The sad story of our Long Term Care crisis continues and this blog will focus on what’s available and the seniors who apply for them.  As we know, Long Term Care homes provide Ontario residents with access to 24 hour nursing and personal care and are available to those 18 years or older whose care needs cannot be safely met in the community.  As the Ministry website states: “you can expect much more nursing or personal care here than you would typically receive in a retirement home or supportive housing[1]”.   In 2017 there were 627 long term care facilities operating 78,120 beds in Ontario[2].  From these, approximately 550 beds are convalescent care beds are allocated to provide short term care and 400 beds are allocated to provide respite care.

In terms of who lives there, in their report, Building Better Long-Term Care: Priorities to keep Ontario from failing seniors.   the Ontario Long Term Care Association provides the following resident profile:

• Average age is 85 year old female
• 9/10 residents exhibit some form of cognitive impairment with one in 3 being severely impaired.
• Over 40% exhibit aggressive behaviours stemming from their cognitive condition
• 1 in 3 are completely dependent on staff and all others require frequent support with their activities of daily living
• 2/3 of residents use a wheelchair
• Almost every resident exhibits multiple chronic conditions.

The bolded points above are, in my opinion, a major contributing factor to the worst of the problems- assaults between residents and between staff and residents. “In many cases, the lack of privacy afforded in older homes, particularly those with three- and four-bed wards, results in more seniors displaying responsive behaviours[3].”

These homes are funded, licensed and regulated  by the Ministry of Health and Long Term Care under the Long Term Care Homes Act, 2007 and Ontario Regulation 709/10. This spells out residents’ rights, care and services available however most amazingly does not spell out a required staffing patient ratio.

Eligible applicants can apply for either a private room (private room and private bathroom) or a semi private room (2 beds per room with shared bathroom in an older building or a private bedroom with a shared bathroom in a newer building) or a ward or basic bed, which can be up to four beds in a room. The applicant can select up to 5 different facilities. Then the wait begins…. The average placement wait time as of June 2017 was 137 days, with a wait list of 32,046 people.  Not every one is equal on the wait list.  There is a priority wait list which is determined by the placement coordinator  from the LHIN and is based on the Inter RAI assessment[4].   The waitlist priority breakdown[5] is determined in a number of different ways based on:

1) Crisis: People who need immediate admission or in crisis

2) Spouse/partner Reunification: People who need to be reunified with their spouses/partners, who are currently residing in LTCH.

3A) Religious, Ethnic or Linguistic Origin: People waiting for LTCH serving those of a religion, ethnic origin, or culture. People with high care needs but can be supported a home.

3B) Religious, Ethnic or Linguistic Origin: People waiting for LTCH serving those of a religion, ethnic origin, or culture. People with care needs currently managed at home with supports.

4A) People who have high care needs, but can still be supported at home until be become available.

4B) People with care needs who are currently managing at home with support

Once your name gets to the top of the list and a bed is offered, you have 24 hours to either accept or reject the offer. If it is your 5^th choice and you are not interested and decline the bed, your name is taken off all of the lists and you must wait 3 months before reapplying, unless there is a significant change in your condition or circumstances.  If you accept, you then have 5 days to move in.

Each resident must pay a monthly co payment; regardless of where one lives in the Province the rates are the same. As of July 1, 2017 they were:

Type of Accommodation	Daily Co-Payment	Monthly Rate
Basic Long Stay	$59.82	$1,819.53
Semi-Private Long Stay*	$68.02-$72.12	$2,193.65
Private Long Stay*	$78.27-$85.45	$2,599.11
Short Stay (Respite)	$38.72

*Varies depending a home’s structural class and date of move-in.

Source: Ministry of Health and Long-Term Care, Senior’s Care: Long-Term Care Homes.

Government subsidies or a rate reduction is available for those who can’t afford to pay the full amount, however it is only available for Basic room accommodation.

Lessons Learnt:

Apply early, ask questions of the placement person,  research your options, visit and tour each facility, check the Ministry wait lists and the licensing and annual inspection reports of the selected residences.

Most importantly choose wisely so whichever facility has a vacancy and when a spot is offered, you are ready to make the move.  My next blog will discuss some of the challenges I have experienced first hand with my clients.

[1] https://www.ontario.ca/page/find-long-term-care-home

[2] City of Toronto 2017 Long Term Care Homes  & Services https://www1.toronto.ca/wps/portal/contentonly?vgnextoid=63fedefa5c528510VgnVCM10000071d60f89RCRD&vgnextchannel=8a87116288528510VgnVCM10000071d60f89RCRD

[3] https://s3-us-west-2.amazonaws.com/oltca/bsc2017/OLTCA_Budget_Submission_Request.pdf

[4] https://www.interrai.org/long-term-care-facilities.html

[5] https://www.oltca.com/OLTCA/Documents/SectorDashboards/TC.pdf