Guidelines for supporting adults with a developmental disability when applying to, moving into and residing in a long-term care home

Read the guidance for supporting adults with a developmental disability in long-term care homes.

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Preamble

The Guidelines for Supporting Adults with a Developmental Disability When Applying to, Moving Into and Residing In a Long-Term Care Home (guidelines) will improve services for adults with a developmental disability who choose to reside in a long-term care home. The guidelines outline the importance of planning, choice and consent and adults with developmental disabilities receiving appropriate developmental services and supports in a long-term care home. The commitment to developing these guidelines and to following them also demonstrates the integrated and co-ordinated approach to care within and between the developmental services and long-term care home sectors.

The Ministry of Children, Community and Social Services (MCCSS) and the Ministry of Long-Term Care (MLTC) are committed to improving the social and health outcomes for adults with a developmental disability who are aging. Placement in long-term care would often be inappropriate for people with developmental disabilities. These guidelines will apply to those individuals who, as a result of aging or other circumstances, require enhanced health and personal care/support. Both MCCSS and MLTC are committed to the principles of choice, community inclusion, and self-directed planning for people with developmental disabilities.

A range of supports related to housing and personal needs are available, including MCCSS-funded supportive living services for people with a developmental disability. As discussed later in these guidelines, part of the eligibility criteria for long-term care home admission includes determining that “the publicly-funded community-based services available to the person and the other caregiving support or companionship arrangements available to the person are not sufficient, in any combination, to meet the person’s requirements.”

Should someone’s support needs or personal circumstances change significantly, they should inform their local Developmental Services Ontario (DSO) office so they can be reassessed by Developmental Services Ontario. MCCSS funded supportive living services may be appropriate as might a long-term care home. Sometimes a person’s health changes significantly, and their needs cannot be adequately or safely met in their home. For example, this could include the need for 24-hour supervision or nursing care due to dementia/Alzheimer’s disease, frailty or physical impairment(s).

These guidelines are intended to support a person’s choice to receive care and support in a long-term care home, when needed. MCCSS and MLTC support long-term care home placements that are appropriate for a person’s health and personal care needs.

In some cases, a person with a developmental disability or their substitute decision-maker, if any, may feel that a long-term care home may be an appropriate place if the individual meets the eligibility criteria. It is important to emphasize that choice and consent underpin the long-term care home placement process, which are consistent with the value that MCCSS and MLTC place on person directed planning and person directed decision-making. It is an individual’s choice or that of their substitute decision-maker, if any, to move into a long-term care home (for those who meet the eligibility criteria and receive a bed offer).

Just as applicant choice to move into a long-term care home is central to the placement process, so too must the rights of residents be respected in a long-term care home. The Fixing Long-Term Care Act, 2021 (FLTCA), the legislation governing long-term care homes, includes a fundamental principle that must be applied in the interpretation of the FLTCA and Ontario Regulation 246/22 (Regulation): that a long-term care home is primarily the home of its residents and is to be operated so that it is a place where its residents may live with dignity and in security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.

The FLTCA includes a Residents’ Bill of Rights which addresses residents’ personal well- being and safety and includes the privileges, choices and protections available to all residents of a home that must be fully respected and promoted. Some of these rights are supported by further requirements in the FLTCA and the Regulation. A copy of the Residents’ Bill of Rights is included in Appendix 2 of these guidelines and must be posted in all long-term care homes.

Purpose of the guidelines

Strong partnerships across the health and social service sectors are required to support the complex needs of those who are aging and have a developmental disability.

The guidelines provide an overview of the developmental services and long-term care home systems in Ontario, the roles and responsibilities of service providers in these sectors and the step-by-step process when applying to and moving into a long-term care home.

Additional information is provided in appendices including a list of acronyms used in the guidelines, the FLTCA’s - Residents’ Bill of Rights, the adult developmental services and supports pathway, overview of long-term care home waiting list categories, modified placement process for alternate level of care (ALC) patients in a public hospital and contact information for Home and Community Care Support Services (HCCSS) and Developmental Services Ontario.

In addition to the long-term care home admissions process described within this document, a modified admissions process applies to ALC patients from public hospitals where long-term care is under consideration as the most appropriate care setting. This modified process enables HCCSS placement coordinators, working collaboratively with hospitals and long-term care homes, to facilitate an eligible ALC patient’s admission into a long-term care home, while they wait for a preferred home. ALC patients with developmental disabilities who may already be on a waitlist or should be on a waitlist for community-based developmental services would likely not be eligible for long-term care placement. The long-term care admissions process for ALC patients will continue to be grounded in an ongoing dialogue with ALC patients, their families, and caregiver(s) about a safe transition to long-term care, striving to understand preferences and promote as much choice as possible throughout the entire process. HCCSS placement coordinators will continually engage the patient, family, caregiver, or substitute decision-maker, making every effort to seek consent at each stage of the process. If not achieved, the placement co-ordinator will continue to move forward with the determination of eligibility and other admission processes, without consent, with the goal of finding a suitable temporary arrangement in a long-term care home while they wait for their preferred home. MLTC and MCCSS are committed to ensuring that both the developmental services and long-term care home sectors continue to work together to support individuals with a developmental disability. The guidance set out in this document including ongoing collaboration and communication between placement co-ordinators and Developmental Services Ontario continues to apply even during the modified admissions process for ALC patients in a public hospital. Appendix 4B provides additional information about this modified admissions process for ALC patients in a public hospital.

These guidelines replace the 2006 Long-Term Care Home Access Protocol for Adults with a Developmental Disability and the previous version of the guidelines published in October 2017. This 2022 version has been updated to reflect legislative and regulatory changes since 2017 as well as other updates such as ministry name and other wording changes and contact information. The guidelines will continue to be updated by MCCSS and MLTC, as required, to reflect any significant developmental services and/or long-term care home system related changes.

These guidelines apply to MCCSS, including its regional offices and transfer payment agencies (“developmental services agencies”), Developmental Services Ontario, MLTC, HCCSS, the Office of the Public Guardian and Trustee (OPGT), Municipal Service Managers and long-term care homes.

These guidelines are intended to complement and clarify relevant legislation, regulations and/or service agreements. MLTC encourages all individuals involved in the long-term care home placement process to ensure that they review all requirements set out in the FLTCA and Regulation and any other relevant legislation, regulations or service agreements. In the event of a conflict between these guidelines and the legislative/regulatory provisions, the legislative/regulatory provisions prevail. In the event of a conflict between these guidelines and any service agreements, the service agreements prevail.

Stakeholders from both the developmental services and long-term care home sectors were consulted as part of the initial creation of these guidelines in 2017.

Aging population and research

The general population in Ontario is aging and living longer, including people with a developmental disability.

In Ontario’s 2022 population projections update for the period of 2021-2046, the Ministry of Finance stated the number of seniors aged 65 and over is projected to increase significantly from 2.7 million, or 18.1% of population, in 2021 to 4.4 million, or 21.8%, by 2046. Rapid growth in the share and number of seniors will continue over the 2021–2031 period as the last cohorts of baby boomers turn age 65.

As part of the Health Care Access Research and Developmental Disabilities (H-CARDD) Program, the profiles of aging adults with developmental disabilities were studied. The study revealed an increase in the number of people with developmental disabilities and that the signs and symptoms related to frailty were often observed earlier in those with developmental disabilities than those without them. The research also noted that people with developmental disabilities are more likely to develop significant health and mobility issues earlier as they age, with a recommendation that staff and agencies prepare in response to the findings. As of March 31, 2022, 8,026 people receiving MCCSS funded supportive living services were 50 years of age or older.

People with developmental disabilities often rely on family caregivers throughout their lifetime. These family members with caregiving responsibilities may also be aging and facing their own health issues. The Aging Project found that caregiver burden was as predictive of admission to long-term care home as was frailty.

Vision and principles

The following vision and principles apply to the implementation of these guidelines:

Vision

The guidelines will improve the planning and co-ordination of health and developmental services and supports for adults with a developmental disability and support people who choose to reside in a long-term care home.

Principles

Flexibility and choice

Adults with a developmental disability have the right to identify, make informed decisions and provide informed consent about long-term care home placement, care and support needs.
The person may consult family, friends and/or staff when considering service and support options. If this includes applying to a long-term care home, the person or their substitute decision-maker, if any, has the right to apply to and, if eligible and approved by the licensee and authorized by the placement co-ordinator, move into a long-term care home.
A substitute decision-maker will only be engaged where the person is incapable of making the decision in accordance with the Health Care Consent Act, 1996 (HCCA). Pursuant to the HCCA, a person is capable with respect to admission to a long-term care home if the person is able to understand the information that is relevant to making a decision about the admission and able to appreciate the reasonably foreseeable consequences of a decision or lack of decision. A finding that a person is incapable with respect to a long-term care home admission can only be made by an evaluator.
Planning for supports and services for people with a developmental disability who are moving into a long-term care home should always be flexible and respectful of a person’s cultural and linguistic preferences, religious beliefs, lifestyle choices, social and family network and medical needs and will be balanced with available community resources. This should include asking people of Indigenous descent about their interest and/or preference in applying to a First Nations long-term care home.
Even though the modified admissions process for ALC patients in a hospital does include the ability for the placement co-ordinator to move forward with the determination of eligibility and other admission processes without consent, placement coordinators will continually engage the patient, family, caregiver, or substitute decision-maker, making every effort to seek consent at each stage of the process. The guidance set out in this document including ongoing collaboration and communication between placement co-ordinators and Developmental Services Ontario continues to apply even during the modified admissions process for ALC patients in a public hospital. This includes confirming with Developmental Services Ontario if a request for community-based services has been made, the need to conduct a reassessment, if required and/or connecting an individual with a Developmental Services Ontario office. In addition, placement co-ordinators must consider various factors, in consultation with the patient and family prior to authorizing admission to a long-term care home, including patient’s care needs, distance from the patient’s preferred location(s), and religious, ethnic, and linguistic preferences.

Inclusion

Adults with a developmental disability have the same rights as other Ontarians to live and participate fully within their communities and to access services and supports that are necessary, available and meet their needs.

Access and co-ordination

Planning for people who will reside in a long-term care home involves co- ordination across health and developmental services sectors. This includes planning for the services they will require and the resolution of any care related issues.
Specialized developmental services or aging-related services and supports will be planned and provided as required, based on identified needs, and as available, for those who have a developmental disability and who either have been determined eligible and are waiting for a bed or who are already residing in a long-term care home.
The planning and provision of required services and supports will be completed through a co-ordinated approach with the involvement of the person, the person’s primary caregiver or substitute decision-maker, if any, and with the consent of the person/substitute decision-maker. This may also involve family and/or friends.
This co-ordinated approach should be led by the agency most involved/familiar with the person’s care needs, if possible.

Health and independence

Services and supports available to people residing in a long-term care home should foster healthy living and maximize independence to the greatest extent possible, including during end of life care.

