Community Care Access Centres : Client Services Policy Manual

Public Information Health Care Providers News Media Text Only Version Community Care Access Centres : Client Services Policy Manual September 2006 Download Manual This CCAC Client Services Policy Manual sets out the requirements of the Ministry of Health and Long-Term Care (MOHLTC) relating to the primary service functions of the Community Care Access Centre (CCAC) as follows : assessing client needs, determining client eligibility, developing a plan of service, and providing or arranging for professional, personal support and homemaking services. providing information and referral services to the public about other community agencies and services. admission into long-term care (LTC) homes. The CCAC is required to comply with all laws. The CCAC Client Services Policy Manual sets out some of these legislative and regulatory requirements as well as the policies with which the CCAC is required to comply. This manual is written for CCACs and focuses on the delivery of services to clients. Statutory and regulatory provisions are usually quoted directly. Where interpretation is needed, examples and further explanatory notes are provided. For situations not covered in this manual, or situations that are covered but require special consideration, staff should consult senior management and management may contact the MOHLTC for further consultation or direction. The manual is intended to be a comprehensive document that will require updates and additions to reflect changes in legislation, regulations and policies. This manual replaces the Home Care Policies and Procedures Manual (1984) and the Placement Coordination Services Manual issued in 1994. The manual is downloadable in individual sections below : INDIVIDUAL SECTIONS Notice 1 page 696 Kb PDF Chapter 1 : Introduction to the Manual 16 pages 78 Kb PDF 1.1 Overview of the Manual

1.2 Overview of Ontario's Long-Term Care System 1.3 Community Support Services 1.4 Long-Term Care Homes 1.5 The Ministry of Health and Long-Term Care 1.6 Development of the Community Care Access Centre 1.7 The Community Care Access Centre Access to Home and Community Care Services (flowchart) Chapter 2 : Legislation 15 pages 56 Kb PDF 2.1 Introduction 2.2 Long-Term Care Act, 1994 2.3 Ontario Regulation 552 under the Health Insurance Act 2.4 Community Care Access Corporations Act, 2001 2.5 Legislation Governing Long-Term Care Homes 2.6 French Language Services Act Chapter 3 : Eligibility Criteria for CCAC Services 21 pages 71 Kb PDF 3.1 Overview of Eligibility Criteria 3.2 Validation of Ontario Health Cards 3.3 Residency Requirements for OHIP Coverage 3.4 Persons without OHIP Coverage are Ineligible for CCAC Services 3.5 Out-of-Province Applicants to Ontario's Long-Term Care Homes 3.6 OHIP Coverage/CCAC Services for Homeless Persons 3.7 OHIP Coverage/CCAC Services for Refugees 3.8 OHIP Coverage/CCAC Services for a Person on Leave of Absence from a LTC Home 3.9 Eligibility for Adult Day Services 3.10 Eligibility for Enhanced Respite Funding 3.11 Services to First Nations Persons Chapter 4 : Consent to Treatment, Admission to Long-Term Care Home and Community Services 52 pages 148 Kb PDF 4.1 Overview of Consent Provisions 4.2 Definitions of Terms of Health Care Consent Act, 1996 4.3 Consent to Treatment

4.4 Capacity to Consent to Treatment 4.5 Consent to Treatment on Behalf of an Incapable Person 4.6 Emergency Treatment Without Consent 4.7 Applications to the Consent and Capacity Board Regarding Treatment 4.8 Consent to Admission to a Long-Term Care Home 4.9 Consent to Admission to a Long-Term Care Home on Behalf of an Incapable Person 4.10 Applications to the Consent and Capacity Board Regarding Admission to a Long-Term Care Home 4.11 Consent to Personal Assistance Services Chapter 5 : Information and Referral Services 9 pages 35 Kb PDF 5.1 Overview of Information and Referral Services 5.2 Design of the Information and Referral Service 5.3 Required Information Services 5.4 Monitoring the Information and Referral Service 5.5 CCAC Information or Referral Services to Specific Communities Chapter 6 : CCAC Case Management 17 pages 63 Kb PDF 6.1 Introduction to Case Management 6.2 Responsibilities of Case Managers 6.3 Case Management Staff Qualifications 6.4 Supports to the Case Management Function Chapter 7 : CCAC Home Care Services 21 pages 72 Kb PDF 7.1 Professional Services 7.2 Personal Support and Homemaking Services 7.3 Management of Waiting Lists for CCAC Services 7.4 Ambulance Services for CCAC Clients 7.5 Drug Benefits for CCAC Clients 7.6 Influenza Services 7.7 Residential Hospices Chapter 8 : Supplementary Services 7 pages 36 Kb PDF 8.1 Home Oxygen Program

