Admission to Long-Term Care Homes Community Care Access Centres
Client Services Policy Manual
September, 2006
 
11.7   Accepting the Offer of Long-Stay Admission,
spacerAccommodation and Bed-Holding Fees

Long-term care (LTC) home legislation establishes timelines for the acceptance of a bed offer and admission that are designed to ensure existing beds in LTC homes are fully utilized. When a Community Care Access Centre (CCAC) makes an offer of admission to a person, the person is given a strict time limit in which to decide whether or not he or she will accept the offer and subsequently to move into the LTC home. The LTC home is allowed to charge the applicant certain fees during the time that the bed is being held for the person.

11.7.1   Timeline for Acceptance of Offer of Admission

An applicant has one day to accept an offer of admission to a LTC home of his or her choice. This timeframe is established by operation of the regulatory provisions related to authorization of admission. The Nursing Homes Act (NHA) regulation states :

Authorization of admission
s. 155(1)   Subject to section 156, the placement co-ordinator designated for a nursing home under subsection 20.1 (3) of the Act shall authorize the admission of a person to the home if, and only if,
. . .
(e)   in the case of a person who is applying for authorization of his or her admission to the home as a long-stay resident, the person agrees in writing with the licensee of the home that,
spacer(i)   the person will move into the home before noon of the fifth day following the day on which he or she is informed of the availability of accommodation in the home.

According to this provision, an applicant is expected to move into the LTC home by the fifth day after the day on which the person is made the offer of admission. That gives the person one day within receiving the offer to accept or reject the offer and sign the agreement with the home.

11.7.2  Accommodation and Bed-Holding Fees

Once a person has accepted the offer of admission, the bed may be held for up to five days following the date of notification, if the person pays the applicable bed holding and accommodation fees. This means that a person who is offered admission will have five days to move in, not counting the date of notification.

The date of notification does not count as one of the days for bed-holding purposes as it is the day the applicant has to decide whether to accept the offer of admission.

Section 155 of the NHA regulation sets out the applicable fees that the LTC home may charge during the five-day period, and subsection 47(4) establishes the amount of the daily bed-holding fee which is payable in addition to the accommodation fee for that part of the period available for bed-holding :

Authorization of admission
s. 155 (1)   Subject to section 156, the placement co-ordinator designated for a nursing home under subsection 20.1 (3) of the Act shall authorize the admission of a person to the home if, and only if,
. . .
(e)   in the case of a person who is applying for authorization of his or her admission to the home as a long-stay resident, the person agrees in writing with the licensee of the home that,
spacer(i)   the person will move into the home before noon of the fifth day following the day on which he or she is informed of the availability of accommodation in the home,
spacer(ii)   if the person moves into the home before noon of the fifth day following the day on which he or she is informed of the availability of accommodation in the home, the person will pay,

(A)   for each day following the day on which the person is informed of the availability of accommodation in the home and preceding the day on which the person moves into the home, the amount that the licensee would have charged him or her for accommodation for that day had he or she been a long-stay resident lodged in the available accommodation on that day, and
(B)   if the person moves into the home on or after the third day following the day on which he or she is informed of the availability of accommodation in the home, the daily bedholding amount as determined under section 47 for each day from and including the second day following the day on which the person is informed of the availability of accommodation in the home and preceding the day on which the person moves into the home, and

spacer(iii)   if the person does not move into the home before noon of the fifth day following the day on which he or she is informed of the availability of accommodation in the home, the person will pay,

(A)   for each of the five days following the day on which the person is informed of the availability of accommodation in the home, the amount that the licensee would have charged him or her for accommodation for that day had he or she been a long-stay resident lodged in the available accommodation on that day, and
(B)   for each of the second, third, fourth and fifth days following the day on which the person is informed of the availability of accommodation in the home, the daily bedholding amount as determined under section 47.

Absences
s. 47(4)   The daily bed-holding amount for a day after March 31, 1995 is $53.

The following chart outlines the applicable accommodation and bed-holding fees for the five-day bed-holding period described in the above referenced provisions.

Note :   The date of notification (i.e., the day the offer is made) is identified as day 0 in the chart.

Day Resident Moves In Accommodation Fee Bed-holding Fee ($53)
Day 0
Date of Notification of Availability
Yes for day 0 No
Day 1
Following Notification
Yes for day 1 No
Day 2
Following Notification
Yes for day 1 and 2 No
Day 3
Following Notification
Yes for days 1, 2 and 3 Yes for day 2
Day 4
Following Notification
Yes for days 1, 2, 3 and 4 Yes for days 2 and 3
Day 5 (Before Noon of Day 5)
Following Notification
Yes for days 1, 2, 3, 4 and 5 Yes for days 2, 3 and 4
Applicant does not move in
 
Yes for days 1, 2, 3, 4 and 5 Yes for days 2, 3, 4 and 5

Saturdays and Sundays count for bed-holding purposes even if the LTC home does not admit applicants over the weekend. This is owing to the fact that the ordinary meaning of the word "day" in the regulation means calendar day. Therefore, if a home does not admit on any particular day such as weekends or holidays, the accommodation and bed-holding fees still apply if the particular day falls within the bed-holding period.