Background

Developmental Services

Since 2004, the developmental services system has experienced significant changes, including the introduction of the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA) which sets out the application process for MCCSS-funded developmental services and supports that may be available to adults with a developmental disability.

All people who wish to apply for MCCSS-funded adult developmental services and supports in Ontario must apply through Developmental Services Ontario.

Definition of a developmental disability in Ontario

Individuals applying for adult developmental services must meet the eligibility criteria set out in the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA) and its regulations.

There are two components to the definition of developmental disability. To be eligible for adult developmental services and supports an individual must meet both.
Under the Act, a person has a developmental disability if the person has the prescribed significant limitations in a) cognitive functioning and b) adaptive functioning and those limitations:
- Originated before the person reached 18 years of age;
- Are likely to be life-long in nature; and
- Affect areas of major life activity, such as personal care, language skills, learning abilities, the capacity to live independently as an adult or any other prescribed activity.

Cognitive functioning

Under SIPDDA, cognitive functioning means a person’s intellectual capacity, including the capacity to reason, organize, plan, make judgments and identify consequences.

The person has an overall score of two standard deviations below the mean, plus or minus standard error measurement, on a standardized intelligence test; or
The person has a score of two standard deviations below the mean in two or more subscales on a standardized intelligence test and the person has a history of requiring habilitative support; or
On the basis of a clinical determination made by a psychologist or a psychological associate, the person demonstrates significant limitations in cognitive functioning and the person has a history of requiring habilitative support.

Adaptive functioning

Under SIPDDA, adaptive functioning means a person’s capacity to gain personal independence based on the person’s ability to learn and apply conceptual, social and practical skills in his or her everyday life.

For the purposes of SIPDDA, a person has significant limitations in adaptive functioning if the person has a score of at least two standard deviations below the mean, plus or minus standard error measurement, in at least one of the areas of conceptual skills, social skills or practical skills, as measured on a standardized test of adaptive behaviour.

Habilitative support

Under the Regulation, habilitative support means support where the objective of the support is to enable the person to acquire, retain and improve skills and functioning related to activities of daily living in the areas of self-care, communication and socialization.

Determination of eligibility

In order to be determined eligible for MCCSS-funded services and supports, a person must provide Developmental Services Ontario with documentation for the eligibility requirements:

A psychological report or assessment signed by a psychologist or psychological associate that confirms the person has a developmental disability according to the definition above. This may include school or medical records.
Proof that they are 18 years of age or older.
Proof that they are an Ontario resident.

Review of documentation by Developmental Services Ontario

Developmental Services Ontario staff review the documentation the applicant is able to provide and if required, make a referral for applicants age 18 and older to have a psychological assessment completed by a MCCSS-funded agency.

The process for confirming eligibility is set out in a policy directive that Developmental Services Ontario offices are to follow.

Some people with a developmental disability may also have medical needs, mental health issues (referred to as a dual diagnosis) and/or behavioural challenges.

Application package and assessment of needs

SIPDDA also provides the legislative authority to assess the individuals’ needs for services and supports.

Following eligibility confirmation, qualified assessors employed by Developmental Services Ontario conduct the assessment of support needs using the application package for all eligible individuals (new applicants, individuals in service or waiting for services) applying for MCCSS-funded services and supports for adults with developmental disabilities.

The application package is a standardized tool used to determine the support needs of adults with developmental disabilities in Ontario, and includes the Application for Developmental Services and Supports (ADSS) and Supports Intensity Scale (SIS).

The Supports Intensity Scale (SIS) provides an opportunity to discuss the support needed to enable the individual to fully participate in the community as a fully engaged citizen. It provides standardized, objective information indicating the support needs compared to a representative sample of all people with developmental disabilities.
The Application for Developmental Services and Supports (ADSS) provides an opportunity to discuss the individual’s personal circumstances (risks), community inclusion, future planning and strengthening natural supports in the community.

The ADSS and SIS complement one another. The ADSS helps to identify needs and wants, and focuses on the individual’s past, present and future life. The SIS helps identify life activity areas that will support the goals and plans, and informs what is needed for the individual to succeed in the present.

The application package is completed by the assessors in two interviews with the individual and at least two (but no more than four) representatives.

After the application package is completed, the assessors complete the Assessor Summary Report (ASR) - a document that includes qualitative information regarding the individual derived from the SIS/ADSS information captured in the two interviews.

MCCSS-funded developmental services and support

MCCSS funds the following services and supports for eligible adults who have a developmental disability. These services are defined in SIPDDA under section 4.

Activities of daily living services and support: Services and support to assist a person with a developmental disability with personal hygiene, dressing, grooming, meal preparation, administration of medication, and includes training related to money management, banking, using public transportation and other life skills.
Community participation services and support: Services and support to assist a person with a developmental disability with social and recreational activities, work activities, and volunteer activities.
Caregiver respite services and support: Services and support that are provided to, or for the benefit of, a person with a developmental disability by a person other than the primary caregiver of the person with a developmental disability and that are provided for the purpose of providing a temporary relief to the primary caregiver.
Professional and specialized services: Includes services provided by a psychologist, psychological associate, adult protective service worker (APSW), social worker, speech language pathologist, physiotherapist or occupational therapist, as well as services for case management, service co-ordination and behaviour management.
Person-directed planning services and support: Services and support to assist a person with a developmental disability in identifying their life vision and goals and finding and using services and supports to meet their identified goals with the help of their family or significant others of their choice.
Supportive living services: Services and support that are provided to a person with a developmental disability who live in one of the following types of residences and includes the provision of accommodations, or arranging for accommodations, in any of the following types of residences:
Intensive support residences: A staff-supported residence operated by a service agency in which one or two persons with developmental disabilities reside, and in which each resident requires and receives intensive support that meets the prescribed requirements
Supported group living residences: A staff-supported residence operated by a service agency, in which three or more persons with developmental disabilities reside and receive services and supports from the agency
Host family residences: The residence of a family, composed of one or more persons, in which a person with a developmental disability who is not a family member is placed by a service agency to reside and receive care, support and supervision from the host family, in exchange for remuneration provided to the host family by the service agency
Supported independent living residences: A residence operated by a service agency that is not supported by staff and in which one or more persons with developmental disabilities reside alone or with others but independently of family members or of a caregiver, and receive services and supports from the service agency.

Direct funding

MCCSS also provides direct funding to eligible adults who have a developmental disability through the Passport program.

This funding can be used by individuals to purchase community participation services and supports, activities of daily living and person-directed planning. Passport funding can also be used for caregiver respite for primary caregivers of an adult with a developmental disability.

Developmental services agencies

A developmental services agency is funded through an agreement with MCCSS to provide services and supports to, or for the benefit of, persons with a developmental disability.

Applying for developmental services and support in Ontario

Nine Developmental Services Ontario offices across the province serve as the application and access points for MCCSS-funded adult developmental services and supports. Developmental Services Ontario determines eligibility for people who are applying for services and supports and, if eligible, complete the developmental services application package with the person and their primary caregiver, friend(s) or substitute decision-maker to assess their service and support needs.

Once the application package has been completed, applicants are prioritized for available services and supports.

From this point, and as services become available, the local Developmental Services Ontario office connects eligible people to MCCSS-funded developmental services and supports provided by developmental services agencies and/or direct funding.

Once an application package has been completed, applicants for adult developmental services and supports are encouraged to update the Developmental Services Ontario office if their circumstances change.

In addition, Developmental Services Ontario is responsible for:

Giving information to the public about available services and supports and about the application process; and
Answering any questions or concerns people may have about the application process and other services provided.

Long-term care home system

Long-term care homes

Long-term care homes are an important part of Ontario’s publicly funded health care system. Long-term care homes are licensed or approved under the FLTCA and provide residential accommodation and care to individuals 18 years of age and older who require assistance with activities of daily living, on-site supervision or monitoring to ensure safety or well-being, or the availability of on-site 24/7 nursing care.

Some long-term care homes also have short-stay programs for those who require respite or convalescent care.

HCCSS, the designated placement co-ordinators under the FLTCA, are required to comply with all of the relevant provisions in the FLTCA and its regulation. Placement co-ordinators are responsible for determining eligibility for admission, providing applicants with information and assisting applicants with the placement related application processes, prioritizing applicants on the waiting list, monitoring and managing waiting lists and authorizing admissions into long-term care homes.

All long-term care homes in Ontario are governed by the FLTCA. The FLTCA sets out requirements to ensure that residents of these homes receive safe, consistent, and quality resident-centred care based on assessed needs in settings where residents feel at home, are treated with respect, and have the services and supports they need for their health and well-being.

Long-term care homes represent an important support option on the continuum of community- based supports that is comprised of both developmental and health-based services, among others.

Long-stay residents

To be eligible for long-term care, a person must be at least 18 years old and insured person under the Health Insurance Act. The person must also require either nursing care to be available on site 24 hours a day or require frequent assistance with activities of daily living, or frequent on-site supervision or on-site monitoring to ensure safety or well-being.

Eligibility is also based on whether publicly funded community based services and other caregiving, support or companionship arrangements are sufficient to meet the person’s requirements and whether that person’s care needs can be met in a long-term care home. Selection and admission are based on the applicant’s choice, need and consent.

An applicant can be on up to five waitlists at any given time and must consent before being placed in a long-term care home, unless admission is through the modified ALC patient process. If they are in the crisis category, the number of waitlists on which an individual can be placed is unlimited. Each home’s general wait time is posted publicly on Ontario.ca/longtermcare and on local HCCSS websites. Placement co-ordinators must provide applicants with information for other homes, including those with shorter wait times.

Prioritization/wait times may change due to individuals who have greater care needs and who are given higher priority in accordance with the FLTCA.

Residents are required to pay for accommodation costs such as room and board. These costs are set out in the regulation, and can be found on Ontario.ca. In order to ensure income is not a barrier to access, residents in basic accommodation may apply for a reduced co-payment. A person who has a developmental disability may be eligible to receive developmental services and supports while they reside in a long-term care home as a long-stay resident.

Short-stay respite program

In the case of short-stay respite care, a person who is being cared for in the community (with or without home care or community support services) may reside for a short time in a long-term care home. The person must require care for a temporary period and must be likely to benefit from the stay or has a caregiver who requires temporary relief from caregiving duties. For example:

A caregiver who needs to be away for more than a day (e.g. a vacation)
A caregiver who is in a hospital and needs temporary assistance to care for his/her care recipient
A care recipient requires 24-hour nursing care and/or assistance with activities of daily living on a short term basis

Short-stay respite care in a long-term care home is available for up to 60 continuous days at one time and up to a total maximum of 90 days over each calendar year. In addition, the person must meet most of the long-stay eligibility criteria described above, excluding the criterion that publicly funded and other caregiving supports are not sufficient.

Residents are required to pay for accommodation costs such as room and board. These costs are set out in the regulation. A person who has a developmental disability may be eligible to continue to receive developmental services and supports while they reside in a short-stay program.

Short-stay convalescent care program

The short-stay convalescent care program is available to a person who requires a period of time in which to recover strength, endurance or functioning and is likely to benefit from a short-stay in a long-term care home.

A person can stay in the short-stay convalescent care program for a maximum of 90 days at one time, and up to a total maximum of 90 days over each calendar year. In addition, the person must meet most of the long-stay eligibility criteria described above, excluding the criterion that publicly funded and other caregiving supports are not sufficient.

Persons in the short-stay convalescent care program do not pay an accommodation fee. A person with a developmental disability may be eligible to continue to receive developmental services and supports during their stay in a short-stay program.

Considering a long-term care home

While it is the hope to have everyone live in their home for their entire life, sometimes one’s health changes or declines to the extent that their needs cannot be adequately or safely met in this setting.

Some people, including those with more complex, age-related health needs, may feel that they require the 24-hour a day nursing care and personal support available in a long-term care home. For example, this could include the need for 24-hour supervision or health care supports due to severe dementia/Alzheimer’s, severe physical impairment(s) and/or end of life care.

It is the role of the placement co-ordinator to support applicants in understanding the long-term care home placement process and determining whether someone meets the eligibility criteria for admission.

Again, it is the choice of the applicant, or their substitute decision-maker, as to whether they wish to meet with a placement co-ordinator to determine whether or not they meet the eligibility criteria for long-term care home placement.

Applying to a long-term care home

In addition to the eligibility criteria set out in the regulation, planning for the care required by adults with a developmental disability should be done by the placement co-ordinator and developmental services sector.

The planning should take into account personal preferences, levels of functional and social independence, spouse or partner relationships, and options for aging in place (for example, remaining in their current residence with additional supports), when possible.

Once an individual is determined eligible for long-term care home admission under the FLTCA, the planning should also include considerations such as individual choice, the need for consultation with a broader support network, potential isolation and lack of social relationships and availability of appropriate supports, services and programs (both within a long-term care home and through the provision of or continuation of developmental services).

Ultimately, it is the individual choice of the long-term care home applicant, or their substitute decision-maker, to select the long-term care homes to which they wish to apply and to accept a bed offer.

It is important to note that, depending on one’s circumstances, there may be consequences to refusing a bed offer based on the requirements in the FLTCA Regulation.

In particular, if the applicant refuses admission, the placement co-ordinator must remove the person from all long-stay waiting lists unless:

The refusal is due to a health condition, short-term illness or injury that prevents the applicant from moving in at that time or would make moving in detrimental to the applicant’s health
The applicant occupies a bed in a hospital or psychiatric facility
The applicant declines to enter into a specialized unit in certain circumstances
The applicant cannot move in due to an emergency in the home or outbreak of disease
The reason a person refuses to consent to admission is that there is a pandemic

Applicants and their substitute decision-makers are encouraged to discuss their individual situation with a placement co-ordinator in order to understand the potential impacts or consequences of their decisions.

If a long-term care home approves a person’s application and has a suitable vacancy (for example, male/female and basic or preferred accommodation), the placement co-ordinator can authorize the person’s admission provided that the person or their substitute decision-maker consents to the admission within 24 hours of being informed of the bed availability. The person must agree to pay certain accommodation charges and move into the home within 5 days of accepting the bed offer.

The length of waiting lists varies in homes across the province, and may impact the amount of time it takes for admission to a desired home.

Long-term care home waiting list categories

The waiting list categories related to prioritization and the requirements for ranking are set out in the regulation under the FLTCA and these are based primarily, but not exclusively, on an applicant’s need for a long-term care home bed. Please refer to Appendix 4a for an overview of the waiting list categories.

An applicant is placed in category 1 (crisis category) on the waiting list if he/she meets the criteria in the regulation. In general, an applicant is placed in category 1 on the waiting list if he or she:

Requires an immediate admission due to a crisis arising from his or her condition or circumstances
Is facing a permanent or temporary bed closure in a long-term care home or public or private hospital or psychiatric facility under the Mental Health Act within 12 weeks
Is a person that occupies a bed in a public hospital and is designated as requiring an alternate level of care (ALC patient)
Was admitted from a public hospital to a long-term care home selected by the placement co-ordinator from September 21, 2022 onwards and seeks transfer to a home selected by the patient

Ranking within this category is according to the urgency of the applicant’s need for admission.

The next priority category (category 2) that ranks immediately after category 1 (crisis) applies to spouses/partners who meet the eligibility criteria for admission based on care needs (unless a higher waiting list category applies). This category only applies once one of the spouses/partners has already moved into the long-term care home. Individuals prioritized in this category are ranked according to the date on which their spouse/partner was admitted to the long-term care home so as to give priority within the category to those who have been separated the longest.

Applicants of a particular religious, linguistic, or ethnic background seeking placement in a long-term care home (or unit of area within a home) that primarily serves the interests of persons of that background are prioritized in category 3A or 3B of the waiting list, unless a higher waiting list category applies. Applicants who are waitlisted in category 3A or 3B have higher prioritization than applicants in category 4A/4B (others).

The criteria to be placed in categories 3A and 4A are:

The applicant is not a resident of a long-term care home and requires or is receiving high service levels under the Connecting Care Act, 2019
The applicant occupies a bed in a hospital under the Public Hospitals Act and requires an alternate level of care
The applicant is a long-stay resident seeking to transfer to his or her first choice of home
The applicant is a short-stay resident in the interim bed short-stay program and is seeking to transfer to the home as a long-stay resident

The interim bed short-stay program is only for individuals who (amongst other requirements) occupy a bed in a public hospital, no longer require acute care services provided by the hospital, require an alternate level of care, are determined eligible for admission to a long-term care home as a long-stay resident, and are on a waiting list for a long-stay bed in a long-term care home.

Other prioritization categories such as re-admission, veteran and exchange exist but are used less frequently. The re-admission category ranks above category 1 (crisis category) and applies to applicants who are discharged from the long-term care home due to specified circumstances (e.g. for exceeding the permitted length of a medical or psychiatric absence and who are seeking re-admission to the same long-term care home).

Reunification of spouses and partners

The FLTCA provides priority to long-term care home applicants who wish to reunite with their spouses or partners. Long-term care home applicants seeking reunification with spouses and partners may be reunited through the following placement mechanisms:

Reunification priority access beds: Those seeking reunification who are deemed to be in the ‘crisis’ category may apply for placement through a separate waitlist. Reunification priority access beds are virtual beds which can be in any location of a long-term care home, rather than specific beds tied to a particular space. Two reunification priority access beds are designated in every long-term care home with regular long-stay beds
Category 2 (Spouse/partner reunification), described above
Category 3B and 4B, also described above

MLTC also supports spouses and partners seeking reunification by subsidizing the cost of a semi-private room.

Supports available in a long-term care home

There needs to be careful consideration by the individual, primary caregiver, the placement co-ordinator, long-term care home and developmental services agency as to the supports a long-term care home applicant or resident with a developmental disability may require to improve their quality of life while residing in a long-term care home.

Depending on the person’s situation, planning for end of life care may also be required. This type of planning will help inform what types of supports, if any, may be required to transition the person into a long-term care home and/or continue to support the person while residing in the long-term care home.

Long-term care home supports that could be required include enhanced staff training and education as well as additional supports to maintain health and quality of life such as behavioural therapists, therapeutic recreationalists, social workers, rehabilitative assistants, developmental services workers and modified equipment. (Long-term care homes are required to meet the individualized care needs of their residents).

People who were receiving MCCSS-funded services and supports as part of the 2006 Long-Term Care Home Access Protocol for Adults with a Developmental Disability and/or a related initiative, should continue to receive these services and supports if they continue to be eligible and the supports are appropriate and necessary to support their quality of life, health and well-being.

MCCSS-funded services and supports for adults with a developmental disability in long-term care homes should be reviewed regularly or as required by the long-term care home with the developmental services sector for need and appropriateness. Developmental services and support would not continue if they duplicate or replace supports typically provided by the specific long-term care home in which the person resides.

MCCSS-funded transfer payment agencies develop individual support plans for each person receiving services and supports from the agency as required by the Quality Assurance Measures Regulation (Ontario Regulation 299/10). Individual support plans can also be developed jointly between an adult with a developmental disability and their case manager, for example an Adult Protective Service Worker (APSW). The APSW program provides MCCSS-funded case management services for people who have a developmental disability and live independently in the community, including those individuals who may be transitioning to a long-term care setting. An individual support plan is not the same as a person-directed plan. While individual support plans can be informed by the same values as the person-directed plan, they are fundamentally different.

Individual support plans are mandatory (the contents are set out in s.5 (4) of Regulation 299/10). The focus of an individual support plan is on service delivery for an individual. These plans are most often developed within an agency setting in which someone is receiving agency supports, or can be developed jointly by the person and their case manager, for example, an APSW.

These plans should be aligned with the support plan developed in consultation with the long-term care home.

Home and Community Care Support Services

Home and Community Care Support Services (HCCSS) organizations, previously known as the Local Health Integration Networks, are the designated placement coordinators under the FLTCA and the Regulation. They are responsible for coordinating admissions/transfers to long-term care homes. As part of its placement function, HCCSS determines a person’s eligibility for admission, providing information and assistance with the placement, and monitoring and managing long-term care home wait lists among other things. Placement co-ordination involves interaction with other partners like Developmental Services Ontario to support individuals.

Placement coordinators are required to work closely with applicants and their families to discuss any questions they may have regarding the long-term care home placement and transfer process, as well as other available options applicants and their families may wish to consider.

HCCSS organizations offer a point of access to Ontario's home and community care system by:

Assessing need, determining eligibility, and providing or arranging for visiting health and professional services in people's homes
Assessing need, determining eligibility, and providing or arranging for the provision of school health services for children
Assessing need, determining eligibility, and managing admissions to long-term care homes
Providing information and referrals to the public about other community agencies and services available to them

Some HCCSS organizations manage admissions to adult day programs, supportive housing and assisted living programs, and to chronic care or rehabilitation beds in hospitals. The services of HCCSS organizations are available to eligible Ontario residents of any age and are fully funded by the Ministry of Health.

HCCSS serves individuals who require support because of frailty, disability or chronic health issues, may be recovering from an acute illness, living with a chronic disease or are in the convalescent, rehabilitative or terminal stage of disease, and those requiring services to participate in school or home schooling.

If a service outlined in a person’s plan of service is not immediately available, the person is placed on a waitlist for the service. The duration of service depends on someone’s needs. The provision of community-based health and support services may be temporary, periodic, or long term.

HCCSS provide or arrange for the following professional services for eligible individuals: nursing, physiotherapy, occupational therapy, speech-language pathology, social work, dietetics, pharmacy services, respiratory therapy services, social service work services, and diagnostic and laboratory services.

HCCSS can also provide or arrange for: medical supplies, dressings and treatment equipment necessary for the provision of nursing, physiotherapy, occupational therapy, speech-language pathology and dietetics services.

HCCSS also provide or arrange for personal support and homemaking services as well as some community support services.

