the supporting facts. The
home’s written notification should not simply reference the legislative provisions under which
approval is denied, but specify how the reason(s) for refusal relate specifically to the condition
of the individual whose approval for admission is being refused. Homes that do not provide this
level of detail should be challenged on their refusal.
11.6.7 LTC Home Withdrawal of Approval
Section 138 of the NHA regulation sets out the conditions for the operator’s withdrawal of
approval for a person’s admission:
s. 138(1) Subject to section 138.1, a licensee may withdraw an approval of a person’s
admission to a nursing home before the person’s admission is authorized if, as a result of a
change in the person’s condition, a ground for withholding approval mentioned in subsection
20.1 (14) of the Act exists.
(2) A licensee who withdraws an approval of a person’s admission to a nursing home under
subsection (1) shall give to the person, the Director and the placement co-ordinator designated
for the home under subsection 20.1 (3) of the Act a written notice,
(a) stating that the licensee is withdrawing the approval of the person’s admission; and
(b) setting out the ground or grounds on which the licensee is withholding approval and a
detailed explanation of the supporting facts.
A LTC home may withdraw approval of a person’s admission to the LTC home prior to
authorization of the person’s admission if a change in the person’s condition results in grounds
for withholding approval. Permitted grounds for withdrawing approval for admission are the
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same as those for withholding approval for admission (i.e., the LTC home lacks the physical
facilities necessary to meet the person’s care requirements or the staff of the home lack the
nursing expertise necessary to meet the person’s care requirements).
Under subsections 138 (2)(a) and (b) of the NHA regulation, when approval for admission is
withdrawn, the LTC home operator must provide a written notice to the Director (i.e.,
MOHLTC regional office), the CCAC and the applicant stating that approval of the person’s
admission is withdrawn and setting out the grounds on which the approval is withheld and a
detailed explanation of the supporting facts.
The LTC home’s written notification should not simply reference the legislative provisions
under which approval is withdrawn, but specify how the reason(s) for the withdrawal of
approval relate specifically to the condition of the individual whose approval for admission is
being withdrawn.
Exemptions: Under subsection 138.1(1) and (2) of the NHA regulation, the applications of
individuals applying to a related temporary LTC home, a re-opened LTC home or a
replacement LTC home are not subject to LTC home approval. In the case of these applicants,
LTC homes are deemed to have approved the admission of any long-stay resident who is or
was a resident of the original nursing home immediately before the closure of his or her bed in
the home.
11.6.8 Re-Determination of Eligibility
LTC home legislation requires that an applicant’s health and functional assessments be current
within six months of admission. The NHA states:
s. 20.1(13) The placement co-ordinator designated for a nursing home under subsection (3)
may authorize the admission of a person to the nursing home only if,
(a) the placement co-ordinator or another placement co-ordinator has determined, within the
six months preceding authorization, that the person is eligible for admission to a nursing
home;…
In the case of individuals who are on waiting lists for long periods of time, the CCAC’s
assessment information must be current within six months of admission into a LTC home.
In the majority of cases, the person’s eligibility will be reconfirmed. Nevertheless, there may be
some situations where the person’s condition has improved or community resources are now
available and adequate to address the person’s needs. Alternatively, the person’s condition may
have changed to such a degree that the LTC home operator has grounds to withdraw its approval
of admission or the CCAC determines that the person’s care requirements cannot be met in a
LTC home (See LTC Home Withdrawal of Approval in subsection #11.6.7 above in this
manual.)
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11.7 Accepting the Offer of Long-Stay Admission,
Accommodation and Bed-Holding Fees
Long-term care (LTC) home legislation establishes timelines for the acceptance of a bed offer
and admission that are designed to ensure existing beds in LTC homes are fully utilized. When
a Community Care Access Centre (CCAC) makes an offer of admission to a person, the person
is given a strict time limit in which to decide whether or not he or she will accept the offer and
subsequently to move into the LTC home. The LTC home is allowed to charge the applicant
certain fees during the time that the bed is being held for the person.
11.7.1 Timeline for Acceptance of Offer of Admission
An applicant has one day to accept an offer of admission to a LTC home of his or her choice.
This timeframe is established by operation of the regulatory provisions related to authorization
of admission. The Nursing Homes Act (NHA) regulation states:
Authorization of admission
and only if,
…
(e) in the case of a person who is applying for authorization of his or her admission to the
home as a long-stay resident, the person agrees in writing with the licensee of the home that,
(i) the person will move into the home before noon of the fifth day following the day on
which he or she is informed of the availability of accommodation in the home,
According to this provision, an applicant is expected to move into the LTC home by the fifth
day after the day on which the person is made the offer of admission. That gives the person one
day within receiving the offer to accept or reject the offer and sign the agreement with the
home.
11.7.2 Accommodation and Bed-Holding Fees
Once a person has accepted the offer of admission, the bed may be held for up to five days
following the date of notification, if the person pays the applicable bed holding and
accommodation fees. This means that a person who is offered admission will have five days to
move in, not counting the date of notification.
The date of notification does not count as one of the days for bed-holding purposes as it is the
day the applicant has to decide whether to accept the offer of admission.
Section 155 of the NHA regulation sets out the applicable fees that the LTC home may charge
during the five-day period, and subsection 47(4) establishes the amount of the daily bed-
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holding fee which is payable in addition to the accommodation fee for that part of the period
available for bed-holding:
s. 155 (1) Subject to section 156, the placement co-ordinator designated for a nursing home
and only if,
…
(e) in the case of a person who is applying for authorization of his or her admission to the
home as a long-stay resident, the person agrees in writing with the licensee of the home that,
(i) the person will move into the home before noon of the fifth day following the day on which
he or she is informed of the availability of accommodation in the home,
(ii) if the person moves into the home before noon of the fifth day following the day on which
he or she is informed of the availability of accommodation in the home, the person will pay,
(A) for each day following the day on which the person is informed of the availability of
accommodation in the home and preceding the day on which the person moves into the
home, the amount that the licensee would have charged him or her for accommodation
for that day had he or she been a long-stay resident lodged in the available
accommodation on that day, and
(B) if the person moves into the home on or after the third day following the day on which
he or she is informed of the availability of accommodation in the home, the daily bedholding amount as determined under section 47 for each day from and including the
second day following the day on which the person is informed of the availability of
accommodation in the home and preceding the day on which the person moves into the
home, and
(iii) if the person does not move into the home before noon of the fifth day following the day
on which he or she is informed of the availability of accommodation in the home, the person
will pay,
(A) for each of the five days following the day on which the person is informed of the
availability of accommodation in the home, the amount that the licensee would have
charged him or her for accommodation for that day had he or she been a long-stay
resident lodged in the available accommodation on that day, and
(B) for each of the second, third, fourth and fifth days following the day on which the
person is informed of the availability of accommodation in the home, the daily bedholding amount as determined under section 47.
Absences
s. 47(4) The daily bed-holding amount for a day after March 31, 1995 is $53.
The following chart outlines the applicable accommodation and bed-holding fees for the fiveday bed-holding period described in the above referenced provisions.
Note: The date of notification (i.e., the day the offer is made) is identified as day 0 in the chart.
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Day Resident Moves In
Accommodation Fee
Bed-holding Fee ($53)
Day 0
Date of Notification of Availability
Yes for day 0
No
Day 1
Following Notification
Yes for day 1
No
Day 2
Yes for day 1 and 2
No
Day 3
Yes for days 1,2 and 3
Yes for day 2
Day 4
Yes for days 1,2,3 & 4
Yes for days 2 and 3
Day 5 (Before Noon of Day 5)
Yes for days 1,2,3,4 and 5
Yes for days 2,3 and 4
Applicant does not move in
Yes for days 1,2,3,4 and 5
Yes for days 2,3,4 and 5
Saturdays and Sundays count for bed-holding purposes even if the LTC home does not admit
applicants over the weekend. This is owing to the fact that the ordinary meaning of the word
“day” in the regulation means calendar day. Therefore, if a home does not admit on any
particular day such as weekends or holidays, the accommodation and bed-holding fees still
apply if the particular day falls within the bed-holding period.
However, there are no provisions in the regulation which address when the CCAC has to make
a bed offer, so a placement co-ordinator may wait to make a bed offer until after the weekend if
he or she knows that the home does not admit applicants over the weekend.
Additionally, the payment of accommodation and bed-holding fees is part of a contractual
arrangement between the applicant and the LTC home operator.
Accommodation and bed-holding fees apply to all applicants including those who are already
residing in another LTC home and hospital-based applicants who are paying the chronic care
co-payment.
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11.7.3 “One-Offer” Policy
The NHA regulation sets out the requirements of the “one-offer” policy:
s. 141(1) A person shall be removed from the waiting list for each nursing home to which the
person is awaiting admission as a long-stay resident and shall be placed on the refusal list if,
(a) the person,
(i) is a long-stay resident of another nursing home, an approved charitable home for the
aged under the Charitable Institutions Act or a home under the Homes for the Aged and
Rest Homes Act, or
(ii) is not described in subclause (i) and does not occupy a bed in,
(A) a hospital under the Public Hospitals Act or a private hospital licensed under the
Private Hospitals Act,
(B) a facility that is designated as a psychiatric facility under section 80.2 of the
Mental Health Act and that is not exempt under that section from the requirement to
provide in-patient services in paragraph 1 of subsection 4 (1) of Regulation 741 of the
Revised Regulations of Ontario, 1990 made under that Act, or
(C) a facility listed in Schedule 1 to Regulation 272 of the Revised Regulations of
Ontario, 1990 made under the Developmental Services Act; and
(b) a placement co-ordinator offers to authorize the person’s admission to a nursing home, an
approved charitable home for the aged under the Charitable Institutions Act or a home under
the Homes for the Aged and Rest Homes Act as a long-stay resident, and the person,
(i) refuses to consent to admission,
(ii) refuses to enter into the written agreement mentioned in clause 155 (1) (e) of this
Regulation, clause 86 (1) (e) of Regulation 69 of the Revised Regulations of Ontario, 1990
made under the Charitable Institutions Act or clause 12.21 (1) (e) of Regulation 637 of the
Revised Regulations of Ontario, 1990 made under the Homes for the Aged and Rest Homes
Act, as applicable, or
(iii) fails to move into the facility on or before the fifth day following the day on which he
or she is informed of the availability of accommodation.
(2) Subsection (1) does not apply if the reason the person acts in the manner described in
subclause (1) (b) (i), (ii) or (iii) is that the person has a short-term illness or injury which,
(a) prevents the person from moving into the facility at that time; or
(a) would make moving into the facility at that time detrimental to the person’s health.
(3) If a person described in subclause (1) (a) (i) is removed from the waiting list for a nursing
home under subsection (1), the person shall be placed on the waiting list for the home again to
await admission as a long-stay resident if,
(a) the person provides to the placement co-ordinator designated for the home under
subsection 20.1 (3) of the Act a new written request for authorization of his or her admission to
the home as a long-stay resident; and
(b) placing the person on the waiting list for the home will not result in the total number of
waiting lists for nursing homes, approved charitable homes for the aged under the Charitable
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Institutions Act and homes under the Homes for the Aged and Rest Homes Act on which the
person is placed exceeding three.
(4) If a person described in subclause (1) (a) (ii) is removed from the waiting list for a nursing
home under subsection (1), the person shall be placed on the waiting list for the home again to
await admission as a long-stay resident if,
the home as a long-stay resident and,
(i) the request is provided 24 weeks or more after the day the person was removed from the
waiting list, or
(ii) the request is provided less than 24 weeks after the day the person was removed from
the waiting list but there has been a deterioration in the person’s condition or
circumstances; and
(5) Clause (4) (b) does not apply to a person who will be placed in category 1A on the waiting
list for the home.
The “one offer” policy applies to applicants currently residing in the community setting and
those who are currently in LTC homes waiting for transfer to another LTC home. The policy
does not apply to applicants in hospitals.
If a community or LTC home based applicant refuses a bed offer made by a CCAC relating to
any of the LTC homes for which the person is waitlisted, the CCAC must remove that person
from all waiting lists and place the person on the refusal list. The same applies if the person
does not move into the LTC home within five days. The only exception to this requirement is
applicants who have a short-term illness or injury that affects their ability to move into the LTC
home: these applicants will not be removed from all of their LTC home waiting lists.
After removal from all waiting lists, community based applicants will be required to wait six
months before reapplying to the CCAC to be reassessed for admission to a LTC home unless
their condition or circumstances deteriorate. LTC home residents seeking to transfer to another
home will also be required to re-apply, however no waiting period will apply to these
individuals. In both cases however, the person will lose his or her original priority for ranking
on the waiting lists of his or her chosen LTC homes.
In light of the “one-offer” policy and the fact that a person will be removed from all waiting
lists if he or she refuses an offer of admission, applicants should be encouraged to choose only
LTC homes for which they are truly willing to accept an offer of admission.
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11.8 CCAC Authorization of Long-Stay Admission
If a long-term care (LTC) home has a suitable vacancy available and the applicant has accepted
the placement, the next step is for the Community Care Access Centre (CCAC) to authorize the
admission of the applicant to the LTC home. Before doing so, the CCAC must ensure that
certain conditions are met.
11.8.1 Conditions for Authorizing Admission to a LTC Home
The Nursing Homes Act (NHA) regulation sets out the requirements for authorization of
admission:
and only if,
(a) the requirements set out in subsection 20.1 (13) of the Act are met;
Note: Subsection 20.1(13) requires that the person has been determined by the CCAC to be
eligible for admission to a nursing home (within the six months preceding authorization); the
nursing home to which the person’s admission is to be authorized approves the person’s
admission to the home; and the person or, if the person is incapable, his or her substitute
decision-maker (SDM) consents to the person being admitted to the home.
s. 155(1)(b) the licensee of the home has not withdrawn the approval of the person's admission
under section 138;
waiting;
be authorized under this section; and
(e) (See “Authorization of Admission” in subsection #11.7.2 in this manual.)
11.8.2 Conditions Under Which Admission is Not Authorized
Sections 46(1) and (2) of the Health Care Consent Act, 1996 (HCCA) set out conditions under
which admission is not authorized. Where the CCAC designated as the placement co-ordinator
for the LTC home is informed that:
•
•
the person who was found to be incapable with respect to admission intends to apply or has
applied to the Consent and Capacity Board (the Board) for a review of the finding;
the incapable person intends to apply or has applied to the Board for appointment of a
representative to give or refuse consent to the admission on his or her behalf; or
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another person intends to apply or has applied to the Board to be appointed as the
representative of the incapable person to give or refuse consent to the admission on his or
her behalf.
