About Long Term Care

Table of Contents

What are long term care homes?

Long term care homes are funded and regulated by the provincial government and generally for those for whom there is no longer sufficient support for them to live independently in the community, or the hospital is ready to discharge a patient who may not be able to cope at home any longer. People living in a home pay a fee for accommodation, which is set by the government and is based on the type of accommodation chosen (e.g. basic/standard, semi-private or private). Long term care homes can operate either on a not-for-profit (municipal, charitable, non-profit nursing home) or for-profit basis.

Generally, residents are seniors and they require a heavy degree of physical care, or they are dealing with Alzheimer disease or other forms of dementia that require constant care. The objectives of long-term care are to promote as much independence as possible for as long as possible, and to ensure the best possible quality of life for each individual resident.

Personal support workers assist residents with their daily care. That may mean help with eating meals, assistance with bathing, and with toileting and general grooming. There are registered nurses (RNs) and registered practical nurses (RPNs) to provide health care, promote wellness, assess for illness, provide treatments and administer prescribed medicines. Each home has arrangements with physicians who act as medical directors and attending physicians to work with the residents and to be on call 24 hours a day.

Another key ingredient of the staffing mix in homes are the program support people who provide social and recreational programs.

Residents either have a private room, or they share a room with one (or sometimes more) other person. Housekeeping and laundry are two of the services included for residents. There are dining rooms where residents gather for three meals each day. The dietary department always includes the services of a dietitian, ensuring good quality, appropriate food- whatever the specific person may require. There are common areas for entertainment, activities, religious services – whatever the home can provide to make life there one of quality. Some homes have means of transportation to take residents to events and activities in the community.

AdvantAge Ontario member homes encourage the community to participate with the residents. They are often partners with various agencies in providing a variety of services to the community, and in encouraging local groups to use the homes, sometimes sharing office space, sometimes meeting space. AdvantAge Ontario members are innovators in creating outreach to their neighbourhoods and within their homes.

Are homes regulated?

All long-term care homes in Ontario are regulated by the Ministry of Long-Term Care, and are inspected at least once a year. In addition, not-for-profit homes are accountable to their governing body (non-profit board or Municipal Council) to adhere to the specific mandates determined by the governing body.

How do I apply for admission?

Applications for long-term care are made through Home and Community Care Support Services. They will complete most of the application, usually during an in-person meeting.

The first call to Home and Community Care Support Services will determine whether a care coordinator should visit you for an in-person assessment. At this visit, the care coordinator will assess the health of the applicant, and may conduct other assessments as well, including capacity, functional and behavioural assessments. With this information, the care coordinator will be able to talk with the applicant about their needs and the options for meeting them.

Applicants are responsible for completing the choice form, where they can select up to five homes, in order of preference.

What is the cost of living in a long term care home?

The Ministry pays directly for the costs of nursing and personal care, as well as for activation, through a funding formula determined by the province. Residents pay for their room and food. Often the governing bodies of not-for-profit homes (including municipalities) augment funding to enhance services. Costs to be paid by residents are set by the province, and are subject to change. The province expects that charges are affordable to any applicant. The basic fee paid by residents in homes is $63.36 per day or $1,927.20 per month for standard accommodation (may be less for residents who are unable to pay) as at July 1, 2020 (to be implemented January 1, 2021). The chart below provides a breakdown based on type of accommodation:

Effective October 1, 2022

* Admitted on or after July 1, 2015.
†Admitted on or after September 1, 2014, but prior to July 1, 2015.
‡ Admitted on or after July 1, 2013, but prior to September 1, 2014.
§ Admitted on or after July 1, 2012, but prior to July 1, 2013.
** Also applies to residents admitted to newer beds prior to July 1, 2012.

Depending upon the accommodation provided in the home, it may be possible to apply for a private room, rather than the semi-private or “basic” accommodation which every home has. Even the cost of a semi-private and private room is regulated by the province. Costs cover meals and nourishments, housekeeping, laundry, maintenance of the home, and administration. Other charges are limited by regulation, such as the drug dispensing fee from the pharmacy.

Residents who are unable to pay the costs set by the Ministry are able to apply for a reduced rate.

Please see ontario.ca/page/get-help-paying-long-term-care for more information on the rate reduction program.

For more information, speak to the staff at your long-term care home.

Families who wish to do so may, of course, decide they will “subsidize” their relative to be in a private room when all the relative can afford would be basic accommodation. That is simply a matter to be determined within the family.

Residents may, at their own cost, provide a telephone or cable TV, and there is a charge for hairdressing, usually provided “on site”.

The following is a breakdown of the funding (per resident per day) received by long term care homes from the Ministry of Long-Term Care (base level of care funding only – does not include one-time funding).

Source: MOHLTC

Are there ways of obtaining extra financial help?

Yes. If you are a veteran, there are programs and services to assist you. For more information visit the Veterans Affairs Canada site.

If you are admitted to a long term care home and cannot pay the full cost that is mandated by the Ministry of Long-Term Care, someone in the home can advise you about applying for the Guaranteed Annual Income Supplement (GAINS). As well, in cases of need, it is possible to apply for “exceptional circumstances” regarding the costs the resident is required to pay, and the home will assist in this process.

