In 2007, the government passed the Long-Term Care Homes Act, 2007 (LTCHA) to give the strongest possible expression to the principle that long-term care homes are the resident’s home and must be a place where they are cared for with dignity and respect.

Fundamental principles of the new Act are :

• A commitment to resident-centred care in a safe, home-like environment
• Public accountability and transparency
• Service planning that focuses on resident needs and the safety needs of all residents
• Clear standards of care supported by a strong compliance, inspection and enforcement system
• Responsibility on everyone involved to take action where standards are not being met
• A recognition of the importance of continuous quality improvement

Public consultations of the proposed draft regulations under the LTCHA are continuing. On September 15, 2009, Part 2 of the proposed initial draft regulation addressing resident care programs and services, reporting and complaints, specialized units, home operations, screening measures, provisions for a new short stay program for interim beds in alternative settings, funding, licensing, compliance and enforcement, and administration and transition matters was released for 30 day public review.

http://www.health.gov.on.ca/english/public/legislation/ltc_homes/ltc_homes.html

Compliance Transformation

The ministry has undertaken the Compliance Transformation project to deliver on the mandate of improved accountability through inspections and licensing. While the current program is one of the most comprehensive in Canada, steps are now being taken to improve its effectiveness and ability to safeguard resident well-being. “The residents are at the heart of this transformation” says Ken Deane, Assistant Deputy Minister, Health Systems Accountability and Performance Division. “Our goal on their behalf is to create a system that enhances the capacity of homes to provide the high quality of care residents deserve.”

The new inspection process, which is currently being designed, builds on structured interviews with residents as well as families and staff to obtain their assessment of the quality of care in the home. It uses a methodology which has been validated through extensive research. New technologies and methods are being implemented to provide accuracy and consistency throughout the process from gathering information to making a decision on the appropriate sanction in the event that standards are not being met.

A comprehensive approach is being followed to ensure the compliance changes meet the principles of the LTCHA and residents’ needs. This includes seeking the opinions of long-term care home residents’ councils, family councils and associations, clinicians, researchers, academic experts and other stakeholders. The inspection process and supporting technology will be thoroughly tested at each stage of development. Following implementation, the ministry will work with stakeholders to assist in continuous quality improvement.

While Compliance Transformation development progresses, the current Compliance Management Program will continue. This includes annual reviews, critical incident follow-ups, complaint investigations and referrals.

Recent accomplishments

• In January 2009, the government mandated the implementation of a common Resident Assessment Instrument – Minimum Data Set (RAI-MDS 2.0) in all homes by 2010. This will provide information to assist homes in developing care plans that are thorough and more accurately reflect residents’ individual needs and preferences. As of September 100% of homes had commenced implementation.
• Specific and reliable indicators of potential risk which will assist in focusing inspections more directly on resident well-being have been defined and validated with researchers and clinical experts.
• In early 2009 the ministry identified the “Quality Indicator Survey” system, which is backed by over 15 years of research, as the basis for its new inspection model. This system, used in conjunction with the assessment data and risk indicators, will enable inspectors to verify whether appropriate care and services are being delivered to residents.
• Since June 2009, the ministry has met with stakeholders including residents’ councils, family councils, long-term care home associations and operators, labour organizations and quality experts to consult on the adaptation of this methodology to Ontario’s unique requirements. In addition, the survey questions were successfully tested in two Ontario long-term care homes. Their feedback was used to inform the development of a detailed request for proposals to assist the government in implementing the system which was released on September 12, 2009.
• Long-term care homes have also been provided with a software tool to securely report critical incidents to the ministry, allowing for more timely reporting and follow up.
• Compliance staff have been equipped with information management tools including mobile devices and specialized reports to facilitate improved planning for and consistency in their inspections.

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