Policy and Political Action

Policy & Political Action

The Retirement Homes Act Review

Dear Juanita,
The Registered Nurses' Association of Ontario (RNAO) is the professional association representing registered nurses (RNs), nurse practitioners (NPs), and nursing students across all sectors and settings in Ontario. RNAO’s mission is to foster knowledge-based nursing practice, promote quality work environments, deliver excellence in professional development, and advance healthy public policy to improve health. We thank the Ontario Seniors’ Secretariat for the opportunity to provide feedback in this review of the Retirement Homes Act, 2010 (the ‘Act’). Please note RNAO previously provided feedback on the initial draft regulations under the Act in 2011.

Within Ontario, most retirement homes are for-profit entities. A strong regulatory mechanism that ensures safe and high quality care must be the utmost top priority - and never compromised by economic gains. RNAO continues to call for increased publicly funded, not-for-profit services and supports for seniors. We encourage Ontario Seniors’ Secretariat and Minister Sergio to advance policy that will help meet this objective.

RNAO is also gravely concerned about the Act’s failure to prevent the introduction of a two-tiered health system. Without a cap on services provided in retirement homes, private for-profit entities can provide the same level of care services as long term care homes for residents that can pay for private care. Since the Act is up for review, this is the opportunity to amend the legislation to ensure seniors with moderate to complex care needs and/or those with mental health needs are not cared for in a retirement home - we call on Premier Kathleen Wynne to make this a priority. Not doing so is directly compromising older persons.

Below are RNAO’s responses to the posed questions:

1) Given the experience and data available to date, what amendments to the Act and its regulations, if any, should be considered by the government at this time to fine-tune the Act (e.g. clarify language or intent, or address technical matters), while maintaining the fundamental principles and policy framework underlying the legislation?

  1. A review should be conducted on the provision that retirement homes are obligated to comply with the Retirement Homes Act only if they have six or more non-relatives living in their facility who are provided two or more care services. Retirement Homes can easily circumvent the definition by adding related persons as tenants to keep the number of non-related persons under six. Furthermore, smaller retirement homes, especially those marketing a “boutique” or “homely” atmosphere can bypass the regulations outlined in this Act by housing fewer than six non-related persons. This is of particular concern in rural and remote areas where access to health services is already extremely challenging. In RNAO’s previous submission to the Secretariat in 2011, we proposed amending the definition of a retirement home to four individuals receiving care to reduce the possibility of neglect and abuse in unregistered boarding homes.
  2. In Part 1(2) of the Act, abuse is defined as:
    “physical abuse, sexual abuse, emotional abuse, verbal abuse or financial abuse, as may be defined in the regulations in each case; (“mauvais traitement”).”
    RNAO suggests the Act be amended to also include neglect as a form of abuse. RNAO’s Preventing and Addressing Abuse and Neglect of Older Adults best practice guideline includes neglect (e.g. failing to provide for basic health or medical needs, abandonment) as a form of abuse. Systemic neglect should also be included in this definition to address the “failure to make best efforts to meet and fund best practices
  3. Under the section on “Care and Safety”, 9 (3):

    “a person with the requisite expertise in assessing the suitability of care services for the resident”

    As the section currently reads above, a person with the requisite expertise should approve a resident’s plan of care. The Act does not stipulate that the individual conducting resident assessments must be a member of a regulated health profession. Given that the majority of older adults entering retirement homes have health-care needs, a regulated health professional, specifically an RN, should review and approve their plan of care in collaboration with the resident. RNs should also be required to determine appropriate time periods for residents to be reassessed and have their plan of care adjusted to reflect their current care needs. Furthermore, licensees should ensure that residents of retirement homes have 24/7 access to regulated health-care providers on site. More specifically, RNAO continues to recommend “a minimum staff mix in retirement homes of one RN working full-time equivalent (FTE) per 100 residents, and one FTE registered practical nurse (RPN) per 50 residents for homes that provide one care service or more.” Retirement homes should also be held accountable for ensuring continuity of care and care provider. This entails achieving 70 per cent full-time employment for care providers in retirement homes and ensuring that their compensation is comparable to other sectors to facilitate staff retention and recruitment. Furthermore, the government has a vital role in ensuring these best practices are being adhered to and conduct research to determine appropriate staffing levels and skill mix in retirement homes.

    Regardless of the type of residents served, retirement homes should also be held to a high standard of care including a minimum of 0.5 hours of stimulating recreational activity, staff certified in food handling, and clear parameters for maintaining the retirement homes’ physical environment.

2) Given the experience and data available to date, what amendments to the Act and its regulations, if any, should be considered by the government at this time to improve the effectiveness of the Act (e.g. enhance compliance and administration of the Act)?

a) In the Corporation section, the Act establishes the Retirement Homes Regulatory Authority and specifies the following objectives:

  1. to administer this Act and the regulations, including overseeing their enforcement, for the purpose of ensuring that retirement homes are operated in accordance with this Act and the regulations;
  2. to educate licensees, consumers and the public about matters relating to this Act and the regulations, including the requirements applicable to licensees, the prescribed care and safety standards for retirement homes, the rights of residents and best practices for the operation of retirement homes;
  3. to provide information about retirement homes;
  4. to advise the Minister on policy matters relating to retirement homes; and
  5. to carry out any other duties or powers assigned to it under any Act or by the Minister.

