Patients First: Action Plan for Health Care

Patient Ombudsman

Frequently Asked Questions

What are powers and functions of the Patient Ombudsman?

As of July 4, 2016, the Patient Ombudsman office will be able to receive and respond to complaints from patients about public hospitals, long-term care homes and Community Care Access Centres (CCACs), in order to help meet the needs of patients who have not had their concerns resolved through existing complaint mechanisms .

The functions and powers of the Patient Ombudsman include:

  • Investigating, helping to resolve, reporting on and responding to complaints about the health care system made by patients, former patients and caregiver
  • Investigating health sector organizations on her own initiative
  • Making recommendations to health sector organizations following investigations
  • Reporting to the Minister of Health and Long-Term Care on her activities and recommendations, and to Local Health Integration Networks as appropriate.

How can I contact the Patient Ombudsman?

Starting July 4, the Patient Ombudsman can be contacted:

By mail at: Patient Ombudsman
Box 130, 77 Wellesley Street West
Toronto, Ontario M7A 1N3
By telephone at: 1-888-321-0339

Existing complaint mechanisms for

  • Home and Community Care
  • Long-Term Care Homes
  • Hospitals
  • Service
  • OHIP-coverage for a hospital room
  • Funding

How do I make a complaint about home and community care service before I contact Patient Ombudsman?

Any client or family member who is not satisfied with the services provided by a Community Care Access Centre (CCAC), may access the CCAC's formal complaint process. CCACs have an obligation to manage complaints, and the ministry expects that they will continue to work with their clients to resolve any concerns. CCACs are required to have a formal complaints process for any of the following matters:

  1. A decision by the approved agency that the person is not eligible to receive a particular community service.
  2. A decision by the approved agency to exclude a particular community service from the person's plan of service.
  3. A decision by the approved agency respecting the amount of any particular community service to be included in the person’s plan of service.
  4. A decision by the approved agency to terminate the provision of a community service to the person.
  5. The quality of a community service provided to the person or arranged for the person by the approved agency.
  6. An alleged violation by the approved agency of any of the person’s rights set out under the HCSSA.

Another option for clients or families is to call the Long-Term Care (LTC) Action Line at 1-866-876-7658 and request the services of an Independent Complaints Facilitator (ICF). This ICF process is free and the Facilitators are trained to listen to the concerns of the caller. This option is available even if a client or family member does not want to go through the formal CCAC complaint and appeal process.

If the CCAC client/family member is not satisfied with a decision made by the CCAC, CCAC clients/family members can apply to the Health Services Appeal and Review Board (HSARB) for a review of the CCAC decision. Decisions by the approved agency relating to the following can be appealed to the HSARB:

  • Eligibility to receive service
  • Exclusion of a service from the person’s plan of service
  • Amount of service to be included in the person’s plan of service
  • Termination of service

The CCAC can provide more information on the process for making an appeal or the HSARB can be contacted in various ways:

Telephone: (416) 327-8512 or
Toll-free: 1-866-282-2179

Long-Term Care (LTC) Action Line

Clients/family can also call the Long-Term Care Action Line. The LTC Action Line provides an intake and referral service to CCAC clients/family members as an additional avenue to the formal CCAC complaints process. When a call is received by the LTC Action Line, the client service representative will collect all information from the caller, and then refer the complaint either to the caller’s CCAC or to an independent third party called Independent Complaint Facilitators (ICFs), as requested by the caller. ICFs are appointed by the Alternative Dispute Resolution Institute of Ontario. The ICF’s role is to work with the CCAC client/family member in order to address their concerns. If during this process the CCAC client/family member wishes to have either or both their CCAC or service provider involved the ICF will contact them.

The LTC Action Line process does not replace the formal CCAC complaint process, nor does it lessen the responsibility of the CCACs to work with their clients to address their concerns. It does, however, provide an additional resource to clients. Clients can reach the LTC Action Line at: 1-866-434-0144.

How do I make a complaint about long-term care service before I contact Patient Ombudsman?

The Long-Term Care ACTION Line is open seven days a week, from 8:30 a.m. to 7:00 p.m., and can be reached toll-free at: 1-866-434-0144.

The Long-Term Care Action Line is a service to hear concerns and complaints from persons receiving service from Long-Term Care (LTC) homes. The ministry will respond quickly to urgent complaints – in some cases, on the same day. For non-urgent complaints, contacting a home directly is often the best and fastest way to address a problem.

Information on complaints is available on the ministry's public website.

How do I make a complaint about a hospital’s service before I contact Patient Ombudsman?

Hospitals are required to have a patient relations process that reflects the hospital's Patient Declaration of Values, which outlines what patients and their families can expect when they visit the hospital.

For any complaint or concern about the care provided, patients or families may contact the Patient Advocate or Patient Relations Office of the hospital directly.

In smaller hospitals where there may be no such role, the President or Chief Executive of the hospital would handle complaints.

In emergency room medical situations, patients can never be refused service regardless of their insurance situation. In situations where a valid health card cannot be presented, the health care provider (i.e. hospital, physician) may bill the patient for medical services rendered.

How do I make a complaint about OHIP coverage for a hospital room?

The Ontario Health Insurance Plan (OHIP) will pay for a hospital room in a standard ward (4 beds per room) for people with valid Ontario health coverage.

Individuals requesting, or signing for, a semi-private (2 or 3 beds per room) or private room (1 bed per room) are responsible to the hospital for any additional charges above the ward rate.

Individuals with private supplementary health insurance may contact their company directly for assistance with the additional charge.

More detailed information in relation to hospital room accommodation rates can be directed to the hospital itself first, or a local district health office for OHIP.

Ottawa District OHIP Office
75 Albert Street, 7th Floor
Ottawa ON K1P 5Y9
Telephone: 613-237-9100

How do I make a funding complaint about a hospital?

Public hospitals in Ontario are funded by Local Health Integration Networks (LHIN). LHINs are not-for-profit corporations that plan, fund and integrate health services in their specific geographic areas. LHINs work with local health providers and community members to determine the health service priorities of their regions. Other areas of LHIN responsibility include:

  • Community Care Access Centres
  • Community Support Service Organizations
  • Mental Health and Addiction Agencies
  • Community Health Centres
  • Long-Term Care Homes.

The link below will bring you to the ministry's web page where you may learn more about LHINs:

Local Health Integration Networks.

For More Information

Call ServiceOntario, Infoline at 1-866-532-3161
In Toronto, 416-314-5518
TTY 1-800-387-5559
In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm