Overview

Short-Stay Program (SSP) beds provide flexibility to the long-term care home sector to meet the needs of diverse resident populations. Short-Stay Program beds are intended to:

  • allow clients to convalesce and return to the community
  • provide relief to caregivers
  • alleviate hospital Alternate Level of Care (ALC) pressures

The “Policy for the operation of short-stay beds” (the “policy”) sets out updated requirements for licensed or approved long-term care home beds that are operated as SSP beds under the Fixing Long-Term Care Act, 2021, Ontario Regulation 246/22, and the Service Accountability Agreement (L-SAA) between Ontario Health and long-term care home licensees.

A “short-stay program” is defined under section 1 of O. Reg. 246/22 as a program in which a person is admitted to a long-term care home for a definite number of days. There are three short-stay programs under O. Reg. 246/22:

  • Convalescent Care Program (CCP)
  • Interim Bed Program (IBP)
  • Respite Care Program (RP)

The policy sets out requirements for the operation of SSP beds that align with applicable requirements set out in the Fixing Long-Term Care Act, 2021, O. Reg. 246/22 and the L-SAA.

This policy does not set out:

  • every statutory and regulatory requirement specifically applicable to residents nor the operation of long-term care home beds, whether short-stay or long-stay
  • how short-stay beds are designated or authorized
  • funding and financial management policies for SSP beds

Definitions

As set out in section 2 of the Fixing Long-Term Care Act, 2021, “licensee” means the holder of a licence issued under the Fixing Long-Term Care Act, 2021 and includes the municipality or municipalities or board of management that maintain a municipal home, joint home or First Nations home approved under Part IX of the Fixing Long-Term Care Act, 2021.

Licensees who operate SSP beds must be knowledgeable of and comply with all requirements of the Policy, the Fixing Long-Term Care Act, 2021, O. Reg. 246/22, L-SAA and all other relevant Ministry of Long-Term Care policies and legislation.

“Requirements under the Act” has the same meaning as “requirement under this Act” as set out in section 2 of the Fixing Long-Term Care Act, 2021.

Policy requirements of short-stay programs

Policy requirements relevant or common to more than one SSP are set out below in the policy under “Common Requirements of SSPs”, followed by three sections on CCP, IBP and RP bed specific requirements.

Common requirements of short-stay programs

Financial rules and requirements for funding short-stay programs

The applicable long-term care home funding and financial management policies for specific funding and financial management rules pertaining to SSP beds are listed in “Schedule F” to the L-SAA.

Care plans

The licensee shall ensure that the following are used to develop the 24-hour admission care plan, required under section 27 of O. Reg. 246/22, for every resident in a CCP, IBP or IBP bed:

  • the Resident Assessment Instrument-Home Care (RAI-HC) assessment completed by the placement co-ordinator under the Fixing Long-Term Care Act, 2021, as part of the admission process
  • other assessments and relevant information provided by the placement co-ordinator
  • relevant hospital reports
  • assessments undertaken by the licensee’s staff

The Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) shall be used to assess the care needs of residents occupying CCP and IBP beds as well as to support the development and revision of the 24-hour admission care plan, initial plan and plan of care, as required under the Act and O. Reg. 246/22.  The RAI-MDS 2.0 must also be used to assess the care needs of residents occupying RP beds whose stay exceeds 14 days and support the revision of the 24-hour admission care plan, as required, for those residents.

Requirements for the use of RAI-MDS 2.0 are set out in the “RAI-MDS 2.0 long-term care Homes - Practice Requirements”, as amended from time to time, and which is listed in “Schedule F” to the L-SAA.

Waiting lists

Nothing in O. Reg. 246/22 precludes a person who is on a waiting list for a CCP or RP bed from also being placed on a waiting list for a long-stay bed, if the placement co-ordinator determines that the person meets the eligibility criteria under the Fixing Long-Term Care Act, 2021 and O. Reg. 246/22 for long-stay admission.

Performance and accountability

The licensee shall operate SSP beds under the applicable performance and accountability requirements or risk termination of the authorization or designation of the SSP beds. Specifically, the licensee must:

  • comply with requirements under the Policy, the Fixing Long-Term Care Act, 2021, O. Reg. 246/22, L-SAA and all other relevant Ministry of Long-Term Care policies and legislation
  • have a satisfactory history of compliance with statutory and regulatory requirements (satisfactory history of compliance means that inspections must show either “no” findings of non-compliance or findings of non-compliance only in areas of low or no risk of harm to residents)
  • collect and report data on SSP residents and provide documentation of all services delivered in accordance with the “RAI-MDS 2.0 long-term care Homes - Practice Requirements”, as amended from time to time, and which is listed in “Schedule F” to the L-SAA

Convalescent care program requirements

Program description and rationale

The CCP is a short-stay program for persons who need time to recover strength, endurance or functioning and are likely to benefit from a short stay in a long-term care home. It is anticipated that these individuals will return to their residence within 90 days after admission to the CCP per subsection 173(2) of the O. Reg. 246/22.

No placement co-ordinator will authorize the admission of an applicant to a long-term care home as a short-stay resident in a CCP for a stay which, when added to the applicant’s other CCP stays during the calendar year, exceeds 90 days, per section 206 of the O. Reg. 246/22.

