October 2017

Table of Contents

Part 1: Preamble

The Guidelines for Supporting Adults with a Developmental Disability When Applying to, Moving Into and Residing In a Long-Term Care Home ‘guidelines’ will improve services for adults with a developmental disability who choose to reside in a long-term care (LTC) home. The guidelines outline the importance of planning, choice and consent and adults with developmental disabilities receiving appropriate developmental services and supports in a LTC home. The commitment to developing these guidelines and to following them also demonstrates the integrated and co-ordinated approach to care within and between the Developmental Services (DS) and LTC home sectors.

The Ministry of Community and Social Services (MCSS) and the Ministry of Health and Long-Term Care (MOHLTC) are committed to improving the social and health outcomes for adults with a developmental disability who are aging. These guidelines will apply to those individuals who, as a result of aging or other circumstances, require enhanced health and personal care/support. Both MCSS and MOHLTC are committed to the principles of choice, community inclusion, and self-directed planning for people with developmental disabilities.

A range of supports related to housing and personal needs are available, including MCSS-funded residential services and supports for people with a developmental disability. As discussed later in these guidelines, part of the eligibility criteria for LTC home admission includes determining that “the publicly-funded community-based services available to the person and the other caregiving support or companionship arrangements available to the person are not sufficient, in any combination, to meet the person’s requirements.”

Should someone’s support needs or personal circumstances change significantly, they should be reassessed by their local Developmental Services Ontario (DSO) office. DS residential services and supports options may be appropriate as might a LTC home. Sometimes a person’s health changes significantly and their needs cannot be adequately or safely met in their home. For example, this could include the need for 24 hour supervision or nursing care due to dementia/Alzheimer’s disease, frailty or physical impairment(s).

These guidelines are intended to support a person’s choice to receive care and support in a LTC home, when needed. MCSS and MOHLTC support LTC home placements that are appropriate for a person’s health and personal care needs.

In some cases, a person with a developmental disability or their substitute decision- maker (SDM), if any, may feel that a LTC home may be an appropriate place if the individual meets the eligibility criteria. However, it is important to emphasize that choice and consent underpin the LTC home placement process which are consistent with the value that MCSS and MOHLTC place on person directed planning and person directed decision-making. It is an individual’s choice or that of their SDM, if any, to move into a LTC home (for those who meet the eligibility criteria and receive a bed offer).

Just as applicant choice is central to the placement process, so too must the rights of residents be respected in a LTC home. The Long-Term Care Homes Act, 2007 (LTCHA), the legislation governing LTC homes, includes a fundamental principle that must be applied in the interpretation of the LTCHA and Ontario Regulation 79/10 (Regulation): that a LTC home is primarily the home of its residents and is to be operated so that it is a place where its residents may live with dignity and in security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.

The LTCHA includes a Residents’ Bill of Rights which addresses residents’ personal well- being and safety and includes the privileges, choices and protections available to all residents of a home that must be fully respected and promoted. Some of these rights are supported by further requirements in the LTCHA and the Regulation. A copy of the Residents’ Bill of Rights is included in Appendix 2 of these guidelines and must be posted in all LTC homes.

Purpose of the Guidelines

Strong partnerships across the health and social service sectors are required to support the complex needs of those who are aging and have a developmental disability.

The guidelines provide an overview of the DS and LTC home systems in Ontario, the roles and responsibilities of service providers in these sectors and the step by step process when applying to and moving into a LTC home.

Additional information is provided in appendices including an illustration of the Adult Developmental Services and Supports Pathway, Overview of LTC Home Waiting List Categories, LTC Home Placement Flow for Long-Stay Beds, a list of the acronyms used in the guidelines, contact information for Local Health Integration Networks (LHINs) and DSOs and the LTCHA’s Residents’ Bill of Rights.

These guidelines replace the 2006 Long-Term Care Home Access Protocol for Adults with a Developmental Disability and apply to MCSS, including its regional offices and transfer payment agencies (“DS agencies”), DSOs, MOHLTC, LHINs, the Office of the Public Guardian and Trustee (OPGT), Municipal Service Managers and LTC homes.

The guidelines will be updated by MCSS and MOHLTC, as required, to reflect any significant DS and/or LTC home system related changes.

These guidelines are intended to complement and clarify relevant legislation, regulations and/or service agreements. MOHLTC encourages all individuals involved in the LTC home placement process to ensure that they review all requirements set out in the LTCHA and Regulation and any other relevant legislation, regulations or service agreements. In the event of a conflict between these guidelines and the legislative/regulatory provisions, the legislative/regulatory provisions prevail. In the event of a conflict between these guidelines and any service agreements, the service agreements prevail. The greater part of these guidelines apply only after a person or his/her SDM has decided to complete an application for determination of eligibility to move into a LTC home.

MCSS and MOHLTC have worked collaboratively to develop these guidelines and have incorporated stakeholder feedback where possible. Stakeholders were consulted and input was received from adults who have developmental disabilities and their family members, People First of Ontario, MCSS regional office staff and DSOs, DS agencies, Native Child and Family Services of Toronto, the Ontario Partnership on Aging and Developmental Disabilities (OPADD) (which includes representation from the Ontario Long Term Care Association, AdvantAge Ontario and Health Shared Services Ontario), the Ontario Association of Residents’ Councils, the Association of Municipalities of Ontario and City of Toronto, the former Community Care Access Centres (CCACs), LTC home licensees, First Nations LTC home providers, LHINs, OPGT, the Ministry of Seniors Affairs (formerly the Ontario Seniors’ Secretariat) and numerous other individuals and stakeholders.

MCSS and MOHLTC would like to thank the dedicated people and organizations who have provided invaluable feedback and input during the development of these guidelines.

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Part 2: Context - Aging Population And Research

The general population in Ontario is aging and living longer, including people with a developmental disability.

In Ontario’s population projections update from year 2015 to 2041, the Ministry of Finance stated the number of seniors aged 65 and over is projected to more than double from about 2.2 million, or 16.0 per cent of the population in 2015, to over 4.5 million, or 25.3 per cent, by 2041. In 2015, for the first time in modern record keeping in the province, seniors accounted for a larger share of the population than children aged 0 to 14. The growth in the number of seniors will only accelerate over the 2012 to 2031 period as the “baby boomer” generation turn 65 years of age.

As part of the Health Care Access Research and Developmental Disabilities (H-CARDD) Program, the profiles of aging adults with developmental disabilities were studied. The study revealed an increase in the number of people with developmental disabilities and that the signs and symptoms related to frailty were observed often earlier in those with developmental disabilities than those without them1. The research also noted that people with developmental disabilities are more likely to develop significant health and mobility issues earlier as they age, with a recommendation that staff and agencies prepare in response to the findings2.

In 2010/11, MCSS undertook a survey of transfer payment agencies across Ontario that were funded to provide residential services for adults with developmental disabilities. Based on the client profiles for 15,246 people submitted by 206 DS agencies and 46 Outside Paid Resources, 59% of the clients were aged 40 to 64 years.

People with developmental disabilities often rely on family caregivers throughout their lifetime. These family members with caregiving responsibilities may also be aging and facing their own health issues. The Aging Project found that caregiver burden was as predictive of admission to LTC home as was frailty3.

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Part 3: Vision And Principles For Guidelines

The following vision and principles apply to the implementation of these guidelines:

Vision

The guidelines will improve the planning and co-ordination of health and developmental services and supports for adults with a developmental disability and support people who choose to reside in a LTC home.

Principles

Flexibility and Choice

Adults with a developmental disability have the right to identify, make informed decisions and provide informed consent about LTC home placement, care and support needs.

The person may consult family, friends and/or staff when considering service and support options and, if this includes applying to a LTC home, the person or their SDM, if any, has the right to apply to and, if eligible, approved by the licensee and authorized by the placement co-ordinator, move into a LTC home.

A SDM will only be engaged where the person is incapable of making the decision in accordance with the Health Care Consent Act, 1996 (HCCA). Pursuant to the HCCA, a person is capable with respect to admission to a LTC home if the person is able to understand the information that is relevant to making a decision about the admission and able to appreciate the reasonably foreseeable consequences of a decision or lack of decision. A finding that a person is incapable with respect to a LTC home admission can only be made by an evaluator4.

Planning for supports and services for people with a developmental disability who are moving into a LTC home should always be flexible and respectful of a person’s cultural and linguistic preferences, religious beliefs, lifestyle choices, social and family network and medical needs and will be balanced with available community resources. This should include asking people of Indigenous descent about their interest and/or preference in applying to a First Nations LTC home.

As described earlier, choice and consent underpin the entire LTC home placement process.

Inclusion

Adults with a developmental disability have the same rights as other Ontarians to live and participate fully within their communities and to access services and supports that are necessary, available and meet their needs.

Access and Co-Ordination

Planning for people who wish to reside in a LTC home will involve co- ordination across health and DS sectors including applying to and moving into a LTC home. This includes planning for the services they will require and the resolution of any care related issues.

Specialized DS or aging-related services and supports will be planned and provided as required, based on identified needs, and as available, for those who have a developmental disability and who either have been determined eligible and are waiting for a bed or who are already residing in a LTC home.

The planning and provision of required services and supports will be completed through a co-ordinated approach with the involvement of the person, the person’s primary caregiver or SDM, if any, and with the consent of the person/SDM. This may also involve family and/or friends.

This co-ordinated approach should be led by the agency most involved/familiar with the person’s care needs, if possible.

Health and Independence

Services and supports available to people residing in a LTC home should foster healthy living and maximize independence to the greatest extent possible, including during end of life care.

Ontario Association Of Residents’ Councils Board Member Quotes:

“Long-term care is a team effort. It takes residents, staff, family, volunteers and the community to meet the needs of our fellow residents.”

“Our physiotherapist helped me get back on my feet again. When I moved into long-term care, I was physically and emotionally devastated and couldn’t walk, they encouraged and supported me and I am up and walking again!”

“Our music and art therapy programs gave me hope. I have never held a paint brush in my hand and now I am painting pictures!”

“Residents’ Councils connect to community organizations that add to the education, programs, fundraising and support received in long-term care homes. There was a case where a Residents’ Council helped a resident with MS access supports through the MS Society that led to a better wheel chair and assistive devices to use a computer.”

