Summary of Recommendations
1. Regulations under the Retirement Homes Act, 2010 be implemented without further delay once they have been strengthened as recommended in the RNAO submission.
2. Changes be made to the Retirement Homes Act, 2010 at the earliest opportunity to impose a limit or cap on the health-care services that can be provided to residents of retirement homes. Residents with moderate to complex health-care needs and those with significant mental health needs should not receive care from a retirement home.
3. Regarding the definition of Abuse and Neglect:
a. The Regulatory Authority establish a third-party complaints investigator role to respond to residents’ complaints of abuse while safeguarding residents in their residency, and educating staff / family about the various types and related impacts of elder abuse.
b. The definition of “neglect” in the draft regulation be expanded to include systemic neglect and the failure to make best efforts to meet and fund best practices for standards of care and staffing.
c. The Regulatory Authority adopt a provincial standard for a zero tolerance policy for abuse and neglect, using RNAO’s Preventing and Managing Violence in the Workplace Best Practice Guideline as a model of a comprehensive and strategic approach.
d. The Regulatory Authority require adequate funding for staffing, mandatory education and leadership development to prevent, identify and respond to abuse and neglect.
e. The regulatory college of any regulated staff be immediately notified of any alleged, suspected or witnessed incident of abuse or neglect in addition to the police notification requirement in s.15(3)(f) of the draft regulation.
f. The regulatory authority require all licensees to require all staff to obtain a police check before starting work, and to dismiss any potential employee or student on placement who presents a police check that discloses criminal activity. Furthermore, all current staff would undergo annual police checks and if criminal activity is disclosed, their employment would be terminated immediately.
g. The minimum number of residents proposed to receive care at a retirement home be reduced to no more than 4 residents, thus reducing the potential for less visible neglect and abuse in unregistered boarding-houses.
4. That the Regulatory Authority enforce tight temperature controls with either a range of acceptable temperatures or a minimum and maximum temperature requirement for the home.
5. That all staff involved with food preparation should successfully complete a food handling training program offered by their local health unit.
6. That the regulations require licensees to initiate falls prevention committees to gather statistics tracking the circumstances of preventable falls and follow best practice guidelines on suitable corrective actions.
7. That the regulations require licensees to report all adverse and sentinel events caused by medication errors to the Regulatory Authority on a quarterly basis.
8. That the medication “route” also be documented in the medication administration records (see s. 33 (a)).
9. That the Ontario Seniors’ Secretariat include requirement for licensees to offer timely and routine access to dental care, including emergency dentistry.
10. That the Ontario Seniors’ Secretariat include a regulation that all diabetic nail care be provided by employees with advanced training in nail care, similar to long-term care home requirements.
11. That retirement homes be limited by the regulations to providing care services other than dementia.
12. That the retirement home regulations require an assessment of dehydration, the presence of pressure ulcers, uncontrolled pain, behavioural issues and the need for assistance with activities of daily living during the initial assessment of the resident.
13. That the regulation establish a minimum staff mix in retirement homes of one registered nurse full-time equivalent (FTE) per 100 residents, and one FTE registered practical nurse per 50 residents for homes that provide one care service or more.
14. That the government 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 caregiver and positive outcomes for retirement home residents.
15. That the government address the inequity in wages between the acute care and community and retirement home sectors to facilitate recruitment and retention and ensure continuity of care-giver and the best quality patient care.
16. That the Ministry of Health and Long-Term Care commission research to determine appropriate staffing levels and staff mix in retirement homes to allow retirement homes to better plan staffing needs in the short and medium term.
17. That the retirement home regulations require a daily minimum of 0.5 hours of activation and recreational programs that promote socialization, engagement in social activities, mental and physical stimulation for residents of retirement homes.
18. That LHINs be engaged in creating incentives for retirement homes that implement cultures that support evidence-based best practices that avert costly hospitalizations.
19. That mandatory reporting in writing be required where a restraint is used and any measures implemented to minimize the use of restraints. This should include educational programs to understand aggression in the elderly and prevent its escalation.
20. RNAO recommends that the Regulatory Authority require and enforce adequate funding from the licensee to ensure adequate numbers of nurses and other care providers. Staffing levels should permit Directors of Care for large facilities to focus on leadership and operations, in addition to allowing the use of full-time rather than replacement nurses / health care providers in monitoring residents in restraints.
21. That implementation of the Retirement Homes Act, 2010 require appropriately educated registered nurses dedicated to infection prevention and control to ensure all retirement homes have the capacity to implement the infection prevention and control program consistent with best practices and professional standards.
22. That pandemic planning be added to the emergency plan for retirement homes with more than ten residents as per s.26 (3)1.