Section 46(3) of the HCCA provides that in the above referenced circumstances, authorization
of admission to the LTC home cannot proceed and the person cannot be admitted:
•
•
•
•
until 48 hours have elapsed since the CCAC was first informed of an intended application
to the Board without an application being made; or
until the application to the Board has been withdrawn; or
until the Board has made a decision and none of the parties to the application before the
Board has informed the CCAC that he or she intends to appeal the Board’s decision; or
if a party before the Board has informed the CCAC that he or she intends to appeal the
Board’s decision:
• until the period for commencing the appeal has elapsed without an appeal being
commenced; or
• until the appeal of the Board’s decision has been finally disposed of.
Note: If a person is determined by the decision of the Board or court to be capable and the
person refuses to consent to the admission, the person’s admission to the LTC home cannot
proceed. The same applies if the finding of incapacity is confirmed by the Board or court and
the SDM on behalf of the incapable person refuses consent to the admission.
Exception: Under subsection 46(4) of the HCCA, despite the above, an incapable person may
be authorized for admission where the CCAC is of the opinion that the incapable person
requires immediate admission to a LTC home as a result of a crisis.
Pursuant to section 39 of the HCCA, “crisis” means a crisis relating to the condition or
circumstances of the person who is to be admitted to the LTC home.
11.8.3 Copies of the Authorization for Admission
Three copies of the authorization for admission must be made available. One copy is for the
eligible person, one for the receiving LTC home, and one for the CCAC. The LTC home must
retain the authorization in the person’s file as required by section 88 of the NHA regulation:
s. 88 Every administrator of a nursing home shall create and maintain a written record and file
for each resident that shall be contained in the resident’s personal file and that shall include,
(a) particulars of admission, transfer, notification of admission to a hospital, discharge,
accident or death.
11.8.4 Cancellation of Authorization of Admission
Subsection 155(3) of the NHA regulation sets out the conditions under which a placement coordinator must cancel an authorization of admission:
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s. 155(3) A placement co-ordinator who authorizes a person’s admission to a nursing home as
a long-stay resident shall cancel the authorization if the person does not move into the home
before noon of the fifth day following the day on which the person is informed of the
availability of accommodation in the home.
The CCAC must cancel the authorization of a person’s admission to a LTC home as a long-stay
resident if the person does not move into the home after accepting an offer.
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11.9 Short-Stay Programs: Respite Care and Supportive Care
(Convalescent Care)
Respite care and supportive care are two short-stay programs that are offered in some long-term
care (LTC) homes. These programs are intended to support individuals who may benefit from
or require a short-stay in a LTC home but who are expected to return to their homes in the
community within a specific period of time. In addition, short-stay crisis admission of up to 14
days may be authorized if a person applying for admission for long-stay is on category 1A of
the waiting list. (This type of admission is explained in subsection #11.9.4 in this manual.)
11.9.1 Respite Care Program
Respite care is intended to provide caregivers with temporary relief from their caregiving
responsibilities. Respite care may be provided to enable the caregiver to take a break. The
person entering the LTC home may also benefit from the programs and services offered by the
home. The anticipated length of stay is a maximum of 60 days.
Respite Care Program – Eligibility Criteria
Eligibility criteria for the Respite Care Program are set out in section 131 of the Nursing Homes
Act (NHA) regulation:
s. 131(1) An applicant shall be determined to be eligible for admission to a nursing home as a
short-stay resident in the respite care program if, and only if,
(a) the applicant's caregiver requires temporary relief from his or her caregiving duties;
(b) it is anticipated that the applicant will be returning to his or her residence within 60 days
after admission to the nursing home; and
(c) the applicant meets the requirements of clauses 130 (1) (a), (b), (c) and (e).
and only if,
(b) the applicant is an insured person under the Health Insurance Act ;
(b) the applicant meets at least one of the conditions set out in subsection (2);
…
s. 130 (2) The following are the conditions referred to in clause (1) (c):
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Note: There is no requirement to consider the availability of publicly-funded community-based
services or other available arrangements when determining a person’s eligibility for short-stay
respite care.
Respite Care Program – Application for Determination of Eligibility
The application process for a determination of eligibility for the Respite Care Program is the
same as that for an applicant seeking long-stay admission (see subsection #11.3 in this manual).
Individuals (or, if incapable, their substitute decision-makers (SDMs)) must apply for a
determination of eligibility and consent to be admitted to a LTC home for respite care.
11.9.2 Supportive Care Program/Convalescent Care Program
The supportive care program referenced in the regulations provides the legal framework for the
program now known as the Convalescent Care Program. The primary focus of the program is to
provide a supportive environment for people discharged from acute care settings who need to
recover their strength, endurance and functioning before returning home.
The Convalescent Care Program is a time-limited LTC home placement. Although there may
be monitoring by the case manager on an ongoing basis, from a data perspective, the person is a
resident of the LTC home and not a Community Care Access Centre (CCAC) in-home client.
The Convalescent Care Program operates under the current legislation and regulations and is
available to individuals coming from either the community or hospital. It must be anticipated
that the person will return to his or her residence within 90 days after admission.
Convalescent Care Program – Eligibility Criteria
The NHA regulation sets out the eligibility criteria for the convalescent care program:
s. 131(2) An applicant shall be determined to be eligible for admission to a nursing home as a
short-stay resident in the supportive care program if, and only if,
(a) the applicant requires a period of time in which to recover strength, endurance or
functioning and is likely to benefit from a short-stay in a nursing home;
(b) it is anticipated that the applicant will be returning to his or her residence within 90 days
after admission to the nursing home; and
(c) the applicant meets the requirements of clauses 130 (1) (a), (b), (c) and (e).
and only if,
(b) the applicant is an insured person under the Health Insurance Act ;
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(c) the applicant meets at least one of the conditions set out in subsection (2);
…
s. 130(2) The following are the conditions referred to in clause (1) (c):
Note: There is no requirement to examine the availability of publicly-funded community-based
services or other available arrangements when determining a person’s eligibility for short-stay
convalescent care.
Convalescent care residents could include individuals recovering from surgery or an illness,
such as cancer, or those with an impairment or disability. Some residents could be preparing for
active rehabilitation before returning home. Others could have non-acute clinical conditions
and need short-term, 24-hour professional attention (e.g., intensive wound care). The level of
medical need of a LTC home’s convalescent care residents is determined by what the LTC
home is able to provide. What all these populations have in common is the need for short-term
care before returning home; specific populations will vary according to the community and
LTC home.
The care provided to convalescent care residents has a greater focus on reactivation in
preparation for returning home. The program’s philosophy is based on promoting self-care and
self-sufficiency, emphasizing adaptation to the current situation, and drawing on the
individual’s abilities and strengths. Therefore, the individuals best suited to the program are
motivated to return home, committed to participating in activities that will make this possible,
and capable of learning. The individuals should have goals and timeframes that are clear,
realistic, and able to be monitored. The program is not for individuals who need permanent
LTC home admission, complex continuing care or palliative care.
The Convalescent Care Program is not designed to serve individuals whose primary diagnosis
is psychiatric and who have behavioural issues. If, however, an applicant has some psychiatric
issues along with a primary medical or surgical condition, but does not have behavioural
challenges, the applicant might be eligible. A LTC home’s acceptance of a convalescent care
applicant depends on its ability to provide the services the particular applicant would need.
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Convalescent Care Program – Application for Determination of Eligibility and Admission
Procedures
The application process for a determination of eligibility for the Convalescent Care Program is
the same as that for an applicant seeking long-stay admission. (See subsection #11.3 in this
manual.) Individuals (or, if incapable, their SDM) must apply for a determination of eligibility
and also consent to be admitted to a LTC home for convalescent care.
Since this program’s primary focus is to assist in relieving pressures within the acute care
setting, there is an expectation that, within 24-72 hours of having been identified in either the
community or hospital, an individual is assessed, eligibility is determined, goals are identified,
and a tentative date for discharge from convalescent care is set. The RAI-HC is the assessment
instrument used for the functional assessment of convalescent care applicants, although a
somewhat abbreviated version is used for applicants from hospital.
Once the application and assessment information are forwarded to the LTC homes selected by
the applicant, the LTC homes are expected to respond verbally within two hours about whether
an applicant is approved for admission. The individual is then to be admitted within 24 hours of
being offered a bed. The whole process should take no more than three to five days, if a bed is
available and if there is no waiting list.
The program’s terms and conditions specify that the LTC home be available to approve
admission every day, including weekends and holidays, and for at least eight continuous hours
during the daytime. This program relies on and demonstrates the importance of collaboration
among hospitals, CCACs, and LTC homes to schedule and co-ordinate referrals and admissions
at mutually acceptable times.
Note: A person who is a resident of a LTC home and who is on a leave of absence from the
LTC home (e.g., on vacation, or as a result of a home outbreak), may be eligible to receive
home care services from the CCAC. The same applies to a person who is on a leave of absence
from the LTC home Convalescent Care Program or on a leave of absence from a hospital.
11.9.3 Determination of Ineligibility for Short-Stay Programs
Pursuant to subsection 20.5(1) of the NHA regulation, if an applicant is determined ineligible
for admission to a LTC home, the CCAC must provide the applicant and the person, if any,
who applied for the determination on behalf of the applicant, with written notice outlining:
•
•
•
the determination of ineligibility;
the reasons for the determination; and
the applicant’s right to apply to the Appeal Board for a review of the determination.
If the applicant is a hospital inpatient, the CCAC may advise the hospital of the CCAC’s
determination of ineligibility, subject to the Personal Health Information Protection Act, 2004
(PHIPA).
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11.9.4 Admission Procedures for Short-Stay Programs
Choice and Consent for Admission
LTC home legislation and regulations specify that an applicant may select the LTC home to
which he or she wishes to be admitted, and this right also applies to respite and convalescent
care. (See subsection #11.4 in this manual.)
Individuals in one CCAC catchment area may apply for a respite or convalescent care bed in
another CCAC catchment area. As with long-stay applicants, the CCACs will work together to
place individuals in LTC homes across catchment areas.
Non-applicability of “Three LTC Home” Rule
Unlike long-stay applicants, individuals applying for short-stay may apply to as many LTC
homes offering short-stay as they wish (there is no “three LTC home” rule). Subsection 137.1(3)
of the NHA regulation provides this exemption by stating:
s. 137.1(1) A placement co-ordinator shall not provide the information and request referred to
in subsection 137 (1) to a licensee of a nursing home selected by an applicant if, at that point in
time, the total number of nursing homes, approved charitable homes for the aged under the
Charitable Institutions Act and homes under the Homes for the Aged and Rest Homes Act,
which have approved or are considering the applicant’s admission, is three or more.
…
(3) This section does not apply to a person who will be placed in category 1A or the short-stay
category on the waiting list for the nursing home if the licensee approves his or her admission
to the home.
Prioritization for Short-Stay Beds
Short-stay waiting lists are separate from long-stay lists. Furthermore, separate waiting lists are
established for each of the short-stay programs. This is set out in section 148.4 of the NHA
regulation:
s. 148.4(1) Sections 143 to 148.3 do not apply to a person applying for authorization of
admission to a nursing home as a short-stay resident in the respite care or supportive care
program.
(2) A person referred to in subsection (1) shall be placed in the short-stay category on the
waiting list for the nursing home.
Pursuant to subsection 148.4(1) of the NHA regulation, applicants who are approved for
admission to a short-stay program are prioritized in chronological order according to the time at
which they applied for authorization of their admission to the nursing home (the waiting list
categories for long-stay applicants do not apply to short-stay applicants).
As well, section 155(2) of the NHA regulation states:
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s. 155(2) For the purposes of clauses (1) (c) and (d), the following are the classes of
accommodation for which a person may be recorded to be waiting:
1. Accommodation for a woman in a respite care or supportive care program.
2. Accommodation for a man in a respite care or supportive care program.
3. Basic accommodation for a woman other than in a respite care or supportive care program.
4. Basic accommodation for a man other than in a respite care or supportive care program.
5. Semi-private accommodation for a woman other than in a respite care or supportive care
program.
6. Semi-private accommodation for a man other than in a respite care or supportive care
program.
7. Private accommodation for a woman other than in a respite care or supportive care program.
8. Private accommodation for a man other than in a respite care or supportive care program.
Note: Applicants for short-stay programs may also be on waiting lists for long-stay admission,
but cannot move directly from a short-stay to a long-stay admission without making a separate
application and being waitlisted according to the prioritization requirements for long-stay
applicants.
Authorization of Admission
Sections 155 and 156 of the NHA regulation set out the requirements applicable to the
authorization of admission of short-stay applicants:
and only if,
(a) the requirements set out in subsection 20.1 (13) of the Act are met.
Clarification: These requirements are:
•
•
•
the person has been determined by the CCAC to be eligible for admission to a LTC home
(within the six months preceding authorization);
the LTC home to which the person’s admission is to be authorized approves the person’s
admission to the home; and
the person or if the person is incapable, his or her SDM consents to the person being
admitted to the home.
s. 155(1)(b) the licensee of the home has not withdrawn the approval of the person's admission
under section 138;
waiting;
be authorized under this section; and
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s. 156 The placement co-ordinator designated for a nursing home under subsection 20.1 (3) of
the Act shall authorize a person's admission to the home as a short-stay resident if, and only if,
the person's admission may be authorized under section 155 and,
(a) the person applied for authorization of his or her admission to the home's respite care or
supportive care program; or
(b) the person did not apply for authorization of his or her admission to the home's respite care
or supportive care program, the person is in category 1A on the waiting list for the home at the
time of authorization of his or her admission, and the person's condition or circumstances are
such that the placement co-ordinator believes that the person will be able to return to his or
her residence within 14 days after admission to the home.
Length of Stay
The Convalescent Care Program is a time-limited LTC home placement. Although there may be
monitoring by the case manager on an ongoing basis, from a data perspective, the person is a
resident of the LTC home and not a CCAC in-home client.
The conditions regarding length of stay for short-stay residents are set out in the NHA
regulation, which states:
s. 157(1) When a placement co-ordinator authorizes the admission of a person to a nursing
home as a short-stay resident, the placement co-ordinator shall indicate the length of the stay
being authorized and the first day and last day of the stay.
(2) No placement co-ordinator shall authorize the admission of a person to a nursing home as
a short-stay resident in the respite care program for a stay exceeding 60 days.
a short-stay resident in the supportive care program for a stay exceeding 90 days.
a short-stay resident in the respite care or supportive care program for a stay which, when
added to the person’s other stays during the year in the respite care or supportive care
program of a nursing home, a home under the Homes for the Aged and Rest Homes Act or an
approved charitable home for the aged under the Charitable Institutions Act, exceeds 90 days.
a short-stay resident under clause 156 (b) for a stay exceeding 14 days.
