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Sponsored Article: The Role of Local Health Integration Networks in Admission to Long Term Care Homes

Understanding the Long Term Care Homes Act, and how the Act interacts with Local Health Integration Networks (LHINs) is a helpful the first step in understanding how admission to a long-term care home occurs.

Local Health Integration Networks Core Services:

The LHINs serve as the single point of accountability for integrated, accessible and consistent high-quality home and community care.

Home and community care core services include:

  • Home care services for post-acute, long-stay and palliative clients
  • Long-term care home placement and referral and navigation to other community services

Community based services include:

  • Meal services
  • Friendly visiting
  • Transportation services
  • Adult day services – help patients stay in their home longer

    More comprehensive support includes:

  • Supportive Housing/Assistive Housing
  • Retirement homes
  • Short stay respite: could be in a long-term care home setting, retirement home setting or community setting
  • Long-term care: when all community options have been exhausted and permanent housing – based on complex care needs – is required

     

    Specialized Programs Include:

  • Convalescent care – short stay rehab treatment program
  • Special behavioral support unit
  • Behavioral supports Ontario
  • Rapid response nurses
  • Palliative care
  • Nurse practitioner supporting team averting transfer – long term care
  • Mental health and addiction nurses

 

Role of the LHINs: Admission to Long-Term Care:

Applying to Long-Term Care:

A long-term care home placement application can be made from a hospital or from the community. All applicants can receive an assessment, however, this does not mean that an individual will be automatically eligible for a placement. Eligibility criteria for long-term care must be met. Referrals can come from a service provider, family physician, neighbor, patient or family member. A physician referral is not required.

Eligibility for long-term care is based on provincial regulations. The regulations are set out by the Ministry of Health and Long-Term Care. If a patient is found to be ineligible for long-term care, and if patients or family members are unhappy with this finding, they can follow the appeals process through the Health Services Appeal and Review Board (HSARB). An HSARB decision can subsequently be appealed to Divisional Court.

Eligibility for Long-Term Car

The Long-Term Care Homes Act and Health Care Consent Act govern the admission and choice process. Only a LHIN Placement Coordinator can determine eligibility based on applicable legislation. Applicants can choose up to a maximum of five homes in Ontario and must consent to these choices. In a crisis, an applicant may choose more than five homes. It is important to note that an applicant cannot be required to go to a long-term care home without giving consent. Consent must relate to admission, be informed and be voluntary, and not be based on misrepresentation of fraud.

  • Be age 18 or older
  • Have care needs which cannot be safely met in the community through publicly-funded community-based services and other care-giving support (has the patient exhausted other community and private resources?)
  • Have care needs which can be met in a long-term care home
  • Have a valid Ontario Health Insurance Plan (OHIP) card
  • Have care needs including
    • 24-hour nursing and personal care
    • Frequent assistance with activities of daily living
    • On-site supervision or monitoring to ensure your safety or well-being

     Long-Term Care Assessment Consists of:

  • Physical and mental health – completed by a registered nurse of doctor
  • Requirements for medical treatment and health care
  • Functional/cognitive capacity
  • Requirements for personal care
  • Current behavior and past behavior (in previous year)
  • Any other assessment or information provided for in the regulations (geriatricians, Adult Day Program providers, etc.)

Process Following Assessment:

For eligible patients, after long-term care assessment, the coordinator will provide information about all aspects relating to placement. They will also ensure the patient is aware of what long-term care providers provide, including costs/subsidies, advantages and disadvantages, in addition to alternative resources while the patient waits for long-term care. If a person is incapable, their Substitute Decision Maker (SDM) may consent on their behalf. The SDM must make that decision in compliance with a known wish and in the best interest of the individual as set out in section 42(2) of the Health Care Consent Act. If the LHIN believes that the SDM is not making the decision in compliance with these sections, an application can be brought to the Consent and Capacity Board.

A Home is to provide a response within five business days with either acceptance/refusal or a request for further information. When asking for further information, a licensee has three business days to accept/refuse the applicant after receiving that information.

Applicants can only be refused by a Long-Term Care Home if the home lacks the physical facilities necessary to meet the applicant’s care requirements, or the staff of the home lacks the nursing expertise necessary to meet the applicant’s care requirements. If a refusal occurs, a detailed written letter must be provided to the Applicant, the Director, and the Placement Coordinator. The letter must set out the grounds for the refusal, a detailed explanation of the supporting facts as they relate to both the home and the applicant’s condition and requirements for care, an explanation of how the supporting facts justify withholding the approval, and the contact information for the Director at the Ministry of Health and Long Term Care.

To contact one of Ontario's Local Health Integration Networks (LHINs), please see the following link: http://www.lhins.on.ca/contactus.aspx.

To report an urgent complaint involving cases of harm, neglect or danger to residents at a Long Term Care Home, Call the Long-term Home Care ACTION Line: toll-free 1-866-434-0144.

If you or a loved one have been a victim of long-term care facility negligence or nursing home negligence, and/or personal injury, the lawyers at Neinstein LLP can help investigate a potential case.