Overview

The purpose of this document is to provide information regarding the process to designate specialized units within Long-Term Care homes. The document outlines the roles and responsibilities relating to the identification of, request for, recommendation of, and designation of specialized units as well as the expiration or revocation of the designation.

Background and rationale

The Fixing Long-Term Care Act, 2021 and Ontario Regulation 246/22 include provisions that enable the designation of “specialized units” in long-term care long-term care homes based on specified resident needs. The Fixing Long-Term Care Act, 2021 and O. Reg. 246/22 allow the director at the Ministry of Long-Term Care to designate these units and provides the ministry with flexibility to address the needs of specialized populations at the local level as admission to these units is limited to individuals with the specified needs.

Specialized units are designated by one of two mechanisms, with both mechanisms being facilitated by Ministry of Long-Term Care and Ontario Health (OH) collaboration and agreement from the long-term care home licensee:

  1. In response to a recommendation from OH for the geographic area where the long-term care home is located.
  2. Upon the director’s own initiative, after having considered the input of OH and the licensee of the home.

The director can only designate a specialized unit in a home if the licensee has agreed to the proposed designation and the director is satisfied with the licensee’s current compliance with the requirements under the Fixing Long-Term Care Act, 2021 and with the licensee’s history of compliance. The following sections apply to both OH recommended and director initiated specialized units, unless specifically referenced as only applicable to one designation type within the sections.

Definitions

  • Additional per-diem funding means funding provided by the Ministry of Long-term Care or OH to the licensee for the Behavioural Specialized Unit (BSU) beds above the regular level-of-care per diem and top-up funding for which the beds are eligible, subject to any terms and conditions specified by the director.
  • Allowable designated specialized unit resident days means the number of designated specialized unit resident days that the Ministry of Long-term Care will fund at the home. This is determined to be the number of approved designated specialized unit beds in operation multiplied by the number of days in the period under consideration.
  • One-time start-up funding means funding provided by the Ministry of Long-Term Care or OH to the licensee for one-time expenses limited to establishing the specialized unit, subject to any terms and conditions made by the director.
  • A requirement under this Act means a requirement contained in the Fixing Long-Term Care Act, 2021, O. Reg. 246/22, or in an order or agreement made under the Fixing Long-Term Care Act, 2021, and includes a condition of a licence under Part VIII or an approval under Part IX, a condition to which funding is subject under section 93 and, subject to subsection 184(7), an operational or policy directive issued by the minister under section 184.
  • Specialized unit means any unit designated by or in accordance with O. Reg. 246/22 to provide or offer certain types of accommodation, care, services, programs and goods to residents.
  • Time-limited means a specialized unit that is designated for a set-term or temporary period of time. Where the director has designated a specialized unit for a specified time, the expiry of the specified time is deemed to be a revocation on the director’s own initiative.

Basic requirements

Section 216 of O. Reg. 246/22 sets out the requirements relating to the designation of a specialized unit in a long-term care home.

Only the director, Capital Planning Branch (CPB), has the authority under the Fixing Long-Term Care Act, 2021 to designate a specialized unit. The designation is subject to any terms and conditions specified by the director.

Only long-stay program beds can be designated for use in a specialized unit. These long-stay program beds may exist under a regular or temporary licence. Exemptions set out in section 370 of O. Reg. 246/22 relating to alternative settings do not apply to long-stay program beds in specialized units. As per the specific healthcare needs of residents, beds in a specialized unit can be located in a specific area of a long-term care home or located throughout the home.

The director shall only designate a specialized unit if the director is satisfied with the licensee’s current compliance with requirements under the Fixing Long-Term Care Act, 2021 and the licensee’s history of compliance and when the licensee of the home agrees to the proposed designation.

The director must advise Ontario Health atHome (OHaH) as placement co-ordinator in writing of any designation. Admission to a specialized unit is subject to the admission provisions of the Fixing Long-Term Care Act, 2021 and O. Reg. 246/22. Only an OHaH placement co-ordinator has the authority to authorize admission to a specialized unit, even if the person seeking to be admitted is currently a resident of the long-term care home who is transferring to the unit. The appropriate OHaH placement co-ordinator must keep a separate waiting list for each designated specialized unit within the home.