If there is an assessed need for equipment, such as a special chair, the physiotherapist can help you through applying through the government’s Assistive Devices Program (ADP).

If the resident is under age 65, there are programs through social service agencies in your area that may be able to help.

If you haven’t done so already, you can also obtain details on the Old Age Security Program from the Government of Ontario website.

Adapting to a long term care home

There is no doubt that there will be a period of adjustment, not only for the resident, but also for anyone who has been providing the care. Sometimes it may feel as if your care, or that of your family member is being given to complete strangers, and there may be feelings of anxiety. If that sounds familiar, you are not alone. The home can help by suggesting a support group that could be useful to families in sharing ways of handling those very normal feelings. In fact, the home may have a family support group right there that will welcome you.

Making the new surroundings as much like home as possible is a good beginning. Talk to the home about what can be brought to the new home. That may include pictures for the wall, perhaps a special bedspread, maybe a small piece of furniture that holds important memories. For families, it helps to take a tour with the new resident, letting her show off her new surroundings. Reassure the person that you and others will be able to visit. If the resident is able, she is certainly free to leave the home for visits or to go to a restaurant – anything that matches her capabilities. He or she is encouraged to participate in the many activities planned in the home. Depending upon the circumstances, families may be able to volunteer in some of those activities, and that involvement gives everyone a deeper sense of inclusion in the new home.

Every home has its own plan to help residents feel at home. It is hard to imagine being lonely while surrounded by staff and other residents, but it can happen, for the first while especially. Perhaps it will be appropriate to have a telephone in the resident’s room so that contact with family and friends is at hand. Staff are particularly supportive of new residents and their families. Don’t hesitate to let them know how you are feeling. Homes have a Residents’ Council, run by the residents, where residents are invited to meet each other and discuss any issues that may have arisen Before you know it, the home will be “home”, and you will see the results of the appropriate care that is being given. Regular conferences are held with the staff to prepare and update the planning for each resident’s care. Families and residents are invited to attend and to contribute their ideas. Rest assured there is always someone at the home to talk to whenever there is a question.

Checklist of questions to consider when visiting homes

The following are some questions you might want to consider getting answers to as you visit homes to help you in your decision making process:

• What group governs the home? Is it operated on a not-for-profit or for-profit basis? What is its Mission Statement?
• Is it convenient for family and friends to visit?
• Is there a welcoming atmosphere when I enter the building?
• Do residents appear well groomed and appropriately dressed?
• How do I see staff reacting toward residents and amongst themselves? Do they appear to know residents’ names?
• Is the home clean? Is it free of offensive odours?
• Are resident rooms well appointed? Is furniture in good repair? Is a call bell – or some communication device or system – within easy reach?  What personal belongings may the resident bring?
• Is there privacy in the resident’s room? Are areas provided in the home for private visits with residents?
• Visit during a meal time. Check the menus and the choices provided. Is the dining area clean and inviting? Do the meals look appetizing? Are special diets provided? Is a dietitian involved with meal planning and assessment of residents? Are family members or friends able to have an occasional meal with the resident?
• Is there a special secured area for the safety of residents who might wander away? Is there special programming provided in that area? Are those residents included in activities with the rest of the residents?
• How is the community involved with the home? Is there an Auxiliary and/or volunteer group?
• Are there any restrictions about visiting?
• What activities are provided for the residents? Are there provisions for services to improve mobility rehabilitation? Are there activities away from the home in which the residents may participate?
• Is there at least one Registered Nurse on duty at all times? What other staff are employed in the home?
• Who are physicians attending the home? How often do they visit?
• Are safe outdoor areas easily available to residents?

Print checklist in PDF format

Advice on the MOHLTC Public Reporting Website on long term care homes

Not-for-profit homes across the province have always supported full public access to information. Our accountability is strengthened by greater transparency, including open councils, regular community meetings, and public reports through municipal councils, not-for-profit and charitable boards.

The Ministry of Long-Term Care has created a Public Reporting website to provide consumers with information on the performance of long term care homes.

The following is advice on importance information to look for on this reporting site:

Home Profile Page

• Look for who operates the home. This will tell you if the home is not-for-profit (charitable, municipal or not-for-profit nursing home).
• Be sure to visit homes you are interested in to see what they look like. Don’t rely solely on the information on the website about design of the home and configuration of the resident rooms.
• Where a website is provided, go to it to get more information on the home.

Inspection Findings

• Be aware that this information is already posted in homes and has been for years but the information in the homes also includes the action the home is taking to address any unmet standards. The information in the home is also the most recent whereas the website data may not be current. Homes often have corrected any concern within days after the finding is made.
• Contact the home administrator to ask about nature of the ‘unmet standards’ and/or ‘verified concerns’ to understand the degree to which this finding truly impacts on care and services to residents.
• Be careful not to rely on it exclusively on this data in making decisions. You should always consider a number of factors, and use a variety of information sources, when choosing a home. For example:
  • visit prospective homes and talk to staff
  • review resident satisfaction surveys
  • ask about the accreditation status of the home
  • ask for references from residents, families and/or ask to speak to a member of the residents’ and/or family council