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ontario regulation 295/19

made under the

Long-Term Care Homes Act, 2007

Made: June 21, 2019
Filed: August 29, 2019
Published on e-Laws: August 29, 2019
Printed in The Ontario Gazette: September 14, 2019

Amending O. Reg. 79/10

(GENERAL)

1. Section 165 of Ontario Regulation 79/10 is amended by adding the following subsection:

(6) Despite subsection (4), sections 166 and 169 to 182 do not apply to the appropriate placement co-ordinator in respect of placing persons on a waiting list for admission to a high acuity priority access bed and ranking persons for admission to that bed, which shall be done in accordance with sections 206.5 and 206.6.

2. Subsection 172.1 (1) of the Regulation is amended by striking out “or” at the end of clause (a) and by adding the following clauses:

(c) is a resident occupying a high acuity priority access bed in a long-term care home who is applying for admission to a regular long-stay bed in another home; or

(d) was a resident in a high acuity priority access bed and,

(i) was transferred from the high acuity priority access bed to another bed in the home pursuant to subsection 206.7 (2), and

(ii) applied for admission before being transferred or within six weeks after being transferred.

3. Clauses 177 (1) (d) and (e) of the Regulation are revoked and the following substituted:

(d) he or she was discharged from a specialized unit or a high acuity priority access bed because he or she was absent on a medical or psychiatric absence for a longer time than permitted under section 138, and is applying for admission to the long-term care home where he or she was a resident immediately prior to his or her admission to the specialized unit or high acuity priority access bed; or

(e) he or she was discharged from a specialized unit or a high acuity priority access bed in a long-term care home and transferred to a bed in another area of the home, and he or she,

(i) is applying for admission to the long-term care home where he or she was a resident immediately prior to his or her admission to the specialized unit or high acuity priority access bed, and

(ii) applied for the admission referred to in subclause (i) before being transferred, or within six weeks after being transferred.

4. Item 6.1 of the Table to section 182 of the Regulation is amended by adding “or former high acuity priority access bed residents” at the end of Column 1.

5. Section 183 of the Regulation is amended by adding the following subsection:

(4) If a person who is on the waiting list for a long-term care home should be placed in a different category on the waiting list as a result of amendments made to this Regulation by Ontario Regulation 295/19, the placement co-ordinator keeping the waiting list shall place the person in the different category.

6. Subsection 185 (2) of the Regulation is amended by adding the following paragraphs:

15. Private accommodation for a woman in a high acuity priority access bed.

16. Private accommodation for a man in a high acuity priority access bed.

7. The Regulation is amended by adding the following sections:

High Acuity Priority Access Beds

Designation of beds, amendment and revocation

206.4 (1) The Director may designate a specified number of private accommodation long-stay program beds in a long-term care home as high acuity priority access beds, subject to any terms and conditions as the Director may specify.

(2) A licensee shall comply with the terms and conditions of a designation.

(3) The Director may, at any time,

(a) amend the terms and conditions of a designation; or

(b) revoke the designation, subject to any terms or conditions the Director considers appropriate.

(4) The Director shall advise the licensee for the long-term care home in which one or more high acuity priority access beds are designated and the appropriate placement co-ordinator in writing of,

(a) the designation and any terms and conditions to which it is subject;

(b) if the Director amends the terms and conditions, the amended terms and conditions; and

(c) if the Director revokes the designation, the revocation of the designation and any terms and conditions of the revocation.

(5) As soon as possible after being advised of a revocation under clause (4) (c), the licensee shall,

(a) advise in writing each resident who will be affected and their substitute decision-maker, if any, of the revocation;

(b) commence arranging for alternate arrangements with the resident and substitute decision-maker, if any; and

(c) provide the Director with a plan for the accommodation of, and the provision of care and services to, each resident who will be affected who was admitted to the bed from the waiting list kept under section 206.5.

(6) Immediately after being advised of a revocation under clause (4) (c), the appropriate placement co-ordinator shall,

(a) inform applicants on the waiting list for admission to the high acuity priority access bed that the designation is being revoked;

(b) cease the authorization of admissions to the high acuity priority access bed; and

(c) cease keeping a separate waiting list for the high acuity priority access bed in the long-term care home.