“We use pictures to create ‘History Boards’, ‘All About Me’ photo albums and are starting up an autobiography program. Residents are able to share information about themselves so that other residents and staff get to know us.”

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Part 4 - Background: Developmental Services And Long-Term Care Home Systems

A. Developmental Services System

Since 2004, the DS system has experienced significant changes, including the introduction of the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA) which sets out the application process and MCSS-funded developmental services and supports available to adults with a developmental disability (Refer to Appendix 3 for a visual depiction of the Adult Developmental Services and Supports Pathway).

All people who wish to apply for MCSS-funded adult developmental services and supports in Ontario must apply through a DSO (See Appendix 6 for contact information).

Definition Of Developmental Disability In Ontario

Individuals applying for adult developmental services must meet the eligibility criteria set out in the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA) and its Regulation.

  • There are two components to the definition of developmental disability. To be eligible for adult developmental services and supports an individual must meet both.
  • Under the Act, a person has a developmental disability if the person has the prescribed significant limitations in a) cognitive functioning and b) adaptive functioning and those limitations:
    • Originated before the person reached 18 years of age;
    • Are likely to be life-long in nature; and
    • Affect areas of major life activity, such as personal care, language skills, learning abilities, the capacity to live independently as an adult or any other prescribed activity.

Cognitive Functioning

Under SIPDDA, cognitive functioning means a person’s intellectual capacity, including the capacity to reason, organize, plan, make judgments and identify consequences.

  1. The person has an overall score of two standard deviations below the mean, plus or minus standard error measurement, on a standardized intelligence test; or
  2. The person has a score of two standard deviations below the mean in two or more subscales on a standardized intelligence test and the person has a history of requiring habilitative support; or
  3. On the basis of a clinical determination made by a psychologist or a psychological associate, the person demonstrates significant limitations in cognitive functioning and the person has a history of requiring habilitative support.

Adaptive Functioning

Under SIPDDA, adaptive functioning means a person’s capacity to gain personal independence based on the person’s ability to learn and apply conceptual, social and practical skills in his or her everyday life.

For the purposes of SIPDDA, a person has significant limitations in adaptive functioning if the person has a score of at least two standard deviations below the mean, plus or minus standard error measurement, in at least one of the areas of conceptual skills, social skills or practical skills, as measured on a standardized test of adaptive behaviour.

Habilitative Support

Under the Regulation, habilitative support means support where the objective of the support is to enable the person to acquire, retain and improve skills and functioning related to activities of daily living in the areas of self-care, communication and socialization.

Determination Of Eligibility

In order to be determined eligible for MCSS-funded services and supports, a person must provide the DSO with documentation for the eligibility requirements:

  1. A psychological report or assessment signed by a psychologist or psychological associate that confirms the person has a developmental disability according to the definition above. This may include school or medical records.
  2. Proof that they are 18-years of age or older.
  3. An Ontario resident.

Review Of Documentation By DSO

DSO staff review the documentation the applicant is able to provide and if required, make a referral for applicants age 18 and older to have a psychological assessment completed by a MCSS-funded agency.

The process for confirming eligibility is set out in a policy directive that DSO organizations are to follow.

Some people with a developmental disability may also have medical needs, mental health issues (referred to as a dual diagnosis) and/or behavioural challenges.

Application Package And Assessment Of Needs

SIPPDA also provides the legislative authority to assess the individuals’ needs for services and supports.

Following eligibility confirmation, qualified assessors employed by DSOs conduct the assessment of support needs using the Application Package for all eligible individuals (new applicants, individuals in service or waiting for services) applying for MCSS-funded services and supports for adults with developmental disabilities.

The Application Package is a standardized tool used to determine the support needs of adults with developmental disabilities in Ontario, and includes the Application for Developmental Services and Supports (ADSS) and Supports Intensity Scale (SIS).

  1. The Supports Intensity Scale (SIS) Provides an opportunity to discuss the support needed to enable the individual to fully participate in the community as a fully engaged citizen. It provides standardized, objective information indicating the support needs compared to a representative sample of all people with developmental disabilities.
  2. The Application for Developmental Services and Supports (ADSS) Provides an opportunity to discuss the individual’s personal circumstances (risks), community inclusion, future planning and strengthening natural supports in the community.

The ADSS and SIS complement one another. The ADSS helps to identify needs and wants, and focuses on the individual’s past, present and future life. The SIS helps identify life activity areas that will support the goals and plans, and informs what is needed for the individual to succeed in the present.

The Application Package is completed by the assessors in two interviews with the individual and four representatives.

After the Application Package is completed, the assessors complete the Assessor Summary Report (ASR) - a document that includes qualitative information regarding the individual derived from the SIS/ADSS information captured in the two interviews.

MCSS-Funded Developmental Services and Supports

MCSS funds the following services and supports for eligible adults who have a developmental disability. These services are defined in SIPDDA under section 4.

  1. Activities of Daily Living Services and Supports
    Services and supports to assist a person with a developmental disability with personal hygiene, dressing, grooming, meal preparation, administration of medication, and includes training related to money management, banking, using public transportation and other life skills.
  2. Community Participation Services and Supports
    Services and supports to assist a person with a developmental disability with social and recreational activities, work activities, and volunteer activities.
  3. Caregiver Respite Services and Supports
    Services and supports that are provided to, or for the benefit of, a person with a developmental disability by a person other than the primary caregiver of the person with a developmental disability and that are provided for the purpose of providing a temporary relief to the primary caregiver.
  4. Professional and Specialized Services
    Includes services provided by a psychologist, psychological associate, adult protective service worker (APSW), social worker, speech language pathologist, physiotherapist or occupational therapist, as well as services for case management, service co-ordination and behaviour management.
  5. Person-directed Planning Services and Supports
    Services and supports to assist persons with a developmental disability in identifying their life vision and goals and finding and using services and supports to meet their identified goals with the help of their families or significant others of their choice.
  6. Residential Services and Supports
    Services and supports that are provided to persons with a developmental disability who reside in one of the following types of residences and includes the provision of accommodations, or arranging for accommodations, in any of the following types of residences:
    1. Intensive support residences
      A staff-supported residence operated by a service agency,
      a. in which one or two persons with developmental disabilities reside, and
      b. in which each resident requires and receives intensive support that meets the prescribed requirements;
    2. Supported group living residences
      A staff-supported residence operated by a service agency, in which three or more persons with developmental disabilities reside and receive services and supports from the agency;
    3. Host Family residences
      The residence of a family, composed of one or more persons, in which a person with a developmental disability who is not a family member is placed by a service agency to reside and receive care, support and supervision from the host family, in exchange for remuneration provided to the host family by the service agency;
    4. Supported independent living residences
      A residence operated by a service agency that is not supported by staff and in which one or more persons with developmental disabilities,
      a. reside alone or with others but independently of family members or of a caregiver, and
      b. receive services and supports from the service agency.

Direct Funding

MCSS also provides direct funding to eligible adults who have a developmental disability, through the Passport program.

This funding can be used by individuals to purchase community participation services and supports, activities of daily living and person-directed planning. Passport funding can also be used for caregiver respite for primary caregivers of an adult with a developmental disability.

Depending on the services requested, a DSO will transfer an individual’s application package to the local Passport Agency, which administers direct funding.

Developmental Services (DS) Agency

A DS agency is funded through an agreement with MCSS to provide services and supports to, or for the benefit of, persons with a developmental disability.

Applying For Developmental Services And Supports In Ontario

Developmental Services Ontario (DSO)

Nine DSO offices across the province serve as the application and access points for MCSS-funded adult developmental services and supports. DSOs determine eligibility for people who are applying for services and supports and, if eligible, complete the developmental services application package with the person and their primary caregiver, friend(s) or SDM to assess their service and support needs.

Once the application package has been completed, applicants are prioritized for services and supports.

From this point, and as services become available, the local DSO office connects eligible people to MCSS-funded developmental services and supports provided by developmental services agencies and/or direct funding.

Once an application package has been completed, applicants for adult developmental services and supports are encouraged to update the DSO office if their circumstances change.

In addition, the DSOs are responsible for:

  • Giving information to the public about available services and supports and about the application process; and
  • Answering any questions or concerns people may have about the application process and other DSO services provided.

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B. LTC Home System

LTC Homes

LTC homes are an important part of Ontario’s publicly funded health care system. LTC homes are licensed or approved under the LTCHA and provide residential accommodation and care to individuals 18 years of age and older who require assistance with activities of daily living, on-site supervision or monitoring to ensure safety or well-being, or the availability of on-site 24/7 nursing care.

Some LTC homes also have short-stay programs for those who require respite or convalescent care.

LHINs, the designated placement co-ordinators under the LTCHA, are required to comply with all of the relevant provisions in the LTCHA and its Regulation. Placement co- ordinators are responsible for determining eligibility for admission, providing applicants with information and assisting applicants with the placement related application processes, prioritizing applicants on the waiting list, monitoring and managing waiting lists and authorizing admissions into LTC homes.

All LTC homes in Ontario (including those formerly known as “Nursing Homes”, “Municipal Homes for the Aged”, and “Charitable Homes”) are governed by the LTCHA. The LTCHA sets out requirements to ensure that residents of these homes receive safe, consistent, and quality resident-centred care based on assessed needs in settings where residents feel at home, are treated with respect, and have the services and supports they need for their health and well-being.

LTC homes represent an important support option on the continuum of community- based supports that is comprised of both developmental and health-based services, among others.

Ontario Association of Residents' Coucils Board Member Quote

"Services and supports available to residents living in a LTC home can provide holistic health care in a safe and secure environment that encourages personal empowerment and authentic relationships.”

Under the LTCHA, all people who apply for LTC home placement must undergo an assessment of eligibility to determine whether a LTC home is an appropriate setting to meet their needs. As part of this assessment, the placement co-ordinator assesses whether the person’s current care requirements are being met through other publicly funded community-based services and other caregiving, support or companionship arrangements available to the person.

LTC homes may be an appropriate option for some people with a developmental disability who have been determined eligible and require the care and services offered by this setting.

