Fixing Long-Term Care Act, 2021

The people of Ontario and their Government: Recognize that long-term care services and care must respect resident diversity and diversity in communities; Respect the requirements of the French Language Services Act in the planning, design, delivery and evaluation of long-term care services for Ontario’s French-speaking communities; Recognize the role of Indigenous peoples in the planning, design, delivery, and evaluation of culturally safe long-term care services and care in their communities; Acknowledge that long-term care residents have diverse and complex physical and mental health needs that require individual, proactive, efficient, and effective supports; Are committed to resident-directed, safe, quality care that responds to a resident’s physical, psychological, emotional, social, spiritual and cultural goals and needs and is respectful of every resident’s individual identity and …

PART I FUNDAMENTAL PRINCIPLE AND INTERPRETATION

1 The fundamental principle to be applied in the interpretation of this Act and anything required or permitted under this Act is that a long-term care home is primarily the home of its residents and is to be operated so that it is a place where they may live with dignity and in security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.

2 (1) In this Act, “abuse”, in relation to a resident, means physical, sexual, emotional, verbal or financial abuse, as defined in the regulations in each case; (“mauvais traitements”) “Administrator”, in relation to a long-term care home, means the Administrator for the home required under section 76; (“administrateur du foyer”) “Agency” means the corporation continued by section 3 of the Connecting Care Act, 2019; (“Agence”) “Appeal Board” means the Health Services Appeal and Review Board under the Ministry of Health and Long-Term Care Appeal and Review Boards Act, 1998; (“Commission d’appel”) “care” includes treatment and interventions; (“soins”) Note: On a day to be named by proclamation of the Lieutenant Governor, subsection 2 (1) of the Act is amended by adding the following definition: (See: 2021, c. 39, Sched. 1, s. 203 (1)) “confine”, except with respect to the common law duty o…

PART II RESIDENTS: RIGHTS, CARE AND SERVICES

Residents’ Bill of Rights

3 (1) Every licensee of a long-term care home shall ensure that the following rights of residents are fully respected and promoted: Right to be treated with respect 1. Every resident has the right to be treated with courtesy and respect and in a way that fully recognizes the resident’s inherent dignity, worth and individuality, regardless of their race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability. 2. Every resident has the right to have their lifestyle and choices respected. 3. Every resident has the right to have their participation in decision-making respected. Right to freedom from abuse and neglect 4. Every resident has the right to freedom from abuse. 5. Every resident has the right to freedom from neglect by the licensee and staff. Right to an Opti…

Mission Statement

4 (1) Every licensee shall ensure that, (a) there is a mission statement for each of the licensee’s long-term care homes that sets out the principles, purpose and philosophy of care of the home; (b) the principles, purpose and philosophy of care set out in the mission statement are driven by the primary goal of providing quality care that is resident-directed and safe; and (c) the principles, purpose and philosophy of care set out in the mission statement are put into practice in the day-to-day operation of the long-term care home. Basic consistency (2) The licensee shall ensure that the mission statement is consistent with the fundamental principle and the Residents’ Bill of Rights. Collaboration (3) The licensee shall ensure that the mission statement is developed, and revised as necessary, in collaboration with the Residents’ Council and the Family Council, if any, and shall invite th…

Safe and Secure Home

5 Every licensee of a long-term care home shall ensure that the home is a safe and secure environment for its residents.

Plan of Care

6 (1) Every licensee of a long-term care home shall ensure that there is a written plan of care for each resident that sets out, (a) the planned care for the resident; (b) the goals the care is intended to achieve; (c) clear directions to staff and others who provide direct care to the resident; and (d) any other requirements provided for in the regulations. Based on assessment of resident (2) The licensee shall ensure that the care set out in the plan of care is based on an assessment of the resident and on the needs and preferences of that resident. Plan to cover all aspects of care (3) The licensee shall ensure that the plan of care covers all aspects of care, including medical, nursing, personal support, mental health, nutritional, dietary, recreational, social, palliative, restorative, religious and spiritual care. Integration of assessments, care (4) The licensee shall ensure that …

7 Nothing in this Act authorizes a licensee to assess a resident’s requirements without the resident’s consent or to provide care or services to a resident without the resident’s consent.

Care and Services

8 (1) This section establishes a target for the average number of hours of direct care to residents to be provided by individuals who are hired by or otherwise work for licensees in a long-term care home as personal support workers, registered nurses, or registered practical nurses. Target (2) The target is for an average of four hours of direct care to be provided per resident per day. Target date (3) The target set in subsection (2) must be achieved no later than March 31, 2025, and once achieved, shall continue at that level, subject to subsection (5). Periodic increase towards target (4) The following periodic increases towards the target must also be achieved: 1. An average of three hours of direct care to be provided per resident per day no later than March 31, 2022. 2. An average of three hours and 15 minutes of direct care to be provided per resident per day no later than March 3…

9 (1) This section establishes a target for the average number of hours of direct care to residents to be provided by allied health care professionals. Target (2) The target is for an average of 36 minutes of direct care to be provided per resident per day. When to be achieved (3) The target set in subsection (2) must be achieved no later than March 31, 2023, and, once achieved, shall continue at that level, subject to subsection (5). Increase towards target (4) An increase towards a target of an average of 33 minutes of direct care to be provided per resident per day must also be achieved no later than March 31, 2022. Additional targets (5) To further the purposes of this section, additional targets that are higher than those set out in subsections (2) and (4) may be established by regulation, and such a regulation, if made, may also set a date by which the excess target time must be ac…

10 (1) The Minister shall assess, and publicly report, before the achievement date of the next target in subsection 8 (4), the progress that is being made or that has been made towards achieving the targets set out in sections 8 and 9 on an annual basis. Assessment (2) For the purposes of subsection (1), the Minister shall assess whether there are barriers or risks to achieving the targets and shall consider mitigations to the barriers and risks. Dates (3) For the purposes of subsection (1), the Minister shall annually assess the progress that is being made or has been made towards achieving the targets no later than six months after the end of every fiscal year of the Government of Ontario. Failure to achieve a target (4) If a target set out in this Part or under the regulations is not achieved, the Minister shall, (a) identify the reasons for the failure to achieve the targets, includi…

11 (1) Every licensee of a long-term care home shall ensure that there is, (a) an organized program of nursing services for the home to meet the assessed needs of the residents; and (b) an organized program of personal support services for the home to meet the assessed needs of the residents. Personal support services (2) In clause (1) (b), “personal support services” means services to assist with the activities of daily living, including personal hygiene services, and includes supervision in carrying out those activities. 24-hour nursing care (3) Every licensee of a long-term care home shall ensure that at least one registered nurse who is both an employee of the licensee and a member of the regular nursing staff of the home is on duty and present in the home at all times, except as provided for in the regulations. Same, Administrator and Director of Nursing and Personal Care (4) During…

12 (1) Every licensee of a long-term care home shall ensure that, subject to section 7, residents are provided with care or services that integrate a palliative care philosophy. Matters in regulations (2) Without restricting the generality of subsection (1), every licensee shall comply with the regulations respecting palliative care and the palliative care philosophy.

13 (1) Every licensee of a long-term care home shall ensure that there is an organized interdisciplinary program with a restorative care philosophy that, (a) promotes and maximizes independence; and (b) where relevant to the resident’s assessed care needs, includes, but is not limited to, care or services that address psychosocial needs and physiotherapy and other therapy services, any of which may be either arranged or provided by the licensee. Certain cases (2) Without restricting the generality of subsection (1), the program shall include services for residents with cognitive impairments and residents who are unable to leave their rooms.

14 (1) Every licensee of a long-term care home shall ensure that there is an organized program of recreational and social activities for the home to meet the interests of the residents. Certain cases (2) Without restricting the generality of subsection (1), the program shall include services for residents with cognitive impairments, and residents who are unable to leave their rooms.

15 (1) Every licensee of a long-term care home shall ensure that there is, (a) an organized program of nutritional care and dietary services for the home to meet the daily nutrition needs of the residents; and (b) an organized program of hydration for the home to meet the hydration needs of residents. Same (2) Without restricting the generality of subsection (1), every licensee shall ensure that residents are provided with food and fluids that are safe, adequate in quantity, nutritious and varied.

16 Every licensee of a long-term care home shall ensure that there is an organized program of medical services for the home.

17 (1) Every licensee of a long-term care home shall ensure that residents are provided with information and assistance in obtaining goods, services and equipment that are relevant to the residents’ health care needs but are not provided by the licensee. Clarification of extent of assistance (2) The information and assistance required under subsection (1) does not include financial assistance.

18 Every licensee of a long-term care home shall ensure that there is an organized program for the home to ensure that residents are given reasonable opportunity to practise their religious and spiritual beliefs, and to observe the requirements of those beliefs.

19 (1) Every licensee of a long-term care home shall ensure that, (a) there is an organized program of housekeeping for the home; (b) there is an organized program of laundry services for the home to meet the linen and personal clothing needs of the residents; and (c) there is an organized program of maintenance services for the home. Specific duties re cleanliness and repair (2) Every licensee of a long-term care home shall ensure that, (a) the home, furnishings and equipment are kept clean and sanitary; (b) each resident’s linen and personal clothing is collected, sorted, cleaned and delivered; and (c) the home, furnishings and equipment are maintained in a safe condition and in a good state of repair.

