Bringing Care Governance to Ontario's Retirement Homes Sector

In 2010, the Ontario government introduced Bill 21, the Retirement Homes Act, 2010 (the Act), which required the licensing of retirement homes (RHs), residents' rights, care and safety standards, inspections, compliance and a newly formed Retirement Homes Regulatory Authority (Authority). The Act and its regulations drew heavily from the content of legislation pertaining to long-term care homes (LTC homes), recognizing that many RHs provided high acuity care. However, the Authority was constituted with a multi-sectoral board, which was arm's length from government. The stated goal of the Act was to ensure the dignity, respect, safety and privacy of residents, though the government also recognized the importance of preserving autonomy and choice for the predominantly private, for-profit operators and their residents. A consultation process spurred considerable debate over the content of the proposed legislation as well as the authority that would oversee it. The unwillingness of the government to fund care services in RHs (unlike LTC homes) influenced its policy decision to pass the Act in a form that gave greater autonomy to the industry to oversee its regulation through a multi-sectoral Authority, rather than one directed by government. A formal five-year review showed the reform to be well received by the public and key stakeholders, and an Effectiveness Survey for Stakeholders conducted by a third party indicated positive results, pointing to the success of both regulatory content and oversight

Ontario's Retirement Homes and Long-Term Care Homes: Policy Implications for Care Services, Funding and Governance Regimes

Abstract Purpose: The Province of Ontario is experiencing substantial growth in the seniors’ population requiring care, with capacity, cost and regulatory pressures across all settings. This study compares long-term care homes (LTCHs) and retirement homes (RHs), significant residential care alternatives for seniors in Ontario, regarding pricing, levels of care and availability of services, in the context of different government funding and regulatory oversight. Attention is given to the way owners of homes shape their services in response to prevailing policy instruments and other environmental factors. Methods: The research uses an explanatory sequential mixed methods design, with a first phase involving the analysis of quantitative data regarding LTCHs and RHs, and a second phase involving qualitative (interview) data from key informants. The first phase informs the interview questions for the second phase, with integration occurring after Phase 2. Results: Substantial overlaps exist in the characteristics of the two resident populations (LTCHs and RHs), which are most evident among the population of seniors requiring high levels of care and support. However, the two sectors are funded and regulated differently, which affect how services are delivered. Most care costs in LTCHs are publicly funded, while residents in RHs generally cover these expenses personally. Equity of access issues arise from shortages of beds in LTCHs and limited government funding for care services in RHs. LTCH owner strategies are affected by excess demand for beds and by regulatory instruments that limit profit for care and accommodation. With RHs, more flexible owner strategies are evident for care levels, pricing and location. However, without public funding, availability and affordability of RHs to the resident suffer and owner strategies focus on areas of higher income, population density or community infrastructure. The two sectors are also regulated differently in respect of care standards, security and enforcement. Conclusions: Policy instruments influence the features of residential care service offerings by shaping how the owners of seniors’ residential care offer services, with important consequences regarding access to those services. Policy instruments play an important part in determining the availability and affordability of seniors’ residential care, and consistency of governance.Ph.D