The transfer of a resident who is being discharged out of a specialized unit into a “regular bed” within the same long-term care home is considered an internal transfer and does not require the authorization of the OHaH placement co-ordinator. In this situation, the licensee must notify the OHaH placement co-ordinator of every such transfer within 24 hours, as set out in subsections 223 (2) and 224 (4) of O. Reg. 246/22.

The funding rules specified in applicable funding and financial management policies apply to specialized unit beds. These include, but are not limited to, all long-term care home funding and financial management policies available on the Ministry of Long-term Care’s public website.

Specialized units will not be designated to meet the needs of residents of a specific religion, ethnic or linguistic origin. Subsection 182 (2) of O. Reg. 246/22 outlines the requirement for each placement co-ordinator to keep a separate waiting list for units or areas in a home that are primarily engaged in serving the interests of a particular religion, ethnic or linguistic origin.

Subsection 216 (7) of O. Reg. 246/22 sets out that the director may, after considering the health and well-being of both the residents in the specialized unit and persons who might be admitted as residents, stipulate that persons who are on the regular waiting list for the long-term care home may be admitted to the specialized unit when there is no one on the waiting list for the unit. The director must advise the OHaH as placement coordinator of any such stipulation.

A resident in the unit who no longer requires and benefits from the accommodation, care, services, programs and goods provided in the unit and for whom alternative arrangements have been made, must be discharged from the unit in accordance with the requirements set out in subsection 158 (7) of O. Reg. 246/22. In addition, a resident who was admitted to the unit pursuant to a stipulation under subsection 216 (7) of O. Reg. 246/22 (that is, from the regular waiting list) must be transferred to another area of the home in the class of accommodation chosen by the resident as soon as such a bed becomes available, per section 224.

Planning and recommendation of director initiated specialized units

Pursuant to section 216(2)(b) of O. Reg. 246/22, the director can designate a specialized unit upon the director’s own initiative, after having considered the input of OH and the licensee of the home. In partnership with OH, the director would:

  • identify specialized healthcare needs that could be met in a specialized unit
  • identify candidate long-term care homes and select a long-term care home
  • identify resident and clinical data to base decision making
  • gain required financial and sector capacity information
  • achieve sector support needed for the designation

In making a recommendation or providing input for the designation of director initiated specialized unit, OH must clearly set out the specific needs of the proposed residents of the specialized unit and distinguish these needs from the residents in the rest of the long-term care home.

Pursuant to subsection 216 (3) of O. Reg. 246/22, in providing input to the director, OH must provide the director with information the director stipulates with respect to the types of accommodation, care, services, programs and goods to be provided by the specialized unit.

In a director initiated specialized unit, OH must provide a statement that OH is satisfied that the licensee will be financially capable of providing the types of accommodation, care, services, programs and goods to be provided by the specialized unit. By making this statement, OH will be confirming to the director that the licensee of the home in which OH is recommending the designation of a specialized unit is not in financial difficulties. OH must include a detailed estimate of the cost of the proposed unit, a full budget and information about the sources of the funding. Further financial information and analysis must be included if the specialized unit requires additional funding.

Process to obtain the designation of an OH recommended specialized unit

Licensee submits an application to OH

A licensee who is interested in operating a specialized unit must submit an application to OH. To assist OH in assessing the application, the licensee’s application to OH should include the following:

  • Information about the licensee, long-term care home, current beds, including numbers and types of long-stay and short-stay beds, and other specialized units in the home.
  • The number of beds proposed to be designated within the unit.
  • The term of the proposal (for example, time-limited or non-time-limited).
  • The resident population to be served (including a detailed resident profile).
  • The description of the accommodation, care, services, programs and goods to be provided to residents in the unit.
  • A description of the care delivery approach (for example, how the licensee will meet the needs of residents of the unit, including determining appropriate staff mix and staff levels).
  • Information about the physical environment, supplies and equipment and information systems for the unit.
  • An overview that demonstrates the home’s readiness to operate the specialized unit, including human resources plan, environmental components, and related experience.
  • A financial plan, including a detailed budget proposal.
  • A proposal to monitor, evaluate, and report on the utilization and effectiveness of the specialized unit. This proposal should address specific resident-centred outcomes, program goals, system impacts (if applicable) and how they will be measured.