20 (1) Every licensee of a long-term care home shall ensure that there is an organized volunteer program for the home that encourages and supports the participation of volunteers in the lives and activities of residents. To be included in program (2) The volunteer program must include measures to encourage and support the participation of volunteers as may be further provided for in the regulations.

21 Every licensee of a long-term care home shall ensure that the home meets the staffing and care standards provided for in the regulations.

22 (1) Every licensee shall ensure that the programs required under sections 11 to 20, the services provided under those programs and anything else required under those sections comply with any standards or requirements, including outcome measures, provided for in the regulations. Matters included (2) Without restricting the generality of subsection (1), every licensee shall comply with the regulations made under paragraph 14 of subsection 193 (2).

23 (1) Every licensee of a long-term care home shall ensure that there is an infection prevention and control program for the home. Requirements of program (2) The infection prevention and control program must include, (a) evidence-based policies and procedures; (b) an educational component in respect of infection prevention and control for staff, residents, volunteers and caregivers; (c) daily monitoring to detect the presence of infection in residents of the long-term care home; (d) measures to prevent the transmission of infections; (e) a hand hygiene program; and (f) any additional matters provided for in the regulations. Standards and requirements (3) The licensee shall ensure that the infection prevention and control program and what is provided for under that program, including the matters required under subsection (2), comply with any standards and requirements, including require…

Prevention of Abuse and Neglect

24 (1) Every licensee of a long-term care home shall protect residents from abuse by anyone and shall ensure that residents are not neglected by the licensee or staff. If absent from the home (2) The duties in subsection (1) do not apply where the resident is absent from the home, unless the resident continues to receive care or services from the licensee, staff or volunteers of the home. Offence (3) Every licensee who contravenes subsection (1) is guilty of an offence.

25 (1) Without in any way restricting the generality of the duty provided for in section 24, every licensee shall ensure that there is in place a written policy to promote zero tolerance of abuse and neglect of residents, and shall ensure that the policy is complied with. Contents (2) At a minimum, the policy to promote zero tolerance of abuse and neglect of residents, (a) shall provide that abuse and neglect are not to be tolerated; (b) shall clearly set out what constitutes abuse and neglect; (c) shall provide for a program, that complies with the regulations, for preventing abuse and neglect; (d) shall contain an explanation of the duty under section 28 to make mandatory reports; (e) shall contain procedures for investigating and responding to alleged, suspected or witnessed abuse and neglect of residents; (f) shall set out the consequences for those who abuse or neglect residents; (g…

Reporting and Complaints

26 (1) Every licensee of a long-term care home shall, (a) ensure that there are written procedures that comply with the regulations for initiating complaints to the licensee and for how the licensee deals with complaints; (b) ensure that the written procedures include information about how to make a complaint to the patient ombudsman under the Excellent Care for All Act, 2010 and to the Ministry; and (c) immediately forward to the Director any written complaint that it receives concerning the care of a resident or the operation of a long-term care home in the manner set out in the regulations, where the complaint has been submitted in the format provided for in the regulations and complies with any other requirements that may be provided for in the regulations. Other documentation (2) A licensee who is required to forward a complaint under clause (1) (c) shall also provide the Director w…

27 (1) Every licensee of a long-term care home shall ensure that, (a) every alleged, suspected or witnessed incident of the following that the licensee knows of, or that is reported to the licensee, is immediately investigated: (i) abuse of a resident by anyone, (ii) neglect of a resident by the licensee or staff, or (iii) anything else provided for in the regulations; (b) appropriate action is taken in response to every such incident; and (c) any requirements that are provided for in the regulations for investigating and responding as required under clauses (a) and (b) are complied with. Reports of investigation (2) A licensee shall report to the Director the results of every investigation undertaken under clause (1) (a), and every action taken under clause (1) (b). Manner of reporting (3) A licensee who reports under subsection (2) shall do so as is provided for in the regulations, and…

28 (1) A person who has reasonable grounds to suspect that any of the following has occurred or may occur shall immediately report the suspicion and the information upon which it is based to the Director: 1. Improper or incompetent treatment or care of a resident that resulted in harm or a risk of harm to the resident. 2. Abuse of a resident by anyone or neglect of a resident by the licensee or staff that resulted in harm or a risk of harm to the resident. 3. Unlawful conduct that resulted in harm or a risk of harm to a resident. 4. Misuse or misappropriation of a resident’s money. 5. Misuse or misappropriation of funding provided to a licensee under this Act, or the Connecting Care Act, 2019. 2021, c. 39, Sched. 1, s. 28 (1), 203 (4). False information (2) Every person is guilty of an offence who includes in a report to the Director under subsection (1) information the person knows to b…

29 (1) The Director shall have an inspector conduct an inspection or make inquiries for the purpose of ensuring compliance with the requirements under this Act if the Director receives information from any source indicating that any of the following may have occurred: 1. Improper or incompetent treatment or care of a resident that resulted in harm or a risk of harm to the resident. 2. Abuse of a resident by anyone or neglect of a resident by the licensee or staff that resulted in harm or a risk of harm to the resident. 3. Unlawful conduct that resulted in harm or a risk of harm to a resident. 4. A violation of section 30. 5. Misuse or misappropriation of a resident’s money. 6. Misuse or misappropriation of funding provided to a licensee under this Act, or the Connecting Care Act, 2019. 7. A failure to comply with a requirement under this Act that resulted in harm or risk of harm to a res…

30 (1) No person shall retaliate against another person, whether by action or omission, or threaten to do so because, (a) anything has been disclosed to an inspector; (b) anything has been disclosed to the Director including, without limiting the generality of the foregoing, (i) a report has been made under section 28, or the Director has otherwise been advised of anything mentioned in paragraphs 1 to 5 of subsection 28 (1), (ii) the Director has been advised of a breach of a requirement under this Act, or (iii) the Director has been advised of any other matter concerning the care of a resident or the operation of a long-term care home that the person advising believes ought to be reported to the Director; (c) anything has been disclosed to any other personnel of the Ministry, or to any other individual or entity that may be provided for in the regulations; or (d) evidence has been or ma…

31 (1) Where a staff member complains that an employer or person acting on behalf of an employer has contravened subsection 30 (1), the staff member may either have the matter dealt with by final and binding settlement by arbitration under a collective agreement, if any, or file a complaint with the Board in which case any rules governing the practice and procedure of the Board apply with all necessary modifications to the complaint. Inquiry by Board (2) The Board may inquire into any complaint filed under subsection (1) and section 96 of the Labour Relations Act, 1995, except subsection (5), applies with all necessary modifications as if that section, except subsection (5), is enacted in and forms part of this Act. Same (3) On an inquiry by the Board into a complaint filed under subsection (1), sections 110, 111, 114 and 116 of the Labour Relations Act, 1995 apply with all necessary mod…

32 Every person is guilty of an offence who attempts, by any means, to prevent another person from providing information to an inspector or the Director where the provision of the information is required or permitted by this Act or the regulations.

Minimizing of Restraining Note: On a day to be named by proclamation of the Lieutenant Governor, the heading before section 33 of the Act is amended by striking out “Restraining” and substituting “Restraining and Confining”. (See: 2021, c. 39, Sched. 1, s. 203 (6))

33 (1) Every licensee of a long-term care home, (a) shall ensure that there is a written policy to minimize the restraining of residents and to ensure that any restraining that is necessary is done in accordance with this Act and the regulations; and (b) shall ensure that the policy is complied with. Note: On a day to be named by proclamation of the Lieutenant Governor, subsection 33 (1) of the Act is repealed and the following substituted: (See: 2021, c. 39, Sched. 1, s. 203 (7)) Policy to minimize restraining and confining of residents, etc. (1) Every licensee of a long-term care home, (a) shall ensure that there is a written policy to minimize the restraining and confining of residents and to ensure that any restraining or confining that is necessary is done in accordance with this Act and the regulations; and (b) shall ensure that the policy is complied with. 2021, c. 39, Sched. 1, s…

34 (1) Every licensee of a long-term care home shall ensure that no resident of the home is: 1. Restrained, in any way, for the convenience of the licensee or staff. 2. Restrained, in any way, as a disciplinary measure. 3. Restrained by the use of a physical device, other than in accordance with section 35 or under the common law duty referred to in section 39. 4. Restrained by the administration of a drug to control the resident, other than under the common law duty referred to in section 39. 5. Restrained, by the use of barriers, locks or other devices or controls, from leaving a room or any part of a home, including the grounds of the home, or entering parts of the home generally accessible to other residents, other than under the common law duty referred to in section 39. Devices that resident can release (2) The use of a physical device from which a resident is both physically and c…

34 (1) Every licensee of a long-term care home shall ensure that no resident of the home is: 1. Restrained or confined, in any way, for the convenience of the licensee or staff. 2. Restrained or confined, in any way, as a disciplinary measure. 3. Restrained by the use of a physical device, other than in accordance with section 35 or under the common law duty referred to in section 39. 4. Restrained by the administration of a drug to control the resident, other than under the common law duty referred to in section 39. 5. Confined, other than in accordance with section 34.1 or under the common law duty referred to in section 39. 2021, c. 39, Sched. 1, s. 203 (8). Devices that resident can release (2) The use of a physical device from which a resident is both physically and cognitively able to release themself is not a restraining of the resident. 2021, c. 39, Sched. 1, s. 203 (8). Use of P…

