OHA BACKGROUNDER Strengthening Home Care Services in Ontario

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1 July 2009 OHA BACKGROUNDER Strengthening Home Care Services in Ontario Summary of Amendments On July 3, 2009, the Ontario government approved amendments a number of regulations as part of a broader mandate to strengthen the quality of home care and community care services in Ontario. Amendments, which will be effective beginning September 18, 2009, have been made to the following regulations: Regulation 554/06 under the Community Care Access Corporations Act, 2001 Regulation 386/99 under the Long-Term Care Act, 1994 Regulation 552 under the Health Insurance Act Regulation 201/96 under the Ontario Drug Benefit Act Community Care Access Corporations Act, 2001 (CCAC Act) The amendments to Ontario Regulation 554/06 under the Community Care Access Corporations Act, 2001 (CCAC Act) expand the case management role of community care access corporations (CCACs). The list of charitable objects in section 5 of the CCAC has been expanded to allow CCACs to manage the placement of persons into: a) Adult day programs that are provided under the Long-Term Care Act, 1994; b) Supportive housing programs that are funded by the Ministry of Health and Long-Term Care or by a local health integration network under the Local Health System Integration Act, 2006 to provide personal support services and homemaking services to the following persons who require that such services be available on-site 24 hours a day: i. Persons who are frail or have a cognitive impairment; ii. Persons with a physical disability;

2 iii. iv. Persons with an acquired brain injury; or Persons with Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV); and c) Chronic care beds and rehabilitation beds in hospitals that are graded as a Group E, F, G, J or R hospital in subsection 1(1) of Regulation 964 of the Revised Regulations of Ontario, 1990 (Classification of Hospitals) made under the Public Hospitals Act. Long-Term Care Act, 1994 (LTCA) 1) Community Support Services Regulation 386/99 under the LTCA has been amended to allow CCACs to provide additional services and service choices to their clients. Subsection 2(4) of the LTCA defines community support services and Regulation 386/99 has been amended to expand this definition. Community support services currently include: meal services; transportation services; caregiver support services; adult day programs; home maintenance and repair services; friendly visiting services; security checks or reassurance services; social or recreational services; providing prescribed equipment, supplies or other goods. The following are prescribed by amendments to Regulation 386/99 as additional community support services : 1. Aboriginal support services 2. Client intervention and assistance services defined as providing support to persons to assist them to cope with activities of everyday living. 3. Emergency response services defined as installing electronic devices in homes to connect persons with emergency response centres. 4. Foot care services 5. Home help referral services defined as referring a person who requires home help services to a person who provides such services. 6. Independence training defined as teaching the skills to improve independent functioning in the community, including the effective use of personal support services. 7. Palliative care education and consultation services 8. Psychogeriatric consulting services related to Alzheimer disease and related dementias defined as providing psychogeriatric consultation, training and support to staff of long-term care homes, CCACs and other approved agencies. 2

3 9. Public education services relating to Alzheimer disease and related dementias 10. Services for persons with blindness or visual impairment defined as providing rehabilitation, visual orientation, counseling, referrals and technology to persons with blindness or visual impairment. 11. Services for persons with deafness, congenital hearing loss or acquired hearing loss defined as providing rehabilitation and communication training, counseling, technology and education to persons with deafness, congenital hearing loss or acquired hearing loss. 2) Eligibility for Homemaking Services and Personal Support Services Sections 2 and 2.1 of Regulation 386/99 have been amended to provide that, in addition to the criteria already set out, a CCAC shall not provide homemaking services or personal support services to a person unless: i. The place in which the homemaking services/personal support services are to be provided must have the physical features necessary to enable the services to be provided; and ii. The risk that a service provider who provides the homemaking services/personal support services to the person will suffer serious physical harm while providing the services must not be significant or, 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. 3) Professional Services New sections 3.4, 3.5, and 3.6 are added to Regulation 386/99 which set out the eligibility for professional services, the location of professional services, and the specific eligibility requirements for professional services in a long-term care home. Subsection 2(7) of the LTCA defines professional services and provides in clause 9 that additional services can be prescribed by regulation. Currently, professional services are defined to include: nursing services; occupational therapy services; physiotherapy services; social work services; speech-language pathology services; dietetics services; training a person to provide any of the services; providing prescribed equipment, supplies or other goods. 3

4 Amendments to Regulation 386/99 broaden professional services to include: 1. Diagnostic and laboratory services 2. Medical supplies, dressings and treatment equipment necessary to the provision of nursing services, occupational therapy services, physiotherapy services, speech-language pathology services or dietetics services 3. Pharmacy services 4. Respiratory therapy services 5. social service work services 1. Plan of Care A service provider that provides professional services shall ensure that there is a written plan of care for each person receiving the services. If professional services provided to a person involve treating or advising the person within the scope of practice of a health profession as defined in subsection 1(1) of the Regulated Health Professions Act, 1991, the service provider shall ensure that the plan of care is developed, evaluated, and revised as necessary by a member of the College that relates to the professional services provided. Note that these requirements do not apply to the provision of nursing services to a person who resides in a long-term care home. 2. Eligibility for Professional Services. A CCAC shall not provide professional services to a person unless the following eligibility criteria are met: 1. The person must be an insured person under the Health Insurance Act 2. The services must be necessary to enable to person to remain in his or her home or enable him or her to return home from a hospital or other health care facility 3. Except in the case of pharmacy services, the services must be reasonably expected to result in progress towards; i. Rehabilitation, ii. Maintenance of functional status, or iii. Palliation, in the case of a person who is in the last stages of life 4. The place in which the services are to be provided must have the physical features necessary to enable the services to be provided 5. The risk that a service provider who provides the services to a person will suffer serious physical harm while providing the services must not be significant, or, 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 6. In the case of pharmacy services; i. the person must be taking three or more prescription medications 4