A communications plan that addresses how to work with the OHaH placement co-ordinator to create an awareness of the unit and ensure that the OHaH has a full understanding of the goals of the unit and profile of the resident population served, as well as a plan to support the appropriate flow of information.

A comprehensive written plan related to admissions and discharges for the unit that complies with all requirements under the Fixing Long-Term Care Act, 2021 including:

  • a policy for communicating with the applicant, family, or substitute decision-maker about the unit that addresses the requirement under O. Reg. 246/22 to discharge the resident when the resident no longer requires or benefits from the accommodation, care, services, programs and goods provided by the unit. (it will address alternate arrangements having been made, as well as when an appropriate bed becomes available in another area of the home for a resident who was admitted from the regular waiting list pursuant to a director’s stipulation)
  • an explanation of how the unit will manage discharges to other areas of the home or other long-term care homes in accordance with the requirements under the Fixing Long-Term Care Act, 2021 (if applicable)
  • a process for ongoing collaboration with the OHaH for managing discharge to other settings (for example, home, community or other long-term care home)
  • a plan for knowledge transfer and provision of any available supports to the receiving home/other destination (prior to and post discharge)

Evaluation of application by OH

OH’s assessment of the proposal should consider and document the following (to be included in the submission referenced in Reporting requirements):

  • Opportunities and risks presented by the proposal with mitigation strategies, as appropriate.
  • Consultation with the community and stakeholders including the local OHaH placement co-ordinator to articulate how the specialized unit would fit into the continuum of care for the community.
  • An independent clinical validation from at least two clinical experts (for example not from the home) that the proposed model will meet the needs of the identified population (if applicable and as part of the consultation).
  • Analysis of local pressures on the health care system (such as funding, alternate level of care (ALC), and human resources limitations), effects of program on other health care sectors and how the proposed specialized unit will impact these pressures.
  • A review of the budget submission to identify the following:
    • How the unit will be funded.
    • A detailed budget of all enhanced costs (not including Level-of-Care per diem funding) and their associated funding envelope.
    • Whether any additional funding is being requested.
    • If funding is being requested, the source of the funding.
    • Any additional funding approvals required.
    • Any concerns related to the budget as submitted.

OH submits a proposal or input to the director for the designation of a specialized unit

OH submits the formal recommendation for the designation of the specialized unit to the director. Any incomplete recommendation package will result in a delay in the review.

As required by subsection 216 (3) of O. Reg. 246/22, in making a recommendation or providing input to the director, OH must provide the director with whatever information the director stipulates with respect to the types of accommodation, care, services, programs and goods to be provided for the specialized unit.

For both director initiated and OH recommended, the following information must be provided by OH:

