REPORT General Committee

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1 REPORT General Cmmittee Fr Infrmatin - - DATE: April 8, 2010 REPORT TITLE: UPDATE ON PROVINCIAL PLAN TO REGULATE RETIREMENT HOMES IN ONTARIO FROM: Janette Smith, Cmmissiner f Health Services Janet Menard, Cmmissiner f Human Services OBJECTIVE T update Reginal Cuncil n Regin f Peel input int regulatin f the retirement hmes sectr, and t summarize key parts f the Retirement Hmes Act, 2010 (the Act) currently befre the Ontari Legislature. Retirement hmes are becming a mre imprtant part f the health and human service systems serving senirs. m In 2007, Ontari's Minister Respnsible fr Senirs held cnsultatins n regulating retirement hmes. The Cmmittee submitted recmmendatins as part f these cnsultatins. In its submissin t the prvincial gvernment, the Cmmittee suggested a mdel where prvincial standards are mnitred and enfrced by a lcal bdy invlving lcal authrities wh have the necessary expertise and knwledge f lcal cnditins. In March 2010, Ontari's Minister Respnsible fr Senirs intrduced the Act prpsing prtectins fr senirs living in retirement hmes. A new Retirement Hme Regulatry Authrity, respnsible fr administering the Act, was DISCUSSION I. Backgrund Over the past several years, Reginal Cuncil has received staff reprts n the status f the retirement hme sectr and the imprtant rle this unregulated sectr plays in accmmdating and caring fr lder adults.

2 The term "retirement hme" generally refers t multi-unit residential facilities allwing lder adults t live independently with varying levels f supprt fr daily activities such as cmmn facilities fr fd preparatin and eating, and where husekeeping and medical services are prvided when needed. The Regin f Peel has a minimal rle with respect t verseeing retirement hmes. Peel Public Health is mandated, thrugh the Health Prtectin and Prmtin Act (HPPA) and regulatins in the Ontari Public Health Standards, t inspect retirement residences fr health hazards. Inspectins fcus n water supply, sewage dispsal and structural integrity, with referral f prblems such as fire preventin t the apprpriate agencies. Hmes which prepare cmmn meals fr ten r mre residents are als subject t regular inspectin fr cmpliance with fd premises regulatins under the HPPA. While the Regin f Peel des nt perate retirement hmes, Reginal staff have wrked acrss departments and with area municipalities t better understand this sectr and t explre issues relating t accmmdating and caring fr Peel's grwing senirs' ppulatin. As reprted t Cuncil in August 2001, there is n clear definitin f a retirement hme, n prvincial inventry f retirement hmes and n specific prvincial legislatin fcusing n retirement hmes. Nevertheless, retirement hmes are becming a mre imprtant part f the health and human service systems serving senirs. a) Retirement Hmes and Lng-Term Care Hmes The lack f any specific regulatins gverning care in retirement hmes cntrasts sharply with the lng-term care (LTC) hmes sectr. Retirement hmes are perated by fr-prfit businesses renting units, subject t prvisins in the Residential Tenancies Act, The sectr receives n public funding and n prvincial gvernment versight r regulatin with respect t care fr residents. Sme retirement residence peratrs implement vluntary standards established thrugh the Ontari Retirement Cmmunities Assciatin (ORCA) that cver a number f imprtant areas essential t the safe peratin f a retirement hme. In cntrast, LTC hmes are licensed by the Ministry f Health and Lng-Term Care (MOHLTC) and receive ministry funding t care fr frail elderly residents. LTC hmes are perated by fr-prfit, nn-prfit and municipal peratrs equally subject t detailed and prescriptive prvincial regulatins, with enfrcement by the MOHLTC. Cmmunity Care Access Centres assess eligibility fr lng-term care and manage the wait lists. The Ontari gvernment estimates that there are abut 750 retirement hmes in Ontari which perate 41,000 beds. An inventry f retirement hmes (2006) estimated that Peel Regin has 23 retirement hmes f varying sizes that tgether perate abut 1,I 00 beds. The rapid grwth in the senirs' ppulatin in Peel has placed pressure n cmmunity supprt services. There is als limited funding f services delivered in the hme, and thrughut the cmmunity, that help senirs remain in their wn hmes. Retirement hmes have begun t fill this gap.

