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3. IMPLICATIONS OF THE
IMPLEMENTATION OF THE LONG-TERM CARE
HOMES ACT, 2007 AND ACCOMPANYING ONTARIO REGULATIONS, 2010 RÉPERCUSSIONS DE LA MISE EN OEUVRE DE LA LOI DE 2007 SUR LES FOYERS DE SOINS DE
LONGUE DURÉE ET DES RÈGLEMENTS
DE L’ONTARIO QUI EN DÉCOULENT, 2010 |
Committee Recommendation
That Council request $2.31 million in one-time funding and
$571,000 in annualized funding from the Minister of Health and Long-Term Care
to offset the increased costs associated with the implementation of the new Long-Term Care Homes Act, 2007 and
accompanying regulations.
Recommandation DU Comité
Que le Conseil demande un
financement ponctuel de 2,31 millions de dollars et un financement annuel de
571 000 $ à la ministre de la Santé et des Soins de longue durée pour compenser
l’augmentation des coûts associés à la mise en œuvre de la nouvelle Loi de 2007 sur les foyers de soins de
longue durée et des règlements qui en découlent.
Documentation
1. Deputy City Manager's report, City
Operations dated 7 May 2010 (ACS2010-COS-CSS-0010).
Community and Protective Services Committee
Comité des services
communautaires et de protection
and Council / et au Conseil
Submitted by/Soumis par: Steve Kanellakos,
Deputy City Manager/
Directeur municipal
adjoint, City Operations/Opérations municipales
Contact Person/Personne ressource : Marlynne Ferguson,
Senior Administrator/
Administratrice principale
Long Term Care/Soins de longue
durée
(613) 580-2424 x 23630,
Marlynne.Ferguson@ottawa.ca
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Ref N°: ACS2010-COS-CSS-0010 |
That the
Community and Protective Services Committee recommend that Council formally
request $2.31 million in one-time funding and $571,000 in annualized funding from
the Minister of Health and Long-Term Care to offset the increased costs
associated with the implementation of the new Long-Term Care Homes Act, 2007 and accompanying regulations.
Que le Comité des services communautaires et de protection recommande
au Conseil de demander officiellement un financement ponctuel de
2,31 millions de dollars et un financement annuel de 571 000 $ à
la ministre de la Santé et des Soins de longue durée pour compenser
l’augmentation des coûts associés à la mise en œuvre de la nouvelle Loi de 2007 sur les foyers de soins de
longue durée et des règlements qui en découlent.
The long
term care sector is presently governed by three acts: Homes for the Aged and
Rest Homes Act (municipal homes); Charitable Institutions Act; and
the Nursing Homes Act (private sector homes). The Province is
streamlining the legislation and the regulations into the Long-Term Care
Homes Act, 2007 (the “LTCHA”).
The LTCHA and the accompanying regulations will come into force July 1, 2010.
The City of Ottawa LTC Homes will need to comply with the new regulations and
requirements of the Act effective July 1, 2010. Some segments of the LTCHA and
regulations have a delayed implementation until July 1, 2011. This report details the implementation of
new measures that are now required and projects the additional costs of $571,000
annually to fully implement the requirements of the LTCHA.
Staff applauds the
Minister for the additional per diem of $1.55 that has been added to the other
accommodation funding envelope to help support indirect resident care needs relating to housekeeping,
laundry and linen, and dietary services. These funds will offest costs for additional staff time in the areas of
dietitian time (increased from 15 to 30 minutes); nutrition manager (food
service supervisor) time and ongoing staff requirements for new program
development and annual evaluations of these programs. This per diem increase is
insufficient to cover all additional annualized expenses to implement the LTCHA.
The Province’s May, 2010 announcement of $30 million in funds to support
all aspects of LTCHA implementation funds is appreciated. On June 9, 2010 the
Minister confirmed that $21 million of this $30 million will go directly to LTC
homes’ per diems to offset new costs of the LTCHA. The Minister also announced that funding will
be coming soon to add 527 personal support workers to LTC homes in the
Province. These funds, although
substantial, will be insufficient to address the full implementation costs for
one-time expenses to physical plants.
