DURING the Covid pandemic, there was a lot of information in the news about Long Term Care homes, both here in Ottawa and in the greater Ontario province. Several facilities struggled to keep the virus out of their buildings, and as a result, many residents passed away. The Ford government is addressing this and focusing on a thorough review of LTC homes to ensure a situation like this doesn’t occur again.
We spoke with many seniors and their families at this time who were rightfully concerned about their loved ones being exposed to Covid-19. What was prevalent however, was that many did not understand that retirement homes and Long Term Care homes are two intrinsically different entities. Because of this, we wanted to break down some common misconceptions and explain the differences – and some similarities -, so everyone can feel properly informed.
Level of Care Provision (a similarity)
Often referred to as ‘nursing homes’, LTC facilities generally provide full, heavy care assistance to their residents. This can be physical support, cognitive support or both. Some retirement homes are also able to provide the same high care needs, including mechanical lifts for transfers, full incontinence support, one-on-one feeding and administration of all medications including injections. This is a similarity. The main difference here though, is the cost. Retirement homes for the most part are all privately paid for by the resident. Long Term Care is subsidized by the government (see below). Retirement homes can accommodate individuals who are looking for carefree, independent living, right up until end of life support. However, not all retirement homes offer advanced levels of care, whereas LTC facilities only offer this provision of care. Both retirement homes and LTC can offer periods of respite, although again, the pricing will be different. It is $40.35 a day in LTC and usually from $90 a day in a retirement home. All meals, care, activities and 24/7 nursing support will be provided.
Ownership (a similarity)
99% of retirement homes in Ottawa are privately owned, either by an organization or company or by a family. 90% of Long Term Care Homes in Ottawa are also owned by an organization or company and equally, work ‘for profit’. The 10% of LTC homes here that are ‘not-for-profit’ are run either by the City of Ottawa (Garry J. Armstrong, Peter D. Clark and Carleton Lodge) or other organizations (St Pats, Hillel Lodge and Perley and Rideau Veterans’ Centre). Not-for-profit LTC homes often have a foundation, along with a bank of family volunteers who fundraise and all monies raised go directly into additional resident improvements – whether that be a new garden, new equipment or programming. By contrast, private LTC homes are often more corporately focused and although they do invest in their buildings, staff and residents, they are responsible to shareholders and look to be able to turn a profit, thereby having less to ‘give back’.
Funding and Paying for Service (a difference)
As mentioned, ownership is very similar but funding and service is different. In a retirement home, the price you pay covers rent of the accommodation, provision of hospitality services (meals, activities, housekeeping) and then any care needs that you have. Homes either have packaged care support for a certain price, or an a la carte style of access where you pay for only what you need and the level at which you need it. In many places, you are also responsible for renting or buying a hospital bed if needed, hiring a mechanical lift if needed and providing/paying for all incontinence products if needed. In Long Term Care, the resident pays for their accommodation and meals and the provincial government pays for the care portion. This also includes hospital beds, lifts and incontinence products.
Accommodations (a difference)
The set up of the accommodations is also different. In a retirement home you have your own room and private ensuite. This might be a studio space up to a two-bedroom, two bathroom suite. There are a few options for you to share a room with another person in a retirement home but for the most part, your space is your own and you can personalize it with furniture, pictures and photos. Often there are kitchenettes, a choice of a tub or shower, and different fixtures and finishings. In LTC, you can have a private room, along with a semi-private room (sharing with another of the same gender) or a basic room, where up to four people sleep. The Ford government is looking into whether four-to-a-room is healthy and safe following the Covid effects in LTC and right now, the most that will be accommodated is two to a room. LTC rooms come with a hospital bed, a chair, a cupboard and a closet (which you might be sharing). The bathroom is usually a sink and a toilet as bathing is done in a shared shower or tub room. Flooring is easy to clean and doorways are wider to accommodate walkers and wheelchairs easier. Everyone pays the same towards their room and board in LTC based on their room set up; $2701 for a private room; $2280 for a semi-private and $1891 for a basic. In a retirement home prices vary from home to home and there is no one set standard across the board.
Governance (a difference)
In 2010 The Retirement Homes Act was passed in parliament and from this in 2011, the Retirement Homes Regulatory Authority was formed. The RHRA is an independent, self-funded, not-for-profit regulator mandated by the government to protect and ensure the safety and well-being of seniors living in Ontario’s retirement homes. Although they look out for the best interests of residents, they do not set any rules for homes to follow in terms of care provision, pricing, accommodations offered or the ratio of staff to residents. This is different for LTC as the Ministry of Health and LTC regulates, inspects and sets out accommodation fees for all provincial facilities regardless of location.They will also investigate any complaints that have been raised to them, and the RHRA will do the same for retirement homes.
Access (a difference)
To be eligible for Long Term Care, you must be 18+ years of age and be a resident of Ontario with an OHIP card. You must also have care needs that can be met in LTC and cannot be met in your home or in a retirement community based on level of need or for financial reasons. The Local Health Integration Network (LHIN) is the gatekeeper for all LTC admissions and to be considered for a place, you must contact the LHIN and begin the intake and assessment process. A case coordinator will meet with you, and ultimately decide whether you’re eligible at that stage to be put on their list. You will have the opportunity to choose up to five residences and then ultimately wait to be called. If your health deteriorates or circumstances change there are options to get a place sooner, but again, you would need to do this through your assigned LHIN coordinator and you might not get a home that is one of your five choices.
In a retirement home there is very rarely any waiting. There are often all types of suites available and move-ins can happen within 72 hours. Right now this is dependent on Covid testing but it is doable. We often help clients with ‘rapid response assistance’, especially if they’re in hospital and realize they can’t safely go back home. Here we immediately provide options based on care needs, budget and location and do all the liaison for you so you can concentrate on getting better. Our service is free and there is never any obligation. Many people also choose to use a retirement home as a stepping stone to eventual LTC; remaining as independent as possible but taking advantage of care services when needed and the added peace of mind of 24/7 nursing support. There are many options to suit every taste and budget but it can be overwhelming navigating this alone. We are always here to help.
www.ontario.ca/page/about-long-term-care – learn more about the process, eligibility, wait times for LTC
www.oltca.com – the Ontario Long Term Care Association. Advocates to influence policy, legislation and regulatory change
www.rhra.ca– read any reports on retirement homes you may be considering.
www.champlainlhin.on.ca – LHIN to speak to re starting a LTC application or to seek in home care support
Wonderful explanation of the system. Perhaps an additional paragraph explaining the process when one decides when their name comes up on the LTC list that’s it’s too soon. Also include an explanation of a situation in crisis.
Hi Bernie Thanks so much for your note and we are already planning just that. There is a lot of confusion around retirement homes and LTC facilities so we are planning our next article around the admission process and strategy. Stay tuned!!
Thanks for providing this very useful explanation of the differences. Most people don’t have any understanding of this until a critical moment when there is a need. Clarification allows informed decision making in advance.