34.1 (1) A resident may be confined as described in paragraph 5 of subsection 34 (1) if the confining of the resident is included in the resident’s plan of care. 2021, c. 39, Sched. 1, s. 203 (8). Provision in plan of care (2) The confining of a resident may be included in a resident’s plan of care only if all of the following are satisfied: 1. There is a significant risk that the resident or another person would suffer serious bodily harm if the resident were not confined. 2. Alternatives to confining the resident have been considered, and tried where appropriate, but would not be, or have not been, effective to address the risk referred to in paragraph 1. 3. The method and degree of confining are reasonable, in light of the resident’s physical and mental condition and personal history, and the method and degree are the least restrictive of the reasonable methods and degrees that would …

35 (1) A resident may be restrained by a physical device as described in paragraph 3 of subsection 34 (1) if the restraining of the resident is included in the resident’s plan of care. Provision in plan of care (2) The restraining of a resident by a physical device may be included in a resident’s plan of care only if all of the following are satisfied: 1. There is a significant risk that the resident or another person would suffer serious bodily harm if the resident were not restrained. 2. Alternatives to restraining the resident have been considered, and tried where appropriate, but would not be, or have not been, effective to address the risk referred to in paragraph 1. 3. The method of restraining is reasonable, in light of the resident’s physical and mental condition and personal history, and is the least restrictive of such reasonable methods that would be effective to address the r…

36 (1) This section applies to the use of a PASD if the PASD has the effect of limiting or inhibiting a resident’s freedom of movement and the resident is not able, either physically or cognitively, to release themself from the PASD. Definition of PASD (2) In this section, “PASD” means personal assistance services device, being a device used to assist a person with a routine activity of living. When PASD may be used (3) Every licensee of a long-term care home shall ensure that a PASD described in subsection (1) is used to assist a resident with a routine activity of living only if the use of the PASD is included in the resident’s plan of care. Inclusion in plan of care (4) The use of a PASD under subsection (3) to assist a resident with a routine activity of living may be included in a resident’s plan of care only if all of the following are satisfied: 1. Alternatives to the use of a PAS…

37 Every licensee of a long-term care home shall keep records in the home, as provided for in the regulations, in relation to the following: 1. The restraining of a resident. 2. The use of a PASD, within the meaning of section 36.

38 Every licensee of a long-term care home shall ensure that no device provided for in the regulations is used on a resident, (a) to restrain the resident; or (b) to assist a resident with a routine activity of living, if the device would have the effect of limiting or inhibiting the resident’s freedom of movement. Note: On a day to be named by proclamation of the Lieutenant Governor, section 38 of the Act is amended by adding the following subsection: (See: 2021, c. 39, Sched. 1, s. 203 (9)) Same, confinement (2) Every licensee of a long-term care home shall ensure that no device provided for in the regulations is used to confine a resident. 2021, c. 39, Sched. 1, s. 203 (9). Section Amendments with date in force (d/m/y) 2021, c. 39, Sched. 1, s. 203 (9) - not in force

39 (1) Nothing in this Act affects the common law duty of a caregiver to restrain or confine a person when immediate action is necessary to prevent serious bodily harm to the person or to others. Restraining by physical device under common law duty (2) If a resident is being restrained by a physical device pursuant to the common law duty referred to in subsection (1), the licensee shall ensure that the device is used in accordance with any requirements provided for in the regulations and that any other requirements provided for in the regulations are satisfied. Restraining by administration of drug, etc., under common law duty (3) A resident may not be restrained by the administration of a drug pursuant to the common law duty referred to in subsection (1) unless the administration of the drug is ordered by a physician or other person provided for in the regulations. Same (4) If a residen…

Office of the Long-Term Care Homes Resident and Family Adviser

40 The Minister may establish an Office of the Long-Term Care Homes Resident and Family Adviser to, (a) assist and provide information to residents and their families and others; (b) advise the Minister on matters and issues concerning the interests of residents; and (c) perform any other functions provided for in the regulations or assigned by the Minister.

Regulations

41 (1) The Lieutenant Governor in Council may make regulations for carrying out the purposes and provisions of this Part. Specific inclusions (2) Without restricting the generality of subsection (1), the Lieutenant Governor in Council may make regulations, (a) governing anything that a licensee is required to do, ensure or provide under this Part, including establishing standards or outcomes that must be met; (b) governing temperature requirements for long-term care homes; (c) requiring and governing the assessment and classification of residents for the purpose of determining care requirements and other needs of residents; (d) governing the mission statements provided for in section 4 and the requirements under that section; (e) governing plans of care, including governing their development and implementation and setting requirements in addition to what is required under section 6; (f) …

PART III QUALITY

42 Every licensee of a long-term care home shall implement a continuous quality improvement initiative as provided for in the regulations.

43 (1) Every licensee of a long-term care home shall ensure that, unless otherwise directed by the Minister, at least once in every year a survey is taken of the residents, their families and caregivers to measure their experience with the home and the care, services, programs and goods provided at the home. Administration (2) Where the regulations provide for how the survey is to be administered, the licensee shall ensure that the survey is administered in the manner and in the form provided for in the regulations, and that it contains the content provided for in the regulations. Action (3) A licensee shall make every reasonable effort to act on the results of the survey and to improve the long-term care home and the care, services, programs and goods accordingly. Advice (4) The licensee shall seek the advice of the Residents’ Council and the Family Council, if any, in carrying out the …

44 (1) The Minister may establish a Long-Term Care Quality Centre. Functions, purposes (2) The functions and purposes of the Long-Term Care Quality Centre are, (a) to support mission-driven organizations; (b) to advance and share research on innovative and evidence-informed person-centred models of care; and (c) any other functions or purposes provided for in the regulations.

45 (1) The Lieutenant Governor in Council may make regulations for carrying out the purposes and provisions of this Part. Specific inclusions (2) Without restricting the generality of subsection (1), the Lieutenant Governor in Council may make regulations, (a) governing the requirements for a continuous quality improvement initiative, including its development and its implementation; (b) providing for and governing the survey of residents, families and caregivers, including its content, form and administration; (c) providing for and governing the composition and additional functions and purposes of the Long-Term Care Quality Centre; (d) providing for anything that under this Part may or must be provided for in regulations, or that is to be done in compliance with or in accordance with the regulations.

PART IV ADMISSION OF RESIDENTS

46 (1) This Part applies to the admission of a person to a long-term care home as a resident and any transfer within a home to a specialized unit. Transfer (2) Where a person is to be transferred to a specialized unit within the long-term care home, this Part applies as though the transfer were an admission of the person to the home. Definition (3) In this section, “specialized unit” means any unit designated by or in accordance with the regulations to provide or offer certain types of accommodation, care, services, programs and goods to residents.

47 (1) The Minister shall designate one or more persons, classes of persons or other entities as placement co-ordinators for the long-term care homes in specified geographic areas. Ineligible persons and entities (2) The Minister shall not designate a person or entity if the person or entity is in a class of persons or entities described in the regulations as ineligible for designation as a placement co-ordinator. Changes in designations (3) The Minister may revoke a designation or make a new designation.

48 A placement co-ordinator shall act in accordance with this Act and the regulations.

49 The following are required in order for a person to be admitted as a resident of a long-term care home: 1. A placement co-ordinator must have determined that the person is eligible for long-term care home admission under section 50. 2. The placement co-ordinator for the geographic area where the home is located must have authorized the admission of the person to that specific home under section 51.

50 (1) A person may apply to a placement co-ordinator for a determination that the person is eligible for long-term care home admission. Criteria for eligibility (2) The criteria for determining eligibility for long-term care home admission shall be provided for in the regulations. Application in accordance with regulations (3) An application shall be made in accordance with the regulations. Required assessments (4) The placement co-ordinator shall determine whether or not the applicant is eligible for long-term care home admission only if the placement co-ordinator has the following: 1. An assessment of the applicant’s physical and mental health, and the applicant’s requirements for medical treatment and health care. 2. An assessment of the applicant’s, i. functional capacity, ii. requirements for personal care, iii. current behaviour, and iv. behaviour during the year preceding the ass…

51 (1) A person who has been determined to be eligible for long-term care home admission may apply to a placement co-ordinator for an authorization of admission, by the appropriate placement co-ordinator, to such long-term care home or homes as the person selects. Appropriate placement co-ordinator (2) In this section, “appropriate placement co-ordinator” means, in relation to a long-term care home, the placement co-ordinator designated pursuant to subsection 47 (1) for the geographic area where the home is located. Note: On a day to be named by proclamation of the Lieutenant Governor, section 51 of the Act is amended by adding the following subsections: (See: 2021, c. 39, Sched. 1, s. 203 (10)) Confinement to be considered (2.1) The placement co-ordinator who determined that the applicant is eligible for long-term care home admission shall consider whether the applicant may need to be c…

52 (1) The following are the elements required for consent to admission to a long-term care home: 1. The consent must relate to the admission. 2. The consent must be informed. 3. The consent must be given voluntarily. 4. The consent must not be obtained through misrepresentation or fraud. Informed consent (2) A consent to admission is informed if, before giving it, (a) the person received the information about the matters set out in subsection (3) that a reasonable person in the same circumstances would require in order to make a decision about the admission; and (b) the person received responses to their requests for additional information about those matters. Same (3) The matters referred to in subsection (2) are: 1. What the admission entails. 2. The expected advantages and disadvantages of the admission. 3. Alternatives to the admission. 4. The likely consequences of not being admitt…

53 A substitute decision-maker may apply on behalf of a person under section 50 or 51.

54 Responsibility for an application under section 50 or 51 may be transferred, with the consent of the applicant, from one placement co-ordinator to another and, upon such a transfer being made, the new placement co-ordinator shall be deemed, for the purposes of this Part, to be the placement co-ordinator to whom the application was made.