8.2 Northern Health Travel Grant Program Chapter 9 : CCAC School Services 30 pages 111 Kb PDF 9.1 Overview of CCAC School Services 9.2 Eligibility for CCAC School Services 9.3 Service Maximums 9.4 Equipment Relating to School Services 9.5 Transportation Relating to School Services 9.6 Case Management Function Relating to the Provision of CCAC School Services 9.7 CCAC Approaches to Service Delivery for School Services 9.8 Service Termination in Public, Private and Home Schools 9.9 CCAC Liaison Activities 9.10 Other Service Delivery Models 9.11 Responsibilities in Emergencies Chapter 10 : Complaints and Appeals 18 pages 62 Kb PDF 10.1 Complaint Resolution - Community Services 10.2 Appeal of CCAC Decisions - Community Services 10.3 Appeal Process Relating to Admission to a Long-Term Care Home Chapter 11 : Admission to Long-Term Care Homes 48 pages 149 Kb PDF 11.1 Introduction 11.2 Eligibility Criteria 11.3 Application Process for Long-Stay Eligibility Determination 11.4 Consents Required for Long-Stay Placement 11.5 LTC Home Selection for Long-Stay Applicants 11.6 Request for Approval of Admission and Response from the LTC Home 11.7 Accepting the Offer of Long-Stay Admission, Accommodation and Bed-Holding Fees 11.8 CCAC Authorization of Long-Stay Admission 11.9 Short-Stay Programs: Respite Care and Supportive Care (Convalescent Care) Chapter 12 : Management of Long-Term Care Home Waiting Lists by CCACs 43 pages 696 Kb PDF 12.1 Overview of Prioritization of Long-Term Care Home Waiting Lists 12.2 Crisis Admissions Category 1A

12.3 Prioritization Criteria Category 1A1 12.4 Prioritization Criteria Category 1B 12.5 Prioritization Criteria Category 2 12.6 Prioritization Criteria Category 3 12.7 Non-Numbered Categories 12.8 Ranking of Priority Categories 12.9 Waiting Lists for Interim Beds in LTC Homes 12.10 Refusals of Offers of Long-Stay Admission to LTC Homes 12.11 Waiting Lists for Short-Stay Programs 12.12 Refusals of Offers of Short-Stay Admissions to LTC Homes APPENDICES Appendix A Glossary of Terms Appendix B Website Addresses To view PDF format files, you need to have Adobe Acrobat Reader installed on your computer. You can download this free software from the Adobe Web site. Call the ministry INFOline at 1-800-268-1154 (Toll-free in Ontario only) In Toronto, call 416-314-5518 TTY 1-800-387-5559 Hours of operation : 8:30am - 5:00pm home central site contact us site map français Queen's Printer for Ontario, 2002 Privacy Policy Disclaimers Last Modified : 09/19/2006 15:55:11

Notice This CCAC Client Services Policy Manual ( Manual ) sets out the policy of the Ontario Ministry of Health and Long-Term Care (MOHLTC) relating to the provision of services by CCACs. The Manual overrides all prior MOHLTC policies relating to these services. The contents of this Manual are subject to change without notice from time to time and are for informational purposes only and are not intended to provide any legal, financial or professional advice or recommendations in any circumstances. The MOHLTC cannot and does not represent or guarantee that the information in the Manual is current, accurate, complete or free of errors. Any reliance upon any information contained in the Manual is solely at the risk of the user of the Manual. The user should always seek legal, financial or such other professional advice relating to the information contained in the Manual. The MOHLTC assumes no responsibility for any changes, errors or omissions in any of the information contained in the Manual. The MOHLTC makes no representation or warranty of any kind whatsoever with respect to this Manual. In no event shall the MOHLTC, the Province of Ontario and their respective officers, employees, servants or agents be liable for any failure to keep the content of this Manual up to date, for errors or omissions contained in the Manual, or for any damages (including without limitation, damages for loss of profits, business interruption or direct, indirect, incidental, special, consequential or punitive damages) arising out of or related to the use of this Manual (including all contents), whether under contract, in tort or under any other basis of liability. This Manual is the property of the MOHLTC and it shall not, in whole or in part, be reproduced without the MOHLTC s prior written permission. Version Date: September 2006

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual Introduction to the Manual 1.1 Overview of the Manual 1.1.1 Purpose of the Manual This CCAC Client Services Policy Manual sets out the requirements of the Ministry of Health and Long-Term Care (MOHLTC) relating to the primary service functions of the Community Care Access Centre (CCAC) as follows: assessing client needs, determining client eligibility, developing a plan of service, and providing or arranging for professional, personal support and homemaking services. providing information and referral services to the public about other community agencies and services. admission into long-term care (LTC) homes. The CCAC is required to comply with all laws. The CCAC Client Services Policy Manual sets out some of these legislative and regulatory requirements as well as the policies with which the CCAC is required to comply. This manual is written for CCACs and focuses on the delivery of services to clients. Statutory and regulatory provisions are usually quoted directly. Where interpretation is needed, examples and further explanatory notes are provided. For situations not covered in this manual, or situations that are covered but require special consideration, staff should consult senior management and management may contact the MOHLTC for further consultation or direction. The manual is intended to be a comprehensive document that will require updates and additions to reflect changes in legislation, regulations and policies. This manual replaces the Home Care Policies and Procedures Manual (1984) and the Placement Coordination Services Manual issued in 1994. September 2006 1

