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Recent incidents involving a lack of proper care in some private retirement homes has brought the issue of regulating retirement and care homes back on the public agenda. The Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS) strongly believes that accountability is fundamental for all providers of care and accommodation for seniors. As such, we are urging the government of Ontario to ensure the provision of care in these homes is regulated, and where appropriate, funded.
We believe that the regulation of retirement and care homes must be province-wide and consistently enforced. As part of this process, the province should clearly define retirement and care homes and care services. We further believe that the regulatory environment must balance the rights of care and retirement home providers with the rights of consumers and the rights of the regulating body to enforce its standards of care.
OANHSS recommends that an independent agency be created to establish standards and regulations to monitor the operation of retirement and care homes. This agency should:
The government of Ontario must ensure that there is adequate funding (a combination of licensing fees and general funding from the province) to ensure the agency can fully carry out its functions, and more importantly, to ensure that seniors are given the dignity they deserve.
Consumer access to appropriate and high quality care and accommodation is of critical importance to OANHSS members. While we have long supported the need for standards in seniors housing, it is important to point out that, even in the absence of government regulations, there are many examples of excellent operators. One of the many strengths of not-for-profit organizations, often run by cultural, religious or community groups, is the built-in accountability to the boards that govern them and to the local communities they serve.
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Recent incidents highlighting inadequate care in some private retirement homes has once again put the spotlight on a long-standing issue – the need for regulations in the retirement and care home sector. The Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS) would like to bring the expertise of its members (who deliver both housing and support or care services to thousands of Ontario’s seniors) to the attention of the provincial government as it looks for solutions to this very complex issue.
Accountability is fundamental for all providers of care and accommodation for seniors. There must be checks and balances to ensure the system is efficient and effective, and that consumers are getting the care and services they have paid for and/or require. One of the many strengths of not-for-profit organizations, often run by cultural, religious or community groups, is the built-in accountability to the boards that govern them and to the local communities they serve.
This submission is in response to the issues raised during the listening tour conducted by Brenda Elliott, Parliamentary Assistant to the Minister of Citizenship, Culture and Recreation. It is the product of input from a diverse array of OANHSS member organizations, as well as other interested groups (consumers, seniors advocates, District Health Council staff) who recently attended a stakeholder session hosted by our Association. The input from this meeting was most valuable in formulating this paper and refining our positions.
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The Ontario Association of Non-Profit Homes and
Services for Seniors (OANHSS) is a provincial, membership-based association
that has represented not-for-profit providers of care, services, and housing
for seniors for over 80 years. Member operations span the full spectrum of
the not-for-profit long term care continuum including municipal and
charitable homes for the aged, non-profit nursing homes, seniors housing
(including retirement homes), and community service agencies. Association
members are respected and recognized for their dedication and commitment to
quality care and services, and for the active and integral role they play in
the communities they serve.
Members have expertise in providing housing as well as care and services. Some members provide support services themselves while others contract with a community agency to provide support services for the residents. There are a number of OANHSS housing providers who have designated themselves as retirement homes.
We would like to emphasize that not-for-profit retirement and care home providers have a higher degree of openness and accountability than their for-profit counterparts. Non-profit providers have their boards elected from the communities they operate in, their meetings are open to residents and the public, and in many cases, residents sit on the board of directors. Additionally, their “books” or operating budgets are open to the public. This built-in accountability should be reflected in the development of any legislation or regulations that affect non-profit retirement or care homes. This openness and accountability which exists in the seniors non-profit housing sector could serve as a model for other retirement and care homes. It will also enhance the value of their involvement in a regulatory agency.
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Our key positions on the issue of care standards in rest and retirement homes, which are further articulated in this paper, are:
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It has been seven years since the government of Ontario clearly brought the residential tenancy relationship between retirement/care homes residents and their respective landlords under the province’s residential tenancy laws (as currently set out in the Tenant Protection Act). Unfortunately the issue of ensuring that quality care services were provided by all operators of retirement homes was not addressed at that time.