Long-Stay Residents

A placement co-ordinator shall determine a person to be eligible for LTC home admission as a long-stay resident only if,

  1. The person is at least 18 years old;
  2. The person is an insured person under the Health Insurance Act (HIA) (has OHIP coverage);
  3. The person requires:
    a. That nursing care be available on-site 24 hours a day;
    b. At frequent intervals throughout the day, assistance with activities of daily living; or
    c. At frequent intervals throughout the day, on-site supervision or on-site monitoring to ensure his or her safety or well-being.
  4. The publicly-funded community-based services available to the person and the other caregiving, support or companionship arrangements available to the person are not sufficient, in any combination, to meet the person’s requirements; and
  5. The person’s care requirements can be met in a LTC home.

Residents are required to pay for accommodation costs such as room and board. These costs are set out in the Regulation5. In order to ensure income is not a barrier to access, residents in basic accommodation may apply for a reduced co-payment. A person who has a developmental disability may be eligible to receive developmental services and supports while they reside in a LTC home as a long-stay resident.

Short-Stay Respite Program

In the case of short-stay respite care, a person who is being cared for in the community (with or without home care or community support services) may reside for a short time in a LTC home. The person must require care for a temporary period and must be likely to benefit from the stay or has a caregiver who requires temporary relief from caregiving duties. For example:

  • A caregiver who needs to be away for more than a day (e.g., a vacation);
  • A caregiver who is in a hospital and needs temporary assistance to care for his/her care recipient; or
  • A care recipient requires 24-hour nursing care and/or assistance with activities of daily living on a short term basis.

Short-stay respite care in a LTC home is available for up to 60 continuous days at one time and up to a total maximum of 90 days over each calendar year. In addition, the person must meet the long-stay eligibility criteria set out in numbers 1, 2, 3 and 5 in the above heading, Long-Stay Residents.

Residents are required to pay for accommodation costs such as room and board. These costs are set out in the Regulation. A person who has a developmental disability may be eligible to continue to receive developmental services and supports while they reside in a short-stay program.

Short-Stay Convalescent Care Program

The short-stay convalescent care program is available to a person who requires a period of time in which to recover strength, endurance or functioning and is likely to benefit from a short-stay in a LTC home.

A person can stay in the short-stay convalescent care program for a maximum of 90 days at one time, and up to a total maximum of 90 days over each calendar year. In addition, the person must meet the long-stay eligibility criteria set out in numbers 1, 2, 3 and 5 in the above heading, Long-Stay Residents.

Participants of this program most often come from a hospital but the program is also available to applicants from the community.

Persons in the short-stay convalescent care program do not pay an accommodation fee. A person with a developmental disability may be eligible to continue to receive developmental services and supports during their stay in a short-stay program.

When Should An Individual Or SDM, If Any, Consider A LTC Home?

While it is the hope to have everyone live in their home for their entire life, sometimes one’s health changes or declines to the extent that their needs cannot be adequately or safely met in this setting.

Some people, including those with more complex, age-related health needs, may feel that they require the 24-hour a day nursing care and personal support available in a LTC home. For example, this could include the need for 24 hour supervision or health care supports due to severe dementia/Alzheimer’s, severe physical impairment(s) and/or end of life care.

It is the role of the placement co-ordinator to support applicants in understanding the LTC home placement process and determining whether someone meets the eligibility criteria for admission.

Again, it is the choice of the applicant, or their SDM, as to whether they wish to meet with a placement co-ordinator to determine whether or not they meet the eligibility criteria for LTC home placement.

What Should Be Considered When Applying To A LTC Home?

In addition to the eligibility criteria set out in the Regulation, planning for the care required by adults with a developmental disability should be done by the placement co-ordinator and developmental services sector.

The planning should take into account personal preferences, levels of functional and social independence, parent/spousal relationships, and options for aging in place (for example, remaining in their current residence with additional supports), when possible.

Once an individual is determined eligible for LTC home admission, the planning should also include considerations such as individual choice, the need for consultation with a broader support network, potential isolation and lack of social relationships and availability of appropriate supports, services and programs (both within a LTC home and through the provision of or continuation of developmental services).

Ultimately, it is the individual choice of the LTC home applicant, or their SDM, to select the LTC homes to which they wish to apply and to accept a bed offer.

It is important to note that, depending on one’s circumstances, there may be consequences to refusing a bed offer based on the requirements in the LTCHA Regulation. In particular, if the applicant refuses admission, the placement co-ordinator must remove the person from all long-stay waiting lists unless:

  • The refusal is due to a health condition, short-term illness or injury that prevents the applicant from moving in at that time or would make moving in detrimental to the applicant’s health;
  • The applicant occupies a bed in a hospital or psychiatric facility;
  • The applicant declines to enter into a specialized unit in certain circumstances; or
  • The applicant cannot move in due to an emergency in the home or outbreak of disease.

Applicants and their SDMs are encouraged to discuss their individual situation with a placement co-ordinator in order to understand the potential impacts or consequences of their decisions.

If a LTC home approves a person’s application and has a suitable vacancy (for example, male/female and basic or preferred accommodation), the placement co-ordinator can authorize the person’s admission provided that the person or their SDM consents to theadmission within 24 hours of being informed of the bed availability. The person must agree to pay certain accommodation charges and move into the home within 5 days of accepting the bed offer.

Most, if not all LTC homes, have waiting lists. The length of waiting lists varies in homes across the province, and may impact the amount of time it takes for admission to a desired home.

LTC Home Waiting List Categories

The waiting list categories related to prioritization and the requirements for ranking are set out in the Regulation under the LTCHA and these are based primarily, but not exclusively, on an applicant’s need for a LTC home bed. Please refer to Appendix 4 for an overview of the waiting list categories.

An applicant is placed in category 1 (crisis category) on the waiting list if he/she meets the criteria in the Regulation. An applicant is placed in category 1 on the waiting list if he or she:

  • Requires an immediate admission due to a crisis arising from his or her condition or circumstances;
  • Is facing a permanent or temporary bed closure in a LTC home or hospital within 12 weeks; or
  • Is a patient designated ALC who requires an immediate admission where the LHIN verifies that the hospital is experiencing severe capacity pressures.

Placement of applicants into this category occurs when the situation experienced by an applicant is of such severity that every effort is required to place the applicant in a LTC home as soon as possible (for example, within a matter of days, rather than weeks or months later). Ranking within this category is according to the urgency of the applicant’s need for admission.

Note: Persons whose care requirements are being met (for example, patients designated ALC in a hospital) often do not meet the criteria for prioritization in the crisis category. Patients designated ALC waiting for LTC home placement are typically prioritized in categories 3A or 4A as noted further below.

The next priority category (category 2) that ranks immediately after category 1 (crisis) applies to spouses/partners who meet the eligibility criteria for admission based on care needs (unless a higher waiting list category applies). This category only applies once one of the spouses/partners has already moved into the LTC home. Individuals prioritized in this category are ranked according to the date on which their spouse/partner was admitted to the LTC home so as to give priority within the category to those who have been separated the longest.

Applicants of a particular religious, linguistic, or ethnic background seeking placement in a LTC home (or unit of area within a home) that primarily serves the interests of persons of that background are prioritized in category 3A or 3B of the waiting list, unless a higher waiting list category applies. Applicants who are waitlisted in category 3A or 3B have higher prioritization than applicants in category 4A /4B (others).

The criteria to be placed in Categories 3A and 4A are:

  • Applicant is not a resident of a LTC home and requires or is receiving high service levels under the Home Care and Community Services Act, 1994;
  • Applicant occupies a bed in a hospital under the Public Hospitals Act and requires an alternate level of care;
  • Applicant is a long-stay resident seeking to transfer to his or her first choice of home; or
  • Applicant is a short-stay resident in the interim bed short-stay program and is seeking to transfer to the home as a long-stay resident.

Note:The interim bed short-stay program is only for individuals who (amongst other requirements) occupy a bed in a public hospital, no longer require acute care services provided by the hospital, require an alternate level of care, are determined eligible for admission to a LTC home as a long-stay resident, and are on a waiting list for a long-stay bed in a LTC home.

Categories 3B and 4B apply when one spouse/partner is in a LTC home and the other will join him/her later.

Other prioritization categories such as re-admission, veteran and exchange exist but are used less frequently. The re-admission category ranks above category 1 (crisis category) and applies to applicants who are discharged from the LTC home for exceeding the permitted length of a medical or psychiatric absence and who are seeking re-admission to the same LTC home.

What Are Some Of The Supports Available In A LTC Home?

There needs to be careful consideration by the individual, primary caregiver, the placement co-ordinator, LTC home and DS agency as to the supports a LTC home applicant/resident with a developmental disability may require to improve their quality of life while residing in a LTC home.

Depending on the person’s situation, planning for end of life care may also be required. This type of planning will help inform what types of supports, if any, may be required to transition the person into a LTC home and/or continue to support the person while residing in the LTC home.

LTC home supports that could be required include enhanced staff training and education as well as additional supports to maintain health and quality of life such as behavioural therapists, therapeutic recreationalists, social workers, rehabilitative assistants, DS workers and modified equipment. (LTC homes are required to meet the individualized care needs of their residents).

People who were receiving MCSS-funded services and supports as part of the 2006 Long-Term Care Home Access Protocol for Adults with a Developmental Disability and/or a related initiative, should continue to receive these services and supports if they continue to be eligible and the supports are appropriate and/or necessary to support their quality of life, health and/or well-being.

MCSS-funded services and supports for adults with a developmental disability in LTC homes should be reviewed regularly or as required by the LTC home with the DS sector for need and appropriateness. Developmental services and supports would not continue if they duplicate or replace supports typically provided by the specific LTC home in which the person resides.

MCSS-funded transfer payment agencies develop Individual Support Plans (ISP) for each person receiving services and supports from the agency as required by the Quality Assurance Measures Regulation (Ontario Regulation 299/10). ISPs can also be developed jointly between an adult with a developmental disability and their case manager, for example an Adult Protective Service Worker (APSW). The APSW program provides MCSS- funded case management services for people who have a developmental disability and live independently in the community, including those individuals who may be transitioning to a long-term care setting. An ISP is not the same as a person-directed plan. While ISP can be informed by the same values as the person-directed plan, they are fundamentally different.

ISP are mandatory (the contents are set out in s.5 (4) of Regulation 299/10). The focus of an ISP is on service delivery for an individual. These plans are most often developed within an agency setting in which someone is receiving agency supports, or can be developed jointly by the person and their case manager, for example, an APSW.