In the first year the Retirement Homes Regulatory Authority was established, it had to inspect approximately 150 homes due to complaints with 50 having multiple complaints and unresolved problems. As recent as 2014, issues with the regulation of retirement homes have been in the media. In November 2014, the Toronto Star printed a story on In Touch retirement home which was ordered closed due to numerous concerns including elder abuse and neglect. While it is written in the legislation that the Retirement Homes Regulatory Authority can revoke licenses and order homes closed, there are gaps in the Legislation. For example, the License Appeal Tribunal found in 8241 v. Registrar of the Retirement Homes Regulatory Authority:

“Finally, the Tribunal notes that there appears to be a gap in the Act that has the potential to leave the residents ... unprotected. Under section 49 of the Act, there is a procedure to be followed by a licensee which is voluntarily ceasing operation. The procedure mandates a transition plan approved by the Registrar, notification to each resident of the proposed closing, and reasonable help for those residents who request alternate accommodation. However, when a licensee involuntarily ceases operation as, for example, when a licence is refused of revoked, the Act is silent on how the residents are to be cared for. A licensee may no longer offer regulated care services after a licence has been revoked or refused. However, there is no provision in the Act to deal with the care of residents during a transition period or pending their removal to alternate care.”

RNAO urges that the legislation be substantively strengthened to ensure the safe and effective care of residents in the unfortunate event that a licensee involuntarily ceases operation. Furthermore, the regulations only require retirement homes to take “reasonable steps” to find alternative accommodation. Clear processes should be in place to ensure residents are safely housed and cared for. Licensees should be transparent with residents if their license is revoked or if conditions are placed on their license, they are fined or being investigated. Also, when an application to open a retirement home is received, a thorough investigation of the applicant must be conducted to ensure they do not have a history of terminated licenses.
Provisions should also be made to specify criteria for residents that need to be transferred from retirement homes to other health-care settings as their care needs increase. Initially clients may be good candidates for residence in a retirement home, but as they age and/or as illnesses progress, if the retirement home is unable to provide a safe level of care, there should be a clear pathway to transition those clients to other health-care facilities that can better meet their needs.
b) The Act should also be reviewed for its positions on the use of restraints in retirement homes. Similar to the Long-Term Care Act , policies to minimize the use of restraints should be embedded within the legislation. Under the rights section of the regulation, it is stipulated that residents have the right not to be restrained except in accordance with the common law.v However, the Act permits the use of chemical restraints through the following provision:

“A licensee of a retirement home who is having a resident of the home restrained by the administration of a drug pursuant to the common law duty described in subsection (1) shall ensure that the drug is used in accordance with any applicable regulations and that its administration was ordered by a legally qualified medical practitioner or another person belonging to a prescribed class”.

RNAO questions whether residents that require restraint in a retirement home are in the appropriate setting to begin with? If any form of restraint, chemical or physical, is being used on a resident of a retirement home, a review should be conducted to determine if they need to be transferred to a facility with a higher level of care. Currently, there is a gap in that the Act does not consider confinement to a secure unit a form of restraint. RNAO’s Best Practice Guideline, Promoting Safety: Alternative Approaches to the Use of Restraints provides evidence-based recommendations on the use of restraints. According to this guideline, the definition of confinement in the Act is comparable to the definition of seclusion, which is a form of restraint. Mandatory education should be provided to all staff so they know how to respond if an elderly resident exhibits aggressive behaviours and clear documentation on the use of restraints should be mandatory.

3) What process do you think should be in place to ensure the legislation stays relevant, given an evolving sector and new trends that may arise (e.g. timing of future reviews)?

  1. To keep pace with an evolving seniors care sector, the Minister Responsible for Seniors should collaborate with other ministers that provide comprehensive services to seniors living in retirement homes. Due to the large number of health-care services provided in retirement homes, the Minister of Health and Long Term Care should also have authority in enforcing this Act. The Retirement Homes Act extends the authority of the “Minister” to the Minister Responsible for Seniors or any other member of the Executive Council to whom responsibility of administration of the act is assigned or transferred. Therefore, the Minister of Health and Long-Term Care could be easily involved when appropriate.
  2. To ensure that the legislation stays relevant, RNAO also calls for the development of ongoing stakeholder forums that involve the Retirement Homes Regulatory Authority, professional associations, sectoral associations, seniors’ advocacy groups, retirement home administration, retirement home residents and others to provide the government with meaningful advice. These forums could be held annually to ensure representation from all areas of the province.
  3. Lastly, we would encourage opportunities, where it is appropriate, to enable the regulation-making authority to permit ongoing enhancements to be made to the Retirement Homes Act by Cabinet as needed (i.e. in response to emerging trends or if new information surfaces). This would be informed by the regular public consultation process that accompanies any proposed regulatory changes.

Thank you for inviting our response and we look forward to seeing the uptake of RNAO's recommendations in the revised Retirement Homes Act.

See the full letter with references below.

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Submission to the Retirement Homes Act Review 689.35 KB
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Letter