Long-term care services and the application process

What services do long-term care homes provide?

Long-term care homes are home-based health care facilities designed for adults who need access to on-site 24-hour nursing care, frequent assistance with activities of daily living (i.e. eating, bathing, toileting, etc.) and monitoring for safety or well being. They are also known as nursing homes, charitable homes, or municipal homes for the aged. 

All long-term care homes are licensed or approved and funded by the Ministry of Health and Long-Term Care and governed by the Long-Term Care Homes Act, 2007 (LTCHA). Long-term care homes are run by privately owned and publicly owned companies, non-profit/charitable organizations, and municipalities. These organizations own the buildings and are granted term licenses and funding by the government to operate long-term care homes. From the government’s perspective, long-term care provides more support and services than can be provided through home care, and less expensively than in hospital. Ministry of Health and Long-Term Care inspectors ensure compliance through unannounced inspections and legislated authority.

All long-term care homes provide nursing and personal support services, restorative and life enrichment programs, dietary and nutritional care and access to medical, pharmacy, diagnostic and therapy services. Today, with a significantly more frail and ill population, most homes are evolving into complex, clinically oriented facilities that care for people at the end of their lives. 

Many leaders in seniors’ care believe there is a growing role for long-term care homes in the broader health care system and as part of the overall care of seniors. Some homes are providing short-term convalescent care to bridge the recovery period between hospitalization and home, and other homes offer respite care, which eases the burden on family caregivers

Long-term care eligibility

The Method for Assigning Priority Levels (MAPLe) is a tool used by health care professionals to prioritize clients’ needs and to appropriately allocate home care resources and placement in long-term care facilities. Since 2010, only people with “high” or “very high” scores are eligible for long-term care in Ontario.

Low clients are generally independent, without physical disabilities, and with only minor cognitive loss. There are no problems with behaviour, the home environment, medication, or skin ulcers. Some limited home care support may be needed because of early losses of function in limited areas.

Mild clients need only a light level of care due to some problems with instrumental activities of daily living (e.g., housework, transportation) or loss of physical stamina.

Moderate clients are beginning to show impairments in individual functioning that may be a threat to their independence, such as problems in the home environment, difficulty managing medications, or physical disability combined with mild cognitive impairment.

High clients are experiencing more complex problems, including challenging behaviour or physical disability combined with cognitive impairment. These people have elevated risks of nursing home placement and caregiver distress.

Very high clients have impairments in multiple areas of function that have a pronounced impact on their ability to remain independent in the community. These include factors such as physical disability, cognitive impairment, falls, challenging behaviour, and wandering. Rates of nursing home placement and caregiver distress are highest in this group.

Local Health Integration Networks (LHINs) have taken over assessment from the Community Care Access Centres (CCACs), which were merged under the LHINs in 2017. LHINs will now assess all applicants for long-term care to determine eligibility for admission and will assist in selecting a long-term care home of choice. The LHIN coordinates the application and manages all wait lists for long-term care homes.

The above information was reprinted (with amendments) from Seniors in need, caregivers in distress: What are the home care priorities for seniors in Canada? Health Council of Canada, April 2012.

Applying for a long-term care home

The long-term care home application process begins with the multi-part assessment listed above. If your LHIN determines that you’re eligible for long-term care, you’ll have the opportunity to select up to five home choices. The LHIN will coordinate your applications for you, and as soon as a spot becomes available at one of the homes you’ll be contacted by your case worker. You’ll have 24 hours to consent to admission, but if you move into a home that isn’t your first choice, you may stay on the waiting list for the others.

To make the choice of home(s) easier for you, Ontario Long Term Care Association members encourage you to visit their homes, take a tour of their facilities, speak with staff and residents, and learn about the services they provide. However, it is important for families thinking about long-term care to understand that homes do not have control over the admission process.

There are 14 LHINs throughout Ontario, who are separately regulated and funded by the Ontario government. Click here to find information for your LHIN, to get more information or request at assessment and start your application process.

Resident and Family Councils
All residents of a home are members of the Residents' Council and are provided with support from the home to form, organize and maintain administrative matters, as required. The purpose of the Residents' Council is:

• To provide a forum for residents to have input and to advocate on their collective behalf concerning the operations of the home;
• To provide residents with a voice in decisions that affect them and their quality of life in the home;
• To establish two-way communication between the residents and the home staff, and to establish a formal mechanism whereby Residents' Council concerns are communicated to administration for intervention and resolution;
• To provide a means of mutual support for Residents' Council members, which extends to new residents in the home; and
• To allow residents to be informed about the long term care system as a whole and to provide a forum for discussion about strategies for improvement; and to promote and encourage activities directed at the provision of quality care and quality of life for residents.

The Ontario Association of Residents’ Councils (OARC) supports Residents’ Councils in speaking with one voice, promoting a standard of care, influencing legislation and ensuring residents maintain their independence, privacy and dignity. More information about OARC can be found on their website. 

Similar to Residents' Council meetings, the Family Council is provided with support from the home to form, organize and maintain administrative matters as required. Some committees are less formal than others; however all Family Councils are chaired by a representative chosen from the family members themselves. The purpose of the Family Council is:

• To provide a forum for family input into the operations of the home;
• To provide families with a voice in decisions that affects them and their family members;
• To establish two-way communication between family members and the home staff;
• To provide a means of mutual support for Family Council members and families of new residents;
• To allow family members to be informed about the long term care system as a whole and to provide a forum for discussion about strategies for improvement; and
• To promote and encourage activities directed at the provision of quality care and quality of life for the residents.

The Ontario Family Councils’ Program (FCP) facilitates the development and sustainability of Family Councils in long-term care homes and cross-regional collaboration. FCP is led by volunteers who work together with the goal of improving the quality of life for residents in long-term care. Learn more about the Family Councils’ Program on their website.