(6) No person whose admission has been authorized for a stay in the respite care or supportive
care program of a nursing home shall apply for authorization of admission to extend the stay,
before the last day of the stay.
Subsections 157(1),(2) and (3) of the NHA regulation provide that when a CCAC authorizes a
person’s admission as a short-stay resident, the CCAC is required to indicate the length of stay
being authorized and the first and last day of the stay. Admissions for short-stay respite care
may only be authorized for up to 60 continuous days and admissions for short-stay
convalescent care (supportive care) may only be authorized for up to 90 days.
Subsection 157(4) of the NHA regulation provides that an applicant may receive up to a
maximum of 90 days in the short-stay programs per year. The CCAC may not authorize a
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person’s stay in a respite care or supportive care program if the stay, when added to his or her
other short-stays in a respite program or supportive care program in one or more LTC homes
exceeds 90 days in a calendar year.
Short-Stay Crisis Admissions
Subsection 157(5) of the NHA regulation provides that a person’s admission as a short-stay
resident may be authorized for up to 14 days where the person is prioritized as a category 1A
(crisis) for the home as a long-stay resident and it is anticipated that the person’s condition and
circumstances are such that he or she will be able to return home within 14 days of the
admission.
Note: There may be some situations where it is impossible to develop and implement plans for
the person within 14 days. In these cases the person, if eligible, could be transferred to the
respite or Convalescent Care Program if available. Eligibility determination and authorization
for such an admission, in accordance with the legislation, would be undertaken by the CCAC
for this transfer.
If a respite or convalescent care bed is not available or the person is not eligible for those
programs, regulations do not prevent the discharge and immediate re-admission of the person
on a short-stay crisis basis up to a maximum of 14 days. In other words, the CCAC could
authorize a further admission of up to 14 days if the person remains in category 1A (crisis).
Under subsection 157(6), persons who have been admitted to a LTC home for a respite care or
convalescent (supportive) care short-stay program cannot apply for authorization of admission
to extend the stay before the last day of the stay.
Transfer to Long-Stay Beds in LTC Homes
Persons in short-stay respite or convalescent care beds in LTC homes may not be transferred to
long-stay beds in a LTC home without applying separately for long-stay admission. This would
entail having their eligibility for long-stay admission determined, being authorized for
admission by the CCAC and being placed on a waiting list according to long-stay prioritization
criteria if a bed is not immediately available.
Resident Charges
Resident accommodation fees apply for the Respite Care Program in accordance with the shortstay fees set out in table 3 of the NHA regulation. The requirement for payment of these fees is
set out in the NHA regulation:
s. 115(1) The maximum daily amount that may be demanded or accepted by or on behalf of a
licensee for providing a short-stay resident with accommodation during a period in Column 1
of Table 3 is the amount in Column 2 of Table 3 set out opposite the period.
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The resident charges for persons in respite care reflect that most people will continue to incur
expenses related to a community dwelling while they are in the LTC home on a short-term
basis. There is no rate reduction available for the Respite Care Program.
As a matter of policy, the Ministry of Health and Long-Term Care (MOHLTC) covers the
accommodation fees for convalescent care residents through the subsidy
payment/reconciliation process. Consequently, convalescent care residents are not charged the
accommodation fees and LTC homes are not permitted to collect it from those residents.
Convalescent care residents may be charged for additional services such as telephone and
television.
The requirements and fees associated with bed-holding for long-stay applicants do not apply to
applicants for the short-stay programs (See subsection 155(1)(e) of the NHA in subsection
#11.7.2 in this manual, which only applies to long-stay residents.)
Refusals of Offers of Short-Stay Admissions
Section 141.1 of the NHA regulation permits, but does not require, the placement co-ordinator
to remove an applicant from the waiting list if the applicant refuses an offer of admission:
s. 141.1(1) A person may be removed from the waiting list for a nursing home to which the
person is awaiting admission as a short-stay resident if the placement co-ordinator designated
for the home under subsection 20.1 (3) of the Act offers to authorize the person's admission to
the home and the person,
(a) refuses to consent to admission; or
(b) fails to move into the home on the day agreed to by the person.
Removal from the list is at the discretion of the CCAC:
s. 141.1(2) A person who is removed from the waiting list for a nursing home under subsection
(1) shall be placed on the waiting list for the home again to await admission as a short-stay
resident if the person provides to the placement co-ordinator designated for the home under
the home as a short-stay resident.
In order to get back on the waiting list for admission as a short-stay resident in a LTC home, a
person who has been removed from the waiting list must re-apply with a new written request
for authorization of admission as a short-stay resident.
Note: If the person who is removed from the waiting list waits longer than six months to
request authorization for another short-stay admission to a LTC home, the person must apply to
have his or her eligibility re-determined.
Pursuant to section 155(4) of the NHA, the CCAC may cancel the authorization of a short-stay
admission if the person does not move into the LTC home on the day agreed to by the person.
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s. 155(4) A placement co-ordinator who authorizes a person’s admission to a nursing home as
a short-stay resident may cancel the authorization if the person does not move into the home on
the day agreed to by the person.
The placement co-ordinator should cancel the authorization for admissions if the person does
not move in on the agreed upon date, unless there are exceptional circumstances where, at the
discretion of the placement co-ordinator, the date of admission is changed.
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Management of Long-Term Care Home
Waiting Lists by CCACs
12.1 Overview of Prioritization of Long-Term Care Home
Waiting Lists
This subsection describes the requirements for prioritizing admissions to long-term care (LTC)
homes and maintaining LTC home waiting lists.
All legislative references in this chapter, unless stated otherwise, are to the Nursing Homes Act
(NHA) and Ontario Regulation 832 under the NHA and will be noted as such. However,
similar provisions are contained in the Charitable Institutions Act (CIA) and Homes for the
Aged and Rest Homes Act (HARHA) and their regulations.
12.1.1 Management of Waiting Lists
Section 139 of the NHA regulation sets out the requirements for the management of LTC home
waiting lists by the Community Care Access Centre (CCAC) as follows:
s. 139(1) Each placement co-ordinator shall keep a waiting list for each of the nursing homes
for which the placement co-ordinator is designated under subsection 20.1 (3) of the Act.
(2) The placement co-ordinator shall place on the waiting list, rank for admission and remove
from the list, in accordance with sections 140 to 150, any person described in section 140 other
than a person who is to be placed on the waiting list for interim beds under section 153.
(3) Each placement co-ordinator shall also keep a refusal list for the purposes of section 141.
Pursuant to section 139 the CCAC must:
•
•
•
keep an updated waiting list for each LTC home within its geographic area;
place a person on the waiting list, rank the person for admission and remove the person
from the waiting list in accordance with the regulation; and
keep a refusal list.
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12.1.2 Placement on Waiting Lists for Admission to a LTC Home
Section 140 of the NHA regulation sets out the requirements related to the placement of
persons on waiting lists for admission to LTC homes as follows:
s. 140(1) The placement co-ordinator designated for a nursing home under subsection 20.1 (3)
of the Act shall place a person on the waiting list for the nursing home if, and only if,
(a) the person is determined by a placement co-ordinator to be eligible for admission to a
nursing home;
(b) the person applies in accordance with this Regulation for authorization of his or her
admission to the home;
(c) the licensee of the home approves the person's admission to the home; and
(d) placing the person on the waiting list for the home will not result in the total number of
(2) Clause (1) (d) does not apply to a person who will be placed in category 1A or the shortstay category on the waiting list.
Note: As a result of subsection 2 above, the “three LTC home” waitlist limit does not apply to
persons who will be placed in category 1A crisis or the short-stay category on the waiting list.
There are no restrictions on the maximum number of waiting lists on which these two groups
may be placed.
Pursuant to section 140 of the NHA, the CCAC must:
•
•
add the name of each eligible person to the waiting list of each LTC home to which the
person has applied after the LTC home operator has approved the person’s admission to the
LTC home; and
ensure that each eligible person is not placed on more than three LTC home waiting lists at
any one time unless the applicant is in category 1A or applying for short-stay.
12.1.3 Application of Prioritization Criteria
The prioritization criteria set out in sections 143 to 148.3 of the NHA regulation apply to
persons who are seeking admission to a LTC home as long-stay residents. Separate
prioritization criteria apply to persons seeking admission to short-stay respite or supportive care
programs. (See subsection #11.9 in this manual.)
The various categories of prioritization for long-stay applicants are:
•
•
•
•
•
category 1A;
category 1A1;
category 1B;
category 2;
category 3;
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•
•
•
•
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groups outside of numbered categories;
veterans;
exchange residents; and
LTC home residents who face relocation as a result of redevelopment to:
• related temporary home;
• reopened home; or
• replacement home.
12.1.4 Classes of Accommodation
The ability of the CCAC to make an offer of admission to persons in the above referenced
categories is dependant on the class of accommodation that becomes available in the LTC
home. Placement co-ordinators must take into account:
•
•
gender; and
type of accommodation (basic, preferred semi-private, preferred private).
12.1.5 Overview of Prioritization Categories 1A-3
Note: The CCAC must place a person on the highest possible category of the waiting list. For
example, a person who meets the criteria for category 1B but is in crisis must be placed in
category 1A of the waiting list.
Prioritization Criteria
Effective as of October 22, 2004
Rank
1A
Crisis Applicants
I. Person requires immediate admission as a result of a crisis arising from the person’s condition
or circumstances.
II. Person occupies a bed in a hospital, psychiatric facility or Schedule 1 facility, and within six
weeks, there will be no bed for the person as a result of a temporary or permanent closure of
some or all of the beds due to an emergency or redevelopment.
III. Person occupies a bed in a long-term care home, and within six weeks, there will be no bed
for the person as a result of a temporary or permanent closure of all or some of the beds in
the home.1
1A1
Spousal Reunification
Reunification of spouses/partners who are determined eligible as a result of their care needs
and wish to reside together in the same long-term care home. (This category applies in all of
1
This will only apply in situations where not all residents have been moved out of a long-term care home under category 2.
At six weeks prior to closure of the long-term care home, residents may be considered in crisis if they have not been
placed in a long-term care home.
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Rank
the following situations: where both are still in the community, one is already in a long-term
care home or both are in a long-term care home but want to move together to another longterm care home).
1B
Ethno-cultural/religious groups
Person is of the religion, ethnic origin or linguistic origin primarily served by the long-term
care home.
2
I.
Person occupies a bed in a public/private hospital, psychiatric hospital or Schedule 1
facility.
II.
Person is a resident of a long-term care home and will become homeless within 16
weeks as a result of a temporary or permanent closure of all or some of the beds in the
long-term care home.
III.
Person is a resident of a long-term care home and was or will be discharged from the
home:
-
because of the inability of the home to provide a secure environment for the applicant;
or
-
because of an absence for the purpose of receiving medical or psychiatric care or
undergoing medical or psychiatric assessment.
IV.
3
Person resides in the community and admission to a long-term care home is required
within the next three months, because:
-
should there be any change in the person’s condition or circumstances, the person would
require immediate admission as a result of a crisis arising from the person’s condition or
circumstances; or
-
attending to the person’s care needs is jeopardizing the health and well-being of the
person’s caregiver.
V.
Reunification of spouses/partners who wish to reside together in the same long-term
care home. (This only applies to a spouse/partner determined eligible for the sole
purpose of accompanying an eligible spouse/partner into the same home for the
purposes of reunification. I.e. Person does not have care needs of their own.)
VI.
Person resides in a long-term care home and is waiting to move to their preferred longterm care home.
Persons who do not meet the requirements for placement in any other category.
This includes but is not confined to:

People residing in the community and waiting for a long-term care home but admission is
not required within the next three months because:
-
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the person’s condition is not expected to deteriorate or put the person at risk of physical
or emotional harm to self or others; or
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Rank

the person’s caregiver is able to continue to provide the same level of care without risk
or harm to the person requiring care or to self.
People already residing in a long-term care home who are not waiting for their preferred
long-term care facility, but decide they want to move to another long-term care home.
12.1.6 Change of Category
A person’s condition can change very quickly. The CCAC must place a person in a different
category on the waiting list when the CCAC is aware that there has been a change in the
person’s condition or circumstances, or a change in the LTC home for which the person is on
the waiting list. This requirement is set out in subsection 154(1) of the NHA regulation as
follows:
s. 154(1) If a placement co-ordinator knows of a change in the condition or circumstances of a
person who is on a waiting list kept by the placement co-ordinator or knows of a change in a
nursing home for which the person is on the waiting list, and if the person should be placed in a
different category on the waiting list under sections 142 to 148.4 as a result of the change in
his or her condition or circumstances or as a result of the change in the home, the placement
co-ordinator shall place the person in the different category.
For example, a person residing in his or her home in the community who is ranked in category
3 may undergo a significant change in his or her condition such that he or she can not continue
to live in the community. This person would then require immediate admission to a LTC home
if he or she could not be served in the community. In such a case, the CCAC must consider
whether to rank this person in category 1A (crisis).
12.1.7 Notification
The CCAC must inform the person of his or her position on the waiting list and provide an
estimate of waiting time to the best of his or her knowledge.
12.1.8 Mandatory Reporting of LTC Home Vacancies
Subsection 155(5) of the NHA regulation requires LTC home operators to report LTC home
vacancies:
s. 155(5) A licensee of a nursing home shall inform the placement co-ordinator designated for
the home under subsection 20.1 (3) of the Act of available accommodation in the home within
24 hours after the accommodation becomes available.
Within 24 hours after a discharge occurs (which includes “death”, as the regulation now
requires a discharge upon death), the LTC home operator is required to inform the CCAC
designated for the LTC home that there is accommodation available in the home.
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This provision is intended to ensure that a CCAC has current information to facilitate more
efficient and timely handling of all placements and improved waitlist management. It does not
necessarily mean that a CCAC must immediately admit a new person. The reporting provision
relates to the reporting of bed vacancies, not to the timeframe within which a bed must be
filled.
There may be legitimate reasons why a vacant bed could be considered “unavailable” for a
couple of days following a vacancy (e.g., internal transfers, need to clean and paint, time to
allow family to remove the resident’s belongings), but the LTC home must still inform the
CCAC of the bed vacancy. The CCAC and the LTC home operator must work together to
determine when a vacant bed is ready for admission and the CCAC must keep track of the date
on which a LTC home advises them of a bed vacancy.
Note: The CCAC is not responsible for enforcing this regulatory requirement placed on LTC
home operators. This is the role of the Ministry of Health and Long-Term Care (MOHLTC). If
a CCAC becomes aware of any LTC home operator that is not complying with this notification
requirement, the CCAC must advise the MOHLTC’s compliance advisor responsible for the
LTC home in question.
