Part 2 of the Draft Regulation under the Long-Term Care Homes Act, 2007 (MOHLTC)
RNAO Response to the Minister of Health and Long-Term Care on: Part 2 of the Draft Regulation under the Long-Term Care Homes Act, 2007
October 15, 2009
Summary of Recommendations
1. RNAO strongly urges the Ministry of Health and Long-Term Care to legislate and fund a minimum of 3.5 hours of nursing and personal care for residents of long-term care homes, attached to average acuity. Greater acuity would require more hours of care.
2. RNAO urges the Ministry of Health and Long-Term Care to establish by regulation a staff mix in long-term care homes of one nurse practitioner per long-term care home or 200 to 300 residents, 20 per cent registered nurses, 25 per cent registered practical nurses and 55 per cent personal support workers, supported by adequate funding.
3. Add “continuity of care-giver” in addition to continuity of care in s.18 of the draft regulation.
4. RNAO urges the government to stay on track with its commitment to achieving 70 per cent full-time employment for nurses and personal support workers as crucial in ensuring continuity of care-giver and positive outcomes for long-term care home residents.
5. RNAO urges the government to address the inequity in wages between the acute care and community and long-term care sectors to ensure continuity of care-giver and the best quality patient care.
6. Amend s.32 of the draft regulation to clarify that “emergencies or exceptional circumstances” does not include budget pressures, whether of a foreseeable nature or not.
7. RNAO strongly urges the Ministry of Health and Long-Term Care to amend s.43 of the draft regulation to require a daily minimum of 0.5 hours of activation and recreational programs that promote socialization, engagement in social activities, and mental and physical stimulation for residents of long-term care homes.
8. RNAO strongly recommends to the government that if the Alternate Level of Care (ALC) strategy is to succeed, adequate funding must be available to support Aging-at-Home and the availability of age-appropriate care from home and community care, long-term care and hospital care.
9. The regulation should recognize the need of applicants for short-stay and long-stay beds to age in place and be placed in a long-term care facility as close to their home, family and community as possible, if requested. Limits on waiting lists should not apply where the facility is in the applicant’s home community.
10. Define “staff who provide direct care” for the purpose of required training and target training to the needs of the particular direct care provider using adult education principles. Training should be ongoing, not limited to once a year, and be based on best evidence and practice such as RNAO’s Best Practice Guidelines.
11. Set a maximum allowable temperature for long-term care homes in addition to the current minimum temperature.
12. Amend s.184(1)(c) to require the resident to have made “reasonable efforts” to exhaust support payments due and owing to the resident under a court order for support.
13. In the interest of resident safety the RNAO recommends that the term “retirement home” in section 192(d) of the draft regulations be deleted or clearly defined.
14. Provide a right of first refusal for not-for-profit homes in any transfer of a long-term care home licence
15. Ensure that any competitive process should not disadvantage the establishment of non-profit homes or reduce the number or share of not-for-profit beds in Ontario.
16. RNAO urges that both terms Registered Nurse (Extended Class) and Nurse Practitioner be used together in the draft regulation to ensure consistency and avoid confusion.
17. Amend s.161(1)(b) to include a registered nurse in the extended class (RN(EC)).
Hon. Deb Matthews
Minister of Health and Long-Term Care
10th Floor, Hepburn Block
80 Grosvenor Street
Toronto, Ontario, Canada
October 15, 2009
Thank you for the opportunity to respond to Part 2 of the Initial Draft Regulation under the Long-Term Care Homes Act, 2007 (LTCHA)
When the Long-Term Care Homes Act, 2007 was introduced on October 3, 2006, the RNAO applauded measures to protect the rights of long-term care residents. While ambitious, the Act sought to give effect to the important principle, articulated in section 1, that long-term care accommodations are the residents’ homes and must be operated so that residents may live with dignity and in security, safety and comfort, and have their physical, psychological, social, spiritual and cultural needs adequately met.
Significant concerns were voiced at the time by the RNAO and others that the legislation failed to commit to a minimum number of hours of nursing and personal care for residents, an omission that in our view compromises resident safety. Moreover, RNAO was concerned that the Act did not contain a stronger commitment to not-for-profit delivery, particularly for new long-term care beds.
RNAO’s concerns were not alleviated by release of Part 1 of the initial draft regulation, nor are they addressed by Part 2.
Most notably, the initial draft regulation represents an intersection of the key government priorities in health care, including the wait times strategy, the Alternate Level of Care (ALC) strategy and the Aging-at-Home strategy. This potential strength can also be a major weakness, particularly during times of government budget-cutting.
The RNAO strongly urges you not to allow the various strategies to operate as silos. Funding decisions need to recognize the primacy of individuals receiving care and services in the most appropriate setting for them and promote aging in place with quality of life. Adequate funding for the government’s Aging-at-Home strategy to ensure the availability of high-quality age-appropriate care must be in place if the ALC strategy – including implementation of the long and interim short-stay programs in the draft regulation – is to succeed.
As RNAO recommended in our response to Part 1 of the proposed initial draft regulation, we urge the government not to rush to finalize the regulations. Rather, we suggest that the government wait for release of the Ontario Ombudsman’s current investigation into Ontario’s long-term care homes and his recommendations. It is vital that we take the time required to get the regulations right.
RNAO looks forward to working closely with you to develop regulations that will improve the care and quality of life of the over 75,000 Ontarians who call long-term care facilities home.
Doris Grinspun, RN, MSN, Wendy Fucile, RN, BScN,
PhD(c),O.ONT. MPA, CHE
Executive Director, RNAO President, RNAO
On June 5, 2009, the RNAO responded in writing to Part 1 of the Initial Draft Regulation under the Long-Term Care Homes Act, 2007. Part 1 included provisions related to care plans, abuse and neglect, restraints and admissions. RNAO’s detailed response to Part 1 can be found at:
Response to Long-Term Care Homes Act
Part 2 of the Initial Draft Regulation covers residents’ rights, care and services; admission of residents; councils; operation of homes; funding; licensing; municipal homes and First Nations homes; compliance and enforcement; and, administration. This corresponds with the content of Parts IV to X of the Act and significant sections of Parts II and III. Once all the regulations have been consulted on and approved by Cabinet, the Long-Term Care Homes Act, 2007 itself will be proclaimed in force.
In the context of a growing and aging population with residents of long-term care homes having more complex care needs, RNAO has consistently argued that long-term care reform must occur within an overall seniors’ strategy focused on aging in place. Long-term care home regulations must represent an integral part of health care transformation focusing on health promotion and quality of life. RNAO endorses the five principles of the National Framework on Aging to guide all policy development in this area: dignity, independence, participation, fairness and security.
For this reason, nurses applauded the introduction of the Long-Term Care Homes Act, 2007 with its articulation of the fundamental principle that long-term care accommodations are the residents’ homes and must be operated so that residents may live with dignity and in security, safety and comfort, and have their physical, psychological, social, spiritual and cultural needs adequately met.
However, RNAO has stated consistently and firmly that patient care would be compromised if the Act and regulations do not prescribe a minimum number of hours of nursing and personal care for residents. It is for this reason that the RNAO is profoundly disappointed that both Parts 1 and 2 of the draft regulation completely omit any mention of minimum number of hours of nursing and personal care in long-term care homes.
If the government is to meet its commitment “to the health and well-being of Ontarians living in long-term care homes now and in the future”, set out in the Bill’s preamble, the regulation must clearly specify the minimum number of hours of nursing and personal care to which every resident is entitled.