55 A licensee of a long-term care home shall not admit a person unless the person’s admission to the home is authorized by the placement co-ordinator for the geographic area where the home is located, and shall admit a person whose admission is so authorized.

56 (1) If the Director believes there is a risk of harm to the health or well-being of residents of a long-term care home or persons who might be admitted as residents, the Director may direct the placement co-ordinator for the geographic area where the home is located to cease authorizing admissions to the home for such period of time and subject to such conditions as the Director specifies. Compliance with direction (2) A placement co-ordinator who receives a direction under subsection (1) shall comply with it.

57 The Minister shall ensure that preference is given to veterans for access to beds that, (a) are located in long-term care homes for which funding is provided under an agreement between the Government of Ontario and the Government of Canada relating to veterans; and (b) are designated by the Minister as veterans’ priority access beds.

58 (1) No action or other proceeding shall be commenced against an employee or agent of a placement co-ordinator for any act done in good faith in the performance or intended performance of the person’s duty or for any alleged neglect or default in the performance in good faith of the person’s duty. Placement co-ordinator’s liability (2) Subsection (1) does not relieve a placement co-ordinator of liability for the acts or omissions of its employees or agents.

59 (1) When the Appeal Board receives an application for a review of a determination of ineligibility, it shall promptly appoint a time and place for a hearing. Same (2) The hearing shall begin within 21 days after the day the Appeal Board receives the application for the hearing, unless the parties agree to a postponement. Notice to parties (3) The Appeal Board shall notify each of the parties of the time and place of the hearing at least seven days before the hearing begins. Parties (4) The parties to the proceeding before the Appeal Board are the applicant who was determined to be ineligible for admission, the placement co-ordinator who made the determination and such other parties as the Appeal Board specifies. Notice to Minister (5) When a placement co-ordinator is notified by the Appeal Board of a hearing, the placement co-ordinator shall promptly give the Minister written notice o…

60 (1) A party to a review of the determination of ineligibility by the Appeal Board may appeal its decision to the Divisional Court on a question of law or fact or both, in accordance with the rules of court. Record (2) If a party appeals a decision of the Appeal Board to the Divisional Court under this section, the Appeal Board shall promptly file with the Divisional Court the record of the proceeding before the Appeal Board and the transcript of the evidence taken before the Appeal Board, which together constitute the record in the appeal. Minister to be notified (3) The placement co-ordinator who commences or is given notice of an appeal shall promptly give the Minister written notice of the appeal. Minister to be heard (4) The Minister is entitled to be heard by counsel or otherwise on the argument of an appeal under this section. Powers of court on appeal (5) On an appeal under thi…

60.1 (1) This section applies to a person who, (a) occupies a bed in a hospital under the Public Hospitals Act; and (b) has been designated by an attending clinician in the hospital as requiring an alternate level of care because, in the clinician’s opinion, the person does not require the intensity of resources or services provided in the hospital care setting. 2022, c. 16, s. 2. Definitions (2) For the purposes of this section, “ALC patient” means a person described in subsection (1); (“patient en NSD”) “attending clinician” means a person who is authorized under the Public Hospitals Act to issue a discharge order for the ALC patient. (“clinicien traitant”) 2022, c. 16, s. 2. Certain actions may be performed without consent (3) This section authorizes the following actions, or any part thereof, to be performed in respect of an ALC patient without their consent or the consent of their s…

61 (1) The Lieutenant Governor in Council may make regulations for carrying out the purposes and provisions of this Part. 2021, c. 39, Sched. 1, s. 61 (1). Specific inclusions (2) Without restricting the generality of subsection (1), the Lieutenant Governor in Council may make regulations, (a) governing determinations of eligibility for long-term care home admission; (b) governing authorizations of admission to long-term care homes, including, without limiting the generality of the foregoing, (i) providing for priorities for persons in circumstances specified in the regulations or for classes of persons specified in the regulations, (ii) governing the notices to be given by licensees under subsections 51 (8) and (9); (c) governing placement co-ordinators, including, without limiting the generality of the foregoing, (i) providing for classes of persons or entities that are ineligible to b…

PART V COUNCILS

Residents’ Council

62 (1) Every licensee of a long-term care home shall ensure that a Residents’ Council is established in the home. Only residents (2) Only residents of the long-term care home may be members of the Residents’ Council.

63 (1) A Residents’ Council of a long-term care home has the power to do any or all of the following: 1. Advise residents respecting their rights and obligations under this Act. 2. Advise residents respecting the rights and obligations of the licensee under this Act and under any agreement relating to the home. 3. Attempt to resolve disputes between the licensee and residents. 4. Sponsor and plan activities for residents. 5. Collaborate with community groups and volunteers concerning activities for residents. 6. Advise the licensee of any concerns or recommendations the Council has about the operation of the home. 7. Provide advice and recommendations to the licensee regarding what the residents would like to see done to improve care or the quality of life in the home. 8. Report to the Director any concerns and recommendations that in the Council’s opinion ought to be brought to the Dire…

64 (1) Every licensee of a long-term care home shall appoint a Residents’ Council assistant who is acceptable to that Council to assist the Residents’ Council. Duties (2) In carrying out their duties, a Residents’ Council assistant shall take instructions from the Residents’ Council, ensure confidentiality where requested and report to the Residents’ Council.

Family Council

65 (1) Every long-term care home may have a Family Council. Request for Family Council (2) If there is no Family Council, a family member of a resident or a person of importance to a resident may request the establishment of a Family Council for a long-term care home. Licensee to assist (3) The licensee shall assist in the establishment of a Family Council within 30 days of receiving a request from a person mentioned in subsection (2). Notification of Director (4) When a Family Council is established, the licensee shall notify the Director or anyone else provided for in the regulations of the fact within 30 days of the establishment. Right to be a member (5) Subject to subsection (6), a family member of a resident or a person of importance to a resident is entitled to be a member of the Family Council of a long-term care home. Who may not be a member (6) The following persons may not be …

66 (1) A Family Council of a long-term care home has the power to do any or all of the following: 1. Provide assistance, information and advice to residents, family members of residents and persons of importance to residents, including when new residents are admitted to the home. 2. Advise residents, family members of residents and persons of importance to residents respecting their rights and obligations under this Act. 3. Advise residents, family members of residents and persons of importance to residents respecting the rights and obligations of the licensee under this Act and under any agreement relating to the home. 4. Attempt to resolve disputes between the licensee and residents. 5. Sponsor and plan activities for residents. 6. Collaborate with community groups and volunteers concerning activities for residents. 7. Review, i. inspection reports and summaries received under section …

67 (1) If the Family Council so requests, the licensee shall appoint a Family Council assistant who is acceptable to that Council to assist the Family Council. Duties (2) In carrying out their duties, a Family Council assistant shall take instructions from the Family Council, ensure confidentiality where requested and report to the Family Council.

General

68 A licensee shall co-operate with the Residents’ Council, the Family Council, the Residents’ Council assistant and the Family Council assistant and shall provide them with such financial and other information and such assistance as is provided for in the regulations.

69 If invited by the Residents’ Council or the Family Council, the licensee shall meet with that Council or, if the licensee is a corporation, ensure that representatives of the licensee meet with that Council.

70 A licensee of a long-term care home shall attend a meeting of the Residents’ Council or the Family Council only if invited, and shall ensure that the staff, including the Administrator, and other persons involved in the management or operation of the home attend a meeting of either Council only if invited.

71 A licensee of a long-term care home, (a) shall not interfere with the meetings or operation of the Residents’ Council or the Family Council; (b) shall not prevent a member of the Residents’ Council or Family Council from entering the long-term care home to attend a meeting of the Council or to perform any functions as a member of the Council and shall not otherwise hinder, obstruct or interfere with such a member carrying out those functions; (c) shall not prevent a Residents’ Council assistant or a Family Council assistant from entering the long-term care home to carry out their duties or otherwise hinder, obstruct or interfere with such an assistant carrying out those duties; and (d) shall ensure that no staff member, including the Administrator or other person involved in the management or operation of the home, does anything that the licensee is forbidden to do under clauses (a) t…

72 No action or other proceeding shall be commenced against a member of a Residents’ Council or Family Council or a Residents’ Council assistant or Family Council assistant for anything done or omitted to be done in good faith in the capacity as a member or an assistant.

73 A licensee has a duty to consult regularly with the Residents’ Council, and with the Family Council, if any, and in any case shall consult with them at least every three months.

74 (1) The Lieutenant Governor in Council may make regulations for carrying out the purposes and provisions of this Part. Specific inclusions (2) Without restricting the generality of subsection (1), the Lieutenant Governor in Council may make regulations, (a) requiring a licensee to assist in the formation of Residents’ Councils and Family Councils, and governing the assistance that the licensee is required to provide to those Councils; (b) respecting and governing the duties of Residents’ Councils and Family Councils; (c) defining “detailed allocation” for the purpose of subparagraph 9 iii of subsection 63 (1) and subparagraph 7 iii of subsection 66 (1); (d) providing for anything that under this Part may or must be provided for in regulations, or that is to be done in compliance with or in accordance with the regulations.