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual 1.1.2 How to Use the Manual This manual is divided into chapters (e.g., chapter 4 is Consent to Treatment and/or Admission to Long-Term Care Home, chapter 9 is CCAC School Services). Each chapter starts on a new page and is divided into subsections. Chapter numbers are on every page. Page numbering starts again at the beginning of each chapter. Thus, if a chapter is revised the pages can be removed and replaced with new material. The internet version of the manual is the authoritative reference. The manual is available online at the MOHLTC website at: [http://www.health.gov.on.ca/english/providers/providers_mn.html]. The MOHLTC is responsible for maintaining and updating the internet version. Readers should ensure they are using the current hard copy by comparing the date in the footer with the online version. Notes are used in this manual to draw attention to information requiring special consideration or extra caution. Clarification statements further explain or interpret cited legislation. Legislation, regulations and document titles are in italics. If the date is part of an Act s official title, the date is included in the full name but not in the acronym. Each CCAC is advised to review applicable laws, including the cited legislation, and to seek legal advice when questions arise. See Appendix #A in this manual, for a glossary of terms including the Acts and regulations, definitions, acronyms and abbreviations used throughout this manual. For first references in each chapter and section, terms are expressed in full form followed by the acronym in parentheses. This manual also references website addresses to provide readers with access to applicable legislation, forms and other related information. See Appendix #B in this manual for a complete list of these website addresses. Information on procurement policies and procedures for CCACs can be found in the following documents, developed in July 2003: Client Services Procurement Policy for Community Care Access Centres; and Client Services Procurement Procedures for Community Care Access Centres. Information on the management information system (MIS) home care standards (including service recipient codes) is available on the MOHLTC Finance and Information Management (FIM) website (private site). September 2006 2

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual 1.2 Overview of Ontario s Long-Term Care System Ontario has developed a system of home and community care with the following partners: the Ministry of Health and Long-Term Care (MOHLTC), Community Care Access Centres (CCACs), community services and long-term care (LTC) homes. The partners work together in different combinations to meet the diverse needs of people accessing their services. MOHLTC funds the LTC homes to meet the needs of people who can no longer live in their own homes and the CCAC manages admissions to LTC homes. The MOHLTC, the CCACs and community service agencies work together to provide support to people of all ages in their places of residence and in their communities. In the home and community care sector, 42 CCACs and over 800 community service agencies receive funding from the Ontario government to help people remain independent and to live with dignity in their homes and communities. Services include professional services, personal support and homemaking, meals, community transportation, acquired brain injury (ABI) services, assisted living services in supportive housing (ALSSH), and elderly persons centres. Provision of community-based health and support services may be: temporary or periodic (e.g., to enable a person to recover or receive treatment at home, rather than in a hospital); or ongoing or long-term (e.g., an elderly person who requires assistance with personal care needs, such as bathing or dressing, to remain at home, or a child with a physical disability who needs professional support to attend school). 1.2.1 Need for Home and Community Services Two major factors affect the demand for home and community services in Ontario: 1. As Ontario s population ages, the demand for community-based health and support services increases 2. The increased volume of referrals from hospitals: hospital restructuring has resulted in shorter hospital stays for patients, and a greater need for in-home supports to address care needs after hospital discharge. In addition, in-home supports can reduce the need for hospital admissions. September 2006 3

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual 1.2.2 Goals of the Home and Community Care System The MOHLTC, CCACs, community support services, ALSSH, and ABI service agencies together form the system of home and community care, which provides services to people living in their homes or other community settings. The goals of the system of home and community care are: to ensure people have access to the services they need, when they need them; to continue to develop a modern, comprehensive health care system to meet future needs and ensure access to key community health services for people of all ages; and to ensure that community-based health and support services are available to serve a growing, aging population. The remainder of this chapter provides the context for the CCAC by giving a brief description of its three key partners: community support services (see subsection #1.3 in this manual); LTC homes (see subsection #1.4 in this manual); and the MOHLTC (see subsection #1.5 in this manual). (Also see subsection #1.7 in this manual for a brief description of the CCAC.) September 2006 4

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual 1.3 Community Support Services Community support services are fully or partially funded by the Ministry of Health and Long- Term Care (MOHLTC) and are delivered by community-based, not-for-profit agencies that rely heavily on volunteers. Historically, services were developed locally in response to local needs and vary from community to community. Clients can access services directly through selfreferral. The 15 key community support services (as per the 2001/2002 Planning, Funding and Accountability Policies and Procedures Manual for Long-Term Care Community Services) are: meal services; transportation services; caregiver support services (these services include counselling, information and education to caregivers and family members who have emotional, severe stress or mental health problems impeding their ability to provide care and support for the client); respite (these services replace the efforts of family and caregiver supports. This occurs both in people's homes and outside the home); homemaking; adult day services (ADS); home maintenance and repair services; volunteer hospice services; palliative care consultation services (e.g. pain and symptom management); palliative education (this includes both physician palliative care education and community and facility palliative care interdisciplinary education for front line health care staff); Alzheimer services (e.g. public education coordinators and psychogeriatric resource consultants); friendly visiting services; security checks; social or recreational services (including services delivered by both elderly persons centres as well as other community support service agencies); and services for persons with physical disabilities (these are services specifically for persons with physical disabilities, including attendant outreach, direct funding and special services for the blind and hearing impaired. This also includes foot care, aphasia and personal support and homemaking services.). Some of these services are also provided to clients in assisted living services in supportive housing (ALSSH) and there are services specifically for clients with acquired brain injury (ABI). September 2006 5