These plans should be aligned with the support plan developed in consultation with the LTC home.

Local Health Integration Networks (LHINS)

LHINs receive funding from MOHLTC. On December 7, 2016, Ontario passed Bill 41, the Patients First Act, 2016 (PFA), to help patients and their families obtain better access to a more local and integrated health care system, improving the patient experience and delivering higher-quality care. The PFA received Royal Assent on December 8, 2016.

To support implementation of the PFA, all services provided or arranged by the CCACs became the responsibility of the LHINs.

LHINs:

  • Provide simplified access to home care and community services;
  • Make arrangements for the provision of home care services to people in their homes, schools and communities;
  • Provide information to the public about, and make referrals to, health and social services; and
  • Manage placement of persons in LTC homes, supportive housing programs, chronic care and rehabilitation beds in hospitals and other programs and places where community services are provided under the Home Care and Community Services Act, 1994.

LHINs serve individuals who require support because of frailty, disability or chronic health issues, may be recovering from an acute illness, living with a chronic disease or are in the convalescent, rehabilitative or terminal stage of disease, and those requiring services to participate in school or home schooling.

There is no age restriction and no charge for services provided by LHINs. If a service outlined in a person’s plan of service is not immediately available, the person is placed on a waitlist for the service. The duration of service depends on someone’s needs. The provision of community-based health and support services may be temporary, periodic, or long term.

LHINs provide or arrange for the following professional services for eligible individuals: nursing, physiotherapy, occupational therapy, speech-language pathology, social work, dietetics, pharmacy services, respiratory therapy services, social service work services, and diagnostic and laboratory services.

LHINs can also provide or arrange for: medical supplies, dressings and treatment equipment necessary for the provision of nursing, physiotherapy, occupational therapy, speech-language pathology and dietetics services.

LHINs also provide or arrange for personal support and homemaking services as well as some community support services.

In addition to the provision of services, LHINs are also required to provide comprehensive information to people in their communities about other options to meet their needs and community services that are available (e.g., meal programs, security checks, and friendly visiting).

Most LTC homes in the province have waiting lists. Information on waiting lists can be viewed on each LHIN website and placement co-ordinators can provide information to applicants on wait times at each of the homes in their geographic area (Refer to Appendix 5 for LHIN contact information).

What Are Some Considerations When Applying To A First Nations LTC Home?

Application And Assessment Processes

With the exception of the provisions pertaining to consent and permitting MOHLTC to cease admissions, the following four First Nations homes are exempt from the placement related provisions in the LTCHA and Regulation: Iroquois Lodge Nursing Home, Ohsweken; Wikwemikong Nursing Home, Wikwemikong; Akwesasne Adult Care Centre, Cornwall and Oneida Nation of the Thames Long-Term Care Home, Southwold.

Anyone seeking to move into one of these LTC homes should inquire with the intake office of the First Nations LTC home they are interested in applying to concerning the home’s processes.

Depending on the particular First Nations LTC Home, the level of placement co-ordinator involvement with referrals, assessment and other intake/moving in processes may vary considerably. In some cases, referrals may be accepted from the placement co- ordinator, community agencies, hospitals, a person or family members. Some homes may require documentation showing First Nations status, for example, a status number.

First Nations LTC Home Supports For Adults With A Developmental Disability

In situations where an adult with a developmental disability is receiving DS supports from a DS agency and is considering applying to a First Nations LTC home, the DS agency is encouraged, with informed consent, to collaborate with the First Nations LTC home to identify any additional developmental services support needs the person may have, and to develop a support plan to meet these needs. A referral to the local DSO by either the DS agency or the First Nations LTC home, as most appropriate, will be made for an assessment to determine eligibility for developmental services and supports in the LTC home.

In situations where a person with a developmental disability is not receiving DS supports and is considering applying to a First Nations LTC home, the LTC home, with informed consent, should make a referral to the DSO for an assessment to confirm eligibility and any other community based resources, as appropriate.

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Part 5 - Roles, Responsibilities And Service Planning When Considering, Applying To And Moving Into A LTC Home

Individuals moving into a LTC home may be receiving MCSS-funded developmental services and supports. This section describes the type of service co-ordination that occurs when an individual moving into a LTC home is already receiving developmental services and supports, or requires such services and supports.

Informed Consent

A person’s informed consent (or that of the person’s SDM, if applicable) is required at multiple junctures in the LTC home placement process.

  • Separate consents are required relating to applications for admission to LTC homes, DSO services and acceptance of bed offers, to move into a LTC home.
    • The LTC home(s) to which a person, or their SDM, applies is their choice.
    • People are not required to be placed on a waiting list for a LTC home or accept a bed in a LTC home to which they have not applied. There may be consequences if the person does not accept a bed in a LTC home to which they have applied.
    • A person, or their SDM, must also consent to any bed offer before the person may move into a LTC home.
  • Separate consents are also required whenever information is to be shared between sector agencies and in situations where information is to be shared with persons other than a SDM, such as a primary caregiver, family members or friends.

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Adults With A Developmental Disability, Families And SDMs

Applying To A LTC Home: No Current Ds Involvement

1. Contact the Designated LTC Home Placement Co-Ordinator to Start the Application Process

When an adult with a developmental disability who has not been assessed by the DSO and/or is not receiving MCSS funded developmental services is considering placement in a LTC home, the local placement co-ordinator will need to be contacted either by the person or their SDM to start the application process. This process begins with an application for determination of eligibility.

2. Contact the DSO to Apply for Developmental Services

When someone is not currently receiving developmental services and supports but is in need of such supports as identified by the individual, caregiver and/or SDM, the placement co-ordinator should ask the person if they (or their SDM, if any) would prefer to initiate contact with the DSO themselves.

If not, the placement co-ordinator, (with consent), should facilitate a referral to the local DSO so that an application for MCSS-funded developmental services may be made.

The LTC home placement process should not be delayed as a result of any referral to a local DSO.

Applying To A LTC Home: Current DS Involvement

1. Contact the Designated Placement Co-ordinator to Start or Update the Application Process

When a person who is receiving MCSS-funded developmental services or supports (including residential services and supports) appears to require the services and supports of a LTC home, the person (or their SDM, if any) should consider contacting their local LTC home placement co-ordinator to determine whether a LTC home is an appropriate option.

Engaging the placement co-ordinator early on is important for planning purposes to help mitigate against urgent situations and to create a baseline of health information and information about their circumstances that can help to inform planning.

2. Contact the DSO about a Significant Change in Circumstances

If a person’s needs change such that they may be eligible to move into a LTC home, the person, DS agency or SDM should notify the DSO of the change in their needs/ supports that has occurred. The DSO will arrange for a reassessment of the person’s developmental service and support needs.

Identification And Provision Of Developmental Services And Supports In LTC Homes:

1. Contact the DSO to Start or Update the Application

The DSO assessment identifies a person’s needs and appropriate developmental services and supports. A DS agency can identify the services and supports being provided to a person by the agency and, (with consent), provide information to a placement co-ordinator and LTC homes.

The DSO and DS agency (if a person has been receiving MCSS-funded services and supports) will work together to determine if additional MCSS-funded developmental services and supports are required and available to support the person in the LTC home.

DS agencies are encouraged to work with placement co-ordinators and LTC homes to identify any required specialized developmental services to support the person’s quality of life and care while residing in a LTC home.

It is important to note that not all people with a developmental disability will require additional supports in order to transition into and/or reside in a LTC home.

Who Should Contact The DSO?

When such needs have been identified, the placement co-ordinator or DS agency should ask the person if they (or their SDM, if any) would prefer to initiate contact with the DSO. If not, the placement co-ordinator or DS agency should facilitate a referral to the local DSO so that a new or updated assessment of the person’s developmental service and support needs can be completed.

The placement co-ordinator or DS agency should agree on who is taking the lead for making the referral. The agency with the greatest involvement with the person at that time should take the lead in this regard and inform/provide documentation to one another.

If the person is new to the DSO, the DSO will confirm the person’s eligibility for developmental services and supports and complete the application assessment. If the DSO had previously completed an application assessment for the person, this application will be updated. The DSO will then determine if developmental services and supports are available to support the person in a LTC home.

Which Developmental Services And Supports Can Be Provided In A LTC Home?

Developmental services and supports that a person may receive or continue to receive while residing in a LTC home include:

  • Activities of daily living services and supports;
  • Community participation services and supports;
  • Professional and specialized services; and,
  • Person-directed planning services and supports.

An explanation of these developmental services and supports is provided in Part 4 of this document.

The processing of LTC home placement-related applications should not be delayed as a result of any referral to a local DSO.

Once an individual has been determined by the placement co-ordinator to be eligible for LTC home placement, the individual, or their SDM, if any, may select the LTC homes to which to apply.

Placement co-ordinators may place individuals on waiting lists for up to five LTC homes at one time. The limit of five does not apply to individuals who are prioritized in category 1 (crisis) on the waiting list (largely, although not exclusively, because they require an immediate admission to a LTC home as a result of a crisis arising from their condition or circumstances).

The placement co-ordinator will then seek approval for the individual’s admission from the LTC home(s).

A LTC home’s obligation to approve or withhold approval is in no way dependent upon whether an applicant has or has not contacted the DSO.

As per subsection 44(7) of the LTCHA, a LTC home can only withhold approval of an application if the home lacks the physical facilities necessary to meet the applicant’s care requirements or the staff of the home lack the nursing expertise necessary to meet the applicant’s care requirements.

Placement Co-Ordinators

Placement co-ordinators are responsible for managing the LTC home placement process and will work (as appropriate) with the person, or the person’s SDM if any, the person’s family, DSOs and DS agencies when dealing with a person’s application and planning for the person’s move into a LTC home, as required.

Is A LTC Home Suitable For The Person?

It is important that a discussion with the applicant, the SDM, if any, and family members (if the applicant or SDM consents to their involvement) occur as to whether a LTC home is suitable to meet the individual’s health and social needs.

MCSS and MOHLTC support people living and aging in the community for as long as they are safe, willing and able to do so.

Assessments:

When an individual or their SDM decides to complete an application for determination of eligibility for LTC home admission, the placement co-ordinator will work with the person, or SDM if any, to gather all of the necessary health and functional assessments, and any other information required to complete the eligibility determination.