  • An assessment identifying the need for a specialized unit to provide or offer certain types of accommodation, care, services, programs and goods to residents, taking into account the input of the OHaH placement co-ordinator for the home, the licensee of the home and others as OH may consider appropriate (for example, clinical experts).
    • The assessment should clearly identify the input provided by each entity.
    • In its identification of the need for the unit, OH should provide an analysis of both the statistics that highlight a need for such a unit, as well as the number of prospective residents and why their particular needs cannot be met in a regular area within the home.
  • An analysis of the advantages and disadvantages of designating a specialized unit.
    • This analysis should include information about the impact that the designation will have on the availability of long-stay beds in OH’s geographic area. For example, if a specialized unit is designated, the beds in that unit will no longer be available for the general population (this may only occur when there are individuals on the dedicated waitlist for the specialized unit per section 216(7) of O. Reg. 246/22) and what this means for the long-term care home, its residents and the broader community.
    • This analysis should also outline other options considered and the rationale as to why other options were not deemed appropriate.
  • A description of the resident population to be served by the specialized unit (including a clinical profile of the group to be served by the unit, if applicable).
    • The submission should identify the population and clearly demonstrate how the resident care needs of the proposed target population to be served by the specialized unit differs from other long-term care home residents and how this justifies designation of the unit.
  • A description of the accommodation, care, services, programs and goods to be provided by the specialized unit.
    • The submission should clearly identify any accommodation, care, services, programs and goods that are to be provided to residents in the specialized unit that differ in any way from those provided to residents in the rest of the long-term care home.

If the proposal contains an enhanced staffing model, the description should compare the proposed staffing levels with those in other areas of the home. The assessment must clearly articulate which portion of the services are enhanced (so as to separate the cost of regular services that would be provided to the other residents in “regular” beds in the home and what has been enhanced to support the care in the specialized unit.)

  • A statement that OH is satisfied that the licensee will be financially capable of providing the types of accommodation, care, services, programs and goods to be provided by the specialized unit.
    • OH must include a detailed estimate of the cost of the proposed unit, a full budget and information about the sources of the funding. Further financial information and analysis must be included if the specialized unit requires additional funding.
  • A statement that the licensee has agreed to the proposed designation. Pursuant to subsection 216(4)(a) of O. Reg. 246/22, the director is only able to designate a specialized unit in a home if the licensee of the home has agreed to the proposed designation.
  • The statement from the licensee can take the form of a letter from the licensee.
  • A detailed proposal for the monitoring, evaluating and reporting on the utilization and effectiveness of the specialized unit.

The evaluation framework should demonstrate alignment with provincial evaluation frameworks (where they exist).

The evaluation plan should be resident centred and include (but is not limited to) specific measures for reporting on resident outcomes, program goals and system impacts including:

  • resident outcomes (including how assessed goals were or were not met)
  • benefits to residents and, if applicable, family members
  • any disadvantages experienced by the residents and, if applicable, family members
  • information on how residents who did not meet the goals of the program were dealt with
  • resident and family satisfaction
  • assessment of the staffing model
  • program measures
  • system measures
  • data related to admission and discharge (for example, calls from interested persons, waitlist management, referral, admission, or discharge times)
  • financial and budget matters (including an assessment of the cost to run the specialized unit as compared to regular areas of the home and a separate accounting of start-up costs as compared to regular operating costs
  • an assessment of resident outcomes

Once goals are met, the status of residents returned to a regular long stay bed or other setting – for example, did the individual remain stable in the destination home or did the individual experience regression, additional ER visits or hospitalizations that should have been minimized through the supports provided in the specialized unit?

The recommendation should also include:

  • a summary of the review process undertaken by OH in its assessment of the home’s proposal
  • a detailed project plan that articulates the model for the specialized unit as well as an implementation plan and schedule
  • documentation from at least two independent clinical experts confirming that the model of care and services will meet the needs of the proposed resident population (if applicable)
  • a statement from OH that they are satisfied that the home has the necessary skills and experience to provide the care and services required in the proposed unit
  • confirmation from OH that the unit has a plan for managing resident discharges to regular areas within the home and elsewhere that complies with the requirements under the Fixing Long-Term Care Act, 2021
  • the communications plan related to the specialized unit

Director’s review and response to OH submission

Specialized unit beds require the designation of the director.

When a specialized unit submission is received from OH, the director conducts a review and analysis of OH’s recommendation in consultation with the long-term care Inspections Branch (IB) and Financial Management Branch (FMB). The director will consult other Ministry partners as appropriate, such as the long-term care Capital Management Branch.

If required, the long-term care IB district office may conduct a pre-occupancy review of the proposed specialized unit.