Hon. Sophia Aggelonitis
Minister Responsible for Seniors
Ontario Seniors’ Secretariat
777 Bay Street, 6th floor
Toronto, ON M7A 2J4
April 8, 2011
Thank you for the opportunity to respond to the Initial Draft Regulations under the Retirement Homes Act, 2010 (RHA) When the Retirement Homes Act, 2010 was first introduced the Registered Nurses’ Association of Ontario (RNAO) applauded the Ontario Seniors’ Secretariat (OSS) for taking measures to protect the most vulnerable residents in Ontario retirement homes. The Retirement Homes Act, 2010 was a welcome piece of legislation given the increasing complexity of care provided along with a persistent lack of regulatory oversight. Significant concerns were voiced by the RNAO and others, however, that the legislation introduced failed to prevent the introduction of a two-tiered system of health care services for the elderly. Moreover, RNAO was concerned that the Act did little to protect the most vulnerable in order to accommodate the needs of more healthy and vocal residents.
While RNAO, along with many seniors’ advocacy groups, strongly supports a cap to health care services provided in retirement homes, a cap was regrettably absent when Bill 21 was passed. Many of the proposed initial draft regulations reflect those currently enforced in long-term care homes (LTCHs). While this lends strength to the regulations and protects the most vulnerable, retirement home regulations without a cap must somehow address the diverse health care needs of both healthy residents and the most frail; those who have a strong voice and those who have no voice; those with strong family advocates and those who have no family to speak of. The regulations are inevitably broad. First and foremost, Ontario must “protect seniors living in retirement homes”. Seniors should be afforded the same protection wherever they live. This means similar regulations should be enforced regardless if care is provided in a long-term care home or a Retirement Home.
Matching broad regulations with specific needs in an initial draft is a lofty goal. Adequate consultation with significant stakeholders requires dialogue that results in greater understanding over time. RNAO looks forward to continuing to work closely with you to develop initial regulations and, in time, revisions that will improve the care and quality of life for the thousands of Ontarians who call retirement homes their home.
With warm regards,
Doris Grinspun, RN, MSN, PhD, O.ONT David McNeil, RN, BScN, MHA, CHE
Executive Director, RNAO President, RNAO
The Registered Nurses’ Association of Ontario (RNAO) is the professional organization representing registered nurses in Ontario. It is the strong, credible voice leading the nursing profession to influence and promote healthy public policy. We welcome the opportunity to respond to the Initial Draft Regulations under the Retirement Homes Act, 2010.
On June 8th, 2010 the Retirement Homes Act, 2010 received Royal Assent. Less than one year later, the first of two draft regulations has been released for consultation by the Ontario Seniors’ Secretariat. Only when the regulations are approved by Cabinet and in place will the Act finally take effect. Most of the Act is covered in the draft regulation subject to this consultation. “Future phase(s) of the proposed regulations will include regulations for the emergency fund, administrative monetary penalties, insurance requirements for retirement homes, confinement and transitional matters to ensure that requirements are attainable… The Ontario Seniors’ Secretariat anticipates posting future phase(s) of proposed regulations for public consultation later in 2011.”
Nurses applaud the Ontario Seniors’ Secretariat (OSS) for taking measures to protect the most vulnerable residents in Ontario retirement homes. The Retirement Homes Act, 2010 was a welcome piece of legislation given the increasing complexity of care provided along with a persistent lack of regulatory oversight. It is for this reason that the RNAO strongly urges the government not to further delay implementation of the regulation even as the regulation is strengthened along the lines recommended in this submission.
Significant concerns were voiced by the RNAO and other seniors’ advocacy groups, however, that the legislation introduced failed to prevent the introduction of a two-tiered system of health care services for the elderly. RNAO continues to be profoundly concerned that regulation of retirement homes must not result in a slippery slope to privately-owned, for-profit retirement homes offering the same level of health-care services as long-term care homes for those who can afford to pay privately for that care. While not within the purview of this regulation, the RNAO takes this opportunity to urge the government in the strongest terms to reopen the Retirement Homes Act, 2010 as soon as feasible to impose a limit or cap on the health-care services that can be provided to retirement home residents. Residents with moderate to complex health-care needs and those with significant mental health needs should not receive care from a retirement home.
Many of the proposed initial draft regulations under the Retirement Homes Act, 2010 reflect those currently enforced in long-term care homes. While this lends strength to the retirement home regulations and protects the most vulnerable, retirement home regulations without a cap must somehow address the diverse health care needs of both healthy residents and the most frail; those who have a strong voice and those who have no voice; those with strong family advocates and those who have no family to speak of. The inevitably broad regulations require compromise; however RNAO encourages the Ontario Seniors’ Secretariat to first and foremost “protect seniors living in retirement homes”. Seniors should be afforded the same protection wherever they live. This means similar regulations should be enforced regardless if care is provided in a LTCH or a Retirement Home.