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12.2 Crisis Admissions – Category 1A
Section 143 of the Nursing Homes Act (NHA) regulation sets out the requirements for
placement in category 1A of the waiting list for a long-term care (LTC) home:
s. 14 (1) A person shall be placed in category 1A on the waiting list for a nursing home if the
person requires immediate admission as a result of a crisis arising from the person’s condition
or circumstances.
(2) A person shall be placed in category 1A on the waiting list for a nursing home if,
(a) the person occupies a bed in,
(i) a hospital under the Public Hospitals Act or a private hospital licensed under the
(ii) a facility that is designated as a psychiatric facility under section 80.2 of the Mental
Health Act and is not exempt under that section from the requirement to provide in patient
services in paragraph 1 of subsection 4 (1) of Regulation 741 of the Revised Regulations of
Ontario, 1990 made under that Act, or
(iii) a facility listed in Schedule 1 to Regulation 272 of the Revised Regulations of Ontario,
1990 made under the Developmental Services Act; and
(b) there will be no bed for the person in the hospital or facility within six weeks as a result of,
(i) a permanent closure of all or some of the beds in the hospital or facility, or
(ii) a temporary closure of all or some of the beds in the hospital or facility due to an
emergency or redevelopment.
(3) A person shall be placed in category 1A on the waiting list for a nursing home if,
(a) the person is a long-stay resident of another nursing home, an approved charitable home
for the aged under the Charitable Institutions Act or a home under the Homes for the Aged and
Rest Homes Act; and
(b) there will be no bed for the person in the facility within six weeks as a result of a permanent
or temporary closure of all or some of the beds in the facility.
Note: The Schedule 1 facilities under the Developmental Services Act (DSA) include: Huronia
Regional Centre (Orillia), Rideau Regional Centre (Smith Falls) and Southwestern Regional
Centre (Blenheim).
12.2.1 Types of Crisis Situations
The above referenced provision sets out three types of crisis situations:
•
•
•
community-based;
hospital and/or LTC home based; and
clients requiring relocation due to hospital or LTC home closure within six weeks.
As no one situation is more critical than any other, these three types of crisis situations are not
ranked in the order in which they are listed above. Ranking among crisis applicants is
according to the urgency of each applicant’s need for admission.
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12.2.2 Community-Based Crisis
In the case of community-based clients, a category 1A (crisis) admission to a LTC home occurs
when a person, as a result of some accident or event, requires services that cannot be provided
in the community and necessitates the person’s immediate admission to a LTC home. Persons
requiring crisis admission take precedence over other individuals on the waiting list for LTC
home admission and must meet the eligibility criteria for admission to a LTC home.
To be considered in a crisis situation, the Community Care Access Centre (CCAC) must
consider the person’s condition or circumstances to be of such severity that it requires the
CCAC to make every effort to arrange for his or her admission to a LTC home within the next
seven days, or as soon as possible, depending on the availability of an appropriate vacancy.
Regardless of the type of crisis situation, only the CCAC is entitled to determine eligibility for
and authorize admission to a LTC home.
When a person’s situation is designated as a crisis, the CCAC must move the person to the top
of the waiting list for immediate admission to his or her selected LTC home(s). If the person’s
selected homes cannot accommodate an immediate admission, the CCAC must advise the
person and discuss with the person whether he or she will consent to being admitted into the
homes that have vacancies. (A similar issue may arise where a person selects a particular type
of accommodation in a LTC home which is not available. The CCAC must advise the person
and discuss with the person whether he or she will agree to change the type of accommodation
requested in order to facilitate his or her admission into a selected LTC home.) When a person
is in the crisis category, the person is expected to accept the first available bed in a home of
their choice.2 However, the person cannot be required to do so. If a person refuses the first
available vacancy in a LTC home of his or her choice, the CCAC should, as a matter of policy,
consider whether the person still meets the criteria for the crisis category.
The CCAC must not place a person in the crisis category to accommodate the person’s desire to
ensure speedy access to a LTC home of choice. In addition, the CCAC must not categorize a
person’s situation as a crisis as a strategy to move persons who, for whatever reasons, are
resisting movement out of the hospital.
Note: The classification of a person in prioritization category 1A does not suspend the consent
requirement in LTC home legislation. Even in this situation, the CCAC shall not authorize a
person for admission to a selected LTC home unless the person (or if the person is incapable,
the person’s substitute decision-maker) has applied for admission to the specific home and
consented to the admission to the specific home. The only exception occurs where the person is
in such a crisis situation, that the person requires an immediate admission to a selected home
and it is not reasonably possible to obtain the immediate consent of the person’s substitute
decision-maker (SDM). In this case, the CCAC may authorize the admission without consent
but must take reasonable steps to locate the person’s SDM in order to seek his or her consent or
refusal of consent to the admission. (See chapter #4 in this manual for information on consent
to admission to a LTC home.)
2
Once in a LTC home, the person can remain on the waiting list in category 2 for his or her preferred choice of LTC home.
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Crisis admissions of community-based applicants usually arise from the following
circumstances:
•
•
•
•
an unexpected change in the person’s condition or circumstances that makes existing care
arrangements no longer appropriate; or
a person being at risk of physical, emotional or financial abuse or harm if he or she remains
in the same environment; or
others in the environment being at risk of physical, emotional or financial abuse or harm; or
caregiver breakdown.
The CCAC determines the presence of a crisis situation based on assessments that indicate the
person’s and/or caregiver’s ability to function safely in his or her current environment has been
compromised. The CCAC also needs to consider whether the person’s health and safety needs
can be met immediately by the provision of community-based services, including the capacity
of the CCAC to exceed the service maximums for personal support and homemaking services
for up to 30 days in exceptional circumstances under subsection 3(3) of Regulation 386/99 of
the Long-Term Care Act, 1994 (LTCA). It must be noted that community services cannot be
provided without the consent of the person or SDM if the person is incapable of making the
decision.
12.2.3 Hospital or Facility-Based Crisis
The majority of applicants deemed to be in a crisis situation by the CCAC will probably reside
in the community. However, there may be instances where people could be deemed to be in a
crisis situation while residing in a LTC home or hospital. These could be as a result of:
•
•
condition or circumstances unique to the individual; or
systemic pressures.
Hospital/LTC Home-Based Crisis: Individual Condition or Circumstances
Individual condition or circumstances that could result in a person being declared in a crisis
situation while staying in a hospital or LTC home setting include but are not limited to the
following:
•
•
•
The person has been physically assaulted or injured by another patient or resident. Despite
corrective measures taken to ensure that this does not occur again, the person does not feel
reassured and remains in a constant state of agitation.
The person has been physically abused by a hospital/home employee. Despite corrective
action, the person no longer feels safe in the current environment.
The person is at risk of jeopardizing the care of other patients because the hospital
environment is not able to provide the necessary security to ensure the safety of the person
or of others. Of course, the person’s care requirements must be able to be met in a LTC
home and there may be some persons in this circumstance who require admission to a
psychiatric facility.
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The CCAC must review the individual circumstances of the case to determine if the person is in
crisis arising from the person’s condition or circumstances.
Presentation at an Emergency Ward
The fact that a person on the waiting list for a LTC home appears at a hospital emergency ward
does not automatically result in the person being prioritized in category 1A. If the person’s
condition has changed, the CCAC must of course reassess the person. On the basis of the
reassessment, the CCAC may decide to:
•
•
•
facilitate community-based services for the person;
initiate or increase CCAC in-home services; or
change the person’s priority category on the LTC waiting list.
The CCAC must not reprioritize the person if the conditions or circumstances necessitating
admission to an LTC home have not changed.
Social Admissions for Emergency Clients
A hospital may be the only place that can provide the necessary emergency care/shelter (social
admission) to a person experiencing a crisis situation who cannot be safely cared for with
community services and where no LTC home vacancy is immediately available. In this
situation, the person could be admitted to hospital and continue to be ranked under priority
category 1A-crisis for admission to a LTC home.
In this situation, the CCAC must conduct a comprehensive assessment of the person’s
condition and circumstances. After the person’s condition has been stabilized, the person may
not require admission to an LTC home, particularly if the person’s condition is of short-term
duration.
Note: The CCAC must use this provision judiciously so that applicants do not inappropriately
present themselves at emergency wards in order to be placed in the crisis category of the
waiting list.
Hospital-Based Crisis: Systemic Pressures
Hospitals often have patients who respond well to treatment and no longer require acute
hospital care. However, the patient is not able to return home. These patients may require care
in a complex continuing care hospital, rehabilitation hospital or LTC home. These patients are
designated as alternative level of care (ALC).
Hospitals have different capabilities to accommodate patients designated as ALCs. When
capacity to admit persons to a hospital is severely compromised, one strategy for resolution is
to classify that hospital’s patients who require care in a LTC home as being in a crisis situation
and requiring immediate admission into a LTC home.
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There may be circumstances when there is a systemic crisis and it is appropriate to expedite the
admission of ALC patients to LTC homes. The CCAC has the authority to change the waiting
list category of ALC patients to category 1A.
Indicators that there is a systemic crisis that may be resolved by expediting the admission of
ALC patients to LTC homes include:
•
•
•
•
normally scheduled elective acute care admissions are cancelled or deferred due to bed
occupancy pressures;
non-elective acute care patients cannot be admitted to the hospital and are being transferred
to other acute care hospitals due to bed occupancy pressures;
patients appropriate for admission to one care unit and/or critical care unit cannot be
admitted due to bed occupancy pressures in the units; and
number of overnight emergency department patients (i.e., admit to “no beds”) impedes
operations in the emergency department.
Since this is a community systems issue, it must be addressed by all service partners in the
community.
Situations that are not to be considered a systemic crisis include but are not limited to the
following:
•
•
•
temporary periods of congestion that only last a few days;
hospitals closing down beds temporarily in the summer time; and
hospitals that retain ALC clients in hospital as long as possible to keep a bed filled until
these beds are required and then request the CCAC to place applicants in LTC homes in a
compressed time period.
Processes involved in designating a systemic crisis include:
1. Discussions between the Ministry of Health and Long-Term Care (MOHLTC) Regional
Director, CCAC and hospital regarding the situation and the hospital’s ALC patients’
discharge plans, and where appropriate, discussions between other MOHLTC regional
offices.
2. Investigation by MOHLTC staff of the situation to ensure that the hospital’s ability to meet
the acute care needs of the community is severely compromised as a result of:
•
•
severe bed blocking in acute care beds; and
external forces specific to that community exacerbating the situation.
3. MOHLTC staff ensuring that the hospital’s discharge and assessment practices are
reviewed and these practices deemed acceptable.
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4. Assessment of ALC patients by the CCAC to determine if they are eligible for LTC home
placement or if their needs could or should be met through other resources, including
rehabilitation or chronic care facilities or community-based services.
Notes:
•
•
CCACs must ensure that the person’s needs cannot be met by community-based
resources as part of the eligibility determination process for admission to LTC homes.
A hospital may recommend that a person be placed in a LTC home; however, the
CCAC determines whether the person is eligible for admission.
5. CCACs, in collaboration with the MOHLTC, developing a strategy that will not
compromise the safety of community-based residents who are also in crisis and waiting for
LTC home admission. Persons placed in the crisis category must be ranked in terms of
urgency of their need for admission; consequently an approach that would place all
hospital-based clients ahead of community-based applicants would disregard the risk to
community-based persons.
6. Determining a specific time period during which this provision will be in effect. This can
not be an open-ended arrangement.
Notes:
•
•
A specific timeframe will be established based on the CCAC’s estimate of the length of
time required to reduce congestion in a specific hospital (e.g., two weeks). Discussions
will have to occur between the CCAC, hospital and MOHLTC in this regard.
The time period that this provision will be in effect must be clearly defined (e.g., days
or weeks), and a date when the situation will be reviewed should be specified.
Timeframes must not be specified in an open-ended manner (e.g., during the flu
season).
7. The decision to use the systemic crisis provision must be made on a hospital-by-hospital
basis as the regulations require that the crisis is due to the person’s circumstances (or
condition). The determination of a crisis and the subsequent strategy involving admissions
to LTC homes, apply to a specific community and at a specific time.
The determination of a crisis situation at a particular hospital and the strategies to deal with
the crisis are not automatically transferable to other hospitals in that community. Nor are
they transferable to other communities.
Notes:
•
The classification of hospital inpatients in prioritization category 1A due to a systemic
crisis situation does not suspend the consent provisions of LTC home legislation. Even in
this situation, the CCAC cannot authorize a person for admission to a selected LTC home
unless the person (or if the person is incapable of making the decision, the person’s SDM)
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•
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has applied to the specific home and consented to the admission to the specific home. The
only exception occurs where the person is in such a crisis situation, that the person requires
an immediate admission to a selected home and it is not reasonably possible to obtain the
immediate consent of the person’s SDM. In this case, the CCAC may authorize the
admission without consent but is required to take reasonable steps to locate the person’s
SDM in order to seek his or her consent or refusal of consent to the admission. (See chapter
#4 in this manual for additional information on consent to admission to a LTC home.)
Furthermore, the regulations require that a CCAC offer an applicant the class of
accommodation that the applicant requested. If the applicant has requested a certain class of
accommodation, but the first bed available is in a different class, the CCAC may discuss
with the applicant the possibility of amending the person’s choices and taking the available
bed. If the person accepts and the bed is in a LTC home that is not the person’s first choice,
the person is then be able to wait for a transfer to his or her preferred LTC home in
prioritization category 2. If the person accepts a different class of accommodation in the
person’s first choice home, in that case the person could ask to be placed on the home’s
transfer list under section 158 of the NHA regulation. Nevertheless, the CCAC cannot
compel the hospital applicant to amend his or her choices to take the alternate bed. If the
hospital applicant is unwilling to take the alternate bed, the CCAC has no authority to
authorize admission. See the comments above concerning consent to admission.
LTC Home-Based Crisis: Emergency Situations in LTC Homes
Emergency situations requiring crisis admission of residents from one LTC home into another
LTC home include:
•
•
an operator suddenly going out of business; or
natural or environmental disasters such as a fire or a gas leak. In disaster situations, an
emergency response involving the relevant service partners in the community will be
necessary to ensure the safe and speedy relocation of all residents.
12.2.4 Clients Requiring Relocation Due to Home Closure within Six Weeks
A LTC home may need to close temporarily or permanently and partially or totally. Closures
may be the result of planned renovations or closures, or emergency situations.
With planned closures, either temporary or permanent, it is anticipated that residents will be
relocated in a timely manner and that the usual movement of residents and a moratorium on
admissions would assist the process. Nevertheless, there may be situations where residents have
not been relocated within six weeks of the planned closing. If these persons are not relocated,
they will become homeless.
