Long Term Care in Ontario

GOVERNMENT-SUBSIDIZED NURSING HOMES

How Nursing Homes are organized and administered

Nursing homes or long-term care homes, as they are called in Ontario, are residential facilities that provide 24-hour skilled nursing care and supervision. They offer higher levels of personal care and support than those offered by retirement homes or supportive housing and cater to individuals, usually seniors, who have serious long term health care needs that cannot be fulfilled in the home. However, they also provide short-stay (respite) services in order to provide family caregivers with a break from caregiving duties or to provide the resident with support to regain strength and confidence, usually following a stay in a hospital.

Long-term care homes are owned and operated by various organizations including private corporations, municipal councils and non-profit organizations such as faith, community, ethnic or cultural groups. The fees for all nursing homes in Ontario, regardless of ownership, are set by the Ontario Ministry of Health and Long-Term Care.

All applications to long-term care homes in Ontario are coordinated by the Home and Community Care Support Services. As of April 1st, 2021, the Local Health Integration Networks (LHINs) are now referred to as Home and Community Care Support Services, and all applications and admission to long term care homes are now arranged by one of Ontario's 14 locations. Once an assessment has been conducted to determine eligibility, the next step is to choose the homes to which to apply. The Home and Community Care Support Services will provide lists and basic information about homes in the area, and an individual may apply to a maximum of five homes.

Eligibility/Requirements for Admission

In order to qualify to move to a long-term care home, a person must:

• be 18 years of age or older,
• possess a valid Ontario Health Card,
• be agreeable to receiving services having care needs including: needing frequent assistance with activities of daily living, 24 hour care and nursing care, on site supervision or monitoring to ensure safety or well being, which can be met in a long term care home.

The LHIN will determine eligibility by conducting an assessment of health needs and the availability of alternative care options such as home care and informal caregivers.

Income/Asset Test

An income or asset test does not form part of the assessment conducted by the LHIN. Anyone who meets the above criteria is eligible to apply for a spot in a nursing home regardless of their financial situation. If an individual's income is not sufficient to pay for the basic accommodation, there is a subsidy available. However, it is only available for basic accommodation. The LHIN will assess whether an individual's income is indeed insufficient to cover the cost of the nursing home based on income tax returns. If such is the case the total monthly income of the individual less $155 will be taken towards covering the cost of a basic bed and the rest of the cost will be covered by the provincial government.

Costs

Fees for nursing homes are standardized across Ontario, regardless of ownership, and are established by the Ministry of Health and Long-Term Care (MOHLTC). The MOHLTC provides funding for homes. The amount paid by residents for their accommodation is called a "co-payment". Costs for accommodation in a long term care home depend upon the type of accommodation.

Nursing Home fees include:

• Furnishings (e.g. bed, chair), meals (including special diets), bed linens and laundry, personal hygiene supplies, medical/clinical supplies and devices (e.g. walkers, wheelchairs for occasional use), housekeeping, pastoral  services, social and recreational programs, medication administration, and assistance with the essential activities of daily living.
• Nursing and personal care on a 24-hour basis and access to a physician, and other health professionals.

Additional services such as hairdressing, cable TV and telephone services, transportation, etc. are usually available for an additional fee. All long-term care homes have dining rooms and common rooms, and may also have features such as a lounge, gift shop, beauty salon, chapel, or garden.

RETIREMENT HOMES / RESIDENCES

How Retirement Homes are Organized and Administered

A retirement home in Ontario is a multi-residence housing facility that provides accommodation and services such as meals and cleaning services for older people. Retirement homes in the province are privately owned and operated and not administered by the provincial government. Each facility usually provides a private or semi-private room or complete living suite and then also provides common living quarters, including a lounge area, a common dining room, recreation rooms, cleaning services, social and/or religious programs and some basic health care services. The unit can be paid for on a monthly fee basis, like an apartment, or can in some instances be bought the same way as a condominium.

Admission, fees and waiting lists for retirement homes are controlled by the homes themselves, not by the government. Admission usually depends on the ability to pay and absence of serious medical conditions that require professional nursing care. Residents are responsible for paying their own fees and government subsidies are not available for accommodation in a retirement residence.