However, there are no provisions in the regulation which address when the CCAC has to make a bed offer, so a placement co-ordinator may wait to make a bed offer until after the weekend if he or she knows that the home does not admit applicants over the weekend.

Additionally, the payment of accommodation and bed-holding fees is part of a contractual arrangement between the applicant and the LTC home operator.

Accommodation and bed-holding fees apply to all applicants including those who are already residing in another LTC home and hospital-based applicants who are paying the chronic care co-payment.

11.7.3   "One-Offer" Policy

The NHA regulation sets out the requirements of the "one-offer" policy :

s. 141(1)   A person shall be removed from the waiting list for each nursing home to which the person is awaiting admission as a long-stay resident and shall be placed on the refusal list if,
(a)   the person,

(i)   is a long-stay resident of another nursing home, an approved charitable home for the aged under the Charitable Institutions Act or a home under the Homes for the Aged and Rest Homes Act, or
(ii)   is not described in subclause (i) and does not occupy a bed in,
(A)   a hospital under the Public Hospitals Act or a private hospital licensed under the Private Hospitals Act,
(B)   a facility that is designated as a psychiatric facility under section 80.2 of the Mental Health Act and that is not exempt under that section from the requirement to provide in-patient services in paragraph 1 of subsection 4 (1) of Regulation 741 of the Revised Regulations of Ontario, 1990 made under that Act, or
(C)   a facility listed in Schedule 1 to Regulation 272 of the Revised Regulations of Ontario, 1990 made under the Developmental Services Act; and

(b)   a placement co-ordinator offers to authorize the person's admission to a nursing home, an approved charitable home for the aged under the Charitable Institutions Act or a home under the Homes for the Aged and Rest Homes Act as a long-stay resident, and the person,

(i)   refuses to consent to admission,
(ii)   refuses to enter into the written agreement mentioned in clause 155 (1) (e) of this Regulation, clause 86 (1) (e) of Regulation 69 of the Revised Regulations of Ontario, 1990 made under the Charitable Institutions Act or clause 12.21 (1) (e) of Regulation 637 of the Revised Regulations of Ontario, 1990 made under the Homes for the Aged and Rest Homes Act, as applicable, or
(iii)   fails to move into the facility on or before the fifth day following the day on which he or she is informed of the availability of accommodation.

(2)   Subsection (1) does not apply if the reason the person acts in the manner described in subclause (1) (b) (i), (ii) or (iii) is that the person has a short-term illness or injury which,
(a)   prevents the person from moving into the facility at that time; or
(a)   would make moving into the facility at that time detrimental to the person's health.

(3)   If a person described in subclause (1) (a) (i) is removed from the waiting list for a nursing home under subsection (1), the person shall be placed on the waiting list for the home again to await admission as a long-stay resident if,
(a)   the person provides to the placement co-ordinator designated for the home under subsection 20.1 (3) of the Act a new written request for authorization of his or her admission to the home as a long-stay resident; and
(b)   placing the person on the waiting list for the home will not result in the total number of waiting lists for nursing homes, approved charitable homes for the aged under the Charitable Institutions Act and homes under the Homes for the Aged and Rest Homes Act on which the person is placed exceeding three.

(4)   If a person described in subclause (1) (a) (ii) is removed from the waiting list for a nursing home under subsection (1), the person shall be placed on the waiting list for the home again to await admission as a long-stay resident if,
(a)   the person provides to the placement co-ordinator designated for the home under subsection 20.1 (3) of the Act a new written request for authorization of his or her admission to the home as a long-stay resident and,

(i)   the request is provided 24 weeks or more after the day the person was removed from the waiting list, or
(ii)   the request is provided less than 24 weeks after the day the person was removed from the waiting list but there has been a deterioration in the person's condition or circumstances; and

(b)   placing the person on the waiting list for the home will not result in the total number of waiting lists for nursing homes, approved charitable homes for the aged under the Charitable Institutions Act and homes under the Homes for the Aged and Rest Homes Act on which the person is placed exceeding three.

(5)   Clause (4) (b) does not apply to a person who will be placed in category 1A on the waiting list for the home.

The "one offer" policy applies to applicants currently residing in the community setting and those who are currently in LTC homes waiting for transfer to another LTC home. The policy does not apply to applicants in hospitals.

If a community or LTC home based applicant refuses a bed offer made by a CCAC relating to any of the LTC homes for which the person is waitlisted, the CCAC must remove that person from all waiting lists and place the person on the refusal list. The same applies if the person does not move into the LTC home within five days. The only exception to this requirement is applicants who have a short-term illness or injury that affects their ability to move into the LTC home : these applicants will not be removed from all of their LTC home waiting lists.

After removal from all waiting lists, community based applicants will be required to wait six months before reapplying to the CCAC to be reassessed for admission to a LTC home unless their condition or circumstances deteriorate. LTC home residents seeking to transfer to another home will also be required to re-apply, however no waiting period will apply to these individuals. In both cases however, the person will lose his or her original priority for ranking on the waiting lists of his or her chosen LTC homes.

In light of the "one-offer" policy and the fact that a person will be removed from all waiting lists if he or she refuses an offer of admission, applicants should be encouraged to choose only LTC homes for which they are truly willing to accept an offer of admission.

PREVIOUS PAGE 11 - 8 NEXT PAGE