To ensure that such persons are appropriately relocated, they are considered to be in a category
1A (crisis) situation and the CCAC must prioritize them as such.
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Note: 1A also applies to hospitals, psychiatric facilities and Schedule 1 DSA facilities that are
permanently closing beds or are temporarily closing beds due to emergency or redevelopment.
(See section 143(2)(b) of the NHA regulation.)
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12.3 Prioritization Criteria – Category 1A1
Section 143.1 of the Nursing Homes Act (NHA) regulation sets out the requirements for
placement in category 1A1 of the waiting list for a long-term care (LTC) home:
s. 143.1 A person shall be placed in category 1A1 on the waiting list for a nursing home if,
(a) the person does not meet the requirements for placement in category 1A;
(b) the person’s spouse or partner is a long-stay resident of the nursing home or neither the
person nor his or her spouse or partner is a long-stay resident of the nursing home but both
wish to reside in the nursing home; and
(c) the person meets the eligibility criteria set out in subsection 130 (1).
According to the above provision, spouses/partners who both wish to reside in the same LTC
home and are both eligible as a result of their care needs are to be placed in category 1A1 of an
LTC home’s waiting list. A spouse/partner who does not require care, but who is determined
eligible only for the purpose of accompanying (or joining) his or her eligible spouse will
continue to be placed in category 2.
Note: There is no change to the requirement to place persons requiring immediate admission as
a result of a crisis arising from their condition or circumstances into category 1A of the waiting
list.
As a result of the wording of clause “(b)” above, the 1A1 category of prioritization applies in
all of the following situations when both spouses/partners have care requirements:
•
•
•
•
when a person is seeking reunification with a spouse/partner who is already in the home to
which the person is applying;
when the person and the person’s spouse/partner are still in the community but both wish
to reside in the same LTC home;
when both are in different LTC homes, but wish to live together in the same home, be it
one of the two where they currently reside or a completely different LTC home; and
when both are in the same LTC home, but wish to move together to a different LTC home.
Note: In the situation where a spouse/partner who has no care needs of his or her own wishes
to accompany a spouse/partner who is eligible for placement based on care needs, the two
individuals will be in different categories of prioritization. The person with the care needs will
be prioritized in category 1A1, while the spouse/partner who has no care needs will be
prioritized in category 2. (See subsection #12.5 in this manual for additional information on
prioritization category 2.)
A further important and somewhat different feature of the 1A1 category relates to the ranking
of applicants within this category. Eligible spouses/partners placed in category 1A1 are ranked
in this category according to the time at which their spouses/partners applied for authorization
of their admission to the home.
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The fact that this date of authorization may predate the determination of eligibility of the
spouse/partner who is seeking to be reunified is not relevant as its sole purpose is for ranking
within this category. If the applicant’s category were to change to another category (e.g., if the
applicant became a crisis applicant), the spouse’s/partner’s date of authorization would no
longer apply. In the case where the spouses/partners are prioritized differently because one has
care needs and the other does not (i.e., category 1A1 for the spouse with care needs and
category 2 for the spouse who has no care needs) their ranking will also differ. The ranking of
spouses/partners who are prioritized in category 2 is according to the date of their own
application. (See subsection #12.8.2 in this manual for additional information on rules for
ranking within categories.)
Community Care Access Centres (CCACs) with clients who are spouses/partners seeking
admission to the same LTC home must caution applicants that prioritization in category 1A1
will not result in all eligible spouses/partners being reunited immediately or necessarily being
able to share the same room once both are admitted to the same LTC home. Some
spouses/partners may not even be in the same part of the home. This can result from the lack of
availability of accommodation or differing care requirements.
For example, one spouse with a severe cognitive impairment could potentially be in a different
part of the home than a spouse who does not have a cognitive impairment. In other cases,
reunification may not be as fast if the spouses/partners are waiting for specific types of
accommodation to become available such as basic, semi-private or private rooms. These are
circumstances that go beyond prioritization.
It is also important to note that the regulation applies to “spouses or partners” and the term
partners is defined in subsection 1(2) of the NHA regulation as:
s. 1(2) Two persons are partners for the purpose of this Regulation if they have lived together
for at least one year and have a close personal relationship that is of primary importance in
both persons' lives.
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12.4 Prioritization Criteria – Category 1B
placement in category 1B of the waiting list for a long-term care (LTC) home:
s. 144 A person shall be placed in category 1B on the waiting list for a nursing home if,
(a) the person does not meet the requirements for placement in category 1A or 1A1;
(b) the home is primarily engaged in serving the interests of persons of a particular religion,
ethnic origin or linguistic origin; and
(c) the person is of the religion, ethnic origin or linguistic origin primarily served by the home.
A Community Care Access Centre (CCAC) may only place persons of a particular religion,
ethnic origin or linguistic origin in category 1B of a LTC home’s waiting list if the LTC home
is “primarily” engaged in serving the interests of the particular group.
“Primarily” engaged means that the main intent of the LTC home is to serve persons of a
particular religion, ethnic or linguistic origin. This means that if a LTC home dedicates only a
portion of its beds to serve the needs of a particular religion, ethnic or linguistic community, it
does not pass the regulatory test that it is “primarily” engaged in serving the needs of a
particular community. As such, the CCAC may not place persons from the religion, ethnic or
linguistic community in category 1B on the waiting list for this LTC home.
There are no provincial guidelines or standardized processes for acknowledging, determining
and designating LTC homes that provide services on a religious, ethnic or linguistic basis. The
CCAC must determine whether a particular LTC home meets the regulatory test so it can place
persons on the waiting list into categories. It is expected that the CCAC would have developed
its own processes to determine whether a particular LTC home meets the test. Under LTC
home legislation, the CCAC must consider an applicant’s preferences relating to admission
based on spiritual, ethnic, linguistic, familial and cultural factors.
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placement in category 2 of the waiting list for a long-term care (LTC) home:
s. 145(1) A person shall be placed in category 2 on the waiting list for a nursing home if,
(a) the person does not meet the requirements for placement in category 1A, 1A1 or 1B; and
(b) the person occupies a bed in,
(i) a hospital under the Public Hospitals Act or a private hospital licensed under the
(ii) a facility that is designated as a psychiatric facility under section 80.2 of the Mental
Health Act and is not exempt under that section from the requirement to provide in-patient
services in paragraph 1 of subsection 4 (1) of Regulation 741 of the Revised Regulations of
Ontario, 1990 made under that Act, or
(iii) a facility listed in Schedule 1 to Regulation 272 of the Revised Regulations of Ontario,
1990 made under the Developmental Services Act.
(2) A person shall be placed in category 2 on the waiting list for a nursing home if,
(a) the person does not meet the requirements for placement in category 1A, 1A1 or 1B;
(b) the person is a long-stay resident of another nursing home, an approved charitable home
for the aged under the Charitable Institutions Act or a home under the Homes for the Aged and
Rest Homes Act; and
(c) there will be no bed for the person in the facility within 16 weeks as a result of a permanent
or temporary closure of all or some of the beds in the facility.
(b) the person was or is a long-stay resident of another nursing home, an approved charitable
home for the aged under the Charitable Institutions Act or a home under the Homes for the
Aged and Rest Homes Act; and
(c) the person was or will be discharged from the facility,
(i) because the facility cannot provide a sufficiently secure environment to ensure the safety
of that person or the safety of persons who come into contact with that person, or
(ii) because of an absence for the purpose of receiving medical or psychiatric care or
undergoing medical or psychiatric assessment.
(a) the person does not meet the requirements for placement in category 1A, 1A1 or 1B; and
(b) the person requires admission within three months because,
(i) should there be any change in the person’s condition or circumstances, the person
would require immediate admission as a result of a crisis arising from the person’s
condition or circumstances, or
(ii) attending to the person’s care needs is jeopardizing the health and well-being of the
person’s caregiver.
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(b) the person’s spouse or partner is a long-stay resident of the nursing home or neither the
person nor his or her spouse or partner is a long-stay resident of the nursing home but both
wish to reside in the nursing home; and
(c) the person meets the eligibility criteria set out in section 132.
(6) If a person applies for authorization of his or her admission to a nursing home, a home
under the Homes for the Aged and Rest Homes Act or an approved charitable home for the
aged under the Charitable Institutions Act as a long-stay resident and a placement coordinator, with the consent of the person, authorizes the person’s admission to a facility that is
not the person’s first choice, the person shall, if he or she wishes, be kept on the waiting lists
for the person’s preferred nursing homes and shall be placed in category 2.
The following is a simplified description of the six types of applicants listed in the above
provision who fall within this category:
1. A person who is in a hospital, psychiatric facility or a facility listed in Schedule 1 of the
regulations under the Developmental Services Act (DSA), and cannot be discharged home
because the community-based services are inadequate or inappropriate to meet his or her
needs, or because he or she does not have an informal caregiver to provide them with the
assistance they require at home.
Note: The Schedule 1 facilities under the DSA include: Huronia Regional Centre (Orillia),
Rideau Regional Centre (Smith Falls) and Southwestern Regional Centre (Blenheim).
2. A resident of a LTC home who will become homeless within 16 weeks as a result of a
temporary or permanent closure of all or some of the beds in the LTC home.
Note: Where residents have not been relocated within six weeks of the planned closing, the
Community Care Access Centre (CCAC) must categorize them in category 1A (crisis).
3. A resident (or a previous resident) of a LTC home who will be (was) discharged from the
LTC home and requires readmission to a LTC home. Two specific types of situations which
can result in discharge are identified:
a) Resident who requires transfer to another LTC home because the home cannot provide
a sufficiently secure environment.
Sometimes a resident’s condition changes after he or she is admitted to a LTC home.
For example, some people with cognitive impairment may reach a stage where they
require a secure ward to prevent them from wandering.
If the LTC home operator is advised by the health care professionals providing care to
the resident that the home cannot provide a sufficiently secure environment to ensure
the safety of the resident or the safety of persons who come into contact with the
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resident, the LTC home operator may discharge the resident provided that other
arrangements are made to provide the accommodation, care and secure environment
required by the person.
These residents may apply to other LTC homes and the CCAC must place them in
category 2.
b) Resident who exceeds the permitted length of time to be absent from a LTC home as a
result of a medical or psychiatric leave or assessment.
LTC homes are required to discharge a resident who exceeds the time limits set out in
the regulations for medical/psychiatric leaves of absences. (See section 47.1 of
Regulation 832 of the NHA for provisions related to absences for medical and
psychiatric leaves.) LTC homes are not required to advise the CCAC when a resident is
transferred to a psychiatric facility or hospital. However, the CCAC will be advised of
situations involving discharge when the discharged resident or his or her substitute
decision-maker contacts the CCAC seeking LTC home admission back to the original
LTC home or another LTC home. These individuals may apply to the CCAC for
readmission to the home from which they were discharged and the CCAC must place
them in category 2.
In the majority of cases, persons prefer to go back to the LTC home where they
originally resided. Re-admission of these persons is possible if the previous LTC home
can provide the type of care the person requires and a vacancy is available.
If a vacancy is not immediately available, the person can consent to be admitted to
another LTC home until a bed becomes available in his or her preferred LTC home. The
CCAC must provide updated and relevant assessment information about the applicant to
the LTC home to which the person wishes to return, or to another chosen LTC home if
the preferred LTC home is not available. Each LTC home must approve the admission
to ensure that the required care can be provided.
4. A community-based applicant whose condition is expected to deteriorate within three
months, or attending to the person’s care needs is jeopardizing the health and well-being
of the caregiver.
The Ministry of Health and Long-Term Care (MOHLTC) has developed guidelines that
provide a framework for CCACs to differentiate between persons who require
admission within three months (category 2) and those who do not. Category 2
applicants are:
•
•
September 2006
persons who are totally dependent on others for three or more activities of daily
living (e.g., eating, toileting, personal hygiene and locomotion);
persons who are verbally or physically abusive, resistant to care, or wander and
require 24-hour supervision;
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•
•
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persons who have moderate to severe cognitive impairments and require 24-hour
supervision; and
persons who have a combination of other issues that may necessitate admission
within the next three months include but are not limited to the following:
• environmental safety issues;
• medical conditions requiring treatment;
• recent history of falls or visits to the emergency department; or
• a change in the capacity of formal/informal caregiving systems to provide the
support the person requires.
5. A spouse/partner who has no care needs of his or her own who wishes to accompany or
reunite with a spouse/partner who is eligible for placement or is already living in a LTC
home.
This category of prioritization only applies in the case of a spouse/partner who is
determined eligible for admission to a LTC home solely for the purpose of joining or
accompanying the other spouse/partner, and not as a result of a personal need for LTC
home care. (This contrasts with the prioritization of spouses/partners who are both
determined eligible for admission to a LTC home on the basis of their own care needs as
these individuals must be prioritized by the CCAC in category 1A1.)
The ranking of spouses/partners who are prioritized in category 2 is according to the date of
their own application. This also differs from the ranking of spouses/partners prioritized in
category 1A1, as these individuals are ranked according to the date of application of their
spouse/partner.
CCACs must be cautious about counselling a well spouse/partner with regard to the timing
of his or her application if the possibility exists that the well spouse/partner could be
admitted sooner than the spouse/partner who has care needs.
For example, if the well spouse is a male and beds for male applicants have been becoming
available more frequently than beds for females, a situation could arise where the well
spouse/partner will have to be made a bed offer before the spouse/partner who needs care.
In such a situation, acceptance of the offer could leave the spouse/partner who requires care
without a caregiver, while a refusal of the offer will result in the person’s name being
removed from all lists and not being able to re-apply for 24 weeks (unless there has been a
deterioration in the person’s condition or circumstances in which case the person may apply
sooner).
Notes:
•
September 2006
The term spouse is defined in subsection 1(1) of the NHA regulation as:
s. 1(2) a person,
(a) to whom the person is married, or
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(b) with whom the person is living, or was living immediately before one of them was
admitted to a nursing home, in a conjugal relationship outside marriage, if the two
persons,
(iii) have together entered into a cohabitation agreement under section 53 of the
Family Law Act.
The term partners is defined in subsection 1(2) of the NHA regulation as:
s. 1(2) Two persons are partners for the purpose of this Regulation if they have lived
together for at least one year and have a close personal relationship that is of primary
importance in both persons' lives.
6. A person who is admitted to a LTC home that is not the person’s first choice and he or she
wishes to remain on the waiting list for his or her preferred LTC home.
Persons who enter a LTC home that is not their preferred choice and choose to wait for a
bed to become available in their LTC home preferred choices, remain in category 2 on the
waiting list of their preferred home. Such persons shall be ranked in category 2 according to
the original date used to rank the person for admission to the preferred LTC home. If a
person agrees to be admitted to a LTC home that is not his or her first choice, the CCAC
must determine if the person wants to remain on other LTC home waiting lists at the time
of admission to the LTC home.
