Fall 2013 Regulatory Amendments

under the Long-Term Care Homes

Act, 2007

Overview and Explanation of Key Components

Presentation for Long-Term Care Homes – September 2013

Ministry of Health and Long-Term Care

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Introduction

• The purpose of this presentation is to provide an overview of the recent regulatory

amendments under the Long-Term Care Homes Act, 2007 (LTCHA). Some of

these amendments came into effect on September 15, 2013 and others will come

into effect on November 1, 2013.

• The presentation includes an overview of all of the regulatory amendments and will

focus on the implications for long-term care (LTC) homes.

• The amendments are now incorporated into Regulation 79/10 on the e-laws website

at www.e-laws.gov.on.ca.

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Table of Contents of the Regulatory Amendments

Amendments that came into effect on September 15, 2013

A.Qualifications for LTC Home Staff slides 4 - 9

B.Critical Incident Reporting slides 10 - 15

C.Locking of Doors to Non-residential Areas slide 16

Amendments that will come into effect on November 1, 2013

D.Convalescent Care Program slides 17 - 19

E.Specialized Unit Admissions and Discharge slides 20 - 22

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A. Qualifications for LTC Home Staff

The amendments to the LTC home staff qualifications relate to the following topics:

1. Expansion of existing ‘grandparenting’ provisions for staff who were employed in

a LTC home on July 1, 2010 (the date when the LTCHA and Regulation came into

force);

2. Changes to the qualifications for cooks and food service workers;

3. A change to the qualifications for registered dietitians; and

4. A clarification of the existing requirements pertaining to nutrition managers.

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A1. Expansion of ‘Grandparenting’ Provisions

• The original grandparenting provisions included in Regulation 79/10 permitted (with

certain exceptions) LTC home staff members who were working in LTC homes prior to July 1, 2010 to continue working in their LTC home in the same position without having to upgrade their qualifications to the new requirements. • With the exception of the administrator, they did not allow grandparented staff to work in a

different home without upgrading their qualifications.

• Generally, under the amended Regulation, as of September 15, 2013, identified positions will be able to be hired into the same position at a different LTC home without meeting the updated qualifications set out in the Regulation, on the condition that they: • were working or employed in the same capacity in a LTC home immediately before July 1,

2010 (i.e. when the LTCHA and Regulation came into force), and have at least three years full-time experience in the position during the five years immediately

before being hired at the different LTC home, or have the equivalent of at least three years full-time experience working part-time in the position

during the seven years immediately before being hired at the different LTC home. • in addition, administrators must have continued to work or be employed in that position

since July 1, 2010. • Identified positions are the following: administrators, directors of nursing and

personal care, leads for the recreational and social activities program, recreational and social activities staff, nutrition managers, cooks, food service workers, and leads for housekeeping, laundry and maintenance.

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A1. Expansion of ‘Grandparenting’ Provisions:

Selected Implications • The mobility of LTC home staff who were already employed in a LTC home at the

time that the LTCHA came into effect is now improved.

• The following slides set out a number of scenarios that clarify how the

‘grandparenting’ provisions will apply.

• The licensee has the onus to ensure that employees meet the requirements relating to

staff qualifications set out the Regulation. Licensees will need to consider what

processes should be put in place to verify the qualifications of individuals being hired

for these positions.

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A1. Expansion of ‘Grandparenting’ Provisions:

Scenarios

Scenario Implication

Full Time Staff (see specific implications with respect to administrators):

i. 1

.

Individual started working in a LTC home on January 1,

2009 and worked until December 31, 2011 in the same

position (3 years). Applying for the same position in a

different LTC home in January 2016.

Does NOT meet the grandfathering requirements

as the person would not have 3 years of full time

experience within the last five years when

applying in 2016. In addition, with respect to

administrators, does not meet requirement for

continuous service.

ii. 2

.

Individual started working in a LTC home on July 1, 2007

and worked until June 30, 2012 in the same position (5

years). Took a leave of absence from July 1, 2012 until

June 30, 2013 (1 year) and returned to work at the home in

the same position. Applying for the same position in a

different LTC home in October 2013.