(7) Where the designation of a high acuity priority access bed is revoked and the bed is occupied by a resident who was admitted to the bed from the waiting list kept under section 206.5,

(a) the licensee shall discharge the resident from the bed and if the resident requests, transfer the resident to another bed in the home in a class of accommodation chosen by the resident as soon as the bed becomes available;

(b) the licensee shall continue to provide the resident with the same level of care the resident was being provided with until the resident is transferred to another bed in the home or is discharged from the home; and

(c) the revocation becomes final once the resident is transferred to another bed in the home or discharged from the home.

(8) A resident who is transferred under clause (7) (a) shall be deemed to have been discharged from the high acuity priority access bed and admitted to the home.

(9) The licensee may transfer residents under clause (7) (a) despite the rules concerning transfer lists in section 207, subject to the first priority being given to residents described in clause 207 (1) (f) and despite subsection 207 (5).

(10) The licensee shall notify the placement co-ordinator of every transfer under clause (7) (a) within 24 hours.

Waiting lists and ranking high acuity priority access beds

206.5 (1) Sections 169 to 175, 177 to 181 and subsection 182 (1) do not apply to an applicant seeking admission to a high acuity priority access bed within a long-term care home.

(2) The appropriate placement co-ordinator for a long-term care home shall keep a separate waiting list for admission to the high acuity priority access beds designated within the home in accordance with this Regulation that is in addition to and separate from any waiting list that is required to be kept under section 165.

(3) The appropriate placement co-ordinator shall place a person on a waiting list for admission to a high acuity priority access bed in a long-term care home if,

(a) the person,

(i) is at significant risk of avoidable admission to a hospital under the Public Hospitals Act or a private hospital licensed under the Private Hospitals Act or to a psychiatric facility within the meaning of the Mental Health Act that is required to provide in-patient services in accordance with that Act,

(ii) occupies a bed in a hospital under the Public Hospitals Act or a private hospital licensed under the Private Hospitals Act or a psychiatric facility within the meaning of the Mental Health Act that is required to provide in-patient services in accordance with that Act and requires an alternate level of care, or

(iii) is a long-stay resident in a long-term care home;

(b) the person is determined by the placement co-ordinator to be eligible for long-term care home admission as a long-stay resident under section 155;

(c) subject to subsection (4), the placement co-ordinator is satisfied, based on the assessment and information provided, that the person requires and is likely to benefit from,

(i) ongoing nursing and other personal care given by or under the supervision of a registered nurse or registered practical nurse who has relevant expertise, whether as the result of experience or training, or

(ii) ongoing technology-based care that requires the support of a member of a college as defined under the Regulated Health Professions Act, 1991;

(d) the person applies, in accordance with this Regulation, for authorization of their admission to a high acuity priority access bed;

(e) the licensee of the long-term care home approves the person’s admission to the high acuity priority access bed; and

(f) placing the person on the waiting list will not result in the total number of long-stay program waiting lists, of all types, on which the person is placed exceeding five, unless the person meets the requirements for placement in category 1 on the waiting list under section 171.

(4) A person shall not be placed on the waiting list for a high acuity priority access bed if the only reason that the person meets the criteria under clause (3) (c) is that the person demonstrates responsive behaviours.

(5) For the purposes of clause (3) (f), where a person will be placed on the waiting list for a high acuity priority access bed in a long-term care home, and will also be placed on the waiting list for the home other than for a high acuity priority access bed, all of the waiting lists for that home shall be counted as one list.

(6) An applicant shall be placed in the exchange category on the waiting list for a high acuity priority access bed in the home if either of the following circumstances exist:

1. The applicant meets the requirements set out in clauses 176 (1) (a) and (b), and the result of the exchange will be that the applicant will become a resident of a high acuity priority access bed in the long-term care home to which the applicant seeks admission and a resident in a high acuity priority access bed in the home will be discharged.

2. The placement co-ordinator becomes aware of the opportunity to exchange a resident in one high acuity priority access bed of a long-term care home who seeks admission to a second long-term care home and a resident of the second high acuity priority access bed in a long-term care home who seeks admission to the first.  In this circumstance, each resident shall be placed in the exchange category of the appropriate waiting list.

(7) A person who was discharged from a high acuity priority access bed because he or she was absent on a medical or psychiatric absence for a longer time than permitted under section 138, and is applying for admission to a high acuity priority access bed, shall be placed in the re-admission category on the waiting list for a high acuity priority access bed.