In addition to the provision of services, HCCSS are also required to provide comprehensive information to people in their communities about other options to meet their needs and community services that are available (e.g. meal programs, security checks, and friendly visiting).

Most long-term care homes in the province have waiting lists. Information on waiting lists can be viewed on Ontario.ca/longtermcare and on each HCCSS website, and placement co-ordinators can provide information to applicants on wait times at each of the homes in their geographic area (Refer to Appendix 5 for HCCSS contact information).

Considerations when applying to a First Nations long-term care home

Application and assessment processes

With the exception of the provisions pertaining to consent and permitting MLTC to cease admissions, the following four First Nations homes are exempt from the placement related provisions in the FLTCA and regulation:

Iroquois Lodge Nursing Home, Ohsweken
Wikwemikong Nursing Home, Wikwemikong
Akwesasne Adult Care Centre, Cornwall
Oneida Nation of the Thames Long-Term Care Home, Southwold

Anyone seeking to move into one of these long-term care homes should inquire with the intake office of the First Nations long-term care home they are interested in applying to concerning the home’s processes.

Depending on the particular First Nations long-term care home, the level of placement co-ordinator involvement with referrals, assessment and other intake/moving in processes may vary considerably. In some cases, referrals may be accepted from the placement co-ordinator, community agencies, hospitals, a person or family members. Some homes may require documentation showing First Nations status, for example, a status number.

First Nations long-term care home supports for adults with a developmental disability

In situations where an adult with a developmental disability is receiving developmental services support from a developmental services agency and is considering applying to a First Nations long-term care home, the developmental services agency is encouraged, with informed consent, to collaborate with the First Nations long-term care home to identify any additional developmental services support needs the person may have, and to develop a support plan to meet these needs. A referral to Developmental Services Ontario by either the developmental services agency or the First Nations long-term care home, as most appropriate, will be made for an assessment to determine eligibility for developmental services and supports in the long-term care home.

In situations where a person with a developmental disability is not receiving developmental services supports and is considering applying to a First Nations long-term care home, the long-term care home, with informed consent, should make a referral to Developmental Services Ontario for an assessment to confirm eligibility and any other community based resources, as appropriate.

Roles, responsibilities and service planning when considering, applying to and moving into a long-term care home

Individuals moving into a long-term care home may be receiving MCCSS-funded developmental services and supports. This section describes the type of service co-ordination that occurs when an individual moving into a long-term care home is already receiving developmental services and supports, or requires such services and supports.

Informed Consent

A person’s informed consent (or that of the person’s substitute decision-maker, if applicable) is required at multiple junctures in the long-term care home placement process. (Limited exceptions apply to ALC patients. Please see Appendix 4B for details).

Separate consents are required relating to applications for admission to long-term care homes, developmental services and acceptance of bed offers to move into a long-term care home.
- The long-term care home(s) to which a person, or their substitute decision-maker, applies is their choice.
- People are not required to be placed on a waiting list for a long-term care home or accept a bed in a long-term care home to which they have not applied. There may be consequences if the person does not accept a bed in a long-term care home to which they have applied.
- A person, or their substitute decision-maker, must also consent to any bed offer before the person may move into a long-term care home.
Separate consents are also required whenever information is to be shared between sector agencies and in situations where information is to be shared with persons other than a substitute decision-maker, such as a primary caregiver, family members or friends.
- Limited exceptions apply to ALC patients. Please see Appendix 4B for details.

Roles and responsibilities for individuals, families and substitute decision-makers

Applying to a long-term care home without current developmental services involvement

Step 1: The designated long-term care home placement co-ordinator starts the application process:

When an adult with a developmental disability who has not been assessed by Developmental Services Ontario and is not receiving MCCSS funded developmental services is considering placement in a long-term care home, the local placement co-ordinator will need to be contacted either by the person or their substitute decision-maker to start the application process. This process begins with an application for determination of eligibility.

Step 2: Contact Developmental Services Ontario to apply for developmental services

When someone is not currently receiving developmental services and supports but is in need of such supports as identified by the individual, caregiver and/or substitute decision-maker, the placement co-ordinator should ask the person if they or their substitute decision-maker would prefer to initiate contact with Developmental Services Ontario.

If not, the placement co-ordinator, with consent, should facilitate a referral to the local Developmental Services Ontario office so that an application for MCCSS-funded developmental services may be made.

The long-term care home placement process should not be delayed as a result of any referral to a local Developmental Services Ontario office except where the placement process requires consultation and/or information from Developmental Services Ontario, including any assessment information as set out in the regulation under the FLTCA and any applicable guidance.

Applying to a long-term care home while already receiving developmental services

Step 1: Contact the designated placement co-ordinator to start or update the application process

When a person who is receiving MCCSS-funded developmental services or support (including supportive living services and support) appears to require the services and support of a long-term care home, the person (or their substitute decision-maker, if any) should consider contacting their local long-term care home placement co-ordinator to determine whether a long-term care home is an appropriate option.

Engaging the placement co-ordinator early on is important for planning purposes to help mitigate against urgent situations and to create a baseline of health information and information about their circumstances that can help to inform planning.

Step 2: Contact Developmental Services Ontario about a significant change in circumstances

If a person’s needs change such that they may be eligible to move into a long-term care home, the person, developmental services agency or substitute decision-maker should notify Developmental Services Ontario of the change in their needs or supports that has occurred. Developmental Services Ontario will arrange for a reassessment of the person’s developmental service and support needs.

Identifying and providing developmental services in long-term care homes:

The Developmental Services Ontario assessment identifies a person’s needs and appropriate developmental services and supports. Developmental Services Ontario can identify the services and supports being provided to a person by a developmental services agency and, with consent (or, in a situation involving an ALC designated patient in a public hospital, in accordance with any legislative or regulatory requirements), provide information to a placement co-ordinator and long-term care homes.

If a person has been receiving MCCSS-funded services and support, Developmental Services Ontario and the developmental services agency will work together to determine if additional MCCSS-funded developmental services and supports are required and available to support the person in the long-term care home.
Developmental services agencies are encouraged to work with placement co-ordinators and long-term care homes to identify any required, available specialized developmental services to support the person’s quality of life and care while residing in a long-term care home.

It is important to note that not all people with a developmental disability will require additional supports in order to transition into and reside in a long-term care home.

Contacting Developmental Services Ontario

When such needs have been identified, the placement co-ordinator should ask the person if they (or their substitute decision-maker, if any) would prefer to initiate contact with Developmental Services Ontario. If not, the placement co-ordinator should facilitate a referral to the local Developmental Services Ontario office so that a new or updated assessment of the person’s developmental service and support needs can be completed.

If the person is new to Developmental Services Ontario, the local office will confirm the person’s eligibility for developmental services and supports and complete the application assessment. If Developmental Services Ontario had previously completed an application assessment for the person, this application will be updated. Developmental Services Ontario will then determine if developmental services and supports are available to support the person in a long-term care home.

Developmental services and support that can be provided in a long-term care home

Developmental services and support that a person may receive or continue to receive while residing in a long-term care home include:

Passport funding
Activities of daily living services and support
Community participation services and support
Professional and specialized services
Person-directed planning services and support

An explanation of these developmental services and supports is provided in Part 4 of this document.

The processing of long-term care home placement-related applications should not be delayed as a result of any referral to a local Developmental Services Ontario office except where the placement process requires consultation and/or information from Developmental Services Ontario, including any assessment information as set out in the regulation under the FLTCA and any applicable guidance.

It is important to note that ALC patients with developmental disabilities who may already be on a wait list or should be on a wait list for community-based services would likely not be eligible for long-term care placement.

Once an individual has been determined by the placement co-ordinator to be eligible for long-term care home placement, the individual, or their substitute decision-maker, if any, may select the long-term care homes to which to apply.

Placement co-ordinators may place individuals on waiting lists for up to five long-term care homes at one time. The limit of five does not apply to individuals who are prioritized in Category 1 (crisis) on the waiting list (largely, although not exclusively, because they require an immediate admission to a long-term care home as a result of a crisis arising from their condition or circumstances).

The placement co-ordinator will then seek approval for the individual’s admission from the long-term care home(s).

A long-term care home’s obligation to approve or withhold approval is in no way dependent upon whether an applicant has or has not contacted Developmental Services Ontario; however, where information, including assessment information from Developmental Services Ontario is required as part of the eligibility determination process and is included in the information to be provided to a long-term care home as part of reviewing an application, such information must be included in accordance with the regulation under the FLTCA and any applicable guidance.

As per subsection 51(7) of the FLTCA, a long-term care home can only withhold approval of an application if the home lacks the physical facilities necessary to meet the applicant’s care requirements, the staff of the home lack the nursing expertise necessary to meet the applicant’s care requirements, or limited circumstances exist as specified in the regulation. Limited circumstances would only apply for alternative settings that are exempt from having certain safety and security features set out in the regulation. In these cases, licensees for alternative settings shall not approve for admission an applicant who requires the safety and security features from which the licensee is exempt.

Roles and responsibilities for placement co-ordinators

Placement co-ordinators are responsible for managing the long-term care home placement process and will work (as appropriate) with the person, or the person’s substitute decision-maker if any, the person’s family, Developmental Services Ontario and developmental services agencies when dealing with a person’s application and planning for the person’s move into a long-term care home, as required.

Deciding if long-term care is suitable for the person

It is important that a discussion with the applicant, the substitute decision-maker, if any, and family members (if the applicant or substitute decision-maker consents to their involvement) occurs as to whether a long-term care home is suitable to meet the individual’s health and social needs.

MCCSS and MLTC support people living and aging in the community for as long as they are safe, willing and able to do so.

Assessments

When an individual or their substitute decision-maker decides to complete an application for determination of eligibility for long-term care home admission, the placement co-ordinator will work with the person, or substitute decision-maker if any, to gather all of the necessary health and functional assessments, and any other information required to complete the eligibility determination.

Such additional information may pertain to the person’s condition, circumstances and care needs as they specifically relate to the person’s medical and/or behavioural needs. A person’s developmental disability should be noted in any application that is supplied to the long-term care home(s) selected by the applicant.

It is very important that this information be comprehensive and accurate, particularly in respect of any behavioural issues.

Full disclosure in this regard will help to ensure that the person can be properly supported by the long-term care home in relation to his/her care needs.

Modifications to these requirements may apply in specific circumstances if admission occurs during a pandemic or when an ALC patient in a public hospital is being assessed for eligibility.

Planning For Care Needs Across Sectors

To facilitate the planning processes, long-term care home placement co-ordinators will have discussions with developmental services agencies that have been involved in the care of the person.

The goal of having these discussions early on in the assessment process is to aid in the transition of the individual into a long-term care home, including timely provision of any of the required specific developmental services and supports.