Would meet the grandfathering requirements for

staff, except for administrators (as does not meet

requirement for continuous service).

iii. 3

.

Individual started working in a LTC home on January 1,

2009 and worked until December 31, 2018 in the same

position (9 years). Applying for the same position in a

different LTC home in January 2020.

Would meet the grandfathering requirements for

staff, except for administrators (as does not meet

requirement for continuous service).

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A2. Changes to Qualifications for Cooks & Food

Service Workers • The qualifications for cooks have been amended to include Institutional Cooks.

• The qualifications for food service workers have been amended to allow apprentice

Cooks, Institutional Cooks, and Assistant Cooks as well as persons who have entered

into registered training agreements in the trade of Cook, Institutional Cook or

Assistant Cook to be hired as food service workers.

• These changes harmonize the qualification requirements for cooks and food service

workers under the LTCHA with existing training and development programs, thereby

enhancing employment opportunities for prospective workers and improving

recruitment opportunities for LTC homes.

• LTC homes will have to cease to employ persons who have entered into registered

training agreements in these trades if the agreement is cancelled, suspended or

revoked or the person fails to complete the program within the specified time period

of being hired.

• The specified time periods are:

• within three years of being hired, in the case of an apprenticeship program in the

trade of Assistant Cook, and

• within five years of being hired, in the case of an apprenticeship program in the

trade of Cook or Institutional Cook.

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A3. Changes to Qualifications for Registered Dietitians

• The qualifications for registered dietitian have been amended to include a temporary

certificate of registration under the Dietetics Act, 1991.

A4. Clarification of Requirements Pertaining to

Nutrition Managers • The Regulation has been amended to clarify that only registered dietitians or active

members of the Canadian Society of Nutrition Management (CSNM) can be hired as

a nutrition manager.

• The CSNM has several classes of membership including Active Members and

Student Members. The “Active” Membership is the most qualified class.

• This clarification is consistent with the original intent of the Regulation.

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B. Critical Incident Reporting

• The amendments related to critical incident reporting pertain to two main topics:

1. environmental hazards; and

2. reporting of injuries that result in a person being taken to hospital.

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B1. Changes to Provisions on Environmental Hazards

• The Regulation has been amended to remove “loss of essential services” and

“flooding” from the list of emergencies that must be reported immediately.

• As a result, these incidents are now added to the list of environmental hazards that

must instead be reported within one business day.

• The reporting requirements for environmental hazards have also been clarified so that

the reporting requirements apply to incidents that affect the provision of care or the

safety, security or well-being of one or more residents of a LTC home for a period

greater than six hours.

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B2. Changes to Reporting of Injuries

• The reporting requirements related to injuries have been amended so that reporting is

only required when there is an incident that causes an injury to a resident for which

the resident is taken to a hospital and that results in a significant change in the

resident’s health condition.

• The term “significant change” is defined as “a major change in the resident’s health

condition that, a) will not resolve itself without further intervention,

b) impacts on more than one aspect of the resident’s health condition, and

c) requires an assessment by the interdisciplinary team or a revision to the resident’s plan

of care.”

• If the LTC home is unable within one business day to determine whether the injury

has caused a significant change in the resident’s health condition, the LTC home must

contact the hospital within three calendar days of the incident to determine whether

the injury resulted in significant change.

• If the injury has resulted in a significant change in the resident’s health condition or

the LTC home remains unable to determine whether this is the case, the LTC home

must inform the Ministry of the incident no later than three business days after the

incident occurred.

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B2. Changes to Reporting of Injuries: Scenarios

i. A resident who became dizzy fell and complained of pain in her leg. The resident

was transferred to hospital and x-rayed, but there was no break, only bruising. The

resident was not admitted to hospital and it was determined that there was no

significant change in the resident’s health condition. • The LTC home would not be required to report this incident to the Ministry under the new

critical incident reporting requirements.

• However, other regulatory requirements would continue to apply relating to the mitigation of

falls, such as the requirements pertaining to the LTC home’s falls prevention and

management program (section 49 of the Regulation).

ii. A resident who became dizzy fell and complained of pain in her leg. The resident

was transferred to hospital and x-rayed, but there was no break in her leg or hip, only

bruising. However, further investigation determined that the resident had a hairline

fracture in her wrist and a cast was applied. The resident was not admitted to

hospital, but as a result of the fracture of the wrist it was determined that there was a

significant change in the resident’s health condition. • The LTC home would be required to report this incident to the Ministry under the new

critical incident reporting requirements.

