Source: The Care Guide

Long-term care facilities can only be accessed through a Community Care Access Centre (CCAC). The CCAC determines eligibility for placement, however each facility retains the right to approve applications based on their ability to meet the care needs of the individual. Generally, eligibility for placement is approved when community based services such as In-Home Health / Community Support Services or retirement residences are no longer able to meet your needs. You will be notified in writing by the facility if your application for admission is accepted or not.

 

If you live in the community, a placement coordinator at the CCAC will assist you in the application process. If you are in the hospital, the staff responsible for discharge planning and CCAC staff will work together to assist you.

 

Consent and Capacity

 

Admission to a long-term care facility is governed by the Health Care Consent Act, 1996. The decision to enter a long-term care home, like treatment decisions for medical care, requires the informed consent of the capable person. With respect to admission to a long-term care home, mental capacity is the ability to understand the information that is relevant to making the decision about admission, and to appreciate the reasonably foreseeable consequences of a decision or lack of decision.

 

A capable person must give consent in order for the long-term care application to proceed. This is demonstrated by the requirement for the applicant to sign his/her own Consent Form and Facility Choice List, and make his or her own decision about admission when a vacancy is offered.

 

A capacity evaluation is required to determine if an applicant is capable of making the decisions to enter a long-term care home. The Health Care Consent Act stipulates the evaluator must be a qualified health practitioner (e.g. physician, nurse, social worker). In attempting to protect individual rights, the law presumes a person is capable unless proven otherwise.

 

Evaluators are required to advise applicants if they are found incapable, and inform them of their right to appeal the finding. This allows for a review of the incapacity finding by the Consent and Capacity Board, which may uphold or overturn the decision. The Consent and Capacity Board will hold the hearing within seven days of receiving the request. The applicant should have a lawyer present to act on their behalf. The Placement staff will arrange for a person to help them obtain more information on their rights and assist them with making the request for a hearing before the Consent and Capacity Board. If the evaluator finds the applicant incapable with respect to the decision to appeal, and the applicant chooses not to appeal the finding, consent may be given or refused by his or her substitute decision-maker.

 

Substitute Decision-Making Responsibilities

 

If you are the authorized substitute decision-maker for an incapable person, the Health Care Consent Act outlines the following principles for making a decision about admission to a long-term care facility:

• Give or refuse consent in accordance with relevant wishes expressed while the person was capable.
• If you do not know of a wish applicable to the circumstances, or if it is impossible to comply with the wish, you shall act in the incapable person's best interests.
• In deciding what the incapable person's best interests are, you shall take into consideration:
• the values and beliefs that you know the person held when capable;
• any wishes expressed by the person with respect to admission to a long-term care facility; and the following factors:
  
  
  • the impact of admission to the facility on the quality of the person's life.
  • the impact of not being admitted to the facility on the quality of the person's life.
  • whether the benefit the person is expected to obtain from admission to the facility outweighs the risk of negative consequences to him or her.
  • whether a course of action that is less restrictive than admission to the facility is available and is appropriate in the circumstances.

Before giving or refusing consent on an incapable person's behalf to his or her admission to a long-term care facility, you are entitled to receive all the information required in order to make the decision.

 

Hierarchy for authorized substitute decision maker for incapable person

1. Guardian of the Person (court ordered)
2. Power of Attorney - Personal Care
3. Board appointed representative
4. Spouse or partner
5. Child or parent
6. Brother or sister
7. Any other relative
8. Relative by marriage or adoption

 

Eligibility Criteria

 

The eligibility criteria to enter a long-term care facility in Ontario are as follows:

 

• Applicant must be 18 years of age or over.
• Applicant must have a valid Ontario Health Card or obtain one.
• Applicant must have care needs that can be met in a long-term care facility.
• Applicant must need one of the following:
• Availability of nursing care 24 hours/day
• Assistance with activities of daily living
• On-site supervision/monitoring daily
• Be at risk of being abused at home (emotional, financial, physical abuse)
• Be at risk due to environmental factors at home
• Be at risk to other persons in present residence
• Applicant's needs are not able to be met in the home by the government-funded community programs.

 

Couples - an Exception

 

A spouse or partner who doesn't meet the above criteria can be admitted to a facility to join their spouse or partner who does qualify and is a resident of a long-term care facility. The spouse or partner must be at least 18 years of age, have a valid Health Care Number and have care requirements that can be met in a long-term care facility.

 

If you are not eligible to live in a long-term care facility

 

If you do not meet the eligibility criteria, CCAC will notify you in writing. You may appeal the decision of ineligibility and written details about the appeal process will be provided.

 

Facility Choice

 

During the application process the applicant is required to select the long-term care facilities of their choice. It is important to take the time to investigate and visit the long-term care homes in your area to determine your choices.

 

When living at home you can select one or more and wait for the facility of your first choice. When the applicant is in the hospital and cannot return home to wait, then the hospital will request the client to choose several facilities (number will depend on the hospital policy) and the person must go to the first facility bed offered. The person will wait at that facility until they are admitted to their preferred facility.

 

If a person is eligible for a long-term care facility, their name is placed on the facility waiting list, ranked based on need and date of facility choice. If a crisis occurs in the home, CCAC will assess the situation and determine priority for placement. If first priority is given, the client must be willing to accept the first available bed. If the applicant is admitted under the first priority category to a facility and chooses to wait for another facility then they are given the regular priority on the waiting list for transfer to their facility of choice.