Licensees receive additional funding to provide the supplementary services, supplies and equipment that are required by CCP bed residents.

The rationale for the program is to:

  • expand the range of options for persons who do not need acute care but cannot yet manage at home
  • improve the flow of persons throughout the health care system to help:
    • reduce unnecessary and avoidable emergency room (ER) visits and wait-times
    • reduce the length of hospital stays for individuals who can be cared for in an alternate setting equipped to provide the right level of quality care
    • reduce unnecessary and avoidable long-stay admissions to long-term care
  • provide more cost-effective choices for hospital patients and individuals in the community who require a period of convalescent care in a residential setting

Program and services

Convalescent Care Program residents generally have higher acuity levels than long-stay long-term care home residents and require a different type and level of care. The licensee of CCP beds is required to provide the staff mix, staffing levels and the rehabilitative focused programs and services needed to address the assessed care needs and acuity levels of CCP residents served by the long-term care home.

In addition to the relevant accommodation, care, services, programs and goods required for all long-term care home beds and residents, the licensee is also required to provide the following to CCP residents based on their assessed care needs:

  • A “core interdisciplinary team” which means a core team of qualified practitioners including medicine, nursing, physiotherapy, recreation therapy, occupational therapy, dietetics, social work, and personal support.
  • Care coordination, interdisciplinary team planning and discharge planning.
  • Specialized and therapeutic equipment and supplies.
  • Diagnostic laboratory services.
  • Wellness and self-care services that strengthen Activities of Daily Living (ADL) and Instrumental ADLs with practice opportunities to support returning residents to the community.

Review care plans

The licensee shall ensure that a case conference is held by the Core Interdisciplinary Team at least weekly to review and revise, as required, each CCP resident’s 24-hour admission care plan, initial plan of care or plan of care (as the case may be).

Admission process

Approval by licensee of a resident admission

The licensee shall ensure that it is available to approve and admit CCP applicants every day of the week, including Saturdays, Sundays, and holidays for no less than eight continuous hours between the hours of 8 a.m. to 6 p.m.

Admission

The licensee and the hospital (if applicable), with the placement co-ordinator’s assistance, is required to coordinate the transfer of the CCP applicant to the long-term care home on the day the applicant agrees to move into the home.

Structural specifications

The licensee shall ensure that every CCP resident resides in a room that meets the following minimum structural specifications:

  • One or two beds.
  • A bathroom shared with no more than one other person.
  • A wheelchair accessible bathroom that can accommodate a resident in a wheelchair and a staff person at the same time. 

Discharge

The licensee shall upon discharge of every CCP resident:

  • Complete an interdisciplinary Discharge Summary within 7 days of the resident’s discharge from a CCP bed.
  • Forward a copy of the Discharge Summary to the resident’s family physician or to the placement co-ordinator, as applicable, to facilitate the provision of health care to the individual following discharge.

Note: “Discharge Summary” means a report that provides relevant information on the resident’s plan of care, including the care provided to the resident, progress in achieving the resident’s goals and objectives, the health status of the resident, and any recommendations on follow-up and/or services required at discharge. The report is intended to strengthen continuity of care and support the resident’s continued progress.

Interim bed program requirements

Program description and rationale

The IBP is only for individuals who (among other requirements) occupy a bed in a public hospital, require an alternate level of care and are on a waiting list for a long-stay bed in a long-term care home per section 210 of O. Reg. 246/22.

Residents in IBP beds are considered to be long-stay residents for the purposes of most provisions set out in O. Reg. 246/22, except as otherwise provided for.

The intent of the IBP is to:

  • provide a mechanism to assist in addressing ER wait-times and ALC pressures
  • facilitate earlier and faster discharge of hospital patients seeking admission to a long-term care home
  • provide a safe and suitable care setting for long-term care home applicants to live as a temporary measure while they wait for a long-stay bed
  • ensure a continuous “flow through” so that interim beds are constantly freed-up for new applicants from hospitals

Respite care program requirements

Program description and rationale

A placement co-ordinator shall determine a person to be eligible for long-term care home admission as a short-stay resident in the respite care program per subsection 173(1) of O. Reg. 246/22 only if:

  • the person:
    • has a caregiver who requires temporary relief from caregiving duties
    • requires temporary care in order to continue to reside in the community and is likely to benefit from a short stay in the home
  • it is anticipated that the person will be returning to their residence within 60 days after admission to the long-term care home
  • the person is otherwise eligible as a long-stay resident

Individuals who require admission to an RP bed can be new or existing home and community service clients. The maximum RP stay that can be authorized by the placement co-ordinator for an eligible person is up to 60 continuous days at one time, with a total maximum of 90 days over the calendar year per section 206 of O. Reg. 246/22. An RP bed may be reserved, through the placement co-ordinator, up to one year prior to the start of the stay, as specified in section 205 of O. Reg. 246/22.

The rationale for the program is to:

  • provide temporary support for caregivers who require relief from their caregiving obligations
  • support and maintain informal caregiving in the community
  • provide a cost-effective care option for persons who do not need a long-stay admission to long-term care, but require temporary support so that they are able to return to their home in the community