A BRAND NEW WORLD: ONTARIO’S NEW LONG-TERM CARE …

1 A BRAND NEW WORLD: ONTARIO'S. NEW LONG-TERM care HOMES ACT. By: Jane E. Meadus, Institutional Advocate & Staff Lawyer IN THIS INSERT October 2010. 2 undamental F. INTRODUCTION be passed by elected members Principle of government. The new The LONG-TERM care Homes 2 Licensee regulations are lengthier and Act, 2007 (LTCHA or the Act). more robust than what previously 2 R. esidents: Rights, came into force in Ontario on July existed. One of the reasons is care and Services 1, 2010. This legislation replaced because the regulations replace the Charitable Institutions Act, 8 ehaviours, B many of the standards previously Altercations and the Homes for the Aged and contained in the LONG-TERM care Other Interactions Rest Homes Act and the Nursing Homes Program Manual which Homes Act. Not only is there 8 eporting and R no longer applies. now only one piece of legislation, Complaints In addition to the Act and its but there has also been a 10 M. inimizing fundamental shift in the way that regulations, LONG-TERM care homes Restraints LONG-TERM care is regulated.

2 This have to comply with many other special edition insert will provide pieces of legislation. Examples 12 O. ffice of the long - include the: term care home a brief guide to the legislation Resident and for residents, families and Health care Consent Act;. Family Adviser friends to acquaint them with Substitute Decisions Act;. the upcoming changes. Future 12 A. dmission of Personal Health Information Residents newsletter articles will explore specific areas of the legislation and Protection Act;. 14 Absences in more detail. Fire Code; and 14 Discharge People need to be aware that Occupational Health and there are two separate parts Safety Act. 15 R. esidents' and to legislation: the statute and Family Councils All legislation can be found the regulations. The statute is online at 16 R. esident the framework that sets out the Information and general areas of the law. The Hopefully, this new system Agreements regulations are the meat that of regulation will be more flesh out the rules and they transparent and more consistent 17 Resident Charges must be read in conjunction with than in the past.

3 As well, the new 19 C. ompliance and the statute. Regulations are compliance system provides the Enforcement subsidiary pieces of legislation Ministry of Health and LONG-TERM which can be easily changed care with more tools to enforce 20 Conclusion by the Lieutenant Governor the legislation which should result in Council, while statutes are in better care for residents. harder to change as they must ACE Newsletter <1> Special Insert FUNDAMENTAL PRINCIPLE In general, the new rights are simply a clarification and expansion of the previous The fundamental principle of the legislation legislation with only a few changes. Rights is stated in section 2: which are new or amended include the rights: The fundamental principle to be Not to be neglected by the licensee applied in the interpretation of this Act or staff;. and anything required or permitted under this Act is that a LONG-TERM To have their personal health care home is primarily the home of information kept confidential and to its residents and is to be operated so have access to their personal health that it is a place where they may live information.

4 With dignity and in security, safety To receive care and assistance towards and comfort and have their physical, independence based on a restorative psychological, social, spiritual and care philosophy to maximize cultural needs adequately met. independence to the greatest extent This principle is to be considered when possible;. applying any part of the legislation or its Not to be restrained except in limited regulations. circumstances and in accordance with the Act;. LICENSEE. When very ill or dying to have friends The legislation refers throughout to the or family present 24 hours a day;. licensee . The licensee is defined as the holder of a licence issued under the Act, and To have their lifestyle and choices includes the municipality or municipalities respected;. or board of management that maintains a To meet privately with their spouse or municipal home , joint home or approved First another person;. Nations To share a room with another resident RESIDENTS: RIGHTS, care AND SERVICES according to their mutual wishes, if appropriate accommodation is Residents' Bill of Rights available; and The LTCHA contains 27 residents' rights,2 To have any friend, family member, expanded from 19 in the previous legislation.

5 Or other person of importance to the resident attend any meeting with the LTCHA, s. 2(1). licensee or the staff of the home . 1. 2. LTCHA, s. 3(1). ACE Newsletter <2> Special Insert Residents' rights can be enforced by the Plumbing; and Ministry of Health and LONG-TERM care 's Compliance with manufacturer's inspectors, either during the annual inspection process, or as a response to a report or a complaint. However, the legislation has also Specific Services enshrined the ability of residents to enforce their rights. The Act states that these rights LONG-TERM care homes are required to can be enforced as if a contract had been provide the following services: entered into between the resident and the Nursing and personal support This means that the resident can services;7. sue the home for damages if he/she believes Restorative care , including for those that his/her rights have not been respected. residents with cognitive impairments or Mission Statement who are unable to leave their rooms;8.