If an applicant does not express the wish to remain on the waiting list of his or her preferred
choice of LTC home upon admission to the second or third choice home, and decides at a
later date that he or she wishes to be on a waiting list for a different LTC home (e.g.,
because a new LTC home is opened), the resident will be placed in category 3 on the
waiting list. The original authorization date will not apply and this will be treated as a new
application for transfer from one LTC home to another.
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The Nursing Homes Act (NHA) regulation sets out the requirements for placement in category
3 of the waiting list for a long-term care (LTC) home:
s. 148.3 A person shall be placed in category 3 on the waiting list for a nursing home if the
person does not meet the requirements for placement in any other category
Persons ranked in category 3 include but are not limited to:
•
•
persons residing in the community who are waiting for a LTC home but admission is not
required within the next three months; and
persons resident in a LTC home who would like to move to another LTC home but are not
currently on a waiting list for any other home.
12.6.1 People Residing in the Community
The first group includes people residing in the community who do not require admission to a
LTC home within the next three months. They have conditions that are not expected to
deteriorate or put themselves or others at risk, and their caregivers are able to continue in the
caregiver role without putting the person at risk or jeopardizing their own health and wellbeing.
“People in the community” should be interpreted broadly. They may be living in their own
homes or settings where support may be available through private means or government-funded
programs. They may be receiving community-based services, but the services are inadequate to
meet their needs. If community-based services are available and adequate, the Community Care
Access Centre (CCAC) must not declare them eligible for LTC home admission.
Sometimes people requiring care may be in a community where no community-based services
are available and may be at risk. At other times, informal caregivers are not able to supplement
formal services or their ability to provide care is time-limited. Without admission to a LTC
home, some of these people would be admitted to an acute care hospital unnecessarily.
12.6.2 People Residing in a LTC Home
The second group includes residents of a LTC home who would like to move to another LTC
home and are not currently on a waiting list for another LTC home. These people are different
from those in a LTC home whose needs can no longer be met by the LTC home and therefore
require a transfer to another LTC home (category 2), or people in a LTC home waiting to move
to a LTC home of their preferred choice (category 2).
People in a LTC home who wish to move to another LTC home must apply to the CCAC to
request a transfer. There could be any number of reasons why a person might want to move to
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another LTC home, but two common examples include wanting to move to a newly opened
LTC home in an area closer to family or preferring another LTC home.
Although the CCAC must automatically determine these residents eligible for admission to
another LTC home in accordance with section 133 of the NHA regulation, the resident must
still apply for authorization of admission to the selected LTC home. The resident must also
make an informed decision about choice of LTC home. The CCAC must provide the operator
of the LTC home chosen by the person with the application package so that the operator can
determine whether to approve the admission. If the LTC home operator approves the person’s
admission, the CCAC shall place the person on the waiting list for the LTC home in category 3
if no other prioritization categories apply.
Note: LTC home operators may not transfer residents between LTC homes without going
through the CCAC. Only the CCAC can authorize admission to a LTC home.
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12.7 Non-Numbered Categories
The groups that are outside the numbered categories include:
•
•
•
veterans applying for veterans’ priority access (VPA) accommodation (see subsection #12.7.1
in this manual);
clients involved in specific hospital – LTC home trades (exchange category) (see subsection
#12.7.2 in this manual); and
Long-term care (LTC) home residents who face relocation as a result of the LTC
redevelopment initiatives (see subsection #12.7.3 in this manual).
12.7.1 Veterans’ Priority Access Beds Category
The Nursing Homes Act (NHA) regulation sets out the criteria for placement in the veterans’
category:
s. 146 Despite sections 143 to 145, a person shall be placed in the veteran category on the
waiting list for a nursing home if,
(a) the home contains veterans' priority access beds;
(b) the person has applied for authorization of his or her admission to a veteran's priority
access bed; and
(c) the person is a veteran.
The Ministry of Health and Long-Term Care (MOHLTC) and Veteran’s Affairs Canada have a
negotiated agreement whereby a veteran who is eligible for LTC home admission and has
applied for admission to a VPA bed in a LTC home will have priority for admission to the VPA
bed over all other applicants.
The Community Care Access Centre (CCAC) must ask applicants whether they might qualify
as a veteran and if so, whether they want to apply for a VPA bed. The CCAC must ensure that
the application for admission is forwarded to Veteran’s Affairs Canada so that the CCAC can
determine whether the applicant is an eligible veteran.
The CCAC must maintain a separate waiting list for eligible veterans who have applied for
VPA accommodation. An eligible veteran may choose any LTC home. If the home does not
have VPA accommodation, the CCAC must place the veteran on the home waiting list and
prioritize the veteran for admission in accordance with the regulatory provisions for nonveterans.
Note: A veteran can apply for both VPA accommodation and a non-VPA accommodation
within the same LTC home. For the purpose of the three home waiting list rule, this is
considered as being on one LTC home waiting list.
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12.7.2 Exchange Category
The NHA regulation sets out the criteria for placement in the exchange category:
s. 147 Despite sections 143 to 145, a person shall be placed in the exchange category on the
waiting list for a nursing home if,
(a) the person,
(i) occupies a bed in a hospital under the Public Hospitals Act or a private hospital
licensed under the Private Hospitals Act,
(ii) occupies a bed in a facility that is designated as a psychiatric facility under section
80.2 of the Mental Health Act and is not exempt under that section from the requirement to
provide in-patient services in paragraph 1 of subsection 4 (1) of Regulation 741 of the
Revised Regulations of Ontario, 1990 made under that Act,
(iii) occupies a bed in a facility listed in Schedule 1 to Regulation 272 of the Revised
Regulations of Ontario, 1990 made under the Developmental Services Act, or
Note: The Schedule 1 facilities under the Developmental Services Act (DSA) include:
Huronia Regional Centre (Orillia), Rideau Regional Centre (Smith Falls) and Southwestern
Regional Centre (Blenheim).
(iv) is a long-stay resident of another nursing home, an approved charitable home for the
Rest Homes Act;
(b) the person is the subject of an agreement between the nursing home to which the person
seeks admission, at least one hospital or facility mentioned in subclause (a) (i), (ii) or (iii) and
possibly one or more other hospitals, facilities or homes, to exchange identified residents or
patients, in order to meet the specialized requirements of any of the exchanged residents or
patients; and
(c) the result of the exchange will be that the person will become a resident of the nursing home
to which the person seeks admission and a resident of the nursing home will be discharged.
People who are the subject of an agreement between LTC homes and hospitals, psychiatric
facilities or Schedule 1 facilities under the DSA for the purpose of exchanging residents or
patients to meet their specialized requirements, do not fall within the numbered priority
categories. This separate exchange category exists to facilitate these mutually beneficial
exchanges.
The CCAC will be informed when an exchange is being considered. In such situations, the
CCAC must:
•
•
ensure that the person who is to be admitted to a LTC home has been determined as eligible
for LTC home admission and has been approved by the LTC home operator;
ensure that the necessary forms and required assessments are conducted and up- to-date in
accordance with the legislative requirements; and
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•
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authorize the admission to the LTC home according to the regulations and applicable LTC
home Act (for example, the requirement for the person’s consent to admission applies).
12.7.3 Categories for Residents Facing Relocation Due to LTC Home
Redevelopment
Separate provisions have been placed in the regulation to streamline the admission process for
persons who are directly affected by the LTC home redevelopment process. The purposes of
these provisions are to:
•
•
•
minimize the impact on the CCAC workload;
limit unnecessary discharges and re-applications by LTC home residents who must be
relocated; and
facilitate, as much as possible, a smooth transfer between LTC homes for residents and
their families.
Note: Subsections 86(1) and (2) of the NHA regulation provide that an operator of a LTC home
who intends to close all or some of the beds on a temporary or permanent basis, is required to
provide 16 weeks written notice of the closure to the director (LTC Homes Branch, MOHLTC),
home administrator, affected residents (and their substitute decision-makers (SDMs)), and the
CCAC designated for the home. After receiving notice of the closure, the CCAC must contact
each affected resident or his or her SDM to begin the process of finding another LTC home.
A number of transfer scenarios will occur as a result of LTC home redevelopment activities.
These are:
•
•
•
relocation of residents to a “related temporary” LTC home managed by the same operator
followed by a transfer to the “re-opened” LTC home managed by the same operator;
relocation of residents to a “non-related temporary” LTC home managed by a different
operator followed by a transfer to the “re-opened” LTC home; and
direct transfer of residents to a redeveloped “replacement” LTC home managed by the same
operator.
Note: The regulatory provisions related to the “related temporary”, “re-opened”, and
“replacement” categories of prioritization apply only to persons who are or were long-stay
residents of the original LTC home. Once all the residents from the “old” LTC home have been
relocated, the remaining beds in the new LTC home will be governed by the other waiting list
categories.
Scenario 1: Relocation of Residents to a “Related Temporary” Home Followed by a
Transfer to the “Re-Opened” Home
Sections 148 and 148.1 of the NHA regulation state:
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s. 148 Despite sections 143 to 145 and section 147 but subject to section 146, a person shall be
placed in the related temporary nursing home category on the waiting list for a nursing home
if,
(a) the nursing home is or will be a related temporary nursing home; and
(b) the person is a long-stay resident of the original nursing home or was a long-stay resident
of the original nursing home immediately before the closure of his or her bed in the home.
s.148.1 Despite sections 143 to 145 and section 147 but subject to section 146, a person shall
be placed in the re-opened nursing home category on the waiting list for a nursing home if,
(a) the nursing home is or will be a re-opened nursing home; and
of the original nursing home immediately before the temporary closure of his or her bed in the
home.
This situation occurs when all or some of the beds in a LTC home close temporarily, and
another LTC home managed by the same operator provides accommodation to the residents on
a temporary basis, until the beds in the original LTC home re-open and are available for these
residents.
Residents who accept to transfer to the related temporary LTC home and later move back to the
re-opened LTC home, will go through a streamlined admission process. Pursuant to sections
134(2) and (3), 136(1.1) and 138.1(1) and (2) of the NHA regulation, the following streamlined
admission process, applies to both the initial move and the move back to the re-opened home at
a later date:
Streamlined Admission Process
1. The long-stay applicants of the original LTC home are exempt from:
•
•
•
•
•
•
establishing that they are at least 18 years old;
providing their request for a determination of eligibility on the form provided by the
Minister of Health and Long-Term Care;
providing proof that the person is an insured person under the Health Insurance Act
(HIA);
providing an up-to-date health assessment of the person;
providing an up-to-date functional assessment; and
providing their request for authorization of admission in writing.
2. The CCAC is not required to provide the LTC home with the information relevant to a
determination of whether to give or withhold approval for the person’s admission to the
LTC home, or request that the LTC home determine whether to give or withhold
approval of the person’s admission to the home.
3. The LTC home is deemed to approve the applicant’s admission to the related temporary
and later the re-opened LTC home.
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Subject to the availability of vacancies, residents would be guaranteed the same type of
accommodation (basic, preferred) in the re-opened LTC home as they had in the old
LTC home. In a situation where the related temporary or re-opened LTC home has
fewer beds than the original home and cannot accommodate all of the original residents,
residents will be ranked according to the date of their admission to the original LTC
home. (See subsection #12.8.2 in this manual for additional information on rules for
ranking within categories.)
Any residents of the original LTC home who do not transfer to the related temporary or
the re-opened LTC home3 will have to go through the regular admissions process and
be prioritized in either category 1A (crisis) or category 2 depending on the number of
weeks left until the resident’s bed closes.
Scenario 2: Relocation of Residents to a “Non-Related Temporary” Home Followed by a
Transfer to the “Re-Opened” Home
This situation occurs when some or all of the beds in a LTC home are temporarily closing, and
another LTC home managed by a different operator provides accommodation to the residents
on a temporary basis until the beds in the re-opened LTC home are available.
In keeping with existing legislative requirements, all residents temporarily relocated to
accommodation managed by another LTC home operator during the redevelopment, will go
through the regular admission process while the transfer back to the re-opened LTC home is
subject to the streamlined admission process described above.
When residents accept to transfer to the non-related temporary LTC home, only those
exemptions that apply in all cases of LTC home to LTC home transfer apply. This means that
to transfer to a non-related temporary home, long-stay applicants of the original LTC home are
only exempt pursuant to subsection 134(2) of the NHA regulation from:
•
•
•
•
establishing that they are at least 18 years old;
providing proof that the person is an insured person under the HIA;
providing an up-to-date health assessment of the person; and
providing an up-to-date functional assessment.
The transfers back to the re-opened LTC home are subject to the same streamlined admissions
process as described in the previous scenario under items 1 to 3 above.
Scenario 3: Direct Transfer of Residents to a Redeveloped “Replacement” LTC Home
The NHA regulation states:
3
Circumstances where a resident may not be transferring to the related temporary or re-opened LTC home could include
situations where the resident chooses not to transfer to the LTC home, or where a LTC home has downsized and can no
longer accommodate all of the former residents.
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s. 148.2 Despite sections 143 to 145 and section 147 but subject to section 146, a person shall
be placed in the replacement nursing home category on the waiting list for a nursing home if,
(a) the nursing home is or will be a replacement nursing home; and
of the original nursing home immediately before the permanent closure of his or her bed in the
home.
In this situation, some or all of the LTC home’s beds are closing on a permanent basis and the
new LTC home, managed by the same operator, is the replacement for the LTC home being
closed.
The development of the new replacement LTC home proceeds without interfering with the
operation of the existing LTC home. When the new LTC home is completed, residents in the
existing LTC home have the option of transferring to the new replacement LTC home.
Residents who accept the option to transfer to the new replacement LTC home go through the
streamlined admission process described in scenario 1 above. Subject to the availability of
vacancy, residents are guaranteed the same type of accommodation (basic, preferred) in the
new replacement LTC home as they had in the old LTC home.
If the new replacement LTC home has fewer beds than the old LTC home, a program of
attrition during the construction period is mandated as part of the LTC home’s service
agreement with the MOHLTC. If, despite the program of attrition, not all of the original
residents can be accommodated in the new home, residents will be ranked according to the date
of their admission to the original LTC home. (See subsection #12.8.2 in this manual for
additional information on rules for ranking within categories.)
Residents from the original LTC home who do not transfer to the replacement LTC home must
go through the regular admission process. They will be prioritized as category 1A (crisis) or
category 2 depending on the number of weeks left until the resident’s bed closes.
