Finding
a Long Term Care (LTC) Home
Seeking admission to a long term care (nursing) home for yourself or a loved one in
Ontario, Canada is a process regulated by the Province of Ontario Ministry of Health and Long Term Care. The process is administered by the local CCAC (Community Care Access Centre) in the area where the person seeking admission
resides.
If you are not already familiar with the process read the web page Find a long-term care home, Information about, and how to find and apply to a long-term care home
The above link will tell you how to do the next step: contact the CCAC (Community Care Access Centre) in the area where the person seeking admission resides. A care coordinator will help you determine
eligibility and whether an LTC home is the right decision. If it is, they will
then tell you to choose up to five homes. That is when your work really begins.
Assuming
all the above is now behind you, the rest of this article provides pointers for
some things to look at when making comparisons between homes.
Points
to compare between LTC homes
You can find a list of LTC homes in say, the Newmarket area, at the Ministry of Health and Long Term Care web page: Reports on Long-Term Care Homes.
Go to the web page and click on the link, 'Find by location'.
This takes you to the page Search for LTC Homes By Location
Go to the web page and click on the link, 'Find by location'.
This takes you to the page Search for LTC Homes By Location
Enter
whatever town is of interest to you into City/Town and click next.
This
takes you to the page Long-Term Care Homes
Search Results. If you entered 'Newmarket' you would see a list of 4
homes to choose from and compare, each with a link that takes you to that
home's report page with two tabs, one for the home profile, the other for the
home's inspection reports in descending chronological order. You may want more
of a choice. In that case, instead of specifying the town, enter the
county/district.
Inspection Reports
The
inspection reports should be of particular interest to you.
1 Resident
Quality Inspection reports are reports from annual inspections by the
Ministry of Health and Long Term Care, and are the most thorough. Inspection
findings are presented as Written Notifications (WN). A WN may conclude with
a Voluntary Plan of Correction (VPC) or, more seriously, a Compliance Order, Director Referral or Work and Activity Order:
DR –
Director Referral
CO –
Compliance Order
WAO –
Work and Activity Order
Not all
WN's are equal. Use common sense to distinguish something like stained
upholstery or missing ceiling tiles or wrong menu courses from noncompliance that poses risk of harm to
residents as with improper control of drugs and medication and broken wheel
chairs or doors not locking with the correct protocols allowing dementia
residents to wander.
2 Critical
Incident Inspection reports are typically as a result of a resident
experiencing some harm. When this happens, the home administrator is required
by law to report the incident within a fixed period of time. The Ministry will
look at the report and decide whether or not to follow up with an inspection to
more fully investigate what happened and whether the home is following all
required procedures.
3 Complaints
inspection reports are as a result of Ministry follow up on an official
complaint lodged by a resident or family member. Complaints are often made in
confidence. There is a strict code against retaliation and abuse.
 |
| Sample list of inspection reports |
In my casual observations I have found there is
generally, on average, an inverse proportion between the number of critical
incident and complaint reports and the length of the wait period for admission. It would appear that the most desirable and well-run homes typically have the longest queues for
admission.
Health Quality Ontario Reports
In
addition to the inspection reports which are focused purely on compliance with
the Long Term Care Homes Act and associated regulations, there are some other
important indicators that you will want to look at that focus more on quality of life. Health Quality Ontario (HQO) currently reports publicly on four quality indicators for individual long-term
care homes. These indicators relate to four health topics:
- falls
- incontinence
- pressure ulcers
- the use of restraints
Once you
know the name of the home for which you want to see this report, go to the HQO web page for
individual homes
Click 'By Home' and then enter the first few words of
the home name to get a list to choose from. Choose the desired home and click 'Search'.
You will
see a table that shows how the home compares with the provincial average on
each quality of life indicator. You can also see whether the home is improving
over the previous year's performance and how it compares with the optimal
benchmark.
 |
| Example of Health Quality Indicators |
So now,
you have looked at inspection reports and quality indicators for some homes and
discovered that comparing homes in this way is not a trivial undertaking. Once you find a 'maybe' home, phone the home
and arrange a tour. Web sites for most CCAC's offer a list of questions to enquire
on. You can find a very comprehensive tour checklist here: www.nursinghomeratings.ca/downloads/NursingHomeTourChecklist.pdf
or here:
Most
people who do the tour do not ask questions. Don't be timid or afraid. You
don't have to ask every question on the check-list, but know beforehand which
are the important questions for you. If you do not feel comfortable asking in
front of other people, confirm that you can phone later and ask your questions.
There is
a lot of information here. I sincerely hope this is not too confusing. Just
take your time to work through the steps.
Registration and Accreditation
All LTC homes in Ontario have to be registered with the Ministry of Health and Long Term Care and are subject to inspections by the Ministry. In addition, some homes seek accreditation from bodies such as CARF and Accreditation Canada. These are standards bodies that assert with accreditation that a long term care home has certain procedures and protocols in place and abides by them. These operational procedures and protocols are in addition to those required for registration by the Ministry of Health and Long Term Care. The Ministry does not require accreditation but encourages LTC homes to acquire accreditation by granting certain funding premiums to accredited homes. Intuitively one would think that this should be a good thing. However, when it comes to complaints and critical incidents there are both accredited and non-accredited homes with a high rate of these inspections just as there are both accredited and non-accredited homes with a low rate. I recommend placing a higher reliance on your own due diligence in reviewing inspection reports rather than merely presuming that an accredited home will automatically have a better record in this regard than a non-accredited home.
I base the above advice on a statistical analysis that I did comparing accredited and non-accredited homes. You can review the two-part analysis in the following videos.
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