Costs for Retirement Homes

Home First Program

How Home First Program Works

Home First Program is a program that was started in 2010. It is an option provided to seniors who are in the hospital with an acute illness and are considering going to long term care.

Eligibility

• frail without needing medical care
• not ill enough to be in hospital care
• possibly looking to be placed into long term care

The LHIN will work with the family and the senior to arrange necessary in-home services for a limited time until either the client recuperates, or a long term care bed becomes available. However, home care assistance is limited (no 24 hour care provided), and family support in caring for the senior is required.

Please note that the senior is required to take the first long term care bed that becomes available to them regardless of their preference. Once admitted here, they can then wait for a bed to become available in their preferred facility.

Also note that if a senior's assessment is deemed unsafe or inappropriate for safety and/or medical reasons, the Home First Program will not be made available to that senior. There must be the required support at home for them to be discharged home from the hospital.

GOVERNMENT-SUBSIDIZED HOME CARE

How Government-subsidized home care is organized and administered

On May 31, 2017, all home and community care services and staff transferred from Community Care Access Centres (CCACs) to Local Health Integration Networks. Therefore, home care subsidized by the provincial government is now administered by Local Health Integration Networks (LHINs). Once contacted, the local LHIN will assign a Care Coordinator who will conduct an assessment of the senior's needs and develop a care plan to meet these needs. Home care services allow seniors to live at home independently for as long as possible.

There are four main categories of Home and Community Support Services:

• Visiting Health Professional Services that provide health care in the home such as skilled nursing,
• Personal Care and Support that can help with a variety of daily living activities such as bathing, dressing, toileting, eating and more,
• Homemaking services that assist with routine household activities such as menu planning and meal preparation, shopping, light housekeeping and more,
• Community support programs which offer a wide variety of services such as meal delivery, transportation, caregiver relief, adult day programs, social and recreational services, security checks and more.

Eligibility/Requirements for Admission

To receive home care services from a LHIN, a person must have:

• a valid Ontario Health Card,
• needs that cannot be met on an outpatient basis, e.g. a client may need help in bathing at home,
• a medical condition that can be adequately treated in the home,
• a need for at least one professional or personal support service.

Income/Asset Test

An income or asset test does not form part of the assessment conducted by the LHIN. Anyone who meets the above criteria is eligible to apply for home care regardless of their financial situation.

Costs

LHIN services are provided at no cost to clients, and are dependent on assessment and availability.

PRIVATE HOME CARE

LHIN resources are limited and go to the neediest. As a result, many seniors get inadequate amounts of LHIN services and have to rely on private home care services to receive the appropriate amount of care.

Costs of Private Home Care

N/A = Insufficient sample size obtained to justify inclusion
* Fees listed are for RNs however, these fees may vary depending on the type of nurse, such as a Registered Nurse (RN) or a Licensed Practical Nurse (LPN), delivering the care.

How Adult Day Programs Work

Adult day programs are designed for dependent adults/seniors, physically located in the community, to provide a safe group setting during the day when family members are not available to care for them. These centres are usually open daily, Monday through Friday (some on Saturday as well). They provide a secure, caring and positive setting for those who are experiencing memory loss, communication disorders, social isolation or physical disabilities. Nutritious lunch meals are provided which usually accommodate any special diet, along with an afternoon snack. Participants need to be mobile, with the possible assistance of a cane, walker or wheelchair. Adult day programs can be public or private, non-profit or for-profit.

Most adult day programs in Ontario are managed and operated by and accessed through the Local Health Integration Networks (LHINs). Seniors pay daily fees to cover part of meals & activities.

The purpose of an adult day program is:

• to provide dependent adults/seniors time to enjoy a setting outside of their house where they can obtain both mental and social encouragement and stimulation and any required health care
• to provide family caregivers with a much-needed break in order to focus on themselves, take time and relax or go to work

Candidates for adult day programs may be:

• challenged either physically and/or cognitively, but do not require 24-hour supervision or,
• in the early stages of dementia or,
• in need of social contact and stimulation.

Costs

The fees are set by individual programs and vary with the number of hours, inclusion of meals, and the use of transportation.