PART VI OPERATION OF HOMES

Directors, Officers and Other Staff

75 (1) Where a licensee is a corporation, every director and every officer of the corporation shall ensure that the corporation complies with all requirements under this Act. Municipal Homes and First Nations Homes (2) In the case of a long-term care home approved under Part IX, (a) if there is a committee of management for the home under section 135, the obligation under subsection (1) is an obligation on every member of that committee; and (b) if there is a board of management for the home under section 128 or 132, the obligation under subsection (1) is an obligation on every member of that board. Offence (3) Every person who fails to comply with this section is guilty of an offence. Corporate prosecution not necessary (4) A person may be prosecuted and convicted under this section even if the corporation has not been prosecuted or convicted.

76 (1) Every licensee of a long-term care home shall ensure that the home has an Administrator. Role (2) The Administrator, (a) shall be in charge of the long-term care home and be responsible for its management; and (b) shall perform any other duties provided for in the regulations. Time must work in position (3) If the number of beds at a long-term care home is, (a) equal to or greater than the prescribed number of beds, the licensee of the home shall ensure that the Administrator works full-time in that position; or (b) less than the prescribed number of beds, the licensee of the home shall ensure that the Administrator works in that position, on average, at least the number of hours per week that is prescribed for the number of beds at the home.

77 (1) Every licensee of a long-term care home shall ensure that the long-term care home has a Director of Nursing and Personal Care. Must be R.N. (2) The Director of Nursing and Personal Care shall be a registered nurse. Role (3) The Director of Nursing and Personal Care, (a) shall supervise and direct the nursing staff and personal care staff of the long-term care home and the nursing and personal care provided by them; and (b) shall perform any other duties provided for in the regulations. Time must work in position (4) If the number of beds at a long-term care home is, (a) equal to or greater than the prescribed number of beds, the licensee of the home shall ensure that the Director of Nursing and Personal Care works full-time in that position; or (b) less than the prescribed number of beds, the licensee of the home shall ensure that Director of Nursing and Personal Care works in tha…

78 (1) Every licensee of a long-term care home shall ensure that the home has a Medical Director. Must be physician (2) The Medical Director shall be a physician. Role (3) The Medical Director, (a) shall advise the licensee on matters relating to medical care in the long-term care home; and (b) shall perform any other duties provided for in the regulations. Must consult (4) In performing their duties under clause (3) (a), the Medical Director shall consult with the Director of Nursing and Personal Care and other health professionals working in the long-term care home.

79 Every licensee of a long-term care home shall ensure that all the staff of the home, including the persons mentioned in sections 76 to 78, (a) have the proper skills and qualifications to perform their duties; and (b) possess the qualifications provided for in the regulations.

80 (1) In order to provide a stable and consistent workforce and to improve continuity of care to residents, every licensee of a long-term care home shall ensure that the use of temporary, casual or agency staff is limited in accordance with the regulations. Agency staff (2) In subsection (1), “agency staff” means staff who work at the long-term care home pursuant to a contract between the licensee and an employment agency or other third party.

81 (1) Every licensee of a long-term care home shall ensure that screening measures are conducted in accordance with the regulations before hiring staff and accepting volunteers. Police record checks (2) The screening measures shall include police record checks, unless the person being screened is under 18 years of age. When agency staff is hired (3) For the purposes of subsection (1), a staff member who is agency staff, as that term is defined in subsection 80 (2), is considered to be hired when they first work at the home. Where convicted of certain offences, etc. (4) Every licensee of a long-term care home shall ensure that no staff member is hired and no volunteer accepted by the licensee if they have been, (a) convicted of an offence prescribed in the regulations; or (b) found guilty of an act of professional misconduct prescribed in the regulations. Same (5) No licensee shall permi…

82 (1) Every licensee of a long-term care home shall ensure that all staff at the home have received training as required by this section. Orientation (2) Every licensee shall ensure that no person mentioned in subsection (1) performs their responsibilities before receiving training in the areas mentioned below: 1. The Residents’ Bill of Rights. 2. The long-term care home’s mission statement. 3. The long-term care home’s policy to promote zero tolerance of abuse and neglect of residents. 4. The duty under section 28 to make mandatory reports. 5. The protections afforded by section 30. 6. The long-term care home’s policy to minimize the restraining of residents. Note: On a day to be named by proclamation of the Lieutenant Governor, paragraph 6 of subsection 82 (2) of the Act is amended by striking out “restraining” and substituting “restraining and confining”. (See: 2021, c. 39, Sched. 1,…

83 Every licensee of a long-term care home shall develop and implement an orientation program for volunteers that includes information on, (a) the Residents’ Bill of Rights; (b) the long-term care home’s mission statement; (c) the long-term care home’s policy to promote zero tolerance of abuse and neglect of residents; (d) the duty under section 28 to make mandatory reports; (e) fire safety and universal infection control practices; (f) any other areas provided for in the regulations; and (g) the protections afforded by section 30.

Residents — Information, Agreements, etc.

84 (1) Every licensee of a long-term care home shall ensure that, (a) a package of information that complies with this section is given to every resident and to the substitute decision-maker of the resident, if any, at the time that the resident is admitted; (b) the package of information is made available to family members of residents and persons of importance to residents; (c) the package of information is revised as necessary; (d) any material revisions to the package of information are provided to any person who has received the original package and who is still a resident or substitute decision-maker of a resident; and (e) the contents of the package and of the revisions are explained to the person receiving them. Contents (2) The package of information shall include, at a minimum, (a) the Residents’ Bill of Rights; (b) the long-term care home’s mission statement; (c) the long-term…

85 (1) Every licensee of a long-term care home shall ensure that the required information is posted in the home, in a conspicuous and easily accessible location in a manner that complies with the requirements, if any, established by the regulations. Communication (2) Every licensee of a long-term care home shall ensure that the required information is communicated, in a manner that complies with any requirements that may be provided for in the regulations, to residents who cannot read the information. Required information (3) The required information for the purposes of subsections (1) and (2) is, (a) the Residents’ Bill of Rights; (b) the long-term care home’s mission statement; (c) the long-term care home’s policy to promote zero tolerance of abuse and neglect of residents; (d) an explanation of the duty under section 28 to make mandatory reports; (e) the long-term care home’s procedur…

86 (1) Every licensee of a long-term care home shall ensure that no regulated document is presented for signature to a resident or prospective resident, a substitute decision-maker of a resident or prospective resident or a family member of a resident or prospective resident, unless, (a) the regulated document complies with all the requirements of the regulations; and (b) the compliance has been certified by a lawyer. Interpretation (2) For the purposes of this section, a “regulated document” is a document, (a) that is required by the regulations to meet certain requirements; and (b) that is described as a regulated document in the regulations.

87 (1) An agreement between a licensee and a resident or prospective resident, a substitute decision-maker of a resident or prospective resident, or a family member of a resident or prospective resident is voidable by the resident, prospective resident, substitute decision-maker or family member for 10 days after it is made. Obligations incurred before voiding (2) The voiding of an agreement under subsection (1) does not relieve any person from liability for charges that were incurred before the voiding. Preferred accommodation (3) Subsection (1) does not apply to an agreement under paragraph 2 of subsection 94 (1) except as provided for in the regulations.

88 An agreement with a licensee cannot prevent a consent or directive with respect to treatment or care from being withdrawn or revoked.

89 (1) Every licensee of a long-term care home shall ensure that no person is told or led to believe that a prospective resident will be refused admission or that a resident will be discharged from the home because, (a) a document has not been signed; (b) an agreement has been voided; or (c) a consent or directive with respect to treatment or care has been given, not given, withdrawn or revoked. Saving (2) Subsection (1) does not apply with respect to a consent that is required by law for admission to a long-term care home .

General Management

90 (1) Every licensee of a long-term care home shall ensure that there are emergency plans in place for the home that comply with the regulations, including, (a) measures for dealing with, responding to and preparing for emergencies, including, without being limited to, epidemics and pandemics; and (b) procedures for evacuating and relocating the residents, and evacuating staff and others in case of an emergency. Testing of plans (2) Every licensee of a long-term care home shall ensure that the emergency plans are tested, evaluated, updated and reviewed with the staff of the home as provided for in the regulations. Attestation (3) Every licensee of a long-term care home shall prepare an attestation attesting to compliance with this section and shall maintain a record of every attestation. Requirements (4) The licensee shall comply with every requirement respecting the attestation that ma…

91 (1) Every licensee of a long-term care home shall submit reports to the Director as provided for in the regulations. Same (2) The Director may at any time request a licensee to submit a report to the Director on any matter, in a form acceptable to the Director, and the licensee shall comply with such a request.

Regulations

92 (1) The Lieutenant Governor in Council may make regulations for carrying out the purposes and provisions of this Part. Specific inclusions (2) Without restricting the generality of subsection (1), the Lieutenant Governor in Council may make regulations, (a) governing how drugs in long-term care homes are dealt with, including, without restricting the generality of the foregoing, governing their administration, handling and storage, requiring their destruction in specified circumstances, allowing licensees to restrict from whom drugs may be supplied and placing restrictions on who may have drugs in their possession; (b) relating to the use of psychotropic drugs in long-term care homes, including requiring a licensee of a home to discuss the use of such drugs with the Medical Director of the home and requiring the Medical Director to prepare reports and advise the licensee on the use of…

PART VII FUNDING

93 (1) The Minister may provide funding for a long-term care home. Conditions (2) The Minister may attach conditions to funding provided under subsection (1), including how funding may be used. Restrictions (3) The provision of funding under subsection (1) is subject to any other conditions, rules and restrictions that may be provided for in the regulations, including requirements relating to eligibility to receive funding or how funding may be used. Set-off (4) Amounts owed to the Crown, including the Agency, may be set off against funding that would otherwise be provided under subsection (1).