The placement co-ordinator must determine, as part of the eligibility determination for long-term care home admission, if the publicly-funded community-based services available to the person and the other caregiving, support or companionship arrangements available to the person in their current living situation are not sufficient, in any combination, to meet the person’s requirements (section 172 (1) (d) of the Regulation) and that the person’s care requirements can be met in a long-term care home.
Long-term care home application and transition planning for a person will include the identification of necessary supports for successful transition through the development of a support plan. These may include additional supports that are specific to the person’s developmental disability, beyond the long-term care home’s required service offering, and necessary for successful transition and residing in a long-term care home.
Where applicable, planning will include, but not be limited to, a confirmation of the service providers who would be involved in providing direct or indirect support through the developmental servics system.

Where appropriate, the placement co-ordinator, in consultation with the developmental services agency involved in the person’s care, may:

Co-ordinate the necessary steps to obtain a completed health assessment from the person’s physician and to meet with the person to complete the functional assessment, both of which are required for a determination of eligibility for admission to a long-term care home.
- The health assessment is required to be completed by a physician, registered nurse or registered nurse in the extended class.
- The health assessment includes information about an applicant’s physical and mental health and requirements for medical treatment and health care.
- The functional assessment is required to be carried out by an employee or agent of the placement co-ordinator who is a registered nurse, a social worker registered under the Social Work and Social Service Work Act, 1998, a physiotherapist, occupational therapist, speech-language pathologist or a dietitian.
- Under the FLTCA, the functional assessment must include an assessment of the applicant’s functional capacity, requirements for personal care, current behaviour and behaviour during the year preceding the assessment. All placement co-ordinators use the standard long-stay assessment instrument known as the Resident Assessment Instrument - Home Care (RAI-HC) for completion of this assessment. Some of the questions in the RAI-HC also relate to an applicant’s behaviours and if these answers indicate that an applicant has previously demonstrated responsive behaviours, another separate assessment related solely to behaviors is triggered.
- The use of the RAI-HC provides for a standardized assessment process and terminology that is applicable throughout the entire province.

The FLTCA requires that the health assessment and functional assessment be made by different individuals.

Considerations as part of the planning process

Moving into a long-term care home is a big decision for any person. It is important to ask the person what their preferences and emotional, physical and care needs are when applying and moving into a long-term care home. Talk to them often to see if these preferences and needs have changed.

The questions below have been suggested by a long-term care home provider as possible questions to ask when a person is considering whether a long-term care home could be an appropriate setting to meet their needs and/or if special supports are required:

What is the person’s usual routine?
How does change in routine affect the person?
Does the person have any obsessive needs or routines that need to be considered?
Does the person require the services of a behavioural therapist?
Is the person independent in travelling with public transit and/or going out into the community unsupervised?
Does the person need enhanced or constant supervision (anything less than a 1:10 ratio)?
Is the person comfortable with being in close quarters (e.g. dining room, care unit) with 30+ people?
There may be wandering residents in a long-term care home who may enter the person’s room without an invitation. How would the person react to this?
Does the person display an unusual sensitivity to sensory stimuli (e.g. loud noises, light, clothing types, touch, smells)?

Additional planning considerations for placement co-ordinators

Placement co-ordinators support the planning process by:

Providing information about specific long-term care homes and encouraging the individual, or their substitute decision-maker, if any, to learn if all aspects of the home environment meet their needs and preferences.
Working with Developmental Services Ontario and developing a support plan with the long-term care home that can meet the needs of the person. This should include discussions of the types of supports long-term care home staff might require such as additional training before or after the person moves into the long-term care home.
Engaging in contingency planning for situations in which a person is determined ineligible for long-term care home admission based on the eligibility criteria set out under the FLTCA and its regulation, or cannot move into a long-term care home.
Contingency planning is also required by long-term care homes and placement co-ordinators in situations where a discharge from a long-term care home is being planned, including a referral to Developmental Services Ontario for persons requesting MCCSS-funded developmental services or supports. A discharge from a long-term care home can occur for a variety of reasons and the regulation under the FLTCA sets out detailed requirements in this regard (Long-term care home residents can only be discharged where permitted or required by the regulation.)

Roles and Responsibilities of long-term care homes

Long-term care homes are responsible for:

Determining whether to give or withhold approval for the person’s application within five business days after receiving the placement co-ordinator’s request and after reviewing the assessments and information provided.
Providing a written response (if not during a pandemic) to the placement co-ordinator acknowledging its review of this material and stating that the applicant is either approved or not to move into the home. During a pandemic, this information may be conveyed either orally or in writing.
Approving an applicant’s admission unless the home lacks the physical facilities to meet the person’s care requirements, or the staff of the home lack the nursing expertise necessary to meet the person’s care requirements.
Assessing and determining with the support of placement co-ordinators what additional supports (e.g. accommodation, education, equipment, staffing) may be required. If the person has a developmental disability, Developmental Services Ontario would assess for needs related to developmental services and supports.
Participating in ongoing knowledge exchange during the person’s application process and information exchange with the placement co-ordinator and other service providers. Developmental Services Ontario is the lead for knowledge exchange about relevant developmental services and supports, which may be available within the community as well as through MCCSS-funded agencies.
Identifying their staff training needs that could be supported by the developmental services sector (e.g. agencies) to facilitate a successful transition.
When applicable, working together and providing reasonable, controlled access for developmental services agency staff and other care providers into the long-term care home to provide any additional developmental services and supports.
Long-term care homes that already have residents with a developmental disability who are not in receipt of MCCSS-funded developmental services but who may benefit from such services to support their living in the long-term care home can initiate discussions with the resident or the person’s substitute decision-maker, if any, as to whether the person would like to be referred to the local Developmental Services Ontario office for determination of eligibility for developmental services. Where a resident indicates such an interest, the long-term care home should facilitate the referral unless the person, or substitute decision-maker if any, prefers to initiate contact themselves.

Discharge from a long-term care home

The long-term care home may discharge a resident in certain circumstances. For example, a discharge may occur if:

The resident's care requirements have changed and, as a result, the long-term care home can no longer provide a sufficiently secure environment to ensure the safety of the resident or the safety of persons who come into contact with the resident
The resident decides to leave the home and signs a request to be discharged
The resident leaves the home and informs the administrator that he or she will not be returning to the home
The resident is absent from the home for a period exceeding seven days and the resident has not informed the Administrator of his or her whereabouts, and the Administrator has been unable to locate the resident

There are also situations when a long-term care home must discharge a resident. For example, long-stay residents must be discharged when:

The resident is on a medical absence that exceeds 30 days or on a psychiatric absence that exceeds 60 days, unless the resident is unable to return to the home because of an emergency in the home or an outbreak of disease, or emergency or natural disaster in the community
The total length of the resident's vacation absences during the calendar year exceeds 21 days, unless the resident is unable to return to the home because of an emergency in the home or an outbreak of disease in the home, emergency or natural disaster in the community, or short-term illness or injury
The long-term care home is being closed

Before any discharge may occur, the long-term care home is responsible for:

Ensuring that notice of the discharge is given to the resident, the resident's substitute decision-maker, if any, and to any other person either of them may direct
Ensuring that the notice is provided as far in advance of the discharge as possible or, if circumstances do not permit the notice to be given before the discharge, as soon as possible after the discharge

Before a discharge may occur relating to the change in the resident's care requirements, the long-term care home is responsible for:

Ensuring that alternatives to discharge have been considered and, where appropriate, tried
Making, in collaboration with the appropriate placement co-ordinator and other health service organizations, alternative arrangements for the accommodation, care and secure environment required by the resident. Developmental Services Ontario will also be notified
Ensuring the resident and the resident's substitute decision-maker, if any, and any person either of them may direct is kept informed and given an opportunity to participate in the discharge planning and that his or her wishes are taken into consideration
Providing a written notice to the resident, the substitute decision-maker, if any, and any person either of them may direct setting out a detailed explanation of the supporting facts, as they relate both to the home and to the resident's condition and requirements for care that justify the long-term care home’s decision to discharge the resident.

Modifications to these requirements apply if discharge occurs during a pandemic. A long-term care home must discharge a long-stay resident if the resident or the resident’s substitute decision-maker provides a written request to be discharged because of the pandemic. Before the resident leaves the long-term care home, the licensee must provide specified information (e.g. care requirements). The process for returning to the home they were discharged from differs based on the length of time since discharge:

For absences less than 3 months, the person is placed in the “re-admission category”
Longer absences require a truncated assessment by the placement co-ordinator and approval by the long-term care home. If accepted, the person is placed in the “re-admission category.”

Roles and responsibilities of the Public Guardian And Trustee And The Office Of The Public Guardian And Trustee

Decision-making in respect of personal care

The Public Guardian and Trustee may become involved as the substitute decision-maker of last resort if the person is found to be incapable of making the decision about admission to a long-term care home and there is no one else willing and able to make the decision on the person’s behalf who meets the requirements to be the substitute decision-maker. In such circumstances, the HCCSS can contact the Office of the Public Guardian and Trustee directly to request that they act as substitute decision-maker.
The Public Guardian and Trustee’s authority would include selecting the long-term care home and making any decisions that are necessary and ancillary to the application to the long-term care home.

Decision-making in respect of property

The Public Guardian and Trustee may be involved as the statutory guardian of property for a financially incapable person who may be transitioning into a long-term care home, even if the Public Guardian and Trustee is not otherwise involved in the decision about a person’s admission to a long-term care home.
As statutory guardian of property, the Public Guardian and Trustee is responsible for financial decisions relating to the person’s move into a long-term care home and will work with the person, family, personal care substitute decision-maker and developmental services agency to ensure that appropriate financial arrangements are made to pay for the person’s accommodation costs in the long-term care home and for the provision of services where the cost is to be paid by the person. Typically this may include items such as moving costs, decisions regarding disposing of property, determining the long-term care home room type, and arranging for private personal support workers, if necessary.

Roles and responsibilities of the developmental services sector

As mentioned above, Developmental Services Ontario will determine the person’s eligibility for developmental services and supports and complete the application assessment. If Developmental Services Ontario had previously completed an application assessment for the person, it will be updated. Developmental Services Ontario will then determine if developmental services and supports are available to support the person in a long-term care home.

Developmental services and supports that a person may receive or continue to receive while residing in a long-term care home include:

Passport funding
Activities of daily living services and support
Community participation services and support
Professional and specialized services
Person-directed planning services and support

Working with placement co-ordinator to identify and co-ordinate required support:

MCCSS-funded developmental services agencies are encouraged to proactively engage in service planning with their local designated long-term care home placement co-ordinator where possible.

When a MCCSS-funded developmental services agency is involved in supporting a person, the local designated long-term care home placement co-ordinator will co-ordinate and work with the developmental services agency to arrange discussions with potential long-term care homes to identify how the home can meet the person’s needs and what additional supports, if any, may be required.

This discussion would identify options and actions that can be taken to address these needs and would usually occur after a person has been found eligible by the placement co-ordinator and has been approved for admission by their selected long-term care homes
When a person has very high care needs, this discussion may occur prior to a determination of eligibility in order for the placement co-ordinator to determine whether a person’s care needs can generally be met in a long-term care home (for example, as part of eligibility determination)

Cross sector co-ordination scenario:

At age 56, Sam began to have significant health issues requiring medical interventions. Sam, with the support of his family, made the decision to apply for admission to a long-term care home. Sam has Down syndrome, Alzheimer’s disease and complex medical needs.