Bringing Care Governance to Ontario's Retirement Homes Sector

In 2010, the Ontario government introduced Bill 21, the Retirement Homes Act, 2010 (the Act), which required the licensing of retirement homes (RHs), residents' rights, care and safety standards, inspections, compliance and a newly formed Retirement Homes Regulatory Authority (Authority).  The Act and its regulations drew heavily from the content of legislation pertaining to long-term care homes (LTC homes), recognizing that many RHs provided high acuity care. However, the Authority was constituted with a multi-sectoral board, which was arm's length from government.  The stated goal of the Act was to ensure the dignity, respect, safety and privacy of residents, though the government also recognized the importance of preserving autonomy and choice for the predominantly private, for-profit operators and their residents.  A consultation process spurred considerable debate over the content of the proposed legislation as well as the authority that would oversee it.  The unwillingness of the government to fund care services in RHs (unlike LTC homes) influenced its policy decision to pass the Act in a form that gave greater autonomy to the industry to oversee its regulation through a multi-sectoral Authority, rather than one directed by government. A formal five-year review showed the reform to be well received by the public and key stakeholders, and an Effectiveness Survey for Stakeholders conducted by a third party indicated positive results, pointing to the success of both regulatory content and oversight. Le gouvernement de l'Ontario a introduit en 2010 le Projet de loi 21, Loi de 2010 sur les Maisons de Retraite (la Loi), qui imposait l'accréditation des Maisons de Retraite (MR), des droits des résidents, des normes de soins et de sécurité, des inspections, une norme de conformité et la création de l'Office de réglementation des maisons de retraite (l'Office). La loi et ses réglements se sont fortement inspirés du contenu de la législation des foyers de soins de longue durée, de nombreuses MR fournissant des soins intensifs. Cependant, l'Office est doté d'un conseil d'administration multi-sectoriel, autonome par rapport au gouvernement. L'objectif déclaré de la Loi était de garantir la dignité, le respect, la sécurité et l?intimité, même si le gouvernement affirmait aussi l'importance de maintenir l'autonomie et le choix des opérateurs, principalement privés et à but lucratif, ainsi que de leurs résidents. Un processus de consultation a lancé un débat nourri sur le contenu de la législation proposée ainsi que sur l'office chargé de la gouverner. La réticence du gouvernement à financer les soins dans les MR (comme il le fait pour les foyers de soins de longue durée) a motivé la décision politique d'écrire une Loi donnant une plus grande autonomie à l'industrie pour mettre en oeuvre sa propre régulation à travers un Office multi-sectoriel, et non piloté par le gouvernement. Une évaluation formelle à cinq ans a montré que la réforme avait été bien reçue par le public et les principales parties prenantes, et une enquête d'efficacité auprès des parties prenantes, conduite par un tiers de confiance, suggère des résultats positifs, tant sur le fond que sur la gouvernance

Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis

Abstract Background Among Canadian residents living in long-term care (LTC) facilities, and especially among those with limited ability to communicate due to dementia, pain remains underassessed and undermanaged. Although evidence-based clinical guidelines for the assessment and management of pain exist, these clinical guidelines are not widely implemented in LTC facilities. A relatively unexplored avenue for change is the influence that statutes and regulations could exert on pain practices within LTC. This review is therefore aimed at identifying the current landscape of policy levers used across Canada to assess and manage pain among LTC residents and to evaluate the extent to which they are concordant with evidence-based clinical guidelines proposed by an international consensus group consisting of both geriatric pain and public policy experts. Methods Using scoping review methodology, a search for peer-reviewed journal articles and government documents pertaining to pain in Canadian LTC facilities was carried out. This scoping review was complemented by an in-depth case analysis of Alberta, Saskatchewan, and Ontario statutes and regulations. Results Across provinces, pain was highly prevalent and was associated with adverse consequences among LTC residents. The considerable benefits of using a standardized pain assessment protocol, along with the barriers in implementing such a protocol, were identified. For most provinces, pain assessment and management in LTC residents was not specifically addressed in their statutes or regulations. In Alberta, Saskatchewan, and Ontario, regulations mandate the use of the interRAI suite of assessment tools for the assessment and reporting of pain. Conclusion The prevalence of pain and the benefits of implementing standardized pain assessment protocols has been reported in the research literature. Despite occasional references to pain, however, existing regulations do not recommend assessments of pain at the frequency specified by experts. Insufficient direction on the use of specialized pain assessment tools (especially in the case of those with limited ability to communicate) that minimize reliance on subjective judgements was also identified in current regulations. Existing policies therefore fail to adequately address the underassessment and undermanagement of pain in older adults residing in LTC facilities in ways that are aligned with expert consensus