94 (1) A licensee shall not charge a resident for anything, except in accordance with the following: 1. For basic accommodation, a resident shall not be charged more than the amount provided for in the regulations for the accommodation provided. 2. For preferred accommodation, a resident shall not be charged more than can be charged for basic accommodation in accordance with paragraph 1 unless the preferred accommodation was provided under an agreement, in which case the resident shall not be charged more than the amount provided for in the regulations for the accommodation provided. 3. For anything other than accommodation, a resident shall be charged only if it was provided under an agreement and shall not be charged more than the amount provided for in the regulations, or, if no amount is provided for, more than a reasonable amount. 4. Despite paragraph 3, a resident shall not be char…

95 Every licensee of a long-term care home shall keep accounts and records with respect to each long-term care home operated by the licensee, (a) that are separate from the accounts and records of any other long-term care home operated by the licensee, and from any other business of the licensee; and (b) that meet any other requirements that may be provided for in the regulations.

96 (1) A licensee shall not enter into a non-arm’s length transaction that is prohibited by the regulations. Same (2) A licensee shall not enter into a non-arm’s length transaction without the prior consent of the Director if the regulations require such consent for that type of non-arm’s length transaction. Reporting (3) Every licensee of a long-term care home shall submit reports to the Director, as provided for in the regulations, on every non-arm’s length transaction entered into by the licensee.

97 (1) The Lieutenant Governor in Council may make regulations for carrying out the purposes and provisions of this Part. Specific inclusions (2) Without restricting the generality of subsection (1), the Lieutenant Governor in Council may make regulations, (a) respecting and governing rules, conditions and restrictions to which the provision of funding under this Act is subject; (b) governing charges for the purposes of section 94, including prescribing different charges for different kinds of basic and preferred accommodation; (c) providing that a resident may apply to the Director for a reduction in the charges for accommodation that would otherwise be required to be paid by the resident on the condition that the Minister pays the licensee the difference between the reduced amount and the amount that would otherwise be charged, and providing for rules governing such an application and …

PART VIII LICENSING

98 (1) No person shall operate residential premises for persons requiring nursing care or in which nursing care is provided to two or more unrelated persons except under the authority of a licence under this Part or an approval under Part IX. Exclusions (2) Subsection (1) does not apply to, (a) premises falling under the jurisdiction of, (i) the Child, Youth and Family Services Act, 2017, (ii) the Private Hospitals Act, (iii) the Public Hospitals Act, or (iv) the Retirement Homes Act, 2010; or (b) other premises provided for in the regulations. Offence (3) Every person who contravenes subsection (1) is guilty of an offence. Section Amendments with date in force (d/m/y) 2021, c. 39, Sched. 1, s. 203 (20) - no effect - see 2023, c. 4, Sched. 1, s. 79 (1) - 18/05/2023

99 (1) Subject to subsection (2), the Minister shall determine whether or not there should be a long-term care home in an area, and how many long-term care home beds there should be in an area, by considering what is in the public interest, having taken into account, (a) the long-term care home bed capacity that exists, (i) in the area, or (ii) in the area and any other area; (b) the other facilities or services that are available, (i) in the area, or (ii) in the area and any other area; (c) the current and predictable continuing demand for long-term care home beds, (i) in the area, or (ii) in the area and any other area; (d) the funds available for long-term care homes in Ontario; (e) any other matters that may be provided for in the regulations; and (f) any other matters that the Minister considers to be relevant. Exception, Minister’s policy (2) The Minister is not required to make a …

100 (1) The Minister may restrict who may be issued a licence based on what the Minister considers to be in the public interest, having taken into account, (a) the effect that issuing the licence would have on the concentration of ownership, control or management of long-term care homes, (i) in the area, (ii) in the area and any other area, or (iii) in Ontario; (b) the effect that issuing the licence would have on the balance between non-profit and for-profit long-term care homes, (i) in the area, (ii) in the area and any other area, or (iii) in Ontario; and (c) any other matters that may be provided for in the regulations. How determined (2) The Minister may make a restriction in a particular case of an application for a licence or, where the Minister has made a policy respecting the matters described in subsection (1), the Director may decide whether an application is covered by the po…

101 (1) A person is only eligible to be issued a licence for a long-term care home if, in the Director’s opinion, (a) the home and its operation would comply with this Act and the regulations and any other applicable Act, regulation or municipal by-law; (b) where the home is subject to a development agreement, the home, or the beds that are subject to a development agreement, complies with, and will continue to comply with, the applicable design manual and any additional design requirements required under the development agreement; (c) the past conduct relating to the operation of a long-term care home or any other matter or business of the following affords reasonable grounds to believe that the home will be operated in accordance with the law and with honesty and integrity: (i) the person, (ii) if the person is a corporation, the officers and directors of the corporation and any other …

102 Following a determination by the Minister or a decision of the Director under section 99, the Director may issue a licence for a long-term care home at the location specified in the licence subject to any restrictions under section 100 and subject to section 101. 2021, c. 39, Sched. 1, s. 102; 2022, c. 16, s. 4. Section Amendments with date in force (d/m/y) 2022, c. 16, s. 4 - 31/08/2022

103 (1) Following a determination by the Minister or a decision of the Director under section 99, the Director may, subject to any restrictions under section 100 and subject to section 101, give an undertaking to issue a licence to a person on condition that the person agrees to satisfy the specified conditions set out in the undertaking. 2021, c. 39, Sched. 1, s. 103 (1); 2022, c. 16, s. 4. Form of undertaking (2) An undertaking shall be in two parts, one to be described as “non-amendable components” and the other to be described as “amendable components”. 2021, c. 39, Sched. 1, s. 103 (2). Non-amendable components (3) The non-amendable components shall consist of, (a) a description of where the long-term care home will be; (b) the following aspects of the licence to be issued: (i) the number, class and type of beds, (ii) the term of the licence, and (iii) any conditions the licence is …

104 (1) A licence is subject to the conditions, if any, that are provided for in the regulations. Additional conditions (2) The Director may make a licence subject to conditions other than those provided for in the regulations, (a) at the time a licence is issued, with or without the consent of the licensee; or (b) at the time a licence is reissued under section 108, with or without the consent of the new licensee. Conditions of licence (3) It is a condition of every licence that the licensee shall comply with this Act, the Connecting Care Act, 2019, the regulations, and every directive issued, order made or agreement entered into under this Act and those Acts. Licensee must comply (4) Every licensee shall comply with the conditions to which the licence is subject.

105 (1) A licence shall be issued for a fixed term, specified in the licence, which shall not exceed 30 years. Expiry at end of term (2) A licence expires at the end of its fixed term. Revocation for cause (3) Nothing in this section prevents a licence from being revoked under section 159.

106 (1) The Director may make a policy respecting the obligations of a licensee with regard to the end of the term of a licence, and every licensee shall comply with the policy. Making policy available (2) If the Director makes a policy under subsection (1), the Director shall ensure that the policy is made available to the public. Non-application of Legislation Act, 2006 (3) Part III (Regulations) of the Legislation Act, 2006 does not apply to a policy made by the Director under subsection (1). Surrender (4) Prior to the end of the term of a licence, a licensee shall not surrender the licence except, (a) with the consent of the Director; or (b) as may be provided for in this Act or the regulations.

107 (1) A licensee shall not operate more beds in a long-term care home than are allowed under the licence for the home or under the terms of a temporary licence issued under section 114 or a temporary emergency licence issued under section 115. Beds must be available (2) Every licensee shall ensure that all the beds that are allowed under the licence are occupied or are available for occupation. Reduction of licensed beds (3) If beds are unoccupied and unavailable for occupancy for 14 consecutive days or more, and the licensee did not obtain written permission from the Director for them not to be available for occupancy, the Director may, by order served on the licensee, (a) amend the licence to reduce the number of beds allowed under the licence by the number of unoccupied and unavailable beds; or (b) impose any conditions on the licence that are provided for in the regulations. Appeal…

108 (1) A licence, or beds under a licence, may not be transferred except by the Director in accordance with this section. 2021, c. 39, Sched. 1, s. 108 (1). If change of location (2) A transfer that results in a change of the location specified in the licence, including a change of location of beds, may only be made following a determination or decision under section 99. 2021, c. 39, Sched. 1, s. 108 (2). Application of Minister’s restrictions, etc. (3) All transfers are subject to any restrictions under section 100 and subject to section 101. 2021, c. 39, Sched. 1, s. 108 (3); 2022, c. 16, s. 4. Request for Director’s approval (4) A request for approval of a proposed transfer may be submitted to the Director for the Director’s consideration. 2021, c. 39, Sched. 1, s. 108 (4). Transfer of licences (5) Where the Director gives approval, a licence may be transferred by being surrendered t…