(8) Applicants on a waiting list for a high acuity priority access bed in a long-term care home shall be ranked for admission in the following order of priority:

1. The highest priority shall be given to an applicant who is in the exchange category on the waiting list for the high acuity priority access bed.  As among themselves, these applicants shall be ranked according to the following order of priority:

i. The highest priority shall be given to an applicant who was discharged from a high acuity priority access bed because he or she was absent on a medical or psychiatric absence for a longer time than permitted under section 138, and is applying for admission to the high acuity priority access bed. As among themselves, these applicants shall be ranked according to the date of their original admission to the high acuity priority access bed.

ii. The next highest priority shall be given to an applicant who meets the requirements for placement in category 1 on the waiting list for a long-term care home under section 171.  As among themselves, these applicants shall be ranked according to the urgency of their need for admission.

iii. All other applicants shall be ranked on the waiting list according to the time at which they applied for authorization of their admission to the high acuity priority access bed.

2. The next highest priority shall be given to an applicant who is in the re-admission category on the waiting list for the high acuity priority access bed. As among themselves, these applicants shall be ranked according to the date of their original admission to the high acuity priority access bed.

3. The next highest priority shall be given to an applicant who meets the requirements for placement in category 1 on the waiting list for a long-term care home under section 171. As among themselves, these applicants shall be ranked according to the urgency of their need for admission.

4. All other applicants shall be ranked on the waiting list according to the time at which they applied for authorization of their admission to the high acuity priority access bed.

(9) In this section,

“technology-based care” means care requiring any specialized medical device, instrument, apparatus, appliance, software application, implant or other article intended by the manufacturer to be used, alone or in combination, for the prevention, monitoring, treatment or alleviation of complex disease, disability, injury or disorder.

Admission to high acuity priority access beds

206.6 (1) The appropriate placement co-ordinator shall authorize the admission of an applicant to a high acuity priority access bed only if,

(a) the applicant’s admission may be authorized under section 185; and

(b) the applicant meets the requirements for placement on a waiting list for admission to a high acuity priority access bed set out in subsection 206.5 (3) when the vacancy arises.

(2) Despite clause (1) (b), if there is no applicant on the waiting list for admission to a high acuity priority access bed who meets the requirements in subsection 206.5 (3) when the vacancy arises, an applicant from the waiting list that is required to be kept under section 165 may be admitted to the bed.

(3) The appropriate placement co-ordinator shall keep the licensee informed as to whether or not there is at least one person on the waiting list that is required to be kept under subsection 206.5 (2).

Discharge and transfer, high acuity priority access beds

206.7 (1) A licensee of a long-term care home shall discharge a resident from a high acuity priority access bed if,

(a) the interdisciplinary reassessment required under section 206.8 indicates that the resident no longer requires and benefits from the type of care described in clause 206.5 (3) (c); and

(b) alternative arrangements have been made for the care required by the resident.

(2) The licensee of a long-term care home may transfer a resident who is being discharged from a high acuity priority access bed under subsection (1) to another bed in the home.

(3) A resident who is transferred under subsection (2) shall be deemed to have been discharged from the high acuity priority access bed and admitted to the home.

(4) The licensee may transfer residents out of a high acuity priority access bed and into another bed in the home despite the rules concerning transfer lists in section 207, subject to the first priority being given to residents described in clause 207 (1) (f) and despite subsection 207 (5).

(5) The licensee of a long-term care home shall transfer a resident who was admitted to a high acuity priority access bed from the waiting list kept under section 165 to another bed in the home in the class of accommodation chosen by the resident as soon as such a bed becomes available.

(6) Subsection (5) applies despite the rules concerning transfer lists in section 207, subject to first priority being given to residents described in clause 207 (1) (f) and despite subsection 207 (5).

(7) A resident who is transferred under subsection (5) shall be deemed to have been admitted to the home.

(8) The licensee shall notify the placement co-ordinator of every transfer under this section within 24 hours.

Reassessment

206.8 (1) The licensee shall ensure that every resident in a high acuity priority access bed undergoes an interdisciplinary reassessment every three months, or sooner if there is a change in the resident’s condition or circumstances, to determine whether the resident continues to require and is benefiting from the care provided in the high acuity priority access bed.

(2) Subsection (1) does not apply with respect to a resident who is admitted to a high acuity priority access bed from the waiting list kept under section 165.

Deemed basic accommodation

206.9 A resident who is admitted to a high acuity priority access bed from the waiting list kept under section 206.5 is deemed to be in long-stay basic accommodation for the purposes of sections 246 to 259 as long as the resident is occupying the high acuity priority access bed.

Commencement

8. This Regulation comes into force on the later of July 1, 2019 and the day it is filed.

 

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