3 b) Retirement Hmes I Barding and Ldging Hmes Advisry Cmmittee The Retirement HmesIBarding and Ldging Hmes Advisry Cmmittee (Cmmittee) was frmed in 2005 t prmte the prtectin f vulnerable peple living in the unregulated retirement hme sectr in Peel. The Cmmittee was cmprised f staff frm the Regin's Scial Services, Husing and Prperty, Health Services and Planning departments, the Cities f Mississauga and Bramptn, the Twn f Caledn, and Peel Reginal Plice. The bjectives f the Cmmittee included: Determining ptins fr the assessment f the unregulated residential retirement sectr; Prviding advice t Reginal Cuncil and lcal Municipal Cuncils and input n prvincial standards; and Develping and implementing an advcacy strategy that suggests apprpriate rles and respnsibilities fr municipal, reginal and prvincial levels f gvernment. c) Prvincial Cnsultatin n Retirement Hmes As previusly reprted t Cuncil in the Reprt entitled "Update n Retirement HmesIBarding and Ldging Hmes Advisry Cmmittee Activities Including lnput int Prvincial Cnsultatin", the prvincial gvernment cmmitted t establishing standards f care fr retirement hmes in the 2006 budget. The Ontari Senirs Secretariat was chsen t lead cnsultatins fr develping these regulatins, including: Defining "retirement hme";. Defining and regulating care services in retirement hmes, including minimum prvincial standards fr administering hmes, fd services, and the hme envirnment; and A mdel fr enfrcing these new standards. The Cmmittee submitted recmmendatins t the Ontari Senirs Secretariat as part f these cnsultatins. Reginal Cuncil received a cpy f the Cmmittee's recmmendatins in spring d) Peel lnput n Standards fr Retirement Hmes In its submissin t the Ontari Senirs Secretariat, the Cmmittee strngly supprted the prvincial gvernment's plan t regulate care prvided in the retirement hme sectr. With respect t enfrcing standards, the Cmmittee expressed cncern that a third-party agency may nt adequately represent the interests f all stakehlders. The Cmmittee pinted t ther mdels where prvincial standards are mnitred and enfrced by a bdy invlving lcal authrities wh have the necessary expertise and knwledge f lcal cnditins. Prvincial and lcal respnsibilities assigned under the Fire and Prtectin Act, 1997 were cited as an example f such a mdel.

4 RE April 8, 2010 UPDATE ON PROVINCIAL PLAN TO REGULATE RETIREMENT HOMES IN ONTARIO 2. Findings The Cmmittee als recmmended that: 0 The definitin f retirement hme include barding and ldging hmes ccupied by vulnerable adults; and 0 The vluntary standards in place thrugh the Ontari Retirement Cmmunities Assciatin (ORCA) regarding the gvernance f residential services are a gd starting pint fr regulating this industry. In March 201 0, Ontari's Minister Respnsible fr Senirs intrduced Bill 21, the Retirement Hmes Act, 2010 (the Act) t the Legislature prpsing prtectins fr senirs living in retirement hmes. The Act's fundamental principle is that retirement hmes are perated s they are a place where residents live with dignity, respect, privacy and autnmy, in security, safety and cmfrt and can make infrmed chices abut their care ptins. The Act defines a retirement hme as a residential cmplex, r part f a residential cmplex, ccupied primarily by persns 65 years r lder wh are nt related t the peratr and where the peratr prvides at least tw care services available t residents. The definitin excludes emergency hstel services, hmes fr special care and ther gvernment-funded services. Prvisins in the Act address a range f issues required t regulate the retirement hmes sectr, including a new regulatry authrity, a resident's bill f rights, and prvisins t regulate care standards. a) Retirement Hme Regulatry Authrity The Act will create a new Retirement Hme Regulatry Authrity ("Authrity"), a crpratin withut share capital, gverned by a bard f directrs, that is respnsible fr administering the Act and its regulatins, and that reprts t the Minister Respnsible fr Senirs. The Authrity will license all retirement hmes, emply inspectrs and a Registrar with pwers t review cmplaints abut hmes, and, in the case f nn-cmpliance, issue Orders t hmes with a range f penalties frm impsing fines t revking a hme's license. The Authrity will als educate licensees, cnsumers and the public abut matters addressed in the Act and abut retirement hmes, and will als advise the Minister Respnsible fr Senirs n issues related t retirement hmes. b) Residents' Bill f Rights The Act cntains a Residents' Bill f Rights requiring written agreements between peratrs and residents t be in place befre residency, ensuring that residents receive infrmatin frm peratrs abut their rights, and that residents have the right t establish Residents' Cuncils.

5 Re-t,~ -5- April 8, 2010 UPDATE ON PROVINCIAL PLAN TO REGULATE RETIREMENT HOMES IN ONTARIO c) Standards f Care Regulatins under the Act can set ut standards f care and safety in retirement hmes, including thse fr fire, safety, public health and emergency requirements. Residents may seek and receive care services frm external prviders. The Act includes prvisins t ensure emplyees and vlunteers are screened by plice backgrund checks, and meet specific qualificatins and training requirements. Prvisins in the Act prtect residents frm abuse and neglect, and prhibit resident restraint measures. CONCLUSION The retirement hme sectr's rle in the health and human service systems fr senirs cntinues t expand as Peel's senirs' ppulatin grws. It is anticipated that prvincial gvernment effrts t regulate the care and envirnment in the retirement hme sectr will prvide mre prtectin t this ppulatin. Regin f Peel staff will cntinue t mnitr develpments cncerning the Retirement Hme Act, 2010 and will update Reginal Cuncil n this legislatin as details becme available. Janette Smith Cmmissiner f Health Services &!net Menard Cmmissiner f Human Services Apprved fr Submissin: D. Szwarc, Chief Administrative Officer Fr further infrmatin regarding this reprt, please cntact Dawn Langtry, Manager, Office f the Cmmissiner, Health Services at extensin 4138 r via at dawn.langtry@peelregin. ca Authred By: Cullen Perry, Health Services c. Legislative Services

Department of Environment Land, Water and Planning

Department of Environment Land, Water and Planning Department f Envirnment Land, Water and Planning Psitin purpse The Senir Plicy Officer is part f the Building Unit which is respnsible fr the delivery f plicies and brad based strategies t achieve imprved