Once Sam was determined eligible and approved by a long-term care home, a transition plan was developed with Sam and his family, the developmental service agency and the long-term care home. This transition plan was in place weeks before Sam moved into the long-term care home and included:

Arranging transportation to the home so he could meet staff and other residents before moving in.
Providing staff from the developmental services residence to work with the long-term care home staff to understand Sam’s needs, his daily care routine and ongoing medications. This support was provided during the first few weeks after Sam moved into the long-term care home.
Sam had direct funding from MCCSS through Passport, so he was able to continue receiving community participation support after he moved into the long-term care home. This helped Sam participate in the activities at the long-term care home and to also stay connected with his community.

Steps when applying to a long-term care home

Step 1: Starting the application process

A long-term care home may be identified by the person who needs care or by someone acting on the person’s behalf. This can include a substitute decision-maker, primary caregiver, family members, clinician or a developmental services agency that is providing supportive living services or other services.
Developmental services agencies are expected to be proactive in identifying aging-related decline in health status for those individuals for whom they are providing supportive living services and support and whose health needs may be more appropriately supported in a long-term care home. All other health and community services should be considered first.
Changes in health status should be tracked on an ongoing basis from the time they are first noticed. This includes changes such as the onset of Alzheimer’s or other dementias, reduced mobility, increases in falls and other aging-related frailties.
When the person or their substitute decision-maker, if any, decides that long-term care home placement may be an option, the person or their substitute decision-maker applies to the local placement co-ordinator for a determination of eligibility.
- Either the person or their substitute decision-maker, if any, can contact the placement co-ordinator to start the application process.
- If the person is determined eligible in accordance with the eligibility criteria set out in the FLTCA and its regulation, the person or their substitute decision-maker applies to the placement co-ordinator for authorization of admission to one or more long-term care homes.
- Step 4 below explains the process to obtain consent for the application process.

Step 2: Applying to and updating Developmental Services Ontario

If a person’s needs change, the person, developmental services agency or substitute decision-maker should notify Developmental Services Ontario of the change in their needs/supports so that a new or updated developmental services application can be completed.
If the person is already in receipt of developmental services, Developmental Services Ontario will arrange for a reassessment of the person’s developmental service and support needs.
While the above long-term care home application process is underway, Developmental Services Ontario will confirm eligibility for developmental services and supports for the person, if needed.

Step 3. Developing a support plan

The process for identifying a person’s support and transition needs should include:

the person or substitute decision-maker, if any
the person’s primary caregiver
Developmental Services Ontario,
Developmental services agencies, if applicable
the long-term care home in which the individual will be residing
the placement co-ordinator

The placement co-ordinator is responsible for a successful transition into a long-term care home. Furthermore, the long-term care home in which the individual will be residing will co- ordinate the development of a support plan for the person.

This plan will be based on information obtained through relevant health and developmental services assessments.
It may also be enhanced by additional information obtained from the person or their substitute decision-maker, if any, as well as the primary caregiver, family, friends, supporting developmental services agency, and primary health care provider (if the applicant or substitute decision-maker consents to their involvement)
The plan is to be shared with the person or their substitute decision-maker, if applicable
with the consent of the person or any substitute decision-maker, it may be shared for consideration and revision with:
- a primary caregiver
- family
- friends
- Developmental Services Ontario and developmental services agency staff as applicable
The final version should then be distributed to the long-term care home that will be involved in supporting the person going forward as well as the developmental services agency if developmental services and supports will be provided.
Developmental services agencies may provide developmental services and supports to long-term care home applicants while they wait for a long-term care home bed as well as to individuals already residing in a long-term care home to support their transition or for a longer period of time depending on their needs.

Step 4: Applying for a Determination of Eligibility for long-term care home admission

Consent is required to start the application process to determine eligibility for admission to a long-term care home as well as for the release of information that will be required as part of this process.

This consent must come from the person who will be applying or the person’s substitute decision-maker, if any.
The placement co-ordinator, in collaboration with the developmental services agency, will obtain this consent and consents needed to release any information.

Limited exceptions apply. Please see Appendix 4B for details.

Step 5: Completing assessments

The following types of assessments are required to be obtained or completed by the placement co-ordinator in order to determine a person’s eligibility for a long-term care home:
- An assessment of the applicant’s physical and mental health, and the applicant’s requirements for medical treatment and health care.
- An assessment of the applicant’s:
  - Functional capacity
  - requirements for personal care
  - current behaviour
  - behaviour during year preceding the assessment
Please note that during a pandemic or when an ALC patient in a public hospital is being assessed for eligibility, the placement co-ordinator’s determination of eligibility for admission to a long-term care home may be based on as much information as is available in the circumstances about the person’s physical and mental health, requirements for medical treatment and health care, functional capacity, requirements for personal care, and behaviour.
- MCCSS expectations for the completion of a full assessment by Developmental Services Ontario to determine eligibility for developmental services and supports under SIPDDA remain unchanged during a pandemic.
If the person is currently receiving services and supports from a developmental services agency, the agency may, if appropriate, co-ordinate the meetings needed for the functional assessment to be completed and ensure that the substitute decision-maker, if any, is told about this process. The developmental services agency will stay in contact with the person, or substitute decision-maker if applicable, throughout the long-term care home placement process.
An employee or an agent of the placement co-ordinator will meet with the person and substitute decision-maker, if any, to complete the functional assessment as part of the process to determine the person’s eligibility for admission to a long-term care home.
- If the person agrees, the primary caregiver and family may also be present for this assessment.
Assessments would also consider the provision of home care supports and/or appropriate referrals if the person is determined ineligible for a long-term care home, or is determined eligible but moving into the long-term care home is delayed.

Step 6: Communicating the results of assessments

If the applicant is determined eligible for long-term care home admission, the placement co-ordinator will provide the information to the applicant about the process for admitting persons into long-term care homes and explain the process, the choices that the applicant has in the process and the implications of those choices.
If the applicant is determined ineligible for long-term care home admission, the placement co-ordinator will suggest alternative services and make appropriate referrals on behalf of the applicant and notify the applicant in writing of the determination of ineligibility, the reasons for the determination and the applicant’s right to apply to the Appeal Board for a review of the determination.
With consent of the person or the substitute decision-maker, if any, the placement co-ordinator will share these results and decision with the primary caregiver, family members, Developmental Services Ontario and the developmental services agency staff, as applicable.

Step 7: Selection of long-term care homes

If a person is determined eligible for a long-term care home, they will be asked to select and make an application for authorization of admission to one or more specific long-term care home(s).
- If the person wants help selecting one or more long-term care homes to which to apply, the placement co-ordinator must provide assistance.
Individuals, or their substitute decision-maker if any, have a choice and can select the long-term care home(s) to which to seek admission. There is no minimum number of long-term care homes to which a person must apply. A person can choose to apply to only one long-term care home if that is their preference.
Individuals can be placed on up to five long-term care home wait lists at one time. The limit of five does not apply to individuals who are prioritized in category 1 (crisis) on the waiting list. An applicant is placed in category 1 (crisis) on the waiting list if he or she:
- Requires an immediate admission due to a crisis arising from his or her condition or circumstances
- Is facing a permanent or temporary bed closure in a long-term care home or public or private hospital or psychiatric facility under the Mental Health Act within 12 weeks
- Is a person that occupies a bed in a public hospital and is designated as requiring alternate level of care (ALC patient)
- Was admitted from a public hospital to a long-term care home selected by the placement co-ordinator from September 21, 2022 onwards and seeks transfer to a home selected by the applicant
Some examples of situations that could result in category 1 prioritization for a long-term care home include:
- an unexpected change in a person’s condition or circumstances that makes existing care arrangements no longer appropriate
- an unexpected change in a person’s condition or circumstances that results in the caregiver’s inability to continue providing care
In assisting the person, the placement co-ordinator should consider the person’s preferences relating to admission, based on ethnic, religious, spiritual, linguistic, familial and cultural factors.
If a home selected by an applicant is not in the geographic area of the placement co-ordinator to whom the application was made, the placement co-ordinator will co-ordinate with the appropriate placement co-ordinator of that home.
To support a person’s selection process, it may be useful to call and visit a long-term care home that a person is considering and to contact the Residents’ Council and Family Council, if any, to ask any questions about the social, recreational and other activities/ supports that are offered.

Step 8: Completing the application for authorization of admission

Once the eligible person or substitute decision-maker, if any, has selected the long-term care home(s) to which he/she would like to apply, the placement co-ordinator, with the developmental services agency staff, where applicable and if needed, will assist them in completing the application for authorization of admission.

Step 9: Sending the application to the long-term care home(s)

Once the application for authorization of admission is completed, this application, together with all the assessment information and information about the person’s selection of accommodation type (for example, private, semi-private, or basic accommodation), will be sent to the selected home(s).
Documentation outlining a plan for any MCCSS-funded developmental services and supports in the long-term care home that are to be provided by a developmental services agency or purchased with direct funding provided through MCCSS’ Passport program, will also be sent with the application. This could relate to continuation of developmental services a person has been receiving to support the person to reside in the long-term care home for a long period of time or new temporary developmental services to assist with transition into the long-term care home. As mentioned above, Developmental Services Ontario should be notified in the event that a new or updated application for developmental services is required.

Step 10: Long-term care home review of application

The long-term care home is required to review the assessments (if applicable) and information provided and must respond in writing to the placement co-ordinator acknowledging its review of this material. The long-term care home must state in writing if the applicant’s admission is either approved or declined within five business days after receiving the placement co-ordinator’s request.
If within those five business days, the long-term care home requests additional information that the placement co-ordinator believes is relevant to the long-term care home’s decision of whether to give approval, the placement co-ordinator must provide the information. The long-term care home’s request must be in writing and once the additional material has been received, the long-term care home has three additional business days to respond.

Step 11: If the long-term care home refuses to approve the application

Should the long-term care home not approve the person’s application (refuse the placement of the person in that home), the long-term care home is required to provide written notice to the applicant and the appropriate placement co-ordinator outlining:
- The ground or grounds for withholding approval
- A detailed explanation of the supporting facts, as they relate both to the home and to the applicant’s condition and requirements for care
- An explanation of how the supporting facts justify the decision to withhold approval
- Contact information for the Director
In accordance with the requirements in the FLTCA, a long-term care home can withhold approval of the applicant’s admission if:
the home lacks the physical facilities necessary to meet the applicant’s care requirements
the staff of the home lack the nursing expertise necessary to meet the applicant’s care requirements
The FLTCA and regulation also provide for additional, limited circumstances that a long-term care home that serves as an alternate setting shall not approve for admission an applicant who requires the safety and security features that would be absent in the alternative setting. In these cases, licensees would be exempt from providing these safety and security features.
Placement co-ordinators will suggest alternative services and make appropriate referrals on behalf of the applicant if the admission of the applicant to a long-term care home is delayed or not approved.