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B2. Changes to Reporting of Injuries: Scenarios

cont… iii. A resident fell as a result of being hit by a staff member of the LTC home and

complained of pain in her leg. The resident was transferred to hospital and x-rayed, but

there was no break, only bruising. The resident was not admitted to hospital and it was

determined that there was no significant change in the resident’s health condition. • The LTC home would not be required to report this incident to the Ministry under the new

critical incident reporting requirements.

• However, other regulatory requirements would continue to apply, such as the requirements

pertaining to the reporting of abuse (s. 24 (1) LTCHA)

iv. A resident who became dizzy fell and complained of pain in her leg. The resident was

transferred to hospital and x-rayed, and although there was no break, the extent of

bruising suggested there may be some other problem so the resident was admitted to

hospital for further investigation. The LTC home could not ascertain within one

business day whether the injury caused a significant change in the resident’s health so

the home contacted the hospital by the third day after the incident to follow-up on the

resident’s condition. The hospital indicated that they were continuing to conduct tests

and it was still unclear as to whether there was a significant change in the resident’s

health condition. • The LTC home would be required to report this incident to the Ministry under the new

critical incident reporting requirements.

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B2. Changes to Reporting of Injuries: cont…

• The LTC home is still required to provide a written report to the Ministry within 10

days of the incident if the LTC home determines that the injury has resulted in a

significant change in the resident’s health condition or is unable to make this

determination.

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C. Locking of Doors to Non-residential Areas

• The Regulation has been amended to specify that all doors leading to non-residential

areas must be kept closed and locked when they are not being supervised by staff in the

LTC home.

• This amendment does not involve redefining what has always been understood to be

‘non-residential’ areas such as janitors closets, storage rooms, garbage chutes, boiler

rooms, etc.

• Areas of the home that are meant to be accessed by residents such as the chapel, library,

quiet rooms, activity rooms, rooms with washers and dryers that are for the use of

residents would not constitute a non-residential area.

• This amendment clarifies the Regulation and supports the original intent that doors

leading to areas not intended for resident use must be equipped with locks and the doors

must be closed and the locks must be used at all times unless staff are directly

supervising the doors.

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D. Convalescent Care Program

• The Regulation has been amended effective November 1, 2013 to permit Community

Care Access Centre (CCAC) placement co-ordinators to refer applicants to the

Convalescent Care Program (CCP) beds in LTC homes, in place of allowing these

applicants to choose a LTC home(s) from among the LTC homes where these beds are

located.

• The CCAC placement co-ordinator will be required to inform potential applicants about

the referral process to access the program, and participation in the program is

conditional on the applicant agreeing to proceed with an application for admission.

• When referring an applicant to a CCP bed, the CCAC placement co-ordinator will have

to take into consideration the applicant’s condition, circumstances and preferences,

including any preferences relating to the proximity of the home or homes to the

applicant’s family, home and community and support networks. • As part of the implementation of this aspect of the requirements, CCACs, with the assistance

of the Ontario Association of Community Care Access Centres (OACCAC), have been asked

to develop policies and protocols that are subject to Ministry approval that will ensure a

consistent, province-wide approach is developed for the referral process.

• It is for this reason that the longer implementation date of November 1, 2013 applies to these

amendments.

• The Ministry of Health and Long-Term Care will provide an information session about these

changes to CCACs and the OACCAC in October 2013.

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D. Convalescent Care Program cont…

• The following modified admission procedures will be of particular interest to LTC

homes: • There is no change to the assessment information that CCACs will be required to provide to

the LTC homes to which an applicant is being referred. LTC homes will have three business

days to review and approve or refuse approval of the admission of an applicant for a CCP bed

rather than the current five business days.

• If LTC homes request additional information about the application, the LTC homes will have

one business day after receiving the additional information to review and approve or refuse

approval of the admission rather than the current three business days.