109 (1) Subject to subsection (3), the Director shall consult the public before, (a) issuing a licence for a new long-term care home under section 102; (b) undertaking to issue a licence under section 103; (c) transferring a licence, or beds under a licence, under section 108; or (d) amending a licence to increase the number of beds or to extend the term of the licence under section 116. Public consultation, format (2) The Director may determine how public consultations under subsection (1) shall be conducted. Exception (3) The Director is not required to consult the public under subsection (1) or under any other provision of this Act where the Director, (a) has determined that a public consultation is not warranted in the circumstances; or (b) has made a policy governing types of circumstances in which public consultation is not warranted, and the policy applies to the circumstances, un…

110 (1) No person may acquire control over, or interfere with, the operation of a long-term care home by exercising a security interest except through a contract under section 113 under which another person manages the home. Application of Act if management contract used (2) If a person exercising a security interest enters into a contract under section 113, then, subject to the regulations, if any, this Act applies, with necessary modifications, to that person as though that person were acting as the licensee. No transfer of licence except under s. 108 (3) No exercise of a security interest in a licence results in a transfer of the licence but this subsection does not limit the transfer of the licence under section 108. Section applies to receivers, etc. (4) This section applies, with necessary modifications, to a receiver or trustee in bankruptcy as though the receiver or trustee was a…

111 (1) A licensee that is a corporation shall notify the Director in writing within 15 days of any change in the officers or directors of the corporation. Same (2) A licensee shall immediately notify the Director in writing if the licensee has reason to believe that a person has gained a controlling interest in the licensee. Same, management contract (3) Where a long-term care home is managed by a person under a contract under section 113, the licensee of the home shall immediately notify the Director in writing if the licensee has reason to believe that anything mentioned in subsection (1) or (2) has occurred with respect to the person.

112 (1) A person that by any method gains a controlling interest in a licensee shall obtain the approval of the Director, unless the regulations provide otherwise. Director’s approval (2) The approval by the Director is subject to any restrictions under section 100 and subject to section 101 as those sections would apply with respect to the licensee if the person had already gained a controlling interest in the licensee, unless the regulations provide otherwise. Attachment of conditions (3) The Director may attach conditions to an approval. Regulations may provide for timing, process (4) The regulations may provide for when the approval of the Director must be obtained and for the process for obtaining such approval.

113 (1) A licensee of a long-term care home shall not allow anyone else to manage the home except pursuant to a written contract approved by the Director. 2021, c. 39, Sched. 1, s. 113 (1). Does not apply to Administrator (2) Subsection (1) does not apply to the management of the home by the Administrator. 2021, c. 39, Sched. 1, s. 113 (2). Compliance with regulations (3) The contract described in subsection (1) must comply with any requirements established by the regulations. 2021, c. 39, Sched. 1, s. 113 (3). Approval by Director (4) The following apply with respect to the approval by the Director of a contract described in subsection (1): 1. Before approving the contract, the Director must be satisfied that the contract complies with any requirements established by the regulations. 2. The approval by the Director is subject to section 101 as if the person who would manage the long-ter…

114 (1) The Director may issue a temporary licence, (a) authorizing premises to be used as a long-term care home on a temporary basis; or (b) authorizing temporary additional beds at a long-term care home. Rules for temporary licence (2) The following apply with respect to a temporary licence: 1. The licence may be revoked by the Director at any time on the giving of the notice provided for in the licence, as well as being revocable under section 159. 2. The licence may be issued for a term of no more than five years, and may not be renewed. 3. No interest in a temporary licence, including a beneficial interest, may be transferred. Provisions that do not apply (3) The following provisions do not apply with respect to a temporary licence: 1. Section 108. 2. Section 109. 3. Any other provisions provided for in the regulations.

115 (1) Subject to any restrictions or requirements that may be prescribed by regulation, in order to accommodate persons affected by a temporary emergency, the Director may issue a temporary emergency licence, (a) authorizing premises to be used as a long-term care home on a temporary basis; or (b) authorizing temporary additional beds at a long-term care home. Conditions of temporary emergency licence (2) Except as otherwise specified in writing by the Director, it is a condition of the temporary emergency licence that the only persons who may be admitted to a bed under the authority of the licence are persons affected by the temporary emergency. Rules for temporary emergency licence (3) The following apply with respect to a temporary emergency licence: 1. The licence may be revoked by the Director at any time on the giving of the notice provided for in the licence, as well as being re…

116 (1) The Director may amend a licence with the consent of the licensee, subject to the restrictions in this section and the regulations. 2021, c. 39, Sched. 1, s. 116 (1). Amendments that are not allowed (2) A licence may not be amended under this section to, (a) change the licensee or the location of the home; (b) extend the term; (c) increase the preferred accommodation the licensee is allowed to provide; or (d) make any other change provided for in the regulations. 2021, c. 39, Sched. 1, s. 116 (2). Extension in certain cases (3) Despite clause (2) (b), a licence may be amended under this section to extend its term where there is, (a) a substantial renovation of the home; or (b) a significant addition of beds to the home. 2021, c. 39, Sched. 1, s. 116 (3). Limitations — increase in number of beds (4) The amendment of a licence under this section to increase the number of beds or ex…

117 A competitive process may be used, but is not required, before a licence is issued or amended under this Part or before an approval is granted or amended under Part IX.

118 (1) Anything done by the Minister or the Director under this Part in respect of sections 99 and 100 is within the sole discretion of the Minister or Director and is not subject to an appeal. Same, Director (2) Decisions of the Director under this Part with respect to the term of a licence, number of beds, or any other condition of a licence are within the sole discretion of the Director and are not subject to an appeal. Note: Section 119 of this Act is not yet in force. It comes into force on a day to be named by proclamation of the Lieutenant Governor.

119 (1) A person, including a licensee, may request the Minister to review a decision of the Director under this Part with respect to a decision to, (a) issue or not to issue a licence; (b) approve or not approve the transfer of a licence or beds under a licence; or (c) give or not to give an undertaking to issue a licence. Conditions and process (2) A Minister’s review under subsection (1) is subject to the conditions and process provided for in the regulations. Minister’s decision (3) Following a review under subsection (1), the Minister may make any decision provided for in the regulations.

120 (1) The Lieutenant Governor in Council may make regulations for carrying out the purposes and provisions of this Part. Specific inclusions (2) Without restricting the generality of subsection (1), the Lieutenant Governor in Council may make regulations, (a) defining “nursing care” for the purposes of subsection 98 (1); (b) governing and clarifying how clauses 100 (1) (a) and (b) are to be applied; (c) defining “design manual” for the purposes of section 101; (d) governing public consultation for the purposes of section 109 and governing requirements and restrictions with respect to any determination or policy of the Director under that section; (e) for the purposes of section 110, requiring a person exercising a security interest to satisfy requirements provided for in the regulations before the person can enter into a contract described in section 113, establishing and respecting li…

PART IX MUNICIPAL HOMES AND FIRST NATIONS HOMES

Interpretation

121 In this Part, “joint home” means a home established pursuant to an agreement made under section 123 or 126; (“foyer commun”) “municipal home” means a home established under section 122, 125 or 128; (“foyer municipal”) “northern municipality” means a municipality in a territorial district as set out in regulations under the Territorial Division Act, 2002, but does not include The District Municipality of Muskoka; (“municipalité du Nord”) “southern municipality” means a municipality that is not a northern municipality. (“municipalité du Sud”)

Southern Homes

122 (1) Every southern municipality that is an upper or single-tier municipality shall establish and maintain a municipal home and may establish and maintain municipal homes in addition to the home that is required. Alternative ways to meet requirement (2) The requirement in subsection (1) is met if the southern municipality participates in the establishment and maintenance of a joint home or helps maintain a municipal home or joint home under an agreement under section 124. Exception, Township of Pelee (3) This section does not apply to the Township of Pelee.

123 (1) Two or more southern municipalities that are required or permitted to establish and maintain a municipal home may, under an agreement with each other, establish and maintain a joint home. Approval required (2) No agreement may be entered into under subsection (1) without the approval in writing of the Minister.

124 (1) A southern municipality that is required or permitted to establish and maintain a municipal home but that is not maintaining a home or joint home may enter into an agreement with a municipality or municipalities maintaining a home or joint home to help maintain that home or joint home. Approval required (2) No agreement may be entered into under subsection (1) without the approval in writing of the Minister.

Northern Homes

125 A northern municipality that is an upper or single-tier municipality and that has a population of more than 15,000 may establish and maintain a municipal home.

126 (1) A northern municipality that is permitted to establish and maintain a municipal home and one or more other northern municipalities may, under an agreement with each other, establish and maintain a joint home. Must be in same district (2) The northern municipalities that enter into an agreement under subsection (1) must all be in the same territorial district. Approval required (3) No agreement may be entered into under subsection (1) without the approval in writing of the Minister.

127 (1) A northern municipality that is not maintaining a municipal home or joint home may enter into an agreement with a municipality or municipalities maintaining a home or joint home, or with a board of management maintaining a home, to help maintain that home or joint home. Approval required (2) No agreement may be entered into under subsection (1) without the approval in writing of the Minister.