OANHSS urges the province to complete the important job of protecting seniors and ensuring accountability within the sector. We recognize the difficulties ahead and offer our thoughts at this point in the discussion. We request that the province consult with our organization and our members as it moves from the Parliamentary Assistant’s listening tour to the development of protections for residents which will be balanced with the rights of care home operators.
The following section details key issues identified by OANHSS members and notes the specific policy positions (see Section 3) that relate to each issue.
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Position #1 Position #2 |
Seniors in retirement homes and other vulnerable people in care facilities deserve protection in their homes. Their residential tenancy relationship does have sufficient legal protection under the Tenant Protection Act, but the other major part of a senior’s relationship with a retirement home - that of the quality of care and support services provided - remains unregulated. There must be minimum standards of care for all residents across Ontario.
Seniors deserve high quality care services and quality care costs money. While there are number of retirement residences for financially well-off individuals, it is worth noting that a significant portion of those living in care homes, including many of those who live in the housing provided by members of OANHSS, have low to moderate incomes.
The province needs to recognize the variety of incomes of retirement home residents. If provincial regulations result in increased costs for providers, there should be subsidies available for low-income residents or providers that serve them.
The care services being provided by retirement homes have changed over the years. Seniors are being encouraged to “remain in the community” longer, and therefore many retirement homes are dealing with a higher level of care needs than twenty years ago (see City of Toronto Regulation of Retirement Homes: Summary of Consultations, November, 1999, prepared by Fern Teplitsky December 6, 1999).
Care services can range from assistance with daily living (help with eating, bathing etc.) to dispensing medication. Provincial regulation can help define the issues and publicize what residents, and their families, can come to expect in retirement and care homes. Attempting to rely on municipal by-laws for regulating care homes means a lack of uniformity across Ontario. The province should be ensuring that seniors and others are receiving the care and services they are paying for and/or require.
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Position #3 |
There is confusion as to what retirement and care homes are, or what level of care they are supposed to provide. One of the most difficult issues in this debate is the key one of definition: What is a retirement home or a care home? What residences will be covered and which residences will not be covered by care standards.
To understand retirement homes, it is sometimes helpful to compare them with other residential settings. Retirement homes are not long-term care facilities that have care and support services clearly regulated under other provincial legislation. They are also distinctly different from seniors apartments that offer accommodation only and no care or services.
The defining of care homes is difficult because there are many types of residences which are neither long term care facilities, nor apartments for seniors. These other types of residences include retirement residences, lodging homes with support services, domiciliary hostels, and supportive housing. It will be a challenge for the province to come up with a precise legislative definition. Such a definition must make clear that if a housing operator is providing (either directly or indirectly) care services such as dispensing medication or providing assistance with daily living activities, for example, and the provision of care services is not regulated under other provincial laws, then it is a retirement or care home.
It will be equally essential, and challenging, to clearly define care and/or care services.
Retirement homes must be defined by the provision of care and support services. We would suggest that the definition of care homes and care services is made consistent with the definition used under the Tenant Protection Act.
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Position #4 |
OANHSS believes that the provincial government must ensure that the regulation of care is province-wide and consistently enforced.
While the province must assume the ultimate responsibility for retirement home/care service regulation, this does not mean that the province has to carry out the regulatory functions directly.
OANHSS recognizes the need to involve a wide spectrum of organizations in the regulatory decision-making process. We also recognize that the province does not want to perform additional regulatory functions. As such, we support the development of an arms-length agency to act as the regulator of retirement homes and care homes.
OANHSS strongly objects to any proposal that allows an industry association to be assigned the responsibility of regulating the care facilities. Regulation by the industry that is being regulated does not provide the checks and balances for a fair system.