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual 1.3.2 Legislation Section 3 of the Long-Term Care Act, 1994 (LTCA) states: For the purpose of this Act, the following are community services: 1. Community support services 2. Homemaking services 3. Personal support services 4. Professional services Section 4 of the LTCA states: For the purpose of this Act, the following are community support services: 1. Meal services 2. Transportation services 3. Caregiver support services 4. Adult day programs 5. Home maintenance and repair services 6. Friendly visiting services 7. Security checks or reassurance services 8. Social or recreational services 9. Providing prescribed equipment, supplies or other goods 10. Services prescribed as community support services September 2006 6

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual 1.4 Long-Term Care Homes Long-term care (LTC) homes (nursing homes, charitable homes for the aged and municipal homes for the aged) provide care for people who are not able to live independently in their own homes and who require 24-hour nursing or personal care, support and/or supervision. 1.4.1 Funding of Long-Term Care Homes LTC homes have two main sources of funds: Ministry of Health and Long-Term Care (MOHLTC) funding for care and services and funding received from residents who pay accommodation fees. The MOHLTC provides funding to LTC homes according to a funding formula known as the envelope system. These funding envelopes are: nursing and personal care; programming and support services; raw food; and other accommodation. The MOHLTC also provides supplementary funding to support operating costs. MOHLTC funding for nursing and personal care services is based on a resident needs-based funding formula with MOHLTC paying the full amount. The MOHLTC pays a fixed per diem for program and support services, which includes recreational activities, therapists, quality of life and other programs designed to assist residents to maintain their optimal level of functioning. The MOHLTC also assists residents who have limited income with their accommodation charges. The MOHLTC pays the LTC home the difference between the basic accommodation rate and what the resident can afford. Further information about MOHLTC policies with respect to LTC homes can be found in the Long-Term Care Home Program Manual, 1993, as revised in 1995, 1998 and 2006, available in MOHLTC offices. September 2006 7

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual 1.5 The Ministry of Health and Long-Term Care This subsection describes the role of the Ministry of Health and Long-Term Care (MOHLTC) as it relates to the Community Care Access Centre (CCAC). 1.5.1 Role of the Ministry of Health and Long-Term Care MOHLTC provides funding, administers legislation and regulations, and sets and ensures compliance with policies and guidelines for Ontario s health care system. The goal is enhancing physical and mental health in all of life s stages through a high quality system that is easily accessible for all Ontarians. MOHLTC is responsible for managing Ontario s health care system including: health insurance, drug benefits, assistive devices, care for the mentally ill, community services, home care, community health, health promotion and disease prevention, hospitals and long-term care (LTC) homes. 1.5.2 Role of Local Health Integration Networks Local Health Integration Networks (LHINs) are non-profit organizations funded by the Government of Ontario, through the MOHLTC. It is intended that LHINs will have authority to make local decisions about health services and perform some functions that are currently done centrally by the MOHLTC. Fourteen LHINs have been established in Ontario, each with specific geographic boundaries. The intent is that LHINs will eventually be responsible for planning, integrating and funding local health services. LHIN functions will be phased in over time. LHINs will commence with planning and community engagement responsibilities, move then to service coordination and system integration, and finally to funding and resource allocation. LHINs will also be responsible for engaging the health care providers and community stakeholders in their areas throughout their evolution. LHINs will eventually fund certain health service providers, including CCACs and community service agencies, which will be accountable to the LHIN. Additional information is available at: [http://www.lhins.on.ca/english/main/home.asp]. 1.5.3 Community Health Division The Community Health Division of the MOHLTC is responsible for programs relating to community health centres, CCACs, community services, LTC homes, mental health community services and the Psychiatric Patient Advocacy Office. The Community Health Division also shares responsibility with the Acute Services Division for MOHLTC regional offices, the Finance and Information Management Branch, French Language Services and the Strategic Projects Unit. September 2006 8

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual The Community Health Division funds its programs, supports best practices, monitors compliance and takes corrective action concerning the province s LTC homes and the community agencies providing home and community care services to seniors, adults with physical disabilities, and people of any age who need health services at home or in school. 1.5.4 The Home Care and Community Support Branch The vision of the Home Care and Community Support Branch is: Getting care to people who need it in their home and community setting. The branch s mission: develops and supports the implementation of policy for home care and community services under the direction of the government and in consultation with stakeholder groups; assists regional offices in appropriate and consistent policy implementation across Ontario; establishes standards for operation of home and community care programs; develops program performance measures, monitoring and evaluation mechanisms for application across the province; and promotes legislative and government intent through funding, monitoring and evaluating service delivery. Given the vision and mission of the Home Care and Community Support Branch of the MOHLTC, the key functions of the branch include: development of legislation and regulations for the home and community care system; development of operational policies aimed at ensuring the consistent administration, implementation and management of community-based programs and services across the province; training and orientation on new program designs; and provision of support to the regional offices in their role of monitoring home and community care services. 1.5.5 Regional Offices Seven MOHLTC regional offices (North, East, Central East, Toronto, Central West, Central South, and South West) lead and support communities in developing and sustaining a locally responsive, accountable and quality system of services in the areas of acute and community health. September 2006 9

