CCAC Client Services Policy Manual Chapter 11 Admission to Long-Term Care Homes

Transcription

1 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 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; September

2 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 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. September

3 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. September

4 11.2 Eligibility Criteria 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 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: September

5 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. September

6 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 September

7 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. September

8 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 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) 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 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: September

9 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, (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. 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.) September

10 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 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 provides for the eligibility of veterans as follows: s 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. September

11 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. September

12 (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 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. September

13 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 # 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 (# ), available at: [ DR&TAB=PROFILE&ENV=WWE&NO= ]. 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 # 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). September

14 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 # 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 (# ) which is available at: [ T=RDR&TAB=PROFILE&ENV=WWE&NO= ]. 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. September

15 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: 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 September

16 eligibility in order to transfer to a related temporary, re-opened or replacement nursing home, see Streamlined Admission Process in subsection # 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. September

17 11.4 Consents Required for Long-Stay Placement 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 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.) 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). September

18 (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 (# ) 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 (# ) is available at: [ DR&TAB=PROFILE&ENV=WWE&NO= ] 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 September

19 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. September

20 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 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 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; September

21 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 # in this manual); and reasons for and costs associated with bed holding 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 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 of the NHA regulation sets out the requirements related to this additional rate reduction: s (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 $ under section 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. September

22 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 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). September

23 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 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 September

24 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. September

25 11.6 Request for Approval of Admission and Response from the LTC Home 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 (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. September

26 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 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.) 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: September

27 s. 137 (1) Subject to sections 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 (# ) is available at: [ ACT=RDR&TAB=PROFILE&ENV=WWE&NO= ].); 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 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), September

28 (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. (4) In this section, "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 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.) 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, September

29 (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 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 September

30 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 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 # above in this manual.) September

31 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 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 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, (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 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- September

32 holding fee which is payable in addition to the accommodation fee for that part of the period available for bed-holding: Authorization of admission 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, (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. September

33 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 Day 2 Following Notification Yes for day 1 Yes for day 1 and 2 No No Day 3 Following Notification Day 4 Following Notification Day 5 (Before Noon of Day 5) Following Notification Yes for days 1,2 and 3 Yes for day 2 Yes for days 1,2,3 & 4 Yes for days 2 and 3 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. September

34 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 (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 September

35 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, (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, (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 (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 Institutions Act and homes under the Homes for the Aged and Rest Homes Act on which the person is placed exceeding three. (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. September

36 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 Conditions for Authorizing Admission to a LTC Home The Nursing Homes Act (NHA) regulation sets out the requirements for authorization of admission: Authorization of admission 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, (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; (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; and (e) (See Authorization of Admission in subsection # in this manual.) 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 September

37 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 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 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: September

38 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. September

39 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 # in this manual.) 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). 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 ; (b) the applicant meets at least one of the conditions set out in subsection (2); (e) the applicant's care requirements can be met in a nursing home. s. 130 (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. September

40 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. 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 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). 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 ; September

41 (c) the applicant meets at least one of the conditions set out in subsection (2); (e) the applicant's care requirements can be met in a nursing home. s. 130(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. 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. September

42 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 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 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). September

43 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 (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 of the NHA regulation: s (1) Sections 143 to 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: September

44 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: 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, (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; (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; and September

45 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. (3) No placement co-ordinator shall authorize the admission of a person to a nursing home as a short-stay resident in the supportive care program for a stay exceeding 90 days. (4) No placement co-ordinator shall authorize the admission of a person to a nursing home as 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. (5) No placement co-ordinator shall authorize the admission of a person to a nursing home as 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 September

46 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. September

47 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 # in this manual, which only applies to long-stay residents.) Refusals of Offers of Short-Stay Admissions Section 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 (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 (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 subsection 20.1 (3) of the Act a new written request for authorization of his or her admission to 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. September

48 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. September