Note: While the admission process has been streamlined for residents facing relocation due to
LTC home redevelopment, the CCAC must still ensure that the person consents to the
admission. The CCAC must prioritize the person, manage the waiting list, and authorize the
person’s admission to the new or redeveloped LTC home.
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12.8 Ranking of Priority Categories
12.8.1 Ranking of Categories
The Nursing Homes Act (NHA) regulation sets out the method of ranking the priority
categories:
s. 149. For each class of beds set out in a column of Table 4, the categories on the waiting list
shall be ranked in the order set out in the rows below that class of beds, such that a category
mentioned in a higher row ranks ahead of a category mentioned in a lower row.
TABLE 4
Ranking of Waiting List Categories
Column 1
Column 2
Column 3
Column 4
Column 5
Column 6
Class of
Beds
Beds in a
related
temporary
nursing
home, other
than
veterans’
priority
access beds
Beds in a reopened
nursing
home, other
than
veterans’
priority
access beds
Beds in a
replacement
nursing home,
other than
veterans’
priority access
beds
Veterans’
priority
access beds in
a nursing
home, other
than a related
temporary,
re-opened or
replacement
nursing home
Veterans’
priority
access beds
in a related
temporary,
re-opened or
replacement
nursing home
All other
beds in a
nursing
home
Waiting
List
Categories
Related
temporary
Re-opened
Replacement
Veteran
Veteran
Exchange
Exchange
Exchange
Exchange
Exchange
Related
temporary,
re-opened or
replacement,
as applicable
1A
1A
1A
1A
1A
Exchange
1A1
1A1
1A1
1A1
1A1
1A
1B
1B
1B
1B
1B
1A1
2
2
2
2
2
1B
3
3
3
3
3
2
3
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Category 1A is the highest ranking priority category, while category 3 is the lowest category
where it will take longer for an applicant to be placed.
An applicant may be on two waiting lists in different categories. For example, a person
applying as an ethno-cultural applicant to a long-term care (LTC) home primarily engaged in
services and programs to meet the specific ethno-cultural needs would be in category 1B.
However, the same person may also wait for another LTC home that is not primarily engaged
in the ethno-cultural services and programs. In this case, the person would be placed in another
waiting list category for the other LTC home. This situation does not affect the applicability of
the three choice rule. This rule still applies with the exception of applicants in prioritization
category 1A.
12.8.2 Rules for Ranking within Categories
The NHA regulation sets out the method of ranking within the priority categories:
s. 150(1) Within a waiting list category set out in Column 1 of Table 5, persons shall be ranked
for admission in accordance with the rules set out opposite the category in Column 2 of Table
5.
TABLE 5
Rules for Ranking within Categories
Item
Category
Rules
1.
Related temporary, re- Persons shall be ranked according to the date of their
opened and
admission to the original nursing home.
replacement nursing
home
2.
Veteran
(a) Veterans who require immediate admission as a result of
a crisis arising from their condition or circumstances shall
rank ahead of all other veterans.
(b) As among themselves, veterans who require immediate
admission as a result of a crisis arising from their condition or
circumstances shall be ranked according to the urgency of
their need for admission.
(c) Veterans who do not require immediate admission as a
result of a crisis arising from their condition or circumstances
but are continuum of care applicants on the waiting list for
the continuum of care nursing home shall rank ahead of all
other veterans who do not require immediate admission as a
result of a crisis arising from their condition or circumstances.
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Item
Category
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Rules
(d) As among themselves, veterans who do not require
immediate admission as a result of a crisis arising from their
condition or circumstances but are continuum of care
applicants shall be ranked according to the time at which they
applied for authorization of their admission to the nursing
home.
(e) As among themselves, veterans who do not require
immediate admission as a result of a crisis arising from their
condition or circumstances and are not continuum of care
applicants shall be ranked according to the time at which they
home.
3.
1A
Persons shall be ranked according to the urgency of their need
for admission.
3.1
1A1
Persons shall be ranked according to the time at which their
spouses/partners applied for authorization of their admission
to the nursing home.
4.
All categories, other
than those in items 1,
2, 3, 3.1 and 5
(a) Persons who are continuum of care applicants on the
waiting list for the continuum of care nursing home shall rank
ahead of all other persons in the same category.
(b) As among themselves, persons in the same category who
are continuum of care applicants shall be ranked according to
the time at which they applied for authorization of their
admission to the nursing home.
(c) As among themselves, persons in the same category who
are not continuum of care applicants shall be ranked
according to the time at which they applied for authorization
of their admission to the nursing home.
5.
Short-stay
Persons shall be ranked according to the time at which they
home.
Some persons are ranked for admission in a category according to the date and time at which
the person applied for authorization of admission. This means the date and time at which the
CCAC received all the information required for the application (e.g., the written request for
authorization, medical history, functional and health assessments). The LTC home operator
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must approve the application and then the person is placed on a waiting list based on the
authorization date.
12.8.3 Applicability of Rules for Ranking Regarding Additional Applications and
Appeal Situations
Subsection 150(2) of the NHA regulation sets out the ranking for homes to which an applicant
makes application within six weeks of an initial application:
s. 150(2) If, within six weeks after making his or her first application for authorization of
admission to one or more nursing homes, homes under the Homes for the Aged and Rest
Homes Act or approved charitable homes for the aged under the Charitable Institutions Act as
a long-stay resident, and before being admitted to one of such facilities, a person makes one or
more additional applications for authorization of his or her admission to one or more nursing
homes as a long-stay resident, the additional applications made within the six-week period
shall, for the purpose of Table 5, be deemed to have been made at the time that the first
application was made.
Long-stay applicants who, prior to their admission, make additional applications within six
weeks of their original application(s) are ranked with respect to the additional applications in
accordance with the date of their original application.
Subsection 150(3) of the NHA regulation sets out the ranking for individuals who are
determined eligible following an appeal to the Health Services Appeal and Review Board or
Divisional Court relating to eligibility:
s. 150(3) If a person who was determined by a placement co-ordinator to be ineligible for
admission to a nursing home as a long-stay resident is determined to be eligible for admission
as a long-stay resident as a result of an application to the Appeal Board under subsection 20.5
(2) of the Act or an appeal to the Divisional Court under subsection 20.8 (1) of the Act, and if
the person then makes an application for authorization of his or her admission to one or more
nursing homes, homes under the Homes for the Aged and Rest Homes Act or approved
charitable homes for the aged under the Charitable Institutions Act as a long-stay resident,
(a) that application for authorization shall, for the purposes of Table 5, be deemed to have been
made at the time that the placement co-ordinator determined that the person was ineligible for
admission; and
(b) all additional applications for authorization of admission to one or more nursing homes as
a long- stay resident, made by the person within six weeks after making the first application
and before being admitted to one of such facilities shall, for the purpose of Table 5, be deemed
to have been made at the time that the first application is deemed under clause (a) to have been
made.
The authorization date for purposes of ranking a person who has been determined eligible
following an appeal to the Health Services Appeal and Review Board or the Divisional Court is
deemed to be the date that the CCAC determined that the person was ineligible. In addition, the
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authorization date of any applications made within six weeks of the original application is
deemed to be the date that the CCAC determined that the person was ineligible.
12.8.4 Explanation of Continuum of Care
Continuum of care provisions relate to applicants who have resided in certain retirement or
supportive housing residences as of a date prior to July 1, 1994 and who are applying for
admission to an affiliated LTC home4 (e.g., retirement homes affiliated with nursing homes, or
supportive housing programs attached to homes for the aged).
The continuum of care residences and affiliated long-term care homes are listed in the
"Continuum of Care Facility Table" published by the Ministry of Health and Long-Term Care
(MOHLTC) and dated October 24, 1996.
Continuum of care applicants are given first choice of the available affiliated long-term care
home beds through their ranking within categories. Table 5, item 4 of the NHA regulation
provides that “Persons who are continuum of care applicants on the waiting list for the
continuum of care nursing home shall rank ahead of all other persons in the same category.”
This means that continuum of care applicants are not prioritized ahead of any categories, but
within the specific categories, they are given the first choice of admission to the affiliated longterm care home.
It is important to note that this provision continues to apply only to those individuals who
resided in an affiliated continuum of care residence prior to July 1, 1994. There has been no
expansion of this client group since that date.
4
The placement co-ordination regulations which were first introduced in 1994 reflected the government's intent to make
access to government funded LTC more equitable and primarily dependent upon a person's care needs. However, at that
time, the government also recognized the need to address the situation of individuals who had been made promises of
access to long-term care homes on the basis of making their residence in an affiliated retirement residence.
The manner in which this issue was addressed in the 1994 regulations was to identify individuals who had entered into a
continuum of care arrangement prior to the introduction of the new regulations, as "continuum of care applicants" and to
provide a separate category of prioritization for these individuals.
This separate category of prioritization for these individuals was intended as a "transitional" category that was expected to
be phased out once all of the individuals who had been made this type of promise had been placed or otherwise removed
from the waiting lists of these homes.
Amendments to the regulations that took effect May 1, 2002 continued to honour the earlier commitment of recognizing
individuals who were made promises of access to an affiliated long-term care facility, albeit with some differences.
Continuum of care applicants were removed as a separate priority category, but are given first choice of the available
affiliated long-term care home beds through their ranking within categories. This means that continuum of care applicants
are not prioritized ahead of any categories, but within the specific categories, they are given the first choice of admission to
the affiliated long-term care facility.
Please note that the revised provisions continue to apply only to those individuals who resided in an affiliated continuum of
care residence prior to July 1, 1994. There was no expansion of this client group as a result of the 2002 amendments.
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12.9 Waiting Lists for Interim Beds in LTC Homes
The Community Care Access Centre (CCAC) must maintain a separate waiting list for
admission to interim beds in long-term care (LTC) homes that have entered into a service
agreement for interim beds. Access to interim beds is restricted to hospital patients only. Only a
person who is a patient in a public hospital may be admitted to an interim bed. Communitybased applicants are not eligible and cannot be admitted to an interim bed. Subsections 1(2) and
153 of the Nursing Homes Act (NHA) regulation state:
s.1(2) Interim bed means a bed that exists in a nursing home for a temporary period of time
under the terms of a service agreement for interim beds.
s. 153(1) The placement co-ordinator designated under subsection 20.1 (3) of the Act for a
nursing home that has entered into a service agreement for interim beds shall keep a waiting
list for admission to the interim beds.
(3) The waiting list for interim beds shall be kept in addition to and separately from the waiting
list required to be kept under section 139.
(4) A person shall be placed on the waiting list for interim beds for a nursing home if,
(a) the person meets the requirements of section 140;
Section 140 of the NHA requires:
• the person is determined eligible for admission to a LTC home;
• the person applies for authorization of his or her admission to the home;
• the licensee of the home approves the person’s admission; and
• the total number of waiting lists on which the person is placed does not exceed three.
The three waiting list rule applies to persons seeking admission to interim beds located in LTC
homes. A person may apply for admission to both interim beds and long-stay beds; however,
the combined number of waiting lists upon which the person can be placed cannot exceed three
unless the person is prioritized in category crisis 1A.
s.153(4)(b) the person is a patient in a hospital that is a public hospital as defined in section 1
of the Public Hospitals Act;
(c) a physician has determined that the person does not require the acute care services
provided by the hospital; and
(d) the person has applied for authorization of his or her admission to an interim bed in the
nursing home.
The policy underlying the above regulatory provisions is to restrict who can be admitted to
interim beds in order to restrict the beds to hospital patients, thereby alleviating hospital
pressures. The purpose of interim beds is to provide for the preferential placement of persons
who are in hospital. These beds are not available to anyone else and individuals placed into
these beds should remain on the waiting list for a regular long-stay bed even if their preferred
choice home is the same as where the interim bed is located. This is to ensure continued “flowthrough” of hospital-based applicants.
September 2006
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Chapter 12
12.9.1 Ranking for Interim Beds
All ranking for interim beds is according to the date and time at which the person applied for
the authorization of admission. Subsection 153(5) of the NHA regulation states:
s. 153(5) Persons on a waiting list for interim beds for a nursing home shall be ranked for
admission according to the time at which they applied for authorization of their admission to
an interim bed in the nursing home.
There are two exceptions to the ranking of applicants according to their date of application for
authorization. (See Applicability of Rules for Ranking Regarding Additional Applications and
Appeal Situations in subsection #12.8.3 in this manual.)
September 2006
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Chapter 12
12.10 Refusals of Offers of Long-Stay Admission to LTC Homes
12.10.1 Refusal List
The Community Care Access Centre (CCAC) must maintain a refusal list for persons whose
names are removed from the waiting list for admission as long-stay residents under section 141
of the Nursing Homes Act (NHA) regulation, subject to the exception noted in #12.10.3 in this
manual. The NHA regulation states:
s. 141(1) A person shall be removed from the waiting list for each nursing home to which the
person is awaiting admission as a long-stay resident and shall be placed on the refusal list if,
(a) the person,
(i) is a long-stay resident of another nursing home, an approved charitable home for the
Rest Homes Act, or
(ii) is not described in subclause (i) and does not occupy a bed in,
(A) a hospital under the Public Hospitals Act or a private hospital licensed under the
(B) a facility that is designated as a psychiatric facility under section 80.2 of the Mental
Health Act and that is not exempt under that section from the requirement to provide inpatient services in paragraph 1 of subsection 4 (1) of Regulation 741 of the Revised
Regulations of Ontario, 1990 made under that Act, or
(C) a facility listed in Schedule 1 to Regulation 272 of the Revised Regulations of
Ontario, 1990 made under the Developmental Services Act; and
Note: The Schedule 1 facilities under the Developmental Services Act (DSA) include:
Huronia Regional Centre (Orillia), Rideau Regional Centre (Smith Falls) and
Southwestern Regional Centre (Blenheim).
(b) a placement co-ordinator offers to authorize the person's admission to a nursing home, an
approved charitable home for the aged under the Charitable Institutions Act or a home under
the Homes for the Aged and Rest Homes Act as a long-stay resident, and the person,
(i) refuses to consent to admission,
(ii) refuses to enter into the written agreement mentioned in clause 155 (1) (e) of this
Regulation, clause 86 (1) (e) of Regulation 69 of the Revised Regulations of Ontario, 1990
made under the Charitable Institutions Act or clause 12.21 (1) (e) of Regulation 637 of the
Revised Regulations of Ontario, 1990 made under the Homes for the Aged and Rest Homes
Act, as applicable, or
(iii) fails to move into the facility on or before the fifth day following the day on which he
or she is informed of the availability of accommodation.