6 Recreational and social activities, Each home must develop a mission including for those residents with statement which sets out the principles, cognitive impairments or who are purpose and philosophy of care of the home unable to leave their rooms;9. and ensure that they are put into practice in the day-to-day operation of the home . The Dietary services and hydration;10. home must also ensure that the mission Medical services;11. statement is consistent with the fundamental Organized programs to ensure a principle of the Act and the Residents' Bill of reasonable opportunity for residents Every licensee must also ensure that to pursue their religious and spiritual the home is a safe and secure environment for practices;12. its The regulations set out specific requirements about the following aspects of Accommodation services, including safety in the home : housekeeping, laundry and maintenance;13 and Doors;. Volunteer Elevators;. In general, each program must comply with Floor space; the following requirements: Furnishings; Include a written description of the Privacy curtains; program, including goals, objectives Grab bars; and relevant policies, procedures and protocols providing methods to Bed rails; reduce risk and monitor outcomes, Windows; including protocols regarding referrals Communication and response of residents to specialized resources systems; where required.

7 Lighting; 6. O. Reg. 79/10, ss. 9-23. Generators; O. Reg. 79/10, ss. 31-47. 7. 8. O. Reg. 79/10, ss. 56-64. Cooling requirements; 9. O. Reg. 79/10, ss. 65-67. Air temperature; 10. O. Reg. 79/10, ss. 68-78. 11. O. Reg. 79/10, ss. 79-84. 12. O. Reg. 79/10, s. 85. 3. , s. 3(3). 13. O. Reg. 79/10, ss. 86-92. 4. , s. 4. 14. O. Reg. 79/10, ss. 94-95. 5. , s. 5. ACE Newsletter <3> Special Insert Where the staff use any equipment, Homes must develop and implement supplies, devices, assistive aids or interdisciplinary programs in the following areas: positioning aids with respect to the Falls prevention and management to resident, they must be appropriate for reduce the incidence of falls and risks the resident based on the resident's of injury;. condition;. Skin and wound care to promote skin Be evaluated and updated at least integrity, prevent the development annually in accordance with either of wounds and pressure ulcers, and evidence based practice or, if there are provide effective skin and wound care none, prevailing practices; and interventions.

8 Keep a written record of these Continence and bowel program to promote continence and to ensure While there are no minimum staffing ratios that residents are clean, dry and for registered nurses and personal support comfortable; and workers, homes are expected to be able to Pain and wound management to provide the care and services spelled out in identify and manage pain in the However, each home must have at least one registered nurse on duty The minimum requirements for each of at all times, except where excluded by the these programs are also set out in detail in the It is intended that each home satisfy the same minimum standards, while These programs are regulated in detail in at the same time allowing them to create a the regulations. The regulation concerning policy that meets their own unique needs. nursing and personal care , for example, includes detailed requirements regarding: Screening and Training of Staff Personal care ; and Volunteers Bathing; All staff and volunteers in a LONG-TERM care Oral care ; home must be screened, which includes the Foot and nail care ; completion of a criminal reference check (unless the person is less than 18 years of Transferring and positioning age).

9 21. techniques;. The majority of staff, including agency Personal items and personal aids;. staff, must receive orientation training before Notification about personal belongings; starting work (a maximum of one week delay is Mobility devices; allowed only in emergencies or in exceptional Dress; and unforeseen circumstances).22. Bedtime and rest routines; Some people are exempted from this requirement to receive training, although End-of-life care ;. they must be provided with the information Communication methods; in writing before providing services. Persons Availability of supplies; and who are exempt are those who: 24-hour nursing Work in the home pursuant to a contract or agreement with the 15. O. Reg. 79/10, s. 30(1). licensee;. 16. LTCHA, s. 17(1). 17. O. Reg. 79/10, s. 45. 20. O. Reg. 79/10, ss. 49-52. 18. O. Reg. 79/10, ss. 31-45. 21. LTCHA, s. 75. 19. O. Reg. 79/10, s. 48(1). 22. LTCHA, s. 76(3). ACE Newsletter <4> Special Insert Work in the home pursuant to a The minimization of restraint, where contract or agreement between the necessary, and the application of licensee and an employment agency or restraint in accordance with the other third party; legislation.

10 Will only provide occasional Palliative care ;. maintenance or repair services to the Any other areas provided for in the home ; and regulations. Presently, the following Will not provide direct care to areas are listed: Fall prevention and management;. The orientation, as well as re-training, must Skin and wound care ;. include the following topics: Continence care and bowel The Residents' Bill of Rights; management;. The mission statement of the long - Pain management, including term care home ; recognition of specific and non- The home 's policy to promote zero specific signs of pain;. tolerance of abuse and neglect of Training in the application, use residents; and potential dangers of physical The duty under section 24 to make devices for staff who apply or mandatory reports about suspected monitor residents restrained by abuse, neglect or misuse of money; physical devices; and The protections afforded by the Training in the application, use whistle-blowing provisions in section and potential dangers of personal 26; assistance service devices for staff The policy of the home to minimize the that apply or monitor residents restraint of residents; with personal assistance services Fire prevention and safety.