The role of long-term care

Ontario’s long-term care homes provide care and support to more than 115,000 people and their families every year. Long-term care homes provide 24/7 nursing care and supervision, primary medical care, help with daily activities and interests, and a safe, caring home environment. The vast majority of people who live in long-term care have some form of cognitive impairment and physical frailty, along with chronic health conditions that have seriously compromised their health.  

An invaluable part of the health care system
As part of the health care system, long-term care homes are licensed and funded by the Ministry of Health and Long-Term Care to provide care for people who need a level of support beyond what is possible at home. Residents also pay a fee for their accommodation. Although most of us hope to age at home indefinitely, it simply isn’t possible for everyone, particularly for people with Alzheimer’s disease and other forms of dementia. An estimated 70% of people with dementia will eventually need long-term care.
 
 
Our seniors need long-term care homes that are ready and capable of meeting their ever-increasing, complex health care needs and able to provide safe quality care when they expect and require it most. Visit us at thisislongtermcare.ca   to learn more about how the government and homes can work together to build the capacity for care. And below, you can find some quick facts about residents, long-term care homes, costs and eligibility. 

How long-term care works

 

In Ontario, long-term care homes are regulated and funded by the provincial government. Government agencies determine who is eligible to be admitted to long-term care, and manage the wait lists. Each home is granted a license to operate by the provincial government. Homes are required to follow the requirements of the Long-Term Care Homes Act, one of the most stringent pieces of nursing home legislation in the world. 

The provincial government provides funding for all the staff and supplies related to nursing and personal care, resident social and recreational programs and support services, and raw food (used to make meals). In addition, long-term care homes receive other government funding for specific needs, such as falls prevention equipment. Residents pay an accommodation fee to the long-term care home that is used to pay for expenses such as non-care staff, utilities, and mortgages, as well as building maintenance and major capital repairs (like a new roof). The government sets the rate for resident fees and provides subsidies for residents as needed. 



Long-term care homes account for every dollar 
As part of their agreement with the government, all funding provided to homes by the province must be rigorously accounted for, and can only be used for its specified purpose. Any unspent funds related to care are returned to the government. 

Funding from residents’ fees is also accounted for, and the home uses these funds to pay for accommodation operating expenses, building & equipment repairs & maintenance, property taxes, insurance, and financing costs.

Every long-term care home produces an audited annual report documenting the home’s spending, which is then reviewed and audited again by the government. The final report is presented to each home’s Residents’ Council and Family Council and posted publicly in the home.
Caring for people with dementia

In the past decade, the resident population in long-term care homes has become much more clinically complex and fragile. The prevalence of cognitive impairment and dementia has increased.  At the same time, there has been an important societal shift over the last decade which has  changed the way we think about dementia and dementia care, and what we expect from long-term care homes. 

Ontario’s long-term care homes have embraced this shift and are moving away from a medical model of care with fixed activities and schedules to a more flexible and personalized approach to care. 

This way of providing care focuses on developing a sensitive understanding of each individual, their likes and dislikes, and what gives their lives meaning — even in the face of advanced dementia.  



Understanding dementia 

One of the tragedies of dementia is that it gradually destroys social skills and the ability to manage emotions. Many people with dementia can become easily irritated, suspicious, frightened, and upset. They may react reflexively by pushing or hitting, or by using angry and accusatory responses. Even something as simple as having hair combed can be confusing or frightening, triggering a negative reaction. 

In addition, the majority of people with dementia will experience one or more behavioural symptoms related to the disease, which include activities such as pacing, wandering, hoarding, disrobing, and repetitive motions or speech. These symptoms — which often change through the course of someone’s disease — can be very distressing to the person experiencing them, as well as to those around them. 

One of the important functions of long-term care homes is to help reduce or better manage dementia-related symptoms. The solution may be to learn to approach a resident differently, to change the environment, or to divert them to pleasurable memories or activities. 

Working with the behavioural symptoms of dementia is an enormous but often unrecognized part of the work of long-term care staff. It is rewarding and meaningful work that has led to some outstanding successes, both in the care of individual residents and in reducing the severity of dementia-related behaviours across the province. 

Scroll down to learn more about long-term care residents and homes, or jump to a section below:
Ontario's long-term care residents (2019)
Ontario's long-term care homes (February 2019)
Long-term care home provincial and LHIN dashboards (February 2019)
Moving to long-term care
Residents pay a portion of long-term care

You can also read our latest sector report, This is Long-Term Care 2019 or download this "OLTCA & LTC 101" presentation for a more thorough overview of long-term care and the Association. 