The district office will forward a report noting any issues related to the pre-occupancy review of the proposed specialized unit. The district office will also provide an overview of the licensee’s compliance (current and historical) with requirements under the Fixing Long-Term Care Act, 2021.

When making the decision whether to designate the specialized unit, the director will take into consideration all the information provided as part of the recommendation, the results of the pre-occupancy review (where applicable) and any other applicable information. In addition, pursuant to subsection 216 (4) of O. Reg. 246/22, the director is only able to designate a specialized unit if the director is satisfied with the licensee’s current compliance with the Fixing Long-Term Care Act, 2021 and history of compliance.

If the director decides to designate the specialized unit, a letter will be sent by the director to OH (including the OHaH placement co-ordinator) and the long-term care home licensee advising of the designation and setting out any terms and conditions of the designation. Additional copies will be provided to the:

  • FMB director
  • long-term care Capital Management Branch director
  • Funding and Programs Branch director
  • long-term care IB director

The director has the discretion to designate a specialized unit on a time-limited basis pending an evaluation of the licensee’s ability to meet specified conditions.

If the director does not designate the specialized unit, a letter will be sent by the director to OH and the long-term care home licensee advising of the decision.

If a management contract is required to operate the specialized unit, the management contract must be approved by the director before the licensee begins to operate the specialized unit. This approval will be included in the overall approval process relating to the specialized unit. If the management contract is approved, pursuant to section 113 of the Fixing Long-Term Care Act, 2021 a copy of the director’s approval will be forwarded to the long-term care home licensee and management company, with a copy to OH.

If OH’s recommendation includes an increase in the licensed or approved bed capacity, a further and separate approval of the director for a temporary licence under the Fixing Long-Term Care Act, 2021 is required. Only the director has the authority to authorize an increase to the licensed or approved bed capacity of a home.

The terms and conditions of the designation for a specialized unit will outline whether it is director (section 216(2)(b) of O. Reg. 246/22) initiated, after having considered OH input, or upon the recommendation of OH (section 216(2)(a) of O. Reg. 246/22).

Addendum to long-term care home service accountability agreement (L-SAA)

Pursuant to section 217 of O. Reg. 246/22, the operation of a specialized unit must be subject to the terms and conditions in an agreement (the L-SAA or another agreement, as the case may be) between the licensee and OH. The agreement must include any terms and conditions specified by the director as part of the designation of the unit. These requirements apply whether the specialized unit is designated on the recommendation of OH or on the director’s own initiative.

Funding and reconciliation

Top-up per diem and one-time start-up funding

The Ministry of Long-term Care or OH may provide additional per-diem funding above the level-of-care per diem and top-up per diem funding for which the beds are eligible, subject to the approval of and any terms and conditions made by the director. Any additional per-diem funding above the level-of-care per diem and top-up per diem funding must be provided in writing by the director or OH.

Long-term care homes operating director-initiated Behavioural Specialized Unit (BSU) beds will receive a top-up per diem funding amount as outlined in the Long-term care homes level-of-care per diem funding summary.

Up to 5% of top-up per diem funding and Additional Per Diem Funding provided to long-term care homes for director-initiated BSU beds may be reported in the OA envelope. Top-up per diem funding and Additional Per Diem Funding for OH initiated BSUs may be used for OA envelope expenditures if specified in the terms and conditions.

Top-up per-diem funding and additional per-diem funding must only be used to support costs for specialized unit beds.

When the allocation of the top-up per-diem funding and additional per-diem funding to the NPC, PSS and OA envelopes respectively has not been specified, funding will be allocated by pro-rating the funding to the envelopes based on the NPC, PSS and OA envelope expenditures reported in the Long-Term Care Home Annual Report, and matching funding against expenditure for each envelope.