Step 12: Wait listing when a long-term care home approves an application

Most long-term care homes have waiting lists. Once a person’s admission has been approved by the long-term care home, he or she may go on a waiting list based on the prioritization criteria set out in the regulation. See Appendix 4A.

Step 13: Reassessments while on a wait list

Where a person remains on one or more waiting lists, the placement co-ordinator must ensure that the health and functional assessments of this person are updated within the three months prior to the date of authorizing the admission to the long-term care home. A reassessment may be also needed if the person has experienced a significant change in his/her condition or circumstances, and the placement co-ordinator must confirm whether the applicant is still eligible for admission.

Step 14: Authorization of admission

When a bed becomes available in one of the long-term care homes to which an individual has been placed on a waiting list, the placement co-ordinator will notify:
- The person, or substitute decision-maker if any, and if consent is provided,
- Developmental Services Ontario and the developmental services agency involved in the referral and/or support needs of the individual.
The person, or substitute decision-maker if any, will have 24 hours of being informed by the placement co-ordinator of the availability of accommodation in the home within which to accept or decline the placement offer.
Once an offer of placement has been accepted, the person has five days to move into the long-term care home, not counting the date of being notified of the availability in the home.
If an applicant is offered a place in a home that is not their first choice, they can:
- Accept the placement offer
- move in, but choose to stay on the waiting list for a transfer to their first choice of home
- reject the placement offer
If the applicant chooses to reject the placement offer, or fails to move into the home by their move-in date deadline, the applicant will be removed from every waiting list they are on. The person will be required to wait 12 weeks before they can reapply for long-term care, unless there is a significant change in their condition or circumstances.
The removal from a waiting list as stated above does not apply if the applicant occupies a bed in a hospital or psychiatric facility, or the applicant has a health condition, short-term illness or injury which prevents the applicant from moving into the home at that time, or would make moving into the home at that time detrimental to the applicant’s health.
A person can remain on the developmental services supportive living services wait list once residing in a long-term care home.
This may be particularly relevant for situations where a person’s care needs are likely to change so that long-term care home supports are no longer sufficient or required or the person can be more appropriately served in another setting.

Step 15: Formalizing the plan for developmental services and supports

The plan for the provision of developmental services in the long-term care home will become formalized through a written agreement between:
- the person, or substitute decision-maker if any,
- the supporting developmental services agency if any
- the long-term care home provider.
This written agreement will set out what supports will be provided, by whom, and the roles and responsibilities of each party in relation to the ongoing assessment/ evaluation of the support plan.
This plan should also include any services and supports purchased through direct funding.
Any developmental services and supports provided by a developmental services agency or purchased through direct funding (e.g. Passport) would need to be identified in the resident's plan of care and provided to the resident as required by the FLTCA.
- Long-term care home licensees must ensure that the care set out in the plan of care is based on an assessment of the resident and the needs and preferences of that resident. The licensee must also ensure that the plan of care covers all aspects of care, including:
  - Medical and nursing support
  - personal support
  - nutritional and dietary support
  - recreational, social, restorative, religious and spiritual care

Step 16: Follow-up and review of the support plan

If a developmental services agency is providing developmental services and supports after a person has moved into a long-term care home, the developmental services agency will conduct a 3 month post-placement follow-up in conjunction with the long-term care home and the individual (i.e. in conjunction with the individual and the long-term care home, as appropriate), as appropriate, to review the person’s status/progress and the support plan in relation to the person’s current situation and circumstances.

Conclusion

It is intended that these guidelines will improve knowledge, planning and co-ordination within both the developmental services and long-term care home sectors as well as result in better service delivery for individuals who have a developmental disability and who are either applying to or residing in a long-term care home.

Appendices

List of acronyms

DS Agency: Developmental Services agency funded by MCCSS
DSO: Developmental Services Ontario
HCARDD: Health Care Access Research and Developmental Disabilities
HCCA: Health Care Consent Act, 1996
HCCSS: Home and Community Care Support Services, formerly referred to as LHINs
LTC home: Long-term care home
FLTCA: Fixing Long-Term Care Act, 2021
MCCSS: Ministry of Children, Community and Social Services
MLTC: Ministry of Long-Term Care
OH: Ontario Health
OPADD: Ontario Partnership on Aging and Developmental Disabilities
OPGT: Office of the Public Guardian and Trustee
SDM: Substitute Decision-Maker
SIPDDA: Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008

Residents’ Bill Of Rights under the Fixing Long-Term Care Act, 2021

Every licensee of a long-term care home shall ensure that the following rights of residents are fully respected and promoted:

Right to be treated with respect

Every resident has the right to be treated with courtesy and respect and in a way that fully recognizes the resident’s inherent dignity, worth and individuality, regardless of their race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability.
Every resident has the right to have their lifestyle and choices respected.
Every resident has the right to have their participation in decision-making respected.

Right to freedom from abuse and neglect

Every resident has the right to freedom from abuse.
Every resident has the right to freedom from neglect by the licensee and staff.

Right to an optimal quality of life

Every resident has the right to communicate in confidence, receive visitors of their choice and consult in private with any person without interference.
Every resident has the right to form friendships and relationships and to participate in the life of the long-term care home.
Every resident has the right to share a room with another resident according to their mutual wishes, if appropriate accommodation is available.
Every resident has the right to meet privately with their spouse or another person in a room that assures privacy.
Every resident has the right to pursue social, cultural, religious, spiritual and other interests, to develop their potential and to be given reasonable assistance by the licensee to pursue these interests and to develop their potential.
Every resident has the right to live in a safe and clean environment.
Every resident has the right to be given access to protected outdoor areas in order to enjoy outdoor activity unless the physical setting makes this impossible.
Every resident has the right to keep and display personal possessions, pictures and furnishings in their room subject to safety requirements and the rights of other residents.
Every resident has the right to manage their own financial affairs unless the resident lacks the legal capacity to do so.
Every resident has the right to exercise the rights of a citizen.

Right to quality care and self-determination

Every resident has the right to proper accommodation, nutrition, care and services consistent with their needs.
Every resident has the right to be told both who is responsible for and who is providing the resident’s direct care.
Every resident has the right to be afforded privacy in treatment and in caring for their personal needs.
Every resident has the right to,
- participate fully in the development, implementation, review and revision of their plan of care,
- give or refuse consent to any treatment, care or services for which their consent is required by law and to be informed of the consequences of giving or refusing consent,
- participate fully in making any decision concerning any aspect of their care, including any decision concerning their admission, discharge or transfer to or from a long-term care home and to obtain an independent opinion with regard to any of those matters, and
- have their personal health information within the meaning of the Personal Health Information Protection Act, 2004 kept confidential in accordance with that Act, and to have access to their records of personal health information, including their plan of care, in accordance with that Act.
Every resident has a right to ongoing and safe support from their caregivers to support their physical, mental, social and emotional wellbeing and their quality of life and to assistance in contacting a caregiver or other person to support their needs.
Every resident has the right to have any friend, family member, caregiver or other person of importance to the resident attend any meeting with the licensee or the staff of the home.
Every resident has the right to designate a person to receive information concerning any transfer or any hospitalization of the resident and to have that person receive that information immediately.
Every resident has the right to receive care and assistance towards independence based on a restorative care philosophy to maximize independence to the greatest extent possible.
Every resident has the right not to be restrained, except in the limited circumstances provided for under this Act and subject to the requirements provided for under this Act.
Every resident has the right to be provided with care and services based on a palliative care philosophy.
Every resident who is dying or who is very ill has the right to have family and friends present 24 hours per day.

Right to be informed, participate, and make a complaint

Every resident has the right to be informed in writing of any law, rule or policy affecting services provided to the resident and of the procedures for initiating complaints.
Every resident has the right to participate in the Residents’ Council.
Every resident has the right to raise concerns or recommend changes in policies and services on behalf of themself or others to the following persons and organizations without interference and without fear of coercion, discrimination or reprisal, whether directed at the resident or anyone else:
- the Residents’ Council.
- the Family Council.
- the licensee, and, if the licensee is a corporation, the directors and officers of the corporation, and, in the case of a home approved under Part IX, a member of the committee of management for the home under section 135 or of the board of management for the home under section 128 or 132.
- staff members.
- government officials.
- any other person inside or outside the long-term care home.

Adult developmental services and supports pathway

A person starts with Developmental Services Ontario which will:
- Provide information
- Confirm eligibility
- Assess support needs
Urgent response related supports may be available to an individual.
Next is prioritization for available services and supports. There are:
1. Agency-based Services and Supports
  - Developmental Services Ontario matches applicant to available services and supports
  - Agency provides services and supports
2. Direct Funding
  - Passport agency administers available direct funding
  - Individual or family purchases supports
Community Networks of Specialized Care co-ordinate access to specialized services for individuals with concurrent mental health or behaviour issues.
Where eligible, an individual may access other services and supports available in the community such as:
- Ontario Disability Support Program (income and employment supports)
- Health care (including attendant care)
- Education
- Housing programs (e.g. affordable housing programs)
- Community programs (e.g. municipal recreation programs, etc.)
- Employment and training programs

Overview of long-term care home waiting list categories

A long-term care home applicant selects one or more long-term care homes and is prioritized for admission and placed on a maximum of five waiting lists (no maximum Category 1 (crisis)). There are the waiting list categories ranked in the order of highest prioritization to lowest:

Exchange
Re-admission
Category 1 “Crisis”
Category 2 “Spousal/Partner Reunification”
Category 2.1 “Former Specialized Unit and High Acuity Priority Access Bed Resident”
Religious, Ethnic or Linguistic Origin
- Category 3A
- Category 3B
Others
- Category 4A
- Category 4B

The waiting list categories related to prioritization and the requirements for ranking are set out in the Regulation under the FLTCA.

In general, individuals with highest care needs are given priority on the waiting list for regular long-stay beds. A person’s position on a waiting list may change as a result of changes to the individual or the addition of new individuals who qualify for a higher position on the waiting list.

Category 1 (Crisis)

In general, an applicant is placed in category 1 on the waiting list if he or she:

Requires an immediate admission due to a crisis arising from his or her condition or circumstances;
Is facing a permanent or temporary bed closure in a long-term care home or public or private hospital or psychiatric facility under the Mental Health Act within 12 weeks;
Is a person that occupies a bed in a public hospital and is designated as requiring alternate level of care (ALC patient); or
Was admitted from a public hospital to a long-term care home selected by the placement co-ordinator from September 21, 2022 onwards and seeks transfer to a home selected by the applicant
Ranking within this category is according to the urgency of the applicant's need for admission.

Category 2 (Spousal Or Partner Reunification)

Persons who meet the eligibility criteria for admission based on care needs and whose spouse/partner is a resident of the long-term care home.
Individuals prioritized in this category are ranked according to the date which their spouse/partner was admitted to the long-term care home so as to give priority within category to those who have been separated the longest.