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual Regional offices: provide a primary point of contact and provide program expertise for MOHLTC transfer payment agencies in the acute and community care health sectors; enable co-ordination and collaboration in the delivery of services across the region; facilitate an integrated approach to services resulting in better solutions for service issues; flow funding directly to hospitals, LTC homes, CCACs, community services, community health centres, and mental health and addictions programs in the regions, consistent with corporate direction; serve as a monitoring and accountability point for program delivery, including program reviews; work with transfer payment partners to develop and execute accountability frameworks; ensure compliance with legislation, regulations and policies; facilitate co-ordination of approvals and requests with other MOHLTC or health care program divisional units; and collaborate on policy development, and implement MOHLTC policies, strategic directions and government initiatives within the region. 1.5.6 Regional Office Staff Program Consultants Program consultants are the point of contact for CCACs, hospitals, LTC homes, community services agencies, and mental health and addiction program agencies. Program consultants in the regional offices: ensure CCAC compliance with MOHLTC legislation, regulations and policies; provide individual transfer payment agencies with funding for services provided within defined accountabilities; support the community in developing and sustaining local programs; facilitate integrated approaches to services; and serve as the point of contact for the public to receive advice or complaints on MOHLTC programs. Finance and Information Staff Finance and information staff ensure a strong financial controllership function is in place in the region. Regional financial staff are responsible for: cash flow to transfer payment agencies; year-end reconciliation; ensuring expenditures are appropriate; resolving financial issues; and ensuring that meaningful financial data is available to assist in planning. September 2006 10

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual Planning Staff Planning staff in regional offices are responsible for: developing planning processes and helping to set planning agendas for MOHLTC regional offices; co-ordinating regional issues and communications; developing and implementing internal management processes for the regional office; working with external planning and health service delivery stakeholders to improve decisions related to health services planning and delivery; and providing project management, facilitation, negotiation, research and information analysis services to the region. LTC Home Compliance Staff (Nursing, Environmental Health and Dietary) LTC home compliance staff monitor LTC home compliance with legislation, regulations, MOHLTC policies, service agreements, and the standards and criteria contained in the Long- Term Care Home Program Manual. Compliance staff are responsible for reviewing resident care, services, programs and operational aspects of LTC homes. September 2006 11

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual 1.6 Development of the Community Care Access Centre The Ontario Minister of Health and Long-Term Care announced the creation of the Community Care Access Centre (CCAC) on January 25, 1996. On January 1, 1998, implementation of 43 CCACs across Ontario was completed, consolidating the services formerly provided by 38 home care programs and 36 placement co-ordination services. 1.6.1 History of Ontario s Home Care and Placement Co-ordination Services Date Description 1958 Six acute home care pilot projects funded with federal health grants and assistance from the Ontario Hospital Services Commission 1971 Three placement co-ordination pilots introduced 1972 Acute home care services implemented province-wide as an insured benefit under the Ontario Health Insurance Plan (OHIP) 1975-84 Chronic home care services phased in province-wide 1978-84 Placement co-ordination services for admission to long-term care (LTC) homes phased in province-wide 1984 School services in publicly-funded schools implemented to support provincial education reforms and enable universal access to public education for students with physical or developmental delays 1986 Integrated Homemaker Program phased in province-wide to provide homemaking and personal care for adults who were living with a physical disability or were frail and elderly 1993 The Long-Term Care Statute Law Amendment Act, 1993 (LTCSLAA) required all admissions to LTC homes (nursing homes and homes for the aged) be authorized by placement co-ordination services. Policy direction was provided to CCACs in 1994. 1995 The Long-Term Care Act, 1994 (LTCA) proclaimed into force 1995 Regulation made under the LTCA relating to the conveyance of assets of an approved agency 1995-96 Acute, chronic, school health and homemakers programs integrated into a single service-based model September 2006 12

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual Date Description 1996-98 Establishment across the province of 43 CCACs consolidating 38 home care programs and 36 placement co-ordination services under new community boards 1999 Regulation made under the LTCA setting out eligibility criteria for persons receiving homemaking services and maximums for homemaking, personal support and nursing services 2000 Regulation made under the LTCA setting out eligibility and service maximums for school health professional services to be provided to children attending private schools and home schools. (Regulation under the Health Insurance Act (HIA) relating to these services was revoked.) 2000 Regulation made under the LTCA setting out the eligibility criteria and service maximums for school services to be provided to children attending private and home schools. Policy direction was provided to CCACs in 2001. 2001 Community Care Access Corporations Act, 2001 (CCACA) proclaimed into force making CCACs statutory corporations with Order in Council appointments for board members and executive directors 2002 Forty-one of 43 CCACs were designated as statutory corporations by regulation on February 16. (Two CCACs governed by integrated health service agencies, Muskoka East Parry Sound and West Parry Sound Health Centre, did not change their governance structures.) Regulation also deemed CCACs to be approved agencies under the LTCA and approved CCACs to provide all professional services and personal support services listed in the LTCA as well as all homemaking services, except for ironing and mending. 2002 Regulation 386/99 under the LTCA amended to prohibit a CCAC from providing personal support services to a person unless the person is insured under the HIA 2003 The Etobicoke and York CCACs merged bringing the total CCACs in Ontario to 42 (from 43) 2006 The CCACA was amended to allow for the reorganization and dissolution of CCACs in support of their alignment with LHINs. Other changes allow for an expanded role for CCACs as navigators for a wider range of services. September 2006 13