We also believe that the any such agency must be properly funded to ensure it can carry out its regulatory functions. This agency must have a broad range of organizations involved in its decision-making and must have the clear authority to enforce its decisions by means of fines or de-licensing. These decisions, however, must be carried out through an appropriate administrative tribunal so that due process is balanced with the need for regulatory enforcement.
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Position #5 Position #6 Position #7 |
The regulatory agency must be comprehensive in its approach. Any facility that does not currently have its care services regulated by another body or by other legislation must be licensed by the new agency. Provincially regulated long term care facilities, for example, would not be covered by this new regulatory agency.
The regulatory agency, in its start-up phase, will have to rigorously identify all of the retirement and care home facilities in the province. If a retirement home or care home does not have a license and will not apply for a license, then the regulatory agency must be prepared to shut it down. The agency should also have the ability to levy meaningful administrative fines for violations of care regulations.
The regulatory agency will need to spend a significant amount of time in the development and implementation of regulations. We would suggest that if the government, as we recommend, is going to move ahead with this initiative, it should begin discussions on the details of the regulations as soon as possible.
It is also imperative that the funding for this agency be adequate to carry out its functions. These functions should include:
The need to have inspections initiated by the new agency (and not just inspect in response to complaints) is crucial. While OANHSS members and most retirement and care home providers provide quality housing and care services, there are a number of retirement homes, as documented in the December 29, 1999 City of Toronto Staff report “Standards of Care in Retirement and Lodging Homes,” which are not meeting the needs of consumers.
Seniors advocates, and those who advocate for people with mental health challenges have long recognized the need for active enforcement of the rights of vulnerable Ontarians. Therefore, the regulatory agency must be more than just a complaints driven organization. It must also have a role in developing incentives to encourage and recognize organizations that consistently meet and exceed standards.
As in any regulatory system there must be a balance in the rights of the operator, the rights of the consumer and the powers of the regulatory body. The operator, for example, must have a right to a hearing. The operator also must be given sufficient time to rectify any situation which is deficient. OANHSS is very interested in further exploring these regulatory and operational issues.
The work of the agency must also be coordinated with the work that has already been undertaken by a number of municipalities which have been inspecting retirement and care homes. Any inspections and reporting done at the municipal level should be forwarded to the province-wide agency. The new agency should also co-ordinate licensing and inspection activities with municipal inspection services that monitor the physical state of the retirement and care homes.
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Position #8 |
OANHSS supports an agency trying to cover at least some of its operating costs through licensing fees. The retirement and care home industry should help cover these costs. However, we are concerned that funding from licensing fees will likely not be enough to cover the costs of operating an effective regulatory agency. OANHSS also believes that the licensing fees should not be so high as to become a factor in driving up the costs of operating a retirement home. Licensing fees should be pro-rated to reflect both the number of residents being served as well as reflecting the economic reality of the residents i.e. homes serving low – income residents should pay lower licensing fees than homes charging top of the market rates.
We believe the province will have to provide financial support for a regulatory agency, especially in the initial regulation development phase.
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Our Association supports the government’s direction to regulate care in Ontario’s retirement and care homes and recommends that this function be the responsibility of an independent agency run by a board of directors that includes consumers, seniors organizations, advocates, retirement and care home operators (both for-profit and non-profit), municipalities, and the province.
We recognize the complexity of this issue and the importance of balancing the needs and interests of consumers and providers to ensure the retirement home sector is an efficient and effective complement to the long term care system in Ontario.
We look forward to further involvement in this discussion.
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Ontario Association of Non-Profit Homes & Services for Seniors
7050 Weston Road, Suite 700, Woodbridge, Ontario L4L 8G7
(P) 905-851-8821
(F) 905-851-0744
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Contact
Debbie Humphreys
at 905-851-8821 ext. 233
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© Copyright 2008 OANHSS
OANHSS members include not-for-profit providers of long term care, services and
housing for seniors in Ontario.
Members include municipal and charitable long term care homes, non-profit
nursing homes,
seniors' housing projects and community
service agencies.