September 2006
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Chapter 12
12.10.2 “One-Offer” Requirement
Under the “one-offer” requirement, community-based applicants and those already resident in a
long-term care (LTC) home waiting to transfer to another LTC home must be removed from all
LTC home waiting lists if the CCAC advises them that a bed is available in one of their
selected LTC homes and they refuse to consent to be admitted to the LTC home, refuse to enter
into the agreement referred to in the regulation or fail to move into the home as referred to in
the regulation.
After removal from all waiting lists, the CCAC must place these applicants on a separate list
(the “Refusal List”). The person is still considered eligible for admission; however, he or she
will not be contacted when a vacancy becomes available.
The “one-offer” requirement does not apply to hospital-based applicants (as well as psychiatric
facility patients and residents of Schedule 1 DSA facilities) who refuse to consent to be
admitted to a selected LTC home. While LTC home legislation does not permit the CCAC to
authorize individuals for admission without their consent, hospital-based applicants should be
encouraged to take the first vacancy that becomes available from among their LTC home
choices, even if that home is not their first choice. These applicants should be advised that if
they accept placement into a LTC home that is not their first choice, they can wait for their
other preferred LTC home choices in priority category 2 and be transferred when a bed
becomes available. However, these hospital or facility-based applicants cannot be compelled to
accept placement in a home that is not their first choice.
The “one-offer” requirement is intended to reduce the number of refusals to offers of LTC
home admissions. The policy is expected to speed up the process of admissions to LTC homes.
12.10.3 Exemption to the “One-Offer” Requirement: Short-Term Illness
Subsection 141(2) of the NHA regulation states:
s 141(2) Subsection (1) does not apply if the reason the person acts in the manner described in
subclause (1) (b) (i), (ii) or (iii) is that the person has a short-term illness or injury which,
(a) prevents the person from moving into the facility at that time; or
(b) would make moving into the facility at that time detrimental to the person's health.
Persons who refuse an offer of admission as a result of a short-term illness or injury that
prevents them from moving into the LTC home will not be removed from the waiting list(s) of
their LTC home choice(s). They will remain on the waiting list for other offers of admission.
This ensures that persons who must refuse an offer of admission as a result of a short-term
illness (e.g., the flu, or a LTC home that is in outbreak and cannot accept an offer of admission,
or injury) are not disadvantaged by the “one-offer” requirement.
September 2006
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Chapter 12
12.10.4 Reinstatement and Ranking on Waiting List after Refusal
s. 141(3) If a person described in subclause (1) (a) (i) is removed from the waiting list for a
nursing home under subsection (1), the person shall be placed on the waiting list for the home
again to await admission as a long-stay resident if,
the home as a long-stay resident; and
Persons residing in LTC homes who refuse an offer of admission to another LTC home will
lose their priority and are required to re-apply. There is no waiting period to re-apply for LTC
home-based applicants. They may re-apply to transfer to another LTC home at any time. The
resident must provide the CCAC with a new written request for authorization of admission.
s. 141(4) If a person described in subclause (1) (a) (ii) is removed from the waiting list for a
nursing home under subsection (1), the person shall be placed on the waiting list for the home
again to await admission as a long-stay resident if,
the home as a long-stay resident and,
(i) the request is provided 24 weeks or more after the day the person was removed from the
waiting list, or
(ii) the request is provided less than 24 weeks after the day the person was removed from
the waiting list but there has been a deterioration in the person's condition or
circumstances; and
(5) Clause (4) (b) does not apply to a person who will be placed in category 1A on the waiting
list for the home.
Community-based applicants must wait six months before re-applying to get back on any LTC
home waiting list, unless their situation or condition deteriorates.
September 2006
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Chapter 12
12.10.5 Ranking upon Re-application
s. 150(4) Despite subsection (2), if a person provides to the placement co-ordinator designated
for a nursing home under subsection 20.1 (3) of the Act a new request for authorization of
admission to the home under subsection 141 (3) or (4) or 141.1 (2), the person shall, for the
purpose of Table 5, be deemed to have applied for authorization of admission to the home at
the time of the provision of the new request.
A person whose name has been removed from the waiting list as a result of a refusal under
sections 141(1) or 141.1(2), and who re-applies for admission to a LTC home, must be ranked
by the CCAC on the waiting list according to the date of the new request for admission to a
LTC home. This provision applies to persons who apply for LTC home admission as short-stay
or long-stay residents.
September 2006
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Chapter 12
12.11 Waiting Lists for Short-Stay Programs
12.11.1 Waiting lists for Short-Stay Programs
The Community Care Access Centre (CCAC) must maintain a separate waiting list for
admissions to short-stay beds in long-term care (LTC) homes.
Subsection 148.4(1) of the Nursing Homes Act (NHA) regulation states:
s. 148.4(1) Sections 143 to 148.3 do not apply to a person applying for authorization of
admission to a nursing home as a short-stay resident in the respite care or supportive care
program.
(2) A person referred to in subsection (1) shall be placed in the short-stay category on the
waiting list for the nursing home.
12.11.2 Ranking for Short-Stay Programs
Subsection 150(1) of the NHA sets out the methodology of ranking for short-stay programs, as
follows:
s. 150 (1) Within a waiting list category set out in Column 1 of Table 5, persons shall be ranked
for admission in accordance with the rules set out opposite the category in Column 2 of Table
5.
Table 5 states that for short-stay applicants, persons shall be ranked according to the time at
which they applied for authorization of their admission to the LTC home. (See Table 5 in
subsection #12.8.2 in this manual.)
September 2006
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Chapter 12
12.12 Refusals of Offers of Short-Stay Admissions to LTC
Homes
12.12.1 Refusals of Offers of Short-Stay Admissions to LTC Homes
(See subsection #11.9.4 in this manual.)
12.12.2 Ranking upon Re-application
(See subsection #12.10.5 in this manual.)
September 2006
43
Appendix A
Glossary of Terms
Appendix A
Glossary of Terms
Acts and Regulations
CA – means the Corporations Act.
CCACA – means the Community Care Access Corporations Act, 2001, S.O. 2001, chapter 33.
CIA – means the Charitable Institutions Act, R.S.O. 1990, chapter C.9.
DSA – means the Developmental Services Act.
EA – means the Education Act, R.S.O. 1990, chapter E.2.
FLSA – means the French Language Services Act, R.S.O. 1990, chapter F.32.
HARHA – means the Homes for the Aged and Rest Homes Act, R.S.O. 1990, chapter H.13.
HARPA – means the Healing Arts Radiation Protection Act, R.S.O. 1990, chapter H.2
HCCA – means the Health Care Consent Act, 1996, S.O. 1996, chapter 2.
HIA – means the Health Insurance Act, R.S.O 1990, chapter H.6.
HSCA – means the Homes for Special Care Act, R.S.O. 1990, chapter H.12.
LTCA – means the Long-Term Care Act, 1994, S.O. 1994, chapter 26.
LTCSLAA – means the Long-Term Care Statute Law Amendment Act, 1993.
MHA – means the Mental Health Act, R.S.O. 1990, chapter M.7.
MHARBA – means the Ministry of Health Appeal and Review Boards Act, 1998, S.O. 1998,
chapter 18, Schedule H.
NA – means the Nursing Act, 1991, S.O. 199, chapter 32.
NHA – means the Nursing Homes Act, R.S.O. 1990, chapter N.7.
ODBA – means the Ontario Drug Benefit Act, R.S.O. 1990, chapter O.10.
September 2006
1
Appendix A
Glossary of Terms
PHIPA – means the Personal Health Information Protection Act, 2004, S.O. 2004, chapter 3,
Schedule A.
RHPA – means the Regulated Health Professions Act, 1991, S.O. 1991, chapter 18.
SDA - means the Substitute Decisions Act, 1992, S.O. 1992, chapter 30.
SWSSWA – means the Social Work and Social Services Work Act, 1998, S.O. 1998, chapter 31.
Definitions
Appeal Board – means the Health Services Appeal and Review Board under the Ministry of
Health Appeal and Review Boards Act, 1998 as defined in the long-term care home legislation.
“the Board” – means the Consent and Capacity Board, an independent adjudicative body created
to conduct hearings under the Mental Health Act and the Health Care Consent Act, 1996.
case manager – means all individuals who perform the case management function. Some
Community Care Access Centres use different names or titles such as care co-ordinator or care
manager for the role of the case manager.
“director” – means an officer of the Ministry of Health and Long-Term Care appointed by the
Minister of Health and Long-Term Care for the purposes of the Nursing Homes Act as defined
in subsection 3(2) of the Nursing Homes Act.
legislation – means the laws of Ontario, as enacted by the legislature.
LTC home – means a long-term care home for which the Community Care Access Centre is
responsible to manage admission. (Note: legislation refers to long-term care “facilities”.)
placement co-ordinator – depending on the specific citation in the long-term care home
legislation, may mean the Community Care Access Centre or the Community Care Access
Centre case manager responsible for assessing a person’s eligibility for admission to a long-term
care home.
policy – means the Ministry of Health and Long-Term Care directives, guidelines, policies and
procedures set out in this manual.
regulation – means a regulation made or approved under an act of the legislature.
September 2006
2
Appendix A
Glossary of Terms
Acronyms and Abbreviations
ABI
– acquired brain injury (services)
ADP
– Assistive Devices Program
ADS
– adult day services
ALC
– alternative level of care
ALSSH
– assisted living services in supportive housing
ARR
– annual reconciliation report
the Board
– Consent and Capacity Board
CCAC
– Community Care Access Centre
CTCs
– children’s treatment centres
EDU
– Ministry of Education and Training
EOL
– End-of-Life (Care Strategy)
Enhanced
Respite
– Enhanced Respite for Children who are Medically Fragile and/or Technology
Dependent
FIM
– Finance and Information Management
FM
– frequency modulation
Formulary/ – Ontario Drug Benefit Formulary/Comparative Drug Index
CDI
HNLU
– Health Number Look-Up (service)
HOP
– Home Oxygen Program
HRP
– Hospital Replacement Program
HSARB
– Health Services Appeal and Review Board
IFH
– Interim Federal Health (program)
IPRC
– Identification, Placement and Review Committee
ISNC
– Integrated Services for Northern Children
IVR
– Interactive Voice Response (system)
LHIN
– Local Health Integration Network
LTC
– long-term care (home)
MCSS
– Ministry of Community and Social Services
MCYS
– Ministry of Children and Youth Services
MDS-HC
– Minimum Data Set for Home Care
September 2006
3
MIS
– management information system
MOHLTC
– Ministry of Health and Long-Term Care
OACCAC
– Ontario Association of Community Care Access Centres
ODB
– Ontario Drug Benefit
OHIP
– Ontario Health Insurance Plan
PCS
– placement co-ordination service
PPM81
– Policy/Program Memorandum No. 81
PPM131
– Policy/Program Memorandum No. 131
RAI-HC
– Resident Assessment Instrument-Home Care
RCMP
– Royal Canadian Mounted Police
SDM
– substitute decision-maker
SEAC
– Special Education Advisory Committee
SHSS
– school health support service
VPA
– veterans’ priority access
September 2006
Appendix A
Glossary of Terms
4
Appendix B
Website Addresses
Appendix B
Website Addresses
Acts and Regulations
Charitable Institutions Act
[http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/90c09_e.htm]
Community Care Access Corporations Act, 2001
French Language Services Act
[http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/90f32_e.htm]
Healing Arts Radiation Protection Act
[http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/90h02_e.htm]
Health Care Consent Act, 1996
Health Insurance Act
Homes for the Aged and Rest Homes Act
Homes for Special Care Act
Long-Term Care Act, 1994
[http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/94l26_e.htm]
Ministry of Health Appeal and Review Boards Act, 1998
[http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/98m18_e.htm]
Nursing Homes Act
[http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/90n07_e.htm]
Ontario Drug Benefit Act
[http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/90o10_e.htm]
September 2006
1
Appendix B
Website Addresses
Personal Health Information Protection Act, 2004
[http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/04p03_e.htm]
Regulated Health Professions Act, 1991
[http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/91r18_e.htm]
Social Work and Social Services Work Act, 1998
[http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/98s31_e.htm]
Substitute Decisions Act, 1992
[http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/92s30_e.htm]
Forms
Application for Northern Health Travel Grant form (#014-0327-88)
[http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?openform&ENV=
WWE&NO=014-0327-88]
Consent for Placement Coordination Services to Collect, Keep on File, and Release Information
form (#014-2724-69)
[http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT
=RDR&TAB=PROFILE&ENV=WWE&NO=014-2747-69]
Health Number Release form (#014-1265-84)
[http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?openform&ENV=
WWE&NO=014-1265-84]
Health Report form (#014-2734-69)
[http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT
=RDR&TAB=PROFILE&ENV=WWE&NO=014-2734-69]
Hospital Replacement Program Questionnaire
[http://www.health.gov.on.ca/english/providers/program/adp/hrp/questionnaire.pdf]
Booklets and Memoranda
A Guide to Choosing Appropriate Patient Transportation
[http://www.ambulance-transition.com]
Interim Federal Health Program Information Handbook for Health Care Providers
[http://www.fasadmin.com/images/pdf/ifh_information_handbook.pdf]
September 2006
2
Appendix B
Website Addresses
Interministerial Guidelines for the Provision of Speech and Language Services (as applicable to
the Education Act), 1988
[http://www.edu.gov.on.ca/extra/eng/ppm/81.html]
Ontario Drug Benefit Formulary/Comparative Drug Index (Formulary/CDI)
[http://www.health.gov.on.ca/english/providers/program/drugs/odbf_eformulary.html]
Policy/Program Memorandum 81 (PPM81)
Policy/Program Memorandum 131 (PPM131)
Information
Consent and Capacity Board including application forms and contact information
[http://www.ccboard.on.ca/]
FAS benefit administration
[www.fasadmin.com]
Identification, Placement and Review Committee for children/youth in publicly-funded schools
[http://www.edu.gov.on.ca/eng/general/elemsec/speced/identifi.html]
Integrated Services for Northern Children
[http://www.children.gov.on.ca/CS/en/programs/SpecialNeeds/integratedServicesforNorther
nChildren.htm]
Local Health Integration Networks
[http://www.lhins.on.ca/english/main/home.asp]
Medical Air Transport Centre
[http://www.gov.on.ca/MOH/english/program/ambul/airamb.html]
Ministry of Education
[http://www.edu.gov.on.ca/eng/funding/]
Ministry of Health and Long-Term Care
[http://www.health.gov.on.ca/english/public/public_mn.html]
Northern Health Travel Grant application
[http://www.health.gov.on.ca/english/public/pub/ohip/northern.html]
Table 5, Rules for Ranking within Categories in the Nursing Home Act
[http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/90n07_e.htm]
September 2006
3
Appendix B
Website Addresses
Table 6 in the Charitable Institutions Act
September 2006
4