Such additional information may pertain to the person’s condition, circumstances and care needs as they specifically relate to the person’s medical and/or behavioural needs. A person’s developmental disability should be noted in any application that is supplied to the LTC home(s) selected by the applicant.

It is very important that this information be comprehensive and accurate, particularly in respect of any behavioural issues.

Full disclosure in this regard will help to ensure that the person can be properly supported by the LTC home in relation to his/her care needs.

Planning For Care Needs Across DS And LTC Home Sectors

To facilitate the planning processes, LTC home placement co-ordinators will have discussions with DS agencies that have been involved in the care of the person.

The goal of having these discussions early on in the assessment process is to aid in the transition of the individual into a LTC home, including timely provision of any of the required specific developmental services and supports.

  • The placement co-ordinator must determine, as part of the eligibility determination for LTC home admission, if the publicly-funded community-based services available to the person and the other caregiving, support or companionship arrangements available to the person in their current living situation are not sufficient, in any combination, to meet the person’s requirements (section 155 (1) (d) of the Regulation) and that the person’s care requirements can be met in a LTC home.
  • LTC home application and transition planning for a person will include the identification of necessary supports for successful transition through the development of a support plan. These may include additional supports that are specific to the person’s developmental disability, beyond the LTC home’s required service offering, and necessary for successful transition and residing in a LTC home.
  • Where applicable, planning will include, but not be limited to, a confirmation of the service providers who would be involved in providing direct or indirect support through the DS system.

Where appropriate, the placement co-ordinator, in consultation with the DS agency involved in the person’s care, may:

  • Co-ordinate the necessary steps to obtain a completed health assessment from the person’s physician and to meet with the person to complete the functional assessment, both of which are required for a determination of eligibility for admission to a LTC home.
    • The health assessment is required to be completed by a physician, registered nurse or registered nurse in the extended class.
    • The health assessment includes information about an applicant’s physical and mental health and requirements for medical treatment and health care.
    • The functional assessment is required to be carried out by an employee or agent of the LHIN who is a registered nurse, a social worker registered under the Social Work and Social Service Work Act, 1998, a physiotherapist, occupational therapist, speech-language pathologist or a dietitian.
    • Under the LTCHA, the functional assessment must include an assessment of the applicant’s functional capacity, requirements for personal care, current behaviour and behaviour during the year preceding the assessment. All placement co-ordinators use the standard long-stay assessment instrument known as the RAI-HC (Resident Assessment Instrument - Home Care) for completion of this assessment. Some of the questions in the RAI-HC also relate to an applicant’s behaviours and if these answers indicate that an applicant has previously demonstrated responsive behaviours, another separate assessment related solely to behaviors is triggered.
    • The use of the RAI-HC provides for a standardized assessment process and terminology that is applicable throughout the entire province.

The LTCHA requires that the health assessment and functional assessment be made by different individuals.

What Questions May Be Useful For An Applicant Or Any SDM To Consider As Part Of The Planning Process?

Moving into a LTC home is a big decision for any person. It is important to ask the person what their preferences and emotional, physical and care needs are when applying and moving into a LTC home. Talk to them often to see if these preferences and needs have changed.

The questions below have been suggested by a LTC home provider as possible questions to ask when a person is considering whether a LTC home could be an appropriate setting to meet their needs and/or if special supports are required:

  • What is the person’s usual routine?
  • How does change in routine affect the person?
  • Does the person have any obsessive needs/routines that need to be considered?
  • Does the person require the services of a behavioural therapist?
  • Is the person independent in travelling with public transit and/or going out into the community unsupervised?
  • Does the person need enhanced/constant supervision (anything less than a 1:10 ratio)?
  • Is the person comfortable with being in close quarters (e.g. dining room; care unit) with 30+ people?
  • There may be wandering residents in a LTC home who may enter the person’s room without an invitation. How would the person react to this?
  • Does the person display an unusual sensitivity to sensory stimuli - e.g. loud noises; light; clothing types; touch; smells (dyspraxia)?

Additional Planning Consider Actions For Placement Co-Ordinators

Placement co-ordinators support the planning process by:

  • Providing information about specific LTC homes and encouraging the individual, or their SDM, if any, to learn if all aspects of the home environment meet their needs and preferences.
  • Working with the DSO and developing a support plan with the LTC home that can meet the needs of the person. This should include discussions of the types of supports LTC home staff might require such as additional training before or after the person moves into the LTC home.
  • Engaging in contingency planning for situations in which a person is determined ineligible for LTC home admission based on the eligibility criteria set out in the Regulation under the LTCHA, or cannot move into a LTC home.
  • Contingency planning is also required by LTC homes/placement co-ordinators in situations where a discharge from a LTC home is being planned, including a referral to the DSO for persons requesting MCSS-funded developmental services or supports. A discharge from a LTC home can occur for a variety of reasons and the Regulation under the LTCHA sets out detailed requirements in this regard (LTC home residents can only be discharged where permitted or required by the Regulation.)

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Responsibilities of LTC Homes

LTC homes are responsible for:

  • Determining whether to give or withhold approval for the person’s application within five business days after receiving the placement co-ordinator’s request and after reviewing the assessments and information provided.
  • Providing a written response to the placement co-ordinator acknowledging its review of this material and stating that the applicant is either approved or not to move into the home.
  • Approving an applicant’s admission unless the home lacks the physical facilities
    to meet the person’s care requirements, or the staff of the home lack the nursing expertise necessary to meet the person’s care requirements.
  • Assessing and determining with the support of placement co-ordinators what additional supports (e.g., accommodation, education, equipment, staffing) may be required. If the person has a developmental disability, the DSO would assess for needs related to developmental services and supports.
  • Participating in ongoing knowledge exchange during the person’s application process and information exchange with the placement co-ordinator and other service providers. The DSO is the lead for knowledge exchange about relevant developmental services and supports, which may be available within the community as well as through MCSS-funded agencies.
  • Identifying their staff training needs that could be supported by the DS sector (e.g. agencies) to facilitate a successful transition.
  • When applicable, working together and providing reasonable, controlled access for DS agency staff and other care providers into the LTC home to provide any additional developmental services and supports.
  • LTC homes that already have residents with a developmental disability who are not in receipt of MCSS-funded developmental services but who may benefit from such services to support their living in the LTC home can initiate discussions with the resident or the person’s SDM, if any, as to whether the person would like to be referred to the local DSO for determination of eligibility for developmental services. Where a resident indicates such an interest, the LTC home should facilitate the referral unless the person, or SDM if any, prefers to initiate contact themselves.

Discharge From A LTC Home

The LTC home may discharge a resident in certain circumstances. For example, a discharge may occur:

  • If a resident's care requirements have changed and, as a result, the LTC home can no longer provide a sufficiently secure environment to ensure the safety of the resident or the safety of persons who come into contact with the resident;
  • The resident decides to leave the home and signs a request to be discharged;
  • The resident leaves the home and informs the Administrator that he or she will not be returning to the home; or
  • The resident is absent from the home for a period exceeding seven days and the resident has not informed the Administrator of his or her whereabouts, and the Administrator has been unable to locate the resident.

There are also situations when a LTC home must discharge a resident. For example, long-stay residents must be discharged when:

  • The resident is on a medical absence that exceeds 30 days or on a psychiatric absence that exceeds 60 days, unless the resident is unable to return to the home because of an emergency in the home or an outbreak of disease, or emergency or natural disaster in the community;
  • The total length of the resident's vacation absences during the calendar year exceeds 21 days, unless the resident is unable to return to the home because of an emergency in the home or an outbreak of disease in the home, emergency or natural disaster in the community, or short-term illness or injury; or
  • The LTC home is being closed.

Before any discharge may occur, the LTC home is responsible for:

  • Ensuring that notice of the discharge is given to the resident, the resident's SDM, if any, and to any other person either of them may direct; and
  • Ensuring that the notice is provided as far in advance of the discharge as possible or, if circumstances do not permit the notice to be given before the discharge, as soon as possible after the discharge.

Before a discharge may occur relating to the change in the resident's care requirements, the LTC home is responsible for:

  • Ensuring that alternatives to discharge have been considered and, where appropriate, tried;
  • Making, in collaboration with the appropriate placement co-ordinator and other health service organizations, alternative arrangements for the accommodation, care and secure environment required by the resident. The DSO will also be notified;
  • Ensuring the resident and the resident's SDM, if any, and any person either of them may direct is kept informed and given an opportunity to participate in the discharge planning and that his or her wishes are taken into consideration;
  • Providing a written notice to the resident, the SDM, if any, and any person either of them may direct setting out a detailed explanation of the supporting facts, as they relate both to the home and to the resident's condition and requirements for care that justify the LTC home’s decision to discharge the resident.

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Public Guardian And Trustee And The Office Of The Public Guardian And Trustee

Decision-Making In Respect Of Personal Care

  • The Public Guardian and Trustee may become involved as the SDM of last resort if the person is found to be incapable of making the decision about admission to a LTC home and there is no one else willing and able to make the decision on the person’s behalf who meets the requirements to be the SDM. In such circumstances, the LHIN can contact the Office of the Public Guardian and Trustee directly to request that they act as SDM.
  • The Public Guardian and Trustee’s authority would include selecting the LTC home and making any decisions that are necessary and ancillary to the application to the LTC home.

Decision Making In Respect Of Property

  • The Public Guardian and Trustee may be involved as the statutory guardian of property for a financially incapable person who may be transitioning into a LTC home, even if the Public Guardian and Trustee is not otherwise involved in the decision about a person’s admission to a LTC home.
  • As statutory guardian of property, the Public Guardian and Trustee is responsible for financial decisions relating to the person’s move into a LTC home and will work with the person, family, personal care SDM and DS agency to ensure that appropriate financial arrangements are made to pay for the person’s accommodation costs in the LTC home and for the provision of services where the cost is to be paid by the person. Typically this may include items such as moving costs, decisions regarding disposing of property, determining the LTC home room type, and arranging for private personal support workers, if necessary.

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DS Sector

As mentioned above, the DSO will determine the person’s eligibility for developmental services and supports and complete the application assessment. If the DSO had previously completed an application assessment for the person, it will be updated. The DSO will then determine if developmental services and supports are available to support the person in a LTC home.