The
City of Ottawa contributes $8.4 million to the operation, including facility
costs, of the City’s four LTC Homes, totalling (711) beds and 6 interim
beds. The City’s total 2010 budget for
the homes is $48.9 million, with provincial and resident revenues at $40.5
million. The revenue distribution has
the following ratios: provincial (51.6%), resident fees (31.2%) and municipal
(17.2%). Because the provincial
contribution and resident fees are established by the Province, any increased
costs to implement the LTCHA would need to be put forth as a 2011 budget
pressure in the absence of further Provincial support.
The LTCHA and accompanying regulations refer to four
broad categories of operation for Long-Term Care Homes:
DISCUSSION
Staff
support the desired outcomes articulated in the LTCHA including a strong,
accountable, resident-centred long-term care system that respects resident
dignity and comfort in a safe and caring environment.
Based
on a detailed review and analysis of the LTCHA and consultation with other
municipal and charitable providers through the Association of Municipalities of
Ontario (AMO), Ontario Association of Non-Profit Homes and Services for Seniors
(OANHSS) and the Resident and Family Councils of our four homes, staff believe
that there are no significant changes in the level of accountability, but
increased operational and physical plant requirements do warrant a recommendation to the Minister of Health and
Long-Term Care regarding additional costs and associated funds required to
fully implement this legislation.
1. Establishment
As
reviewed by City legal services there are no significant changes or increased
requirements in this area. Of notable interest, the City will now sign an
accountability agreement with the Champlain Local Health Integration Network
(LHIN), not the Minister of Health and Long-Term Care (MOHLTC). The first Long-Term
Care Service Accountability Agreement will be signed with the Champlain LHIN
before June 30, 2010.
2. Infrastructure
This
area of the LTCHA addresses issues related to staffing and physical plant
design. There are increased requirements with regard to these requirements as
detailed below.
Staffing
With
the LTCHA there is an increased requirement with 18 training topics per year
that are prescribed for all staff. There
is also an increased requirement to “ensure” staff are trained versus a
previous requirement to “offer” training.
It
is important to note that there is a new requirement for the home to have a
volunteer program and that there must be a designated staff lead for the
program. New volunteers are to be oriented in six key topic areas.
Traditionally
City Homes have met the requirement to “offer” ten training topics annually for
staff. In the past the City Homes have never had an unmet standard with respect
to the requirement for staff training. An average of 60-70% of staff are
captured in these training sessions. The full implications of the cost of these
training requirements are not known. If the expectation is that 100% of all
staff, including casual staff, are retrained annually then LTC would be
required to call staff in on their days off to provide training in the required
topics. To meet resident care needs these staff would need to be back-filled.
We would anticipate an additional training cost of $260,000 annually. Changes
to the staff training program are to be implemented effective July 1, 2010.
The
City Homes have volunteer programs at varying degree of implementation across
the four Homes. There is a volunteer orientation session, but it is much less
rigorous than what is required under the LTCHA and regulations.
While
the City has a designated lead for the current volunteer program it is unlikely
that this individual shared across two Homes and responsible for other program
areas could meet the new requirement. To meet the robustness of the regulation
staff believe there must be a designated staff lead for the program in each
Home. This would require that the LTC Branch put forth a budget pressure as
part of the 2011 budget of approximately $216,000.
Physical Plant
The new Act has an increased requirement for many safety systems in the Homes. Three key areas where not all City Homes will meet the new requirement are with respect to:
Although $21 million in implementation funds have been confirmed it is not clear what the parameters around these dollars will be, nor how they can be used. Even the City’s newest Home, Garry J. Armstrong will require upgrades to the physical plant as the guidelines presented in the LTCHA are more stringent than those in the design standards for new homes.
In two of the four City homes there will be a requirement to upgrade the call bell system ($500K) to allow connectivity to interior and exterior door alarms. Exterior doors and interior stairwell doors will need to be outfitted with audible alarms that are connected to the nurse call system. This will be required in all 4 homes at a cost of approximately ($250K). This work must be complete by July 1, 2010. In two of four homes the elevator systems will need to be equipped with card readers ($60K) to remove elevator access to non-resident areas. In three of the four homes generator capacity ($1.5M) will need to be expanded to ensure that the generator can supply all required emergency systems immediately following a power outage as listed in the LTCHA. A further $15K will be required for ongoing maintenance and repair for generators and $80K for call bell systems.
