Long-term care facilities can only be accessed through a Community Care Access Centre
. 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
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
- In deciding what the incapable person's best interests are, you shall take
- 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
- 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
- Guardian of the Person (court ordered)
- Power of Attorney - Personal Care
- Board appointed representative
- Spouse or partner
- Child or parent
- Brother or sister
- Any other relative
- Relative by marriage or adoption
The eligibility criteria to enter a long-term care facility in Ontario are
- 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.
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
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.