The Ministry of Long-term Care or OH may provide one-time start-up funding to the licensee for the specialized unit, subject to any terms and conditions made by the director. Where it is specified in the terms and conditions, long-term care homes may use the one-time start-up funding for the following purposes:

  1. Training of long-term care staff who provide supports and services for residents in specialized units.
  2. Acquiring eligible equipment and supplies that support the delivery of care and comfort for residents in specialized units, which include but are not limited to, beds and mattresses, blanket warmers, privacy screens, call bells, activity boards, activity tables and specialized seating, Montessori equipment, mirrors, upgrades to telephone or computer systems.
  3. Infrastructure changes to enhance the safety of residents, if required.
  4. Any other costs approved by the director. Director approval must be specified in the terms and conditions.

Reimbursement for the loss of income from preferred accommodation

Specialized units may be private or semi-private accommodation. For director-initiated specialized units, the Ministry of Long-term Care will pay long-term care home licensees for the loss of income that may otherwise have been charged for the preferred accommodation if the bed had not been occupied by a resident approved for a specialized unit bed. The daily rate that the Ministry of Long-term Care will pay is equal to the difference between the applicable maximum daily rates for preferred accommodation and basic accommodation respectively.

Residents in director-initiated specialized units cannot be charged more than the maximum basic co-payment. Please refer to the latest Long-Term Care Home Accommodation Charges bulletin for the applicable rate.

For director-initiated specialized units, the Ministry of Long-term Care will pay long-term care home licensees for any applicable lost preferred accommodation revenue related to allowable specialized units resident days, regardless of the actual number of days that the specialized units bed is occupied.

OH may specify in the terms and conditions of its L-SAA with the licensee whether specialized units established upon the recommendation of OH will be reimbursed for lost preferred accommodation revenues. If the terms and conditions specify that OH will reimburse for lost preferred accommodation fees, the licensee will be reimbursed the difference between the maximum allowable preferred accommodation rate and the maximum basic accommodation rate. In this case, residents cannot be charged more than the maximum basic co-payment. Please refer to the Important News Regarding Long-Term Care Home Accommodation Charges bulletin for the applicable rate.

If reimbursement for lost preferred accommodation fees for specialized units established upon the recommendation of OH is not specified by OH in the L-SAA, the licensee will not be reimbursed for lost preferred revenue and may charge a specialized unit resident a preferred accommodation rate.

Reporting requirements

All expenditures must be reported in the Long-Term Care Home Annual Report.

All additional per-diem funding is subject to adjustment, as per the LTCH Reconciliation and Recovery Policy. Unused funds must be declared surplus and returned to OH or Ministry of Long-term Care, as per the LTCH Reconciliation and Recovery Policy. Unused additional funding remaining after deducting eligible expenditure reported from additional per-diem funding, in the NPC and PSS envelopes, is recoverable by the Ministry of Long-term Care.

Should the licensee receive funding for one-time start-up costs, the licensee shall report related expenditures, including initial training-related expenditures funded using the one-time start-up funding in Section I, Part A of the Long-Term Care Home Annual Report in accordance with the reporting requirements of the LTCH Reconciliation and Recovery Policy.

Expenditures related to the top-up or Additional Per diem funding must be reported in the NPC, PSS and OA envelopes of the Long-Term Care Home Annual Report. The expenditures must also be reported on separate lines in the NPC, PSS and OA sections of the Long-Term Care Home Annual Report. Operational expenditures shall be reported in accordance with the Guideline for Eligible Expenditures for Long-Term Care Homes (PDF).

OH or Ministry may adjust or withhold funding for their respective specialized unit when OH or Ministry is of the opinion that the licensee has failed to meet the objectives of the specialized unit.

If OH decides to reduce, withhold or cancel funding for the beds in a specialized unit established upon the recommendation of OH for any reason and at any time during the term of the designation, OH must inform the director of this decision at least six months before the reduction, withholding or cancellation.

Accountability

Legislative and regulatory parameters

Specialized unit beds are long-term care home beds and are regulated under the Fixing Long-Term Care Act, 2021 and O. Reg. 246/22

For both director initiated specialized units, and specialized unit established upon the recommendation of OH, OH must submit the reports/evaluations for each specialized unit as set out in the terms and conditions specified by the director in the designation of the specialized unit.