Developmental services and supports that a person may receive or continue to receive while residing in a LTC home include:

  • Activities of daily living services and supports;
  • Community participation services and supports;
  • Professional and specialized services; and,
  • Person-directed planning services and supports.

Placement Co-Ordinator To Work With DS Agency To Identify And Co-Ordinate Required Supports:

MCSS-funded DS agencies are encouraged to proactively engage in service planning with their local designated LTC home placement co-ordinator where possible.

When a MCSS-funded DS agency is involved in supporting a person, the local designated LTC home placement co-ordinator will co-ordinate and work with the DS agency to arrange discussions with potential LTC homes to identify how the LTC home can meet the person’s needs and what additional supports, if any, may be required.

  • This discussion would identify options and actions that can be taken to address these needs and would usually occur after a person has been found eligible by the placement co-ordinator and has been approved for admission by their selected LTC homes.
  • When a person has very high care needs, this discussion may occur prior to a determination of eligibility in order for the placement co-ordinator to determine whether a person’s care needs can generally be met in a LTC home (for example, as part of eligibility determination).

Cross Sector Co-Ordination Scenario:

At age 56, Sam began to have significant health issues requiring medical interventions. Sam, with the support of his family, made the decision to apply for admission to a LTC home. Sam has Down syndrome, Alzheimer’s disease and complex medical needs.

Once Sam was determined eligible and approved by a LTC home, a transition plan was developed with Sam and his family, the developmental service agency and the LTC home. This transition plan was in place weeks before Sam moved into the LTC home and included:

  • Arranging transportation to the LTC home so he could meet staff and other residents before moving in.
  • Providing staff from the DS residence to work with the LTC home staff to understand Sam’s needs, his daily care routine and ongoing medications. This support was provided during the first few weeks after Sam moved into the LTC home.
  • Sam had direct funding from the Ministry of Community and Social Services through Passport , so he was able to continue receiving community participation support after he moved into the LTC home. This helped Sam participate in the activities at the LTC home and to also stay connected with his community.

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Part 6 - What Is The Step By Step Process For Applying To A LTC Home?

1. Starting the Application Process

  • A LTC home may be identified by the person who needs care or by someone acting on the person’s behalf. This can include a SDM, primary caregiver, family members, or a DS agency that is providing residential or other services.
  • DS agencies are expected to be proactive in identifying aging-related decline in health status for those individuals they are providing residential services and supports to and whose health needs may be more appropriately supported in a LTC home. All other health and community services should be considered first.
  • Change in health status should be tracked on an ongoing basis from the time they are first noticed. This includes changes such as the onset of Alzheimer’s or other dementias, reduced mobility, increases in falls and other aging-related frailties.
  • When the person or their SDM, if any, decides that LTC home placement may be an option, the person or their SDM applies to the local placement co-ordinator for a determination of eligibility.
    • Either the person or their SDM, if any, can contact the placement co-ordinator to start the application process.
    • If the person is determined eligible in accordance with the eligibility criteria set out in the Regulation, the person or their SDM applies to the placement co- ordinator for authorization of admission to one or more LTC homes.
    • Step 4 below explains the process to obtain consent for the application process.

2. Applying to and/or Updating the DSO

  • If a person’s needs change, the person, DS agency or SDM should notify the DSO of the change in their needs/supports so that a new or updated DS application can be completed.
  • If the person is already in receipt of developmental services, the DSO will arrange for a reassessment of the person’s developmental service and support needs.
  • While the above LTC home application process is underway, the DSO will confirm eligibility for developmental services and supports for the person, if needed.

3. Developing a Support Plan

The person, or SDM if any, the person’s primary caregiver, DSO, DS agencies, if applicable, the LTC home in which the individual will be residing and the placement co-ordinator should all be involved in the identification of support and transition needs. The placement co-ordinator is responsible for a successful transition into a LTC home. Furthermore, the LTC home in which the individual will be residing will co- ordinate the development of a support plan for the person.

  • This plan will be based on information obtained through relevant health and DS assessments.
  • It may also be enhanced by additional information obtained from the person or their SDM, if any, as well as the primary caregiver, family, friends, supporting DS agency, and primary health care provider (if the applicant or SDM consents to their involvement).
  • The plan is to be shared with the person or their SDM, if applicable, and, with the consent of the person or any SDM, it may be shared with a primary caregiver, family, friends, DSO and DS agency staff as applicable, for consideration/revision. The final version should then be distributed to the LTC home that will be involved in supporting the person going forward as well as the DS agency if developmental services and supports will be provided.
  • DS agencies may provide developmental services and supports to LTC home applicants while they wait for a LTC home bed as well as to individuals already residing in a LTC home to support their transition or for a longer period of time depending on their needs.

4. Making the Application for a Determination of Eligibility for LTC Home Admission

Consent is required to start the application process to determine eligibility for admission to a LTC home as well as for the release of information that will be required as part of this process.

  • This consent must come from the person who will be applying or the person’s SDM, if any.
  • The placement co-ordinator, in collaboration with the DS agency, will obtain this consent and consents needed to release any information.

5. Completing Assessments

  • The following types of assessments are required to be obtained or completed by the placement co-ordinator in order to determine a person’s eligibility for a LTC home:
    • Health Assessment; and
    • Functional Assessment.
  • These assessments provide information about a person’s medical and health care needs as well as functional capacity, current and past behaviours, and personal care needs.
  • If the person is currently receiving services and supports from a DS agency, the agency may, if appropriate, co-ordinate the meetings needed for the functional assessment to be completed and ensure that the SDM, if any, is told about this process. The DS agency will stay in contact with the person, or SDM if applicable, throughout the LTC home placement process.
  • The placement co-ordinator will meet with the person and SDM, if any, to complete the functional assessment as part of the process to determine the person’s eligibility for admission to a LTC home.
    • If the person agrees, the primary caregiver and family may also be present for this assessment.
  • Assessments would also consider the provision of home care supports and/or appropriate referrals if the person is determined ineligible for a LTC home, or is determined eligible but moving into the LTC home is delayed.

6. Communicating Results of Assessments

  • The placement co-ordinator will share the results of the health and functional assessments with the person, or the person’s SDM, if any. The placement co- ordinator will also share its decision about eligibility.
  • With consent of the person or the SDM, if any, the placement co-ordinator will share these results and decision with the primary caregiver, family members, DSO and the DS agency staff person identified as the primary contact as applicable.
  • If the person is thinking about moving into a LTC home that is in a different geographic area, the placement co-ordinator completing the assessment will also share the referral and assessment information with the placement co-ordinator that is
    responsible for LTC home placement in the community where the person wants to live.
  • If a person is determined ineligible for LTC home admission, the person has the right to appeal this decision to the Health Services Appeal and Review Board. The placement co-ordinator is responsible for letting the applicant know of this right of appeal at the time the determination of ineligibility is communicated.

7. Selection of LTC Homes

  • If a person is determined eligible for a LTC home, they will be asked to select and make an application to one or more specific LTC home(s).
    • If the person wants help selecting one or more LTC homes to which to apply, the placement co-ordinator must provide assistance.
  • Individuals, or their SDM if any, have a choice and can select the LTC home(s) to which to seek admission.
    Note: There is no minimum number of LTC homes to which a person must apply. A person can choose to apply to only one LTC home if that is their preference.
  • Individuals can be placed on up to five LTC home wait lists at one time. The limit of five does not apply to individuals who are prioritized in category 1 (crisis) on the waiting list. An applicant is placed in category 1 (crisis) on the waiting list if he or she:
    • Requires an immediate admission due to a crisis arising from his or her condition or circumstances;
    • Is facing a permanent or temporary bed closure in a LTC home or hospital within 12 weeks; or
    • Is a patient designated alternate level of care (ALC) who requires an immediate admission where the LHIN verifies that the hospital is experiencing severe capacity pressures.
  • Some examples of situations that could result in category 1 prioritization for a LTC home include an unexpected change in a person’s condition or circumstances that makes existing care arrangements no longer appropriate, or results in caregiver inability to continue providing care.
  • In assisting the person, the placement co-ordinator must consider the person’s preferences based on ethnic, religious, spiritual, linguistic, familial and cultural factors.
  • To support a person’s selection process, it may be useful to call and visit a LTC home that a person is considering and to contact the Residents’ Council and Family Council, if any, to ask any questions about the social, recreational and other activities/ supports that are offered.

8. Completing the Application for Authorization of Admission

  • Once the eligible person or SDM, if any, has selected the LTC home(s) to which he/she would like to apply, the placement co-ordinator, with the DS agency staff person, where applicable and if needed, will assist them in completing the application for authorization of admission.

9. Sending the Application to the LTC Home(s)

  • Once the application for authorization of admission is completed, this application, together with all the assessment information and information about the person’s selection of accommodation type (for example, private, semi-private, or basic accommodation), will be sent to the selected home(s).
  • Documentation outlining a plan for any MCSS-funded developmental services and supports in the LTC home that are to be provided by a DS agency or purchased with direct funding provided through MCSS’ Passport program, will also be sent with the application. This could relate to continuation of developmental services a person has been receiving to support the person to reside in the LTC home for a long period of time or new temporary developmental services to assist with transition into the LTC home. As mentioned above, the DSO should be notified in the event that a new or updated application for developmental services is required.

10. LTC Home Review of Application

  • The LTC home is required to review the assessments and information provided and must respond in writing to the placement co-ordinator acknowledging its review of this material. The LTC home must state in writing if the applicant’s admission is either approved or not within five business days after receiving the placement co-ordinator’s request.
  • If within those five business days, the LTC home requests additional information that the placement co-ordinator believes is relevant to the LTC home’s decision of whether to give approval, the placement co-ordinator must provide the information. The LTC home’s request must be in writing and once the additional material has been received, the LTC home has three additional business days to respond.

11. Refusal by the LTC Home to Approve the Application

  • Should the LTC home not approve the person’s application (refuse the placement of the person in that home), the LTC home is required to provide written notice to the person, the placement co-ordinator and the Director (MOHLTC’s Director of the Long- Term Care Inspections Branch) outlining:
    • The ground or grounds for withholding approval;
    • A detailed explanation of the supporting facts, as they relate both to the home and to the person’s condition and requirements for care;
    • An explanation of how the supporting facts justify the decision to withhold approval; and
    • Contact information for the Director.