The total cost of these changes to the physical plant is approximately $2.31 million in one-time funding and represents an annual maintenance requirement of $95,000. This is an estimate based on the information available in the LTCHA. As implementation proceeds a thorough engineer’s study will be required for more accurate kilowatt hour sizing, electrical requirements and cost estimates. The physical plant changes to generators and elevators must be completed by July 1, 2011. It is unclear whether the MOHLTC will inspect homes to verify if changes are made or will simply respond in the event of a critical incident, such as a resident fall or elopement. The City is responsible for ensuring these physical plant requirements are met. If the requirements are not met, the MOHLTC may issue an order requiring the City to correct physical plant deficiencies. If the City does not comply with such an Order, the LTCHA allows the MOHLTC to undertake the work and charge back to the City all associated reasonable costs.
3. Residents
These
sections of the legislation include items related to care plans, programs and
services offered in the home, the prevention of resident abuse, the promotion
of resident rights and the management of resident trust accounts. There are new
rights added to the resident’s bill of rights. There is some overlap with
previous rights and changes are minimal.
There
is a continued requirement to ensure care plans are in place and to provide
training for staff regarding the prevention of abuse.
The
resident bill of rights is posted in all homes and the new bill of rights will
be posted as modified effective July 1, 2010. This is not a significant change
for City Homes. All LTC staff are trained
in the residents bill of rights at orientation.
The
City Homes migrated to the Resident Assessment Instrument-Minimum Data Set
(RAI-MDS) in 2009. This Provincial resident care needs assessment and planning
system will ensure that City homes are compliant with the new legislation with
respect to care plans.
The
City Homes have a strong prevention program for resident abuse and staff are
trained in gentle persuasive approaches to use with residents who exhibit
challenging behaviours associated with dementia and other mental health issues.
The
Financial Services Unit has not noted any significant changes, nor increased
funds required to manage resident trust accounts. No major issues for
compliance are anticipated in this area.
4.Compliance and Enforcement
The
LTCHA will result in changes to the existing compliance program. Current compliance advisors are moving into
the role of “Inspector”. The MOHLTC is moving to a Quality Indicator Survey
that is based on compliance programs used in the nursing home sector in the
United States. Although it is unclear
how the move from compliance “advisor” to “inspector” will practically affect
the Homes, it is anticipated that a greater number of standards will have to be
addressed in City Homes. We anticipate a transition period until staff become
accustomed to the requirements of the new enforcement program. Staff training to increase understanding of
the new compliance system will be undertaken over the summer and early fall.
Compliance inspections are unannounced so it is unknown if this training will
be implemented before the next compliance visit in a City Home. Training cannot begin immediately because at
this time City LTC Homes are awaiting training tools to be disseminated by the
MOHLTC. Changes to the compliance program will be seen in all inspections
following July 1, 2010.
The
LTCHA includes comprehensive enforcement provisions. These wide-ranging powers
include the ability to issue orders, withhold funding or require repayment of
funding and to take control of the management and operation of a LTC home. The
LTCHA creates several offences, including the offence of failing to cooperate
with inspectors. If individuals, including directors or officers of the LTC
home, are convicted of an offence under the LTCHA, they could be liable to imprisonment for a term of not more than 12
months and/or a fine.
There are no specific rural implications associated with this report.
There are no legal/risk management impediments to implementing the recommendation in this report.
Funding of the proposed capital works of $2.31 million required for the physical plants and the increased annual operating costs of $571,000 will be identified in the 2011 Capital and Operating Budgets respectively.
N/A
That Council send a letter to the Minister of Health and Long-Term Care to formally request $2.31 million in one-time funding and $571,000 in annualized funding to offset the increased costs associated with the implementation of the new Long-Term Care Homes Act, 2007 and regulations.