Category 2.1 (Former Specialized Unit and High Acuity Priority Access Bed Residents)

Applicants who do not meet the requirements for placement in category 1 or 2 and are residents of specialized units or high acuity priority access beds (HPAB) who no longer require the specialized care and seek admission to another home other than the one they were in prior to being admitted to the specialized unit or HPAB.

Category 3A

Applicant (or spouse/partner) matches the religious/ethnic/linguistic origin the long-term care home is primarily engaged in serving, and
Requires/receives high service levels of home care,), seeks a transfer to 1st choice home, or is an interim bed resident awaiting a long-stay bed.

Category 3B

Applicant (or spouse/partner) matches the religious/ethnic/linguistic origin the long-term care home is primarily engaged in serving, and
Applicant does not meet 3A requirements (also includes “well” spouses/partners of existing residents)

Others

Applicants who do not meet the criteria in any of the other prioritization categories are prioritized in 4A/4B.

Category 4A

Applicant requires/receives high service levels of home care, seeks a transfer to 1st choice home, or is an interim bed resident awaiting a long-stay bed.

Category 4B

Applicant does not meet 4A requirements (also includes “well” spouses/partners of existing residents)

Modified Placement Process for ALC Patients in a Public Hospital

ALC patients with developmental disabilities who may already be on a waitlist or should be on a waitlist for community-based services would likely not be eligible for long-term care placement. The applicable Developmental Services Ontario office should be consulted to confirm if a request for community-based services has been made, to understand the status of any developmental services assessments and/or the need to conduct a reassessment, if required. If the ALC patient has or may have a developmental disability but has not yet been connected to appropriate supports by the hospital discharge team, placement co-ordinators should raise this as a consideration for discharge and can connect directly with Developmental Services Ontario if necessary.

The long-term care admissions process for ALC patients will continue to be grounded in an ongoing dialogue with ALC patients, their families, and caregiver(s) about a safe transition to long-term care, striving to understand preferences and promote as much choice as possible throughout the entire process. Placement co-ordinators must continue to strive to engage the ALC patient to participate in the process and obtain consent whenever possible. Where an ALC patient requiring long-term care declines to participate in the admission process, the FLTCA and Regulation 246/22 allow for the process and conversation to continue.

Legislative and regulatory changes have been made to enable the collection, use and disclosure of personal health information by and to placement co-ordinators for the purposes of determining long-term care eligibility of ALC patients and determining admission of an ALC patient to a long-term care home in circumstances where consent may not be provided. Details of the changes can be found in para. 5 of s.60.1(3) of the FLTCA and ss.240.1(9) and (10) of the Regulation.

If the ALC patient does not consent to a health or functional assessment as defined under the FLTCA s.50(4), placement co-ordinators are able to assess eligibility through review of available hospital records and health records from the patient’s primary care provider, home and community care provider, an application entity or a service agency defined under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA).

There is no additional or enhanced prioritization for MCCSS funded services and supports under SIPDDA for ALC designated patients in hospital. Situations involving an ALC designated patient in hospital for whom an application for determination of eligibility is being completed would not be deemed an urgent response situation. Existing MCCSS requirements and processes relating to urgent response remain unchanged.

Ontario Health - Home and Community Care Support Services (HCCSS) Contacts

Central
11 Allstate Parkway, Suite 500
Markham, ON L3R 9T8
Toll-free: 1-888-470-2222
Fax: 416-222-6517

Central East
920 Champlain Court
Whitby, ON L1N 6K9
Toll-free: 1-800-263-3877
Fax: 1-855-352-2555

Central West
199 County Court Boulevard
Brampton, ON L6W 4P3
Toll-free: 1-888-733-1177
Fax: 1-866-465-9662

Champlain
4200 Labelle Street, Suite 100
Ottawa, ON K1J 1J8
Toll-free: 1-800-538-0520
Fax: 613-745-6984

Erie St. Clair
180 Riverview Drive
Chatham, ON N7M 5Z8
Toll-free: 1-888-447-4468
Fax: 519-351-5842

Hamilton Niagara Haldimand Brant
211 Pritchard Road, Unit 1
Hamilton ON L8J 0G5
Toll-free: 1-800-810-0000
Fax: 1-866-655-6402

Mississauga Halton
2655 North Sheridan Way, Suite 140
Mississauga, ON L5K 2P8
Toll-free: 1-877-336-9090
Fax: 905-855-8989

North Simcoe Muskoka
15 Sperling Drive, Suite 100
Barrie, ON L4M 6K9
Toll-free: 1-888-721-2222
Fax: 705-792-6270

North East
Rainbow Centre
40 Elm Street, Suite 41-C
Sudbury, ON P3C 1S8
Toll-free: 1-800-461-2919
Fax: 1-855-893-0803

North West
961 Alloy Drive
Thunder Bay, ON P7B 5Z8
Toll-free: 1-800-626-5406
Fax: 807-684-9533

South East
470 Dundas Street East
Belleville, ON K8N 1G1
Toll-free: 1-800-668-0901
Fax: 1-866-839-7266

South West
356 Oxford Street West
London, ON N6H 1T3
Toll-free: 1-800-811-5146
Fax: 519-472-4045

Toronto Central
250 Dundas Street West, Suite 305
Toronto, ON M5T 2Z5
Toll-free: 1-866-243-0061
Fax: 416-506-0374

Waterloo Wellington
141 Weber Street South,
Waterloo ON, N2J 2A9
Toll-free: 1-888-883-3313
Fax: 519-883-5555

Developmental Services Ontario Contact Information

There are nine Developmental Services Ontario agencies across the province. Please contact your local Developmental Services Ontario office if you want information about, or to apply to receive, developmental services and supports. To find the right agency for your region and for your postal code, please visit the website: https://www.dsontario.ca/find-your-dso.

Central East Region Serves the following areas:

York
Durham
Simcoe
Peterborough
Northumberland
Haliburton
Kawartha Lakes

Phone: 905-953-0796 or Toll-free: 1-855-277-2121
Fax: 905-952-2077
Address: 240 Edward Street, Unit 3, Aurora, ON L4G 3S9
Hours: Monday – Friday 8:30 a.m. – 4:30 p.m.

Developmental Services Ontario Central West Region Serves the following areas:

Peel
Dufferin
Halton
Waterloo
Wellington

Toll-free: 1-888-941-1121
Fax: 905-272-0702(Dufferin/Peel)
Fax: 519-894-9563 (Waterloo/Wellington)
Fax: 905-876-2740 (Halton)

Address:

Dufferin/Peel -
5975 Whittle Road, Suite 250, Mississauga, ON L4Z 3N1

Waterloo/Wellington
2749 Kingsway Drive, Kitchener, ON N2C 1A7

Halton
917D Nipissing Road, Milton, ON L9T 5E3
Hours: Monday - Friday 9:00 a.m. - 4:30 p.m.

Developmental Services Ontario Eastern Region Serves the following areas:

Stormont, Dundas and Glengarry
Prescott-Russell
Ottawa Region
Renfrew

Phone: 1-855-DSO-ERDS (376-3737) (Toll-free: 1-855-376-3737)
Fax: 1-855-858-3737
Toll-free TTY: 1-855-777-5787

Address:

Ottawa (Main Office)
200 - 150 Montreal Road, Ottawa ON K1L 8H2

Stormont, Dundas & Glengarry (SD&G)
280 Ninth Street West, Cornwall, ON K6J 3A6

Prescott - Russell
657 rue Principale, P.O. Box 849, Casselman, ON K0A 1M0

Renfrew County
77 Mary Street, Pembroke, ON K8A 5V4
Hours: Monday - Friday 8:30 a.m. - 4:30 p.m.

Developmental Services Ontario Hamilton-Niagara Region Serves the following areas:

Brant
Brantford
Haldimand
Hamilton
Niagara
Norfolk

Phone: 1-877-DSO-HNR4 (376-4674) (Toll-free: 1-877-376-4674)
Address: 140 King Street East, Suite 4 Hamilton, ON L8N 1B2
Hours: Monday – Friday 8:30 a.m. – 4:30 p.m.

Developmental Services Ontario North East Region Serves the following areas:

Nippising
Cochrane
Timiskaming
Parry Sound
Muskoka
James Bay Coast

Toll-free: 1-855-376-6376
Toll-free TTY: 1-800-855-0511
Fax: 705-495-1373

Addresses:

North Bay
391 Oak Street East North Bay, ON P1B 1A3

Bracebridge
23 Ball’s Drive Bracebridge, ON P1L 1T1

Timmins
60 Wilson Avenue, Suite 103, Timmins, ON P4N 2S7

Hours:
Monday – Friday
8:30 a.m. – 4:30 p.m. (September to June)
8:30 a.m. – 4:00 p.m. (July and August)

Developmental Services Ontario Northern Region Serves the following areas:

Kenora
Rainy River
Thunder Bay
Sault Ste. Marie
Dryden
Algoma
Sudbury
Sudbury District
Manitoulin

Phone: 1-855-DSO-NORD (376-6673) (Toll-free: 1-855-376-6673)
Toll-free TTY: 1-866-752-5427
Fax: 1-807-346-8713

Addresses:

Thunder Bay
245-B Bay Street Thunder Bay, ON P7B 6P2

Sudbury
760 Notre Dame Avenue, Unit A, Sudbury ON P3A 2T4

Sault Ste. Marie
262 Queen Street East Unit 203, Sault Ste. Marie, ON P6A 1Y7

Dryden
100 Casimir Avenue Unit 218, Dryden, ON P8N 3L4

Hours:
Monday - Friday
8:30 a.m. to 4:30 p.m. (Thunder Bay)

Tuesdays
8:30 a.m. to 12:00 a.m. (Dryden)

Thursdays
12:30 p.m. to 4:30 p.m. (Sault Ste. Marie)

Developmental Services Ontario South East Region Serves the following counties:

Hastings
Prince Edward
Frontenac
Lennox and Addington
Lanark
Leeds and Grenville

Toll-free: 1-855-237-6737or Tel: 613-544-8939

Address:

Extend a Family Kingston, 361 Montreal Street, Kingston, ON K7K 3H4
Hours: Monday - Friday 8:30 a.m. - 4:00 p.m.

Developmental Services Ontario South West Region Serves the following areas:

Bruce
Chatham-Kent
Elgin
Essex
Grey
Huron
Lambton
London-Middlesex
Middlesex
Oxford
Perth
Sarnia-Lambton
Windsor-Essex

Toll-free: 1-855-437-6797
Fax: 519-673-1509

Address: 171 Queens Ave, Suite 750 London, ON N6A 5J7
Hours: Monday - Friday 8:30 a.m. - 4:30 p.m.

Developmental Services Ontario Toronto Region Serves the following areas:

Toronto
Etobicoke
North York
Scarborough

Phone: 1-855-DSA-DULT (372-3858) (Toll-free: 1-855-372-3858)
Fax: 416-925-5645
Tel TTY: 416-925-0295
Address: Surrey Place Centre, 2 Surrey Place, Toronto, ON M5S 2C2

Updated: November 23, 2022

Published: November 22, 2022