In accordance with the requirements in the LTCHA, a LTC home can only withhold approval of the applicant’s admission if the home lacks the physical facilities necessary to meet the applicant’s care requirements or the staff of the home lack the nursing expertise necessary to meet the applicant’s care requirements.

  • Placement co-ordinators will also assist in the planning for other health-based supports where moving into a LTC home is not possible. In order to allow people to continue to reside in the community, including in their current residence (which may be a DS agency residence), appropriate options could be explored which, depending on the type of residence, may include the provision of homemaking services, personal support services, professional services and referrals to other community support services as permitted under the Home Care and Community Services Act, 1994 and subject to availability.

12. Wait Listing When a LTC Home Approves an Application

  • Most LTC homes have waiting lists. Once a person’s admission has been approved by the LTC home, he or she may go on a waiting list based on the prioritization criteria set out in the Regulation.

13. Reassessments While On a Wait List

  • Where a person remains on one or more waiting lists, the placement co-ordinator must ensure that the health and functional assessments of this person are updated within the three months prior to the date of authorizing the admission to the LTC home. A reassessment may be also needed if the person has experienced a significant change in his/her condition or circumstances, and the placement co-ordinator must confirm whether the applicant is still eligible for admission.

14. Authorization of Admission

  • When a bed becomes available in one of the LTC homes to which an individual has been placed on a waiting list, the placement co-ordinator will notify the person, or SDM if any, and if consent is provided, the DSO and DS agency involved in the referral and/or support needs of the individual.
  • The person, or SDM if any, will have 24 hours within which to accept or decline the bed offer.
  • Once an offer has been accepted, the person has five days to move into the LTC home, not counting the date of notification.
    • The bed can only be held for these 5 days following the date of notification if the person pays the applicable accommodation fees.
      Note: Moving into the LTC home cannot be delayed beyond these 5 days as placement co- ordinators are obliged to cancel the authorization of admission of anyone who has not moved in by the fifth day.
  • As noted earlier, depending on one’s circumstances, there may be consequences to refusing a bed offer based on the requirements in the LTCHA Regulation.
  • A person can remain on the DS residential wait list once residing in a LTC home.

This may be particularly relevant for situations where a person’s care needs are likely to change so that LTC home supports are no longer required or the person can be more appropriately served in another setting.

15. Formalizing the Plan for Developmental Services and Supports

  • The plan for the provision of DS supports in the LTC home will become formalized through a written agreement between the person, or SDM if any, supporting DS agency if any, and the LTC home provider. This plan should also include any services and supports purchased through direct funding.
  • This written agreement will set out what supports will be provided, by whom, and the roles and responsibilities of each party in relation to the ongoing assessment/ evaluation of the support plan.
  • Any developmental services and supports provided by a DS agency or purchased through direct funding (e.g. Passport) would need to be identified in the resident's plan of care and provided to the resident as required by the LTCHA.
    • LTC home licensees must ensure that the care set out in the plan of care is based on an assessment of the resident and the needs and preferences of that resident. The licensee must also ensure that the plan of care covers all aspects of care, including medical, nursing, personal support, nutritional, dietary, recreational, social, restorative, religious and spiritual care.

16. Follow-up and Review of the Support Plan

  • If a DS agency is providing developmental services and supports after a person has moved into a LTC home, the DS agency will conduct a 3 month post-placement follow-up in conjunction with the LTC home and the individual (i.e. in conjunction with the individual and the LTC Home, as appropriate), as appropriate, to review the person’s status/progress and the support plan in relation to the person’s current situation and circumstances.

Refer to Appendix 4 for a visual depiction of the LTC home placement process.

Conclusion

MCSS and MOHLTC are grateful for the stakeholder feedback received during the development of these guidelines. It is hoped that these guidelines will improve knowledge, planning and co-ordination within both the DS and LTC home sectors as well as result in better service delivery for individuals who have a developmental disability and who are either applying to or residing in a LTC home.

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Appendix 1: List of Acronyms

DS Agency: Developmental Services agency funded by MCSS

DSO: Developmental Services Ontario

HCARDD: Health Care Access Research and Developmental Disabilities

LHIN: Local Health Integration Network

LTC home: Long-term care home

LTCHA: Long-Term Care Home Act, 2007

MCSS: Ministry of Community and Social Services

MOHLTC: Ministry of Health and Long-Term Care

OPADD: Ontario Partnership on Aging and Developmental Disabilities

OPGT: Office of the Public Guardian and Trustee

SDM: Substitute Decision-Maker

SIPPDA: Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008

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Appendix 2: Residents’ Bill Of Rights Under The Long-Term Care Homes Act, 2007

Every licensee of a long-term care home shall ensure that the following rights of residents are fully respected and promoted:

  1. Every resident has the right to be treated with courtesy and respect and in a way that fully recognizes the resident’s individuality and respects the resident’s dignity.
  2. Every resident has the right to be protected from abuse.
  3. Every resident has the right not to be neglected by the licensee or staff.
  4. Every resident has the right to be properly sheltered, fed, clothed, groomed and cared for in a manner consistent with his or her needs.
  5. Every resident has the right to live in a safe and clean environment.
  6. Every resident has the right to exercise the rights of a citizen.
  7. Every resident has the right to be told who is responsible for and who is providing the resident's direct care.
  8. Every resident has the right to be afforded privacy in treatment and in caring for his or her personal needs.
  9. Every resident has the right to have his or her participation in decision-making respected.
  10. Every resident has the right to keep and display personal possessions, pictures and furnishings in his or her room subject to safety requirements and the rights of other residents.
  11. Every resident has the right to:
    1. participate fully in the development, implementation, review and revision of his or her plan of care,
    2. give or refuse consent to any treatment, care or services for which his or her consent is required by law and to be informed of the consequences of giving or refusing consent,
    3. participate fully in making any decision concerning any aspect of his or her care, including any decision concerning his or her admission, discharge or transfer to or from a long-term care home or a secure unit and to obtain an independent opinion with regard to any of those matters, and
    4. have his or her personal health information within the meaning of the Personal Health Information Protection Act, 2004 kept confidential in accordance with that Act, and to have access to his or her records of personal health information, including his or her plan of care, in accordance with that Act.
  12. Every resident has the right to receive care and assistance towards independence based on a restorative care philosophy to maximize independence to the greatest extent possible.
  13. Every resident has the right not to be restrained, except in the limited circumstances provided for under this Act and subject to the requirements provided for under this Act.
  14. Every resident has the right to communicate in confidence, receive visitors of his or her choice and consult in private with any person without interference.
  15. Every resident who is dying or who is very ill has the right to have family and friends present 24 hours per day.
  16. Every resident has the right to designate a person to receive information concerning any transfer or any hospitalization of the resident and to have that person receive that information immediately.
  17. Every resident has the right to raise concerns or recommend changes in policies and services on behalf of himself or herself or others to the following persons and organizations without interference and without fear of coercion, discrimination or reprisal, whether directed at the resident or anyone else,
    1. the Residents’ Council,
    2. the Family Council,
    3. the licensee, and, if the licensee is a corporation, the directors and officers of the corporation, and, in the case of a home approved under Part VIII, a member of the committee of management for the home under section 132 or of the board of management for the home under section 125 or 129,
    4. staff members,
    5. government officials,
    6. any other person inside or outside the long-term care home.
  18. Every resident has the right to form friendships and relationships and to participate in the life of the long-term care home.
  19. Every resident has the right to have his or her lifestyle and choices respected.
  20. Every resident has the right to participate in the Residents’ Council.
  21. Every resident has the right to meet privately with his or her spouse or another person in a room that assures privacy.
  22. Every resident has the right to share a room with another resident according to their mutual wishes, if appropriate accommodation is available.
  23. Every resident has the right to pursue social, cultural, religious, spiritual and other interests, to develop his or her potential and to be given reasonable assistance by the licensee to pursue these interests and to develop his or her potential.
  24. Every resident has the right to be informed in writing of any law, rule or policy affecting services provided to the resident and of the procedures for initiating complaints.
  25. Every resident has the right to manage his or her own financial affairs unless the resident lacks the legal capacity to do so.
  26. Every resident has the right to be given access to protected outdoor areas in order to enjoy outdoor activity unless the physical setting makes this impossible.
  27. Every resident has the right to have any friend, family member, or other person of importance to the resident attend any meeting with the licensee or the staff of the home.

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Appendix 3: Adult Developmental Services And Supports Pathway

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Appendix 4a: Overview Of LTC Home Waiting List Categories

The waiting list categories related to prioritization and the requirements for ranking are set out in the Regulation under the LTCHA.

People must be placed in the highest prioritization category that applies to them.

Category 1 (Crisis)

  • An applicant is placed in category 1 (crisis) on the waiting list if he or she requires an immediate admission due to a crisis arising from his or her condition or circumstance facing a permanent or temporary bed closure in a LTC home or hospital within 12 weeks; is an ALC public hospital patient who requires an immediate admission where the LHIN verifies that the hospital is experiencing severe capacity pressures.
  • Ranking within this category is according to the urgency of the applicant's need for admission.

Category 2 (Spousal Or Partner Reunification)

  • This priority category applies to spouses/partners who meet the eligibility criteria for admission based on care needs and once one of the spouses/partners has been admitted to the LTC home.
  • Individuals prioritized in this category are ranked according to the date which their spouse/partner was admitted to the LTC home so as to give priority within category to those who have been separated the longest.

Category 3a

  • Applicants of a particular religious, linguistic, or ethnic background seeking admission to a LTC home that primarily serves people of that background are prioritized in category 3A or 3B of the waiting list, unless a higher waiting list category applies (e.g. category 2 spousal/partner reunification).

Category 3b

  • Category 3B applies to “well” spouses/partners determined eligible for the sole purpose of accompanying/joining a spouse/partner who has care needs in the same LTC home.

Category 4a

  • Applicants who do not meet the criteria in any of the other prioritization categories are prioritized in 4A /4B, which contains the largest number of awaiting admission to LTC homes.

Category 4b

  • Category 4B applies to “well” spouses/partners determined eligible for the sole purpose of accompanying/joining a spouse/partner who has care needs in the same LTC home.