5 ii. the person must be at risk of medication complications due to complex medical needs, and iii. the person must be unable to access the services in a setting outside the person s home because of his or her condition. 7. In the case of physiotherapy services and medical supplies, dressings and treatment equipment necessary to the provision of physiotherapy services, i. If the services are provided in the person s home in accordance with clause 3.5(3)(a), the person must be unable to access the services in a setting outside the home because of his or her condition, or ii. If the services are provided in a congregate or group setting in accordance with clause 3.5.(3)(b), A. the person must be 65 years of age or older, or B. the person must have been recently discharged as an inpatient of a hospital and the services must be directly connected to the condition, illness or injury for which the person was admitted to the hospital. 8. In the case of respiratory therapy services, the person must be ventilatordependant, have artificial airways or be receiving home oxygen services under the Assistive Devices Program administered by the Ministry. 9. In the case of services described in paragraph 1 or 2 of section 3.1 (diagnostic and laboratory or medical supplies), the person must be in need of nursing services, occupational therapy services, physiotherapy services, speechlanguage pathology services or dietetics services. 3. Location of Professional Services A CCAC may provide a professional service to a person in the person s home or in a congregate group setting. A CCAC may provide pharmacy services to a person only in the person s homes. A CCAC may provide physiotherapy services and medical supplies, dressings and treatment equipment necessary to the provision of physiotherapy services to the person, a. in the persons home, if the criteria in subparagraph 7(i) above is met; or b. in a congregate or group setting, if one of the eligibility criteria in subsubparagraph 7(ii) A and B of section 3.4 is met. 4. Application to Long-Term Care Subsection 3.4 and 3.5 (Eligibility for Professional Services and Location of Professional Services) do not apply to the provision of professional services by a CCAC to a person who resides in a long-term care home. 5

6 5. Eligibility for Professional Services in a Long-Term Care Home A CCAC may provide only the following professional services to a person who is a resident of a long-term care home: 1. Nursing services that are provides as part of the Nurse-led Long-Term care Outreach Team program funded by the Ministry or a local health integration network 2. Occupational therapy services 3. Physiotherapy services 4. Respiratory therapy services 5. Speech-language pathology services 6. Training to a person to provide nursing services to persons who are residents of a long-term care home A CCAC shall not provide the professional services listed above to a person who is a resident of a long-term care home unless the following eligibility criteria are met: 1. The person must be an insured person under the Health Insurance Act 2. Except in the case of nursing services, the person must be unable to access to services in a setting outside the person s home because of his or her condition 3. The services must be reasonably expected to result in progress towards, i. Rehabilitation. ii. Maintenance of functional status or iii. Palliation, in the case of a person who is in the last stages of life. 4. In the case of respiratory therapy services, the person must be ventilatordependent, have artificial airways or be receiving home oxygen services under the Assistive Devices Program administered by the Ministry. 4) Maximum Amount of Nursing Service Subsection 4(1) of Regulation 386/99 is amended to include extended class registered nurses. The amendments provide that a CCAC shall not provide a person with more than the lesser of the following amounts of nursing services: visits to or from a registered nurse, a registered practical nurse or a registered nurse in the extended class in a 30-day period 2. the following number of hours of service in a 30-day period i. 184 hours of service, if the services are provided by either or both registered nurses or registered nurses in the extended class ii. 227 hours of service, if the services are provided by registered practical nurses; or iii. 206 hours of service, if the services are provided by, A. Both registered nurses and registered practical nurses 6

7 B. Both registered practical nurses and registered nurses in the extended class, or C. All of registered nurses, registered practical nurses and registered nurses in the extended class. Registered nurse in the extended class means a registered nurse who holds an extended certificate of registration under the Nursing Act, Health Insurance Act (HIA) Section 13 of Regulation 552 under the HIA, which set out the eligibility criteria for professional services, has been revoked. The specific provisions relating to professional services have been updated and incorporated into Regulation 386/99 under the Long-Term Care Act, Clause 15(6)(h) of Regulation 552 was also amended to ensure that persons receiving professional services as defined in paragraphs 1-6, 8 and 9 of subsection 2(7) of the Long-Term Care Act, 1994, provided by a CCAC, continue to be exempt from the requirement to pay a co-payment fee for insured ambulance services. Ontario Drug Benefit Act (ODBA) Paragraph 1 of subsection 2(1) of Regulation 201/96 under the ODBA is amended to ensure that persons received professional services provided by or arranged by a CCAC continue to be eligible for drug benefits. The amendments define eligible persons as those who are receiving a professional service referred to in paragraphs 1-6, 8 or 9 of subsection 2(7) under the Long-Term Care Act, 1994, that is provided for or arranged by a CCAC defined in Regulation 386/99 under that Act. For more information, please contact Melissa Prokopy at or

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