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual 1.7 The Community Care Access Centre The Ministry of Health and Long-Term Care (MOHLTC) established CCACs across the province to provide simplified access to home and community care; to deliver and make the arrangements for the delivery of home care services to people in their homes, schools and communities; to provide information and referral to the public on community-related services; and to authorize admissions to long term care (LTC) homes. There is no age restriction, and no charge for services provided by the CCAC. The duration of service depends on a person s needs. The CCAC is responsible for: assessment of applicant s requirements and determination of eligibility for professional health services, homemaking (excluding ironing and mending), and personal support services provided in people s homes, schools and in the community; assessment of applicant s requirements and determination of eligibility for professional health and personal support services for children in schools and receiving home schooling; development of plans of service; information and referral for the public to home and community care and related services; purchasing home care services from service providers through a procurement process; admission to LTC homes; and co-ordination of the delivery of home care services provided by the CCAC. The CCAC plays an important role in collecting, reviewing and conveying information regarding service needs, trends or gaps in the community. The CCAC participates with other key health system partners (e.g., hospitals) on key community health system committees, and works in collaboration with other service providers, planning agencies and educational institutions to enhance services for people in the community. CCAC services provided in the home or school on a visitation basis enable home care recipients, resident pupils as defined by the Education Act (EA) and those who are home instructed to: remain in their own homes; return home more quickly from hospital; delay or prevent the need for admission to a hospital or LTC home; and attend school and participate in school routines and receive instruction or receive home schooling. The CCAC accomplishes these objectives directly or indirectly by providing or purchasing and arranging the following community services on behalf of eligible clients: nursing; personal support and homemaking; September 2006 14

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual physiotherapy; occupational therapy; speech-language pathology; social work; dietetics; medical supplies and dressings; hospital and sickroom equipment; assistance in obtaining drug card; laboratory and diagnostic services; and transportation to medical appointments and hospitals. The CCAC serves clients who may be: recovering from an acute illness; living with a chronic disease, or are in the convalescent, rehabilitative, or terminal stage of disease; requiring support because of frailty or disability; or requiring service to participate in school or home schooling. September 2006 15

CCAC Client Services Policy Manual Chapter 1 Introduction to the Manual ACCESS TO HOME AND COMMUNITY CARE SERVICES HEALTH & SUPPORT SERVICES (e.g., NURSING, PERSONAL SUPPORT AND HOMEMAKING) CCAC INFORMATION & REFERRAL DIRECT ACCESS ADMISSIONTO LONG-TERM CARE HOMES CASE MANAGEMENT WITH CLIENT COMMUNITY SERVICES (E.G., MEAL PROGRAMS, TRANSPORTATION, ASSISTED LIVING SERVICES IN SUPPORTIVE HOUSING, ATTENDANT SERVICES, ADULT DAY PROGRAMS, ACQUIRED BRAIN INJURY) 3 As shown by the above diagram, CCACs are the first point of contact to home care services in the community. CCAC case managers will assess a person s needs, determine eligibility for services, develop a plan of care and arrange for the delivery of professional services and personal support and homemaking services, the provision of medical equipment and supplies, and authorize admission into long-term care (LTC) homes. The CCAC case manager will also make referrals for a client and provide information, including information on how to access community services such as meal delivery, transportation and attendant care services. September 2006 16

CCAC Client Services Policy Manual Chapter 2 Legislation Legislation 2.1 Introduction The Community Care Access Centre (CCAC) is required to comply with all laws. The following legislation is particularly significant to the government-funded system of community services and placement co-ordination services that the CCAC is required to provide: Long-Term Care Act, 1994 (LTCA); Health Insurance Act (HIA); Community Care Access Corporations Act, 2001 (CCACA); Nursing Homes Act (NHA); Charitable Institutions Act (CIA); Homes for the Aged and Rest Homes Act (HARHA); Local Health System Integration Act, 2006 (LHSIA); and French Language Services Act (FLSA). Each CCAC must also be familiar with the all other relevant laws, including but not limited to: Health Care Consent Act, 1996 (HCCA); Substitute Decisions Act, 1992 (SDA); Personal Health Information Protection Act, 2004 (PHIPA); and Ministry of Health Appeal and Review Boards Act, 1998 (MHARBA). 2.1.1 Background A large portion of the current legislative framework was developed and implemented during the first half of the 1990s, as part of a major reform of Ontario s long-term care system. The reform of the long-term care system was initiated in July 1993 with the enactment of the Long-Term Care Statute Law Amendment Act, 1993 (LTCSLAA) which focused primarily on reforms related to admission to and operation of long-term care (LTC) homes. The LTCSLAA amended the NHA, the CIA and the HARHA to provide consistent expectations about admission to and operation of all LTC homes. The amendments included: setting out the admission process and role of placement co-ordinators; requiring all admissions to LTC homes to be conducted by placement co-ordinators; September 2006 1