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Appendix 4b: LTC Home Placement Flow for Long Stay Beds

Placement Co-ordinator (PC) Responsibilities:

  • Determine eligibility for admission
  • Provide applicants with information
  • Assist applicants with placements related application process
  • Prioritize for admission
  • Monitor and manage waiting list
  • Authorize admission to LTC homes

Applicant Responsibilities:

  • Make an application for determination of eligibility
  • May apply to Appeal Board for review of placement co-ordinator’s determination of ineligibility for LTC home admission
  • Choose homes and accommodation type
  • Accept or refuse the authorization of admission within 24 hours of bed offer
  • Move in by the noon of the 5th day after the bed offer

LTC Home Licensee Responsibilities:

  • Review the application package (assessment and all information) provided by the placement co-ordinator
  • Respond to placement co-ordinator within 5 business days (3 days for interim bed)
  • Provide written notice to placement co-ordinator if approve the applicant for admission
  • Provide written notice to placement co-ordinator, Director, and applicant if withhold approval that outlines the ground for withholding approval and detailed explanation
  • Identify any developmental services and supports provided by a DS agency or purchased through direct funding (e.g. Passport) in the resident's plan of care and care is provided to the resident as required by the LTCHA
  • Keep a transfer list for residents who apply for internal transfer to other accommodation type.

* This does not apply if the reason that the person does one of the things mentioned above is that he or she has a health condition, short-term illness or injury which prevents the person from moving into the LTC home at that time, would make moving into the LTC home detrimental to the person’s health, or there is an emergency in the LTC home or an outbreak of disease which prevents the person from moving into the LTC home at that time. It also does not apply if an applicant who does not have specialized care requirements declines to enter a specialized unit.

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Appendix 5: LHIN Contacts

Central
60 Renfrew Dr., Suite 300
Markham, ON L3R 0E1
tel: 905-948-1872 1-866-392-5446 fax: 905-948-8011

Central East
Harwood Plaza, 314 Harwood Ave S., Suite 204A Ajax, ON L1S 2J1
tel: 905-427-5497 1-866-804-5446 fax: 905-948-8011

Central West
8 Nelson St. W., Suite 300
Brampton, ON L6X 4J2
tel: 905-455-1281 1-866-370-5446 fax: 905-455-0427

Champlain
1900 City Park Dr., Suite 204
Ottawa, ON K1J 1A3
tel: 613-747-6784 1-866-902-5446 fax: 613-747-6519

Erie St. Clair
180 Riverview Dr. Chatham, ON N7M 5Z8
tel: 519-351-5677 1-866-231-5446 fax: 519-351-9672

Hamilton Niagara Haldimand Brant
264 Main St. E. Grimsby, ON L3M 1P8
tel: 905-945-4930 1-866-363-5446 fax: 905-945-1992

Mississauga Halton
700 Dorval Dr., Suite 500
Oakville, ON L6K 3V3
tel: 905-337-7131 1-866-371-5446 fax: 905-337-8330

North Simcoe Muskoka
210 Memorial Ave., Suite 128
Orillia, ON L3V 7V1
tel: 705-326-7750 1-866-903-5446 fax: 705-326-1392

North East
555 Oak St. E., 3rd Floor
North Bay, ON L3V 7V1
tel: 705-840-2872 1-866-906-5446 fax: 705-840-0142

North West
975 Alloy Dr., Suite 201
Thunder Bay, ON P7B 5Z8
tel: 807-684-9425 1-866-907-5446 fax: 807-684-9533

South East
71 Adam St.
Belleville, ON K8N 5K3
tel: 613 967- 0196 1-866-831-5446 fax: 613 967-1341

South West
201 Queens Ave., Suite 700
London, ON N6A 1J1
tel: 519-672-0445 1-866-294-5446 fax: 519-672-6562

Toronto Central
425 Bloor St. E., Suite 201
Toronto, ON M4W 3R4
tel: 416-921-7453 1-866-383-5446 fax: 416-921-0117

Waterloo Wellington
50 Sportsworld Crossing Rd., Suite 220
Kitchener, ON 2P 0A4
tel: 519-650-4472 1-866-306-5446 fax: 519-650-3155

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Appendix 6: Developmental Services Ontario (DSO) Contact Information

There are nine DSO agencies across the province. Please contact your local DSO if you want information about or to apply to developmental services and supports. To find the right agency for your region and for your postal code, please visit the website:

https://www.dsontario.ca/agencies

Central East Region

Serves the following areas:

Regional Municipality of York
Regional Municipality of Durham
Simcoe County
Peterborough County
Northumberland County
Haliburton County
City of Kawartha Lakes

Email: dsocentraleast@yssn.ca
Phone: 905-953-0796 or 1-855-277-2121
Fax: 905-952-2077

DSO Central West Region

Serves the following areas:

Peel Region
Phone: 905-453-2747
Fax: 905-272-0702

Halton Region
Phone: 905-876-1373
Fax: 905-876-2740

Dufferin/Wellington County
Phone: 519-821-5716
Fax: 519-821-4422

Waterloo Region
Email: dso@dscwr.com
Toll free: 1-888-941-1121
Address: 1120 Victoria St. N. Suite 205, Kitchener, ON N2B 3T2
Hours: Monday - Friday 9:00 a.m. - 4:30 p.m.

DSO Eastern Region

Serves the following areas:

Unity Counties of Stormont, Dundas and Glengarry
United Counties of Prescott-Russell
Ottawa Region
Renfrew County

Email: admin@dsoer.ca
Phone: 1-855-DSO-ERDS (1-855-376-3737)
Fax: 1-855-858-3737
TTY: 1-855-777-5787
Address: 200 - 150 Montreal Rd., Ottawa ON K1L 8H2
Hours: Monday - Friday 8:30 a.m. - 4:30 p.m.

DSO Hamilton-Niagara Region

Serves the following areas:

Brant, Haldimand and Norfolk
Hamilton
Niagara
First Nations communities of Six Nations of the Grand River and Mississaugas of the New Credit First Nation

DSO Hamilton-Niagara Region is administered by Contact Hamilton which is a non-profit agency funded by the Ministry of Community and Social Services.

Email: info@dsohnr.ca
Phone: 1-877-DSO-HNR4 (1-877-376-4674)
Address: 140 King St. E., Suite 4 Hamilton, ON L8N 1B2

DSO North East Region

Serves the following areas:

Nippising
Cochrane
Timiskaming
Parry Sound
Muskoka
James Bay Coast

Email: dso@handstfhn.ca
Phone: 1-855-376-6376
TTY: 1-800-855-0511
Fax: 705-495-1373

Addresses:

North Bay
222 Main Street E. North Bay, ON P1B 1B1

Bracebridge
23 Ball’s Dr. Bracebridge, ON P1L 1T1

Timmins
60 Wilson Ave., Suite 103 Timmins, ON P4N 2S7

DSO Northern Region

Serves the following areas:

Kenora
RainyRiver
Thunder Bay
Sault Ste. Marie
Dryden
Algoma
Sudbury
Manitoulin

Email: info@lccctbay.org
Phone: 1-855-DSO-NORD (1-855-376-6673)
TTY: 1-866-752-5427
Fax: 1-807-346-8713

Adresses:

Thunder Bay
245B Bay St. Thunder Bay, ON P7B 6P2
Monday - Friday 8:30 a.m. - 4:30 p.m.

Sudbury
403 - 96 Larch St. Sudbury, ON P3E 1C1
Monday - Friday 8:30 a.m. - 4:30 p.m. Closed 1:00 p.m. - 2:00 p.m.

Sault Ste. Marie
203 - 262 Queen St. E. Sault Ste. Marie, ON P6A 1Y7
Thursday 12:30 p.m. - 4:30 p.m.

Dryden
116 - 100 Casimir Ave. Dryden, ON P8N 3L4
Tuesday 8:30 a.m. - 12:30 p.m. Thursday 8:30 a.m. - 12:30 p.m.

DSO South East Region

Serves the following counties:

Hasting and Prince Edward
Frontenac
Lennox and Addington
Lanark
Leeds and Grenville

Email: esteele@dsoser.com
Phone: 1-855-237-6737 or 1-613-354-7977

DSO South West Region

Serves the following areas:

Bruce County
Chatham-Kent
Elgin County
Grey County
Huron County
London-Middlesex
Oxford County
Perth County
Sarnia-Lambton
Windsor-Essex

Email: maryregan@dsoswr.ca
Phone: 1-855-437-6797
Fax: 519-673-1509
Address: 171 Queens Ave, Suite 750 London, ON N6A 5J7

DSO Toronto Region

Serves the following areas:

Toronto
Etobicoke
North York
Scarborough

DSO Toronto region is administered by Surrey Place.

Email: DSOTR@surreyplace.on.ca
Phone: 1-855-DS-ADULT (1-855-372-3858)

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  1. Ouellette-Kuntz, H., Martin, L., & McKenzie, K. (2015). Health surveillance in older adults with intellectual and developmental disabilities - a review of special considerations. International Review of Research in Developmental Disabilities, 48, 151-194.
  2. Ouellette-Kuntz, H., Martin, L., & McKenzie, K. (2016). From research to practice: implementing a frailty measure for older adults with intellectual and developmental disabilities. Ministry of Community and Social Services Speaker Series. February 24, 2016 (Toronto, ON).
  3. McKenzie, K., Ouellette-Kuntz, H., & Martin, L. (2016). Frailty as a predictor of institutionalization among adults with intellectual and developmental disabilities in Ontario. Intellectual and Developmental Disabilities, 54(2), 123-135
  4. Pursuant to subsection 2(1) of the Health Care Consent Act, 1996 and Ontario Regulation 104/96, the following professionals are evaluators of capacity for LTC home admission:
    (a) a member of the College of Audiologists and Speech-Language Pathologists of Ontario,
    (b) a member of the College of Dietitians of Ontario,
    (c) a member of the College of Nurses of Ontario,
    (d) a member of the College of Occupational Therapists of Ontario,
    (e) a member of the College of Physicians and Surgeons of Ontario,
    (f) a member of the College of Physiotherapists of Ontario,
    (g) a member of the College of Psychologists of Ontario
    (h) a member of the College of Social Workers and Social Service Workers of Ontario who holds a certificate of registration for social work.
  5. http://www.health.gov.on.ca/en/public/programs/ltc/