Agreements Between Parties

The licensee must enter into an agreement with OH or the Ministry of Long-term Care to operate a specialized unit, either as an addendum to the existing L-SAA as a separate agreement or as a Direct Funding Agreement. The agreement must include any terms and conditions specified by the director.

Revocation of the designation of a specialized unit (or expiry of the designation)

As set out in section 225 of O. Reg. 246/22, the director may revoke the designation of a specialized unit in a long-term care home or the designation of some of the beds in a specialized unit, in accordance with any terms and conditions the director may specify. The director may also allow a designation that is time-limited (as set out in its terms and conditions) to expire. The director may do any of these things upon the recommendation of OH where the home is located or on the director’s own initiative. Section 225(7) provides that where the director has designated a specialized unit for a specified time, the expiry of the specified time is deemed to be a revocation on the director’s own initiative. The following steps are required if the designation of the entire specialized unit, all or some of the beds within the unit are being revoked or allowed to expire:

Revocation and expiration of designation recommended by OH or the licensee

If the revocation or expiration of the designation of a specialized unit is being recommended by OH, 6 months prior to the revocation or expiration date OH must provide the following to the director:

  • The reason(s) for recommending the revocation or expiry.
  • A plan developed by the OH in consultation with the licensee and in consideration of OH’s role as the appropriate placement co-ordinator that sets out:
    • the arrangements that will be made for the accommodation, care and services of the residents of the specialized unit
    • anticipated timelines for carrying out the plan when revoking the designation or allowing it to expire
    • a proposal for what is to occur with respect to the beds that will no longer be designated as part of the specialized unit

The director will inform the licensee and OH (including the OHaH placement co-ordinator) of the revocation or expiration of the unit and provide the approved plan, with or without amendments made by the director, to the licensee and OH (including the OHaH placement co-ordinator).

Revocation and expiration of designation initiated by the director

If the revocation of the designation of a specialized unit is on the director’s own initiative, or the director has made a determination that the designation will be allowed to expire, the director will provide six months’ notice of the revocation/expiration to the licensee and OH (including the OHaH placement co-ordinator). Upon receipt of the notice, OH must provide the following to the director:

  • A plan developed by OH in consultation with the licensee and in consideration of the OHaH placement co-ordinator that sets out:
    • the arrangements that will be made for the accommodation, care and services of the residents of the specialized unit
    • anticipated timelines for carrying out the plan when revoking the designation

The director will provide the approved plan, with or without amendments made by the director, to the licensee and OH (including the OHaH placement co-ordinator).

The role of the licensee

The licensee must:

  1. comply with the approved plan
  2. provide each resident who will be affected by the revocation or expiration of the designation, and the resident’s substitute decision-maker, if any, with written notification of the revocation or expiration of the designation of the specialized unit
  3. contact those residents and substitute decision-makers to begin the process of making alternate arrangements

Role of the OHaH placement co-ordinator

In accordance with the approved plan, the OHaH placement co-ordinator must :

  1. inform applicants on the waiting list for admission to the specialized unit that the designation is being revoked or is expiring
  2. cease the authorization of admissions to the specialized unit
  3. cease keeping a separate waiting list for the specialized unit in the long-term care home

Renewal or extension of designation

If the designation of a specialized unit established upon the recommendation of OH is time-limited (as set out in its terms and conditions) OH, in consultation with the licensee, may submit a request to the director to extend the time period or designate the specialized unit on a non-time-limited basis. The request must include an evaluation of the operation of the specialized unit and the rationale for the proposed extension or non-time-limited designation. This request should be submitted 6 months prior to the expiry of the current designation to allow for a thorough review of the request. The director will make a determination related to such a request in consultation with long-term care IB, FMB and other ministry partners as applicable.

For specialized units designated on the director’s own initiative, the Ministry of Long-term Care will seek confirmation of the OH’s support and the licensee’s agreement 6 months prior to the expiry of the current designation, if a renewal or extension is being considered.