CCAC Client Services Policy Manual Chapter 2 Legislation a service agreement between the province and each home; maximum resident charges; a plan of care for each resident; a quality management system in each home; requirements to give notice and post specific documents in the home; residents councils at each home; and new inspection criteria with protection from reprisals for persons making disclosures to an inspector. Two years later in March 1995, the LTCA came into force. The LTCA represented the second phase of legislative change undertaken to support the reform of long-term care. The Act created a new system of community-based long-term care home and community services for people of all ages, including seniors, adults with physical disabilities and people of any age who need health services at home or in school. There was also continued reliance on the regulations under the HIA that addressed nursing and other professional home care services. Following implementation of the LTCA, the Ministry of Health and Long-Term Care (MOHLTC) established CCACs across the province between 1996 and 1998 by consolidating 38 home care programs and 36 placement co-ordination services under new community boards. The intent was to provide Ontarians with simplified access to: home and community care, including services in schools; and LTC homes. Separate legislation governing the structure and operations of the CCACs was subsequently passed in December 2001. The CCACA was introduced to strengthen consistency and accountability of CCAC operations across the province. September 2006 2

CCAC Client Services Policy Manual Chapter 2 Legislation 2.2 Long-Term Care Act, 1994 2.2.1 Purpose of Act and Bill of Rights As the primary legislation covering community-based long-term care home and community services, the Long-Term Care Act, 1994 (LTCA) provides the authority for a significant portion of the services provided by each Community Care Access Centre(CCAC). The LTCA sets out the purpose of the Act: Purposes of Act s. 1 The purposes of this Act are, (a) to ensure that a wide range of community services 1 is available to people in their own homes and in other community settings so that alternatives to institutional care exist; (b) to provide support and relief to relatives, friends, neighbours and others who provide care for a person at home; (c) to improve the quality of community services and to promote the health and well-being of persons requiring such services; (d) to recognize, in all aspects of the management and delivery of community services, the importance of a person s needs and preferences, including preferences based on ethnic, spiritual, linguistic, familial and cultural factors; (e) to integrate community services that are health services with community services that are social services in order to facilitate the provision of a continuum of care and support; (f) to simplify and improve access to a continuum of community services by providing a framework for the development of multi-service agencies 2 ; (g) to promote equitable access to community services through the application of consistent eligibility criteria and uniform rules and procedures; (h) to promote the effective and efficient management of human, financial and other resources involved in the delivery of community services; (i) to encourage local community involvement, including the involvement of volunteers, in planning, co-ordinating, integrating and delivering community services and in governing the agencies that deliver community services; (j) to promote co-operation and co-ordination between providers of community services and providers of other health and social services; and (k) to ensure the co-ordination of community services provided by multi-service agencies with those services offered by hospitals, long-term care facilities, mental health services, health care professionals and social service agencies, and to promote a continuum of health and social services. The LTCA also sets out the Bill of Rights for persons receiving community services. The Bill of Rights has been developed and enshrined in the LTCA in order to protect and promote an individual s personal well-being and safety. It outlines the privileges, choices and protections available to individuals receiving community services under the LTCA. 1 2 See chapter #7 in this manual for definition of community services. Multi-service agencies do not exist, however, references to them have not yet been repealed from the LTCA. September 2006 3

CCAC Client Services Policy Manual Chapter 2 Legislation In the following passages from the LTCA, service provider means the CCAC, all community service agencies and all service providers with whom the CCAC has service contracts. Bill of Rights s. 3(1) A service provider shall ensure that the following rights of persons receiving community services from the service provider are fully respected and promoted: 1. A person receiving a community service has the right to be dealt with by the service provider in a courteous and respectful manner and to be free from mental, physical and financial abuse by the service provider. 2. A person receiving a community service has the right to be dealt with by the service provider in a manner that respects the person s dignity and privacy and that promotes the person s autonomy. 3. A person receiving a community service has the right to be dealt with by the service provider in a manner that recognizes the person s individuality and that is sensitive to and responds to the person s needs and preferences, including preferences based on ethnic, spiritual, linguistic, familial and cultural factors. 4. A person receiving a community service has the right to information about the community services provided to him or her and to be told who will be providing the community services. 5. A person applying for a community service has the right to participate in the service provider s assessment of his or her requirements and a person who is determined under this Act to be eligible for a community service has the right to participate in the service provider s development of the person s plan of service, the service provider s review of the person s requirements and the service provider s evaluation and revision of the person s plan of service. 6. A person has the right to give or refuse consent to the provision of any community service. 7. A person receiving a community service has the right to raise concerns or recommend changes in connection with the community service provided to him or her and in connection with policies and decisions that affect his or her interests, to the service provider, government officials or any other person, without fear of interference, coercion, discrimination or reprisal. 8. A person receiving a community service has the right to be informed of the laws, rules and policies affecting the operation of the service provider and to be informed in writing of the procedures for initiating complaints about the service provider. 9. A person receiving a community service has the right to have his or her records kept confidential in accordance with the law. 2.2.2 CCAC as an Approved Agency Under the LTCA Regulation 33/02 of the Community Care Access Corporations Act, 2001, (CCACA) provides that the CCAC is deemed to be an approved agency under the LTCA. As an approved agency, the CCAC falls within the definition of service provider under the LTCA. The CCAC is therefore required to comply with all the provisions in the LTCA relating to both approved agencies and service providers. September 2006 4