Scenario 1: Low level of care (early in the crisis management stage of care)

Mrs. Williams is an 85 year old widow living in her own home. She has osteoarthritis and leg edema. She must wear support stockings to relieve her edema and because her fingers and back are arthritic, she needs help getting dressed. To get around her home, she uses a walking support device or rollator. Both of Mrs. Williams' daughters help her out regularly on weekends and evenings while her son-in-law helps maintain the house and takes care of the lawn.

After fracturing her femur in a significant fall 9 months ago, Mrs. Williams' mobility has been severely decreased and she lost 9 kg or almost 20 lbs as a result. She tells her daughters that she forgets to eat and the food in her refrigerator is spoiled. During their visits, her daughters notice she eats very little and sometimes chokes on her food.

To help her eat safely and address her other needs, Mrs. Williams and her daughters agree it's time for some formal care. She needs her meals delivered to her home, someone to supervise her meals and assistance with dressing and bathing. She would also benefit from a home safety assessment.

Care plan to assist family caregivers part-time

• Meal preparation - 2 hours a day on weekdays
• Meal supervision - 1 hour a day on weekdays (to include a record of food intake and assistance if patient chokes)
• Personal Care (bathing, dressing) - 1 hour a day on weekdays
• Occupational therapist: to provide initial home safety assessment and recommendations

In addition, there will be expenses for two visits of an occupational therapist including a 1 hr. initial assessment and 45 min. follow up after equipment has been installed. The two visits will cost $210.00 altogether.

Scenario 2: Intermediate Level of Care (late in the crisis management stage of care)

Mr. Leung is a 72 year old widower. He lives with his daughter and her husband in a small community outside the city. Mr. Leung has cataracts in both eyes. He also has dementia which has progressed to the point where he requires continual supervision. He forgets to take his medication, does not eat properly and cannot safely prepare meals. He needs cues for dressing and bathing.

Mr. Leung's daughter and her husband assist him mornings, evenings and weekends but aren't available on weekdays. For weekdays, they enrolled him in an adult day program 2 days per week and hired someone to accompany him to and from the program. For the remaining 3 days of the week they've hired someone to supervise him and keep him company. They've also arranged help for laundry and house cleaning.

Care Plan to assist family caregiver full days, during the week

• Companionship/Supervision: 3 times a week, 8 hrs a day
• Adult Day Program: 2 days a week
• Safety Supervision: to and from the Adult Day Program - 2 times a week, 30 minutes each way
• Laundry/House cleaning: 3 hrs a week

Scenario 3: High level of care (in the dependence stage of care)

Mr. and Mrs. Jensen live in a two-bedroom condominium. Mr. Jensen is 93 years old, alert and aware but physically frail. Mrs. Jensen is 88 years old, diabetic and recently had a stroke. Her balance is poor and she's at high risk for falling. She can only walk short distances and needs help to get around. She also has heel ulcers that make walking even more difficult. For longer distances, she uses a wheelchair.

Her family doctor recommends Mrs. Jensen move to a nursing home. But because Mr. and Mrs. Jensen's daughter promised she wouldn't send her parents to a nursing home, she needs to make alternate arrangements. Options include a caregiver to assist Mrs. Jensen with bathing, dressing, toileting, walking, meal preparation, household chores and transportation to and from appointments. A nurse could monitor and chart her medicine use and blood sugar levels, clean her heel ulcers and change her bandages. Mr. and Mrs. Jensen would also benefit from a home safety assessment by an occupational therapist who may recommend safety bars, raised toilet seats, better lighting, removing clutter and securing loose rugs.

Care plan to assist family caregivers full-time, every day

• In-home meal preparation - 7 days a week, 2 hours daily
• Private caregiver - 7 days a week, 8 hours daily to assist with bathing, dressing, toileting and walking and relieve spouse of caregiver duties
• Private Registered Nurse - 4 times a week for 30 minutes to monitor and chart medicine use and blood sugar levels and monitor and change dressing on heel ulcers
• Laundry - 2 hours every other week
• House cleaning - once a week for 90 minutes
• Occupational therapist: to provide initial home safety assessment, recommendations and a 45 minute follow-up after equipment installation

In addition, there will be expenses for two visits of an occupational therapist including a 1 hr initial assessment and 45 min follow up after equipment has been installed. The two visits will cost $210.00 altogether.