128 (1) If a majority of the municipalities in a single territorial district pass by-laws authorizing the establishment and maintenance of a municipal home under a board of management, the following apply: 1. A certified copy of every by-law passed under this subsection shall be promptly transmitted to the Director. 2. If the Minister gives approval for the establishment of the home under section 133, a board of management shall be established as a corporation, by regulation, for the home. 3. The home shall be vested in the board of management and the board shall have charge of the home. 4. All the municipalities in the territorial district shall contribute to the establishment and maintenance of the municipal home. Non-application of Not-for-Profit Corporations Act, 2010 (2) The Not-for-Profit Corporations Act, 2010 does not apply to a board of management, except as provided for under t…

129 (1) A board of management shall determine the amount that it estimates will be required to defray its expenditures for each year and apportion that amount, in accordance with the regulations under section 131, among the municipalities in the district and shall on or before February 25 notify the clerk of each municipality of the amount to be provided by that municipality. Payment by municipality (2) Each municipality shall pay the amount apportioned to it. Operating reserve (3) In preparing the estimates, the board may provide for a reserve for working funds, but the amount of the reserve in a year shall not exceed the higher of, (a) 15 per cent of the total estimates of the board for the year; or (b) such other percentage or limit as may be prescribed by the regulations. Power of district homes to borrow for operating costs (4) Subject to subsections (5) and (6) and to any restricti…

130 (1) If a municipal home is to be established under a board of management, or an existing municipal home under a board of management is to be renovated, altered or added to, the board of management shall determine the amount that it estimates will be required and apportion that amount, in accordance with the regulations under section 131, among the municipalities in the district and shall notify the clerk of each municipality of the amount to be provided by that municipality. Payment by municipality (2) Each municipality shall pay the amount apportioned to it. Power of district homes to borrow for capital costs (3) In the circumstances prescribed by regulation and subject to any restrictions or requirements that may be prescribed by regulation, a board that meets the prescribed requirements may borrow such sums as the board considers necessary to meet the capital costs it estimates un…

131 (1) Despite any other Act, the Lieutenant Governor in Council may, with respect to a year, make regulations prescribing the basis on which apportionments are to be made by boards of management. Application for review (2) Where, in respect of any year, the council of a supporting municipality is of the opinion that an apportionment made pursuant to a regulation made under subsection (1) is incorrect because of an error, omission or failure set out in subsection (3), the supporting municipality may apply to the Director, within 30 days after notice of the apportionment was sent to the supporting municipality, for a review to determine the correct proportion of the apportionments that each supporting municipality shall bear in the year. Same (3) The errors, omissions and failures referred to in subsection (2) are, (a) an error or omission in the amount of the assessment of one or more s…

First Nations Homes

132 (1) A council of a band may establish and maintain a First Nations home under this section. Joint First Nations homes (2) The councils of two or more bands may, under an agreement with each other, establish and maintain a First Nations home under this section. Approval required (3) No agreement may be entered into under subsection (2) without the approval in writing of the Minister. Board of management (4) The following apply with respect to a First Nations home established under this section: 1. If the Minister gives approval for the establishment of the home under section 133, a board of management shall be established as a corporation, by regulation, for the home. 2. The home shall be vested in the board of management and the board shall have charge of the home. 3. The Not-for-Profit Corporations Act, 2010 does not apply to a board of management, except as provided for under the r…

General

133 (1) No municipal home or joint home shall be established without the approval of the Minister. Same, beds (2) Where the Minister grants an approval, the Minister shall provide for the number of beds that are to be established under the approval, and the number of beds may not be increased without an amendment of the approval. No expiry (3) An approval does not expire. No fee (4) The Minister shall not charge a fee for granting or amending an approval under this Part.

134 (1) Part VIII does not apply with respect to an approval, except as provided under this section. Determination or policy required (2) An approval shall be granted only following a determination or decision under section 99. Provisions that apply (3) The following provisions of Part VIII apply, with necessary modifications, and the modifications specified in this section, with respect to an approval as though the approval were a licence under Part VIII: 1. Section 103 (Undertaking to issue licence), other than subsection 103 (8). 2. Section 104 (Conditions of licence), other than clause 104 (2) (b). 3. Section 107 (Beds allowed under licence). 4. Section 109 (Public consultation), other than clauses 109 (1) (c) and (d). 5. Subsection 111 (3) (Notice, management contract). 6. Section 113 (Management contracts). 7. Section 116 (Amendments with consent). 8. Section 117 (Competitive proce…

135 (1) The council of a municipality establishing and maintaining a municipal home or the councils of the municipalities establishing and maintaining a joint home shall appoint from among the members of the council or councils, as the case may be, a committee of management for the municipal home or joint home. Board of control (2) Where a municipal home is established and maintained by a municipality having a board of control, the members of the committee of management shall be appointed on the recommendation of the board of control, and section 68 of the Municipal Act, as that section read on December 31, 2002, applies in respect of the home except that a reference in subsections (3), (6) and (7) of that section to a two-thirds vote shall be deemed to be a reference to a majority vote. Composition (3) The regulations may provide for the composition of a committee of management and the …

136 A municipality or municipalities that maintain a municipal home or joint home or a board of management that maintains a municipal home may receive, hold and administer the property of a resident in trust, subject to any restrictions provided for in the regulations.

137 (1) A head and an institution are authorized to disclose personal information to an inspector or the Director for the purpose of complying with any requirement under this Act or facilitating an inspection or inquiries under this Act. Definitions (2) In this section, “head”, “institution” and “personal information” have the same meaning as in the Municipal Freedom of Information and Protection of Privacy Act.

138 (1) The Director may make an order to a municipality or municipalities or a board of management maintaining a municipal home or joint home respecting renovations, additions or alterations to the home and respecting information, plans and other material that are to be furnished to the Director, and requiring the order to be complied with within a certain time. Appeal (2) A decision of the Director under subsection (1) may be appealed to the Appeal Board, and sections 166 and 170 to 177 apply to such an appeal with necessary modifications.

139 The Director may take control of, operate and manage a municipal home or joint home if the municipality maintaining and operating the home, each of the municipalities maintaining and operating the joint home or the board of management of the municipal home, as the case may be, consents to the Director so acting.

140 (1) Subject to subsections (2) to (7), the Director may take control of, operate and manage a municipal home or joint home if the Director believes on reasonable grounds that the home is not being or is not likely to be operated with competence, honesty, integrity and concern for the health, safety and well-being of its residents. Hearing (2) Unless the municipality maintaining and operating the municipal home, each of the municipalities maintaining and operating the joint home or the board of management of the municipal home, as the case may be, has consented to the exercise of the Director’s power under subsection (1), the Minister, before the power is exercised, shall cause a hearing to be held to determine whether it should be exercised. Person conducting hearing (3) The Minister shall appoint a person who is not an employee of the Ministry to conduct the hearing. Procedure (4) S…

141 (1) Despite section 140, on notice to the municipality maintaining and operating the municipal home, each of the municipalities maintaining and operating the joint home or the board of management of the municipal home, as the case may be, the Director may provisionally exercise the power under subsection 140 (1) without a hearing if, in the Director’s opinion, it is necessary to do so to avert an immediate threat to a person’s health, safety or well-being. Content of notice (2) The notice to the municipality, municipalities or board of management under subsection (1) shall set out, (a) the Director’s opinion on which the provisional exercise of the power is based; and (b) the reasons for the Director’s opinion. Continuation of exercise of power (3) As soon as possible after a power is exercised under subsection (1), the procedure set out in subsections 140 (2) to (7) shall be followe…

142 (1) The following apply when control is taken of a municipal home or joint home under section 139 or 140: 1. The Director has all of the powers of the municipality, municipalities or board of management, as the case may be, to occupy, manage, operate and administer the home, and they do not have those powers. 2. The following provisions apply, with necessary modifications, with respect to the operation and management of the home by the Director, i. paragraphs 2 to 7 of subsection 159 (10), and ii. section 160. Occupation of premises (2) Without limiting the generality of subsection (1), the Director, (a) despite sections 25 and 39 of the Expropriations Act, may immediately occupy, operate and manage the municipal home or joint home or arrange for it to be occupied, operated and managed by a person or entity designated by the Director; and (b) may apply without notice to the Superior …

143 (1) The Lieutenant Governor in Council may make regulations for carrying out the purposes and provisions of this Part. Specific inclusions (2) Without restricting the generality of subsection (1), the Lieutenant Governor in Council may make regulations, (a) clarifying the application of Part VIII to this Part; (b) providing additional or alternate rules governing approvals under this Part; (c) governing boards of management under sections 128 and 132, including, without limiting the generality of the foregoing, (i) establishing a board of management as a corporation and governing the operation of boards of management as corporations, including prescribing provisions of the Not-for-Profit Corporations Act, 2010 that apply to such boards and modifications to such provisions as they apply to such boards, and (ii) for boards of management under section 128, providing for the division of …

PART X COMPLIANCE AND ENFORCEMENT

Inspections

144 (1) The Minister may appoint inspectors for the purposes of this Act. Director is an inspector (2) The Director is, by virtue of office, an inspector. Certificate of appointment (3) The Minister shall issue to every inspector a certificate of appointment which the inspector shall produce, upon request, when acting in the performance of their duties.

145 An inspector may conduct inspections for the purpose of ensuring compliance with requirements under this Act.

146 Every long-term care home shall be inspected at least once a year.

147 No notice shall be given of, (a) any inspection required under section 146; or (b) any other inspection of a long-term care home, subject to any exceptions provided for in the regulations.

148 Where an inspection is required under section 146, the inspector may meet with the Residents’ Council or the Family Council, if requested or permitted to do so by the Council.