CCAC Client Services Policy Manual Chapter 2 Legislation 2.2.3 LTCA Provisions Applicable to the CCAC The following provisions of the LTCA apply to the CCAC. Section 3: Requires contracted service providers to fully respect and promote the rights of persons receiving community services, as set out in the Bill of Rights. Subsection 3(3): A service provider is deemed to have entered into a contract with each person receiving a community service from that service provider, agreeing to respect and promote the rights set out in the Bill of Rights. Section 4: The Minister may fund the provision of community services and make agreements for the provision of these services. The Minister may also fund operational and capital expenditures relating to the provision of these services. Section 5: The Minister may approve agencies. (However, a CCAC is deemed to be an approved agency pursuant to the regulation under the CCACA.) Section 6: The Minister may approve premises for the provision of community services and provide financial assistance relating to the operation of the premises. Section 7: The Minister may impose terms and conditions on any financial assistance and require security for repayment of funds. Section 19: The CCAC cannot transfer, assign, lease, encumber, or otherwise convey an interest in any of the assets it acquires with financial assistance from the Province of Ontario, except in accordance with the regulations. The regulations set restrictions on the transfer of assets. Section 22: When a person applies to a CCAC for service, the CCAC must assess the person's requirements, determine the person s eligibility for the services required, and develop a plan of service for each person determined eligible. The plan of service must set out the amount of service to be provided. The CCAC must review the person s requirements when appropriate depending on the person's condition and circumstances, evaluate the person s plan of service and revise it as necessary when the person s requirements change. The CCAC must also assist the person in co-ordinating the services received, in accordance with the person s wishes. The CCAC must provide the person, their substitute decision-maker or any person designated by the person with an opportunity to participate in the development, evaluation and revision of the plan of service. In assessing and reviewing a person's requirements, the CCAC must take into consideration all assessments and information provided to the CCAC relating to the person's capacity, impairment or requirements for health care or community services. In developing, evaluating and revising a person's plan of service, the CCAC must take into account the person s preferences, including preferences based on ethnic, spiritual, linguistic, familial and cultural factors. In addition, in assessing a person's requirements, September 2006 5

CCAC Client Services Policy Manual Chapter 2 Legislation determining a person's eligibility and developing, evaluating and revising a plan of service, the CCAC must comply with the regulations. The regulations set out the eligibility criteria and service maximums for personal support services, homemaking services and school services as well as service maximums for nursing services. (The regulations under the Health Insurance Act (HIA) set out the eligibility criteria for professional services.) Section 23: The CCAC must ensure that the available services in a person s plan of service are provided within a time that is reasonable in the circumstances. If the services are not immediately available, the CCAC must place the person on a waiting list and advise the person when the service becomes available. Section 24: The CCAC must not assess a person s requirements, determine eligibility for the program and the service, or provide a community service without the consent of the person. Section 25: The CCAC must notify a person, their substitute decision-maker or anyone designated by the person in writing or in an alternative format prescribed by the regulations of the following: the person s rights under the Bill of Rights, and the obligation upon the CCAC and the contracted service providers to respect and promote those rights; the procedure for making complaints or suggestions respecting the CCAC or the contracted service provider; the right to access the person s record of personal health information, and the procedure for doing so; and the right to inspect and review the agreement (Memorandum of Understanding) between the CCAC and Ministry of Health and Long-Term Care (MOHLTC) for the provision of community service. Section 26: The CCAC must develop and implement a plan for preventing, recognizing and addressing physical, mental and financial abuse of persons receiving community services provided or arranged by the CCAC. The plan must include, among other things, the education and training of employees and volunteers of the CCAC in methods of preventing, recognizing and addressing physical, mental and financial abuse. Section 27: The CCAC must ensure that a quality management system is developed and implemented for monitoring, evaluating and improving the quality of community services provided or arranged by the CCAC. Section 28: The CCAC cannot charge or accept payment for professional or personal support services. The legislation provides a mechanism for the CCAC to charge for homemaking services in accordance with the regulations; however, the current regulations do not address this issue and therefore the CCAC is not permitted to charge for homemaking services. Section 29: Service providers under contract with the CCAC cannot require or accept payment for CCAC services from anyone other than a CCAC. The contracted service provider is September 2006 6