• These new timeframes for LTC homes to respond to the CCAC are consistent with the

timeframes for applications to short-stay interim beds.

• A further feature of interest relates to the provision of the written notice when refusing

an application for admission. • As of November 1, 2013, a LTC home that refuses to approve an applicant’s admission to a

CCP bed will only be required to give the written notice of refusal to the CCAC placement

co-ordinator.

• The LTC home will not be required to provide copies of the notice to the applicant or the

Director (Ministry); however, the CCAC placement co-ordinator will be required to provide a

copy of the refusal to the applicant if the applicant requests a copy.

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D. Convalescent Care Program cont…

• Applicants who choose not to participate in the referral process, will, upon the person’s

request, be referred by the CCAC placement co-ordinator to other types of services and

provided with assistance in arranging alternative accommodation, care or services as

appropriate in the circumstances.

• These requirements will come into effect on November 1, 2013, but will not apply to

applicants who were determined eligible for admission to the CCP prior to November 1,

2013.

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E. Specialized Unit Admissions and Discharge

• These amendments will come into force on November 1, 2013.

• Although there are currently only six LTC homes in the province with designated

specialized units, there is increasing interest by Local Health Integration Networks

(LHINs) and LTC homes in establishing more specialized units to meet the needs of a

variety of resident populations throughout the province.

• Therefore, even if these amended provisions will not have an immediate impact on your

particular LTC home, it is worthwhile to gain some understanding of these new

provisions.

• The amendments to the specialized unit provisions relate to the following: 1. Providing enhanced prioritization for residents who are ready to be discharged from

specialized units and waiting to be admitted to a long-stay bed in a home that is not his/her

“original LTC home” as well as for residents who were transferred from the specialized unit

into another area of the home and are waiting for admission into a long-stay bed in his/her

“original LTC home” or any other LTC home; and

2. Establishing the ability and conditions under which applicants for admission to a ‘regular’

LTC home long-stay bed can be admitted to a specialized unit when there is no one on the

waiting list for the specialized unit.

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E1. Specialized Unit Admissions and Discharge:

Enhanced Prioritization • The Regulation has been amended to provide a higher admission priority for current

residents who are ready to be discharged from specialized units or former residents in

the unit who were transferred to another area of the home, both of whom are waiting to

be admitted to a long-stay bed in a home that is not his/her “original LTC home”

• Residents in these circumstances will now be placed in category 2.1 on the waiting list

unless the person meets the criteria for placement in a higher category.

• Category 2.1 is ranked below category 2 “spousal/partner reunification” and above

category 3A “religious, ethnic or linguistic origin.”

• Additionally, the readmission category of prioritization has also been expanded to

include residents who were transferred from the specialized unit into another area of the

home and are waiting for admission into a long-stay bed in his/her “original LTC

home”.

• These high categories of prioritization will only apply to residents who made an

application to be admitted prior to the internal transfer or within six weeks after the

transfer.

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E2. Specialized Unit Admissions and Discharge:

Long-Stay Clients in Specialized Units • The Regulation has been amended to allow for applicants who have applied for

admission to a regular long-stay bed in a home to be admitted into a specialized unit

bed in the same home whenever there is no applicant on the waiting list for the

specialized unit.

• This will only apply to specialized units stipulated by the Director by means of a term

or condition of the specialized unit designation.

• When providing this stipulation, the Director will be required to take into consideration

the health and well-being of both the residents in the specialized unit and persons who

might be admitted as residents in the unit. • For example, the Director may not permit these admissions in relation to a behavioural

support specialized unit, but may permit these admissions in relation to peritoneal dialysis

specialized unit.

• The LTC home will be required to transfer any resident admitted under the Director’s

stipulation to a bed in another area of the home as soon as a bed in the class of

accommodation chosen by the resident becomes available.

• Residents admitted to the specialized unit under these circumstances will not be placed

in the previously referenced category 2.1 on the waiting list if they apply for admission

to another LTC home.

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Questions

• If you have any additional questions about the Regulation amendments that arise after

today’s information session you can direct them to:

Robert Francis, Manager

Aging and Long-Term Care Unit

Robert.Francis@Ontario.ca

416-212-7137