Ontario's long-term care residents (2019)

  • 90% have some form of cognitive impairment
  • 86% of residents need extensive help with daily activities such as getting out of bed, eating, or toileting
  • 80% have neurological diseases
  • 76% have heart/circulation diseases
  • 64% have a diagnosis of dementia
  • 62% have musculoskeletal diseases such as arthritis and osteoporosis
  • 61% take 10 or more prescription medications
  • 40% need monitoring for an acute medical condition
  • 21% have experiences a stroke

Source: Excerpted from This is Long-Term Care 2019 by the Ontario Long Term Care Association. Data references are available in the report.

Ontario's long-term care homes (February 2019)

  • 626 homes are homes licensed and approved to operate in Ontario
  • 58% of homes are privately owned, 24% are non-profit/charitable, 16% are municipal
  • About 40% of long-term care homes are small, with 96 or fewer beds
  • Of these small homes, about 45% are located in rural communities that often have limited home care or retirement home option
  • 77,257 long-stay beds are allocated to provide care, accommodation and services to frail seniors who require permanent placement
  • 669 convalescent care beds are allocated to provide short-term care as a bridge between hospitalization and a patient's home
  • 321 beds are allocated to provide respite to families who need a break from caring 24/7 for their loved one
  • Approximately 300 of the province's long-term care homes are older and need to be redeveloped (more than 30,000 beds)
  • The average time to placement in long-term care, as of February 2019, is 161 days 
  • The wait list for long-stay beds, as of February 2019, is 34,834
Sources: Long-Term Care Utilization Report, February 2019, Ontario Ministry of Health and Long-Term Care; Ontario Long Term Care Association, internal database, 2019.

Long-term care home provincial and LHIN dashboards (February 2019)

The Association has developed a series of dashboards with data related to resident demographics, quality indicators, waitlist, wait times and more, within each Local Health Integration Network (LHIN). We have also developed an overall dashboard for all of Ontario, using province-wide data. These dashboards are meant to help you gain a better understanding of what long-term care looks like in your own community and how regional homes are faring when it comes to factors such as wait lists and quality improvement. Please note that this information is gathered from various data sources that are collected throughout the year and, as such, some numbers may not be available on some reports; the information on the dashboard is the most recent available as per date of publication.

Click below to view the Ontario-wide or a LHIN-specific dashboard:

Moving to long-term care

In Ontario, Community Care Access Centres (CCACs) are the gatekeepers of long-term care. A family doctor, family member, or home care worker may tell the CCAC that it is no longer possible to keep the person in his or her home, but the CCAC conducts the assessment and makes the decision. 

In order to be placed in a long-term care home an individual must meet certain eligibility criteria as defined by regulation and assessed by your local CCAC:
  • Be 18 years-of-age or older
  • Have a valid Ontario Health Card
  • Have health care needs that cannot be met with any combination of care giving, care in your home or care in your community
  • Have health care needs that can be met in a long-term care home

CCACs assess all applicants for long-term care homes to determine eligibility for admission and will assist in selecting a long-term care home of choice. For more information on assessment and eligibility, the application process and the services provided in long-term care, click here.

Residents pay a portion of long-term care

Long-term care is part of the province’s health care system and publicly funded on a cost-shared basis with residents. The government does not pay the full cost of long-term care and expects residents to pay a portion of their “room and board” to the long-term care home. This “room and board” payment is what long-term care homes use to make a return on their investment. Funding allocated by the Ministry of Health and Long-Term Care for nursing and personal care, programs, support services, or raw food (used to make meals) is separate and must be reconciled at the end of the year. Unspent funds are returned to the government.

Provincial funding for long-term care in 2018:
  • $4.28 billion (7% of the overall provincial health budget)
  • $149.95 per resident, per day ($54,730 per year)
  • Approximately $100.91 per day for nursing and personal care (such as assistance with personal hygiene, bathing, eating, and toileting)
  • $12.06 per day for specialized therapies, recreational programs, and support services
  • $9.54 per day for raw food (ingredients used to prepare meals)

Source: 2018 Ontario Budget, LTCH Level-of-Care Per Diem Funding Summary (July 1, 2018) 

The government sets the amount that residents must pay the home, with an opportunity to qualify for a subsidy if a resident's basic accommodations are not affordable. Residents also pay out of pocket for any medications or other services not covered by their private insurance plans or the provincial drug benefit program.

As of July 1, 2019, the maximum accommodation rates will be as follows:

Type of Accommodation  Daily Co-Payment
 Basic Long Stay  $62.18
 Semi-Private Long Stay*  $70.70-$74.96
 Private Long Stay*  $81.35-$88.82
 Short Stay (Respite)  $40.35

*Varies depending a home’s structural class and date of move-in.

Source: Ministry of Health and Long-Term Care