Ontario LTC Background:
Long Term Care facilities are governed by the Ontario Government Ministry of Health and Long Term Care. The government licenses LTC “beds” where the government co-pays for all the care and services and the individual pays for the accommodations and meals fees. Therefore, for the most part, the rate for a LTC facility is the same at all homes and is set by the Ministry. On average, the 2020 rates were:
Basic Ward – $1891.27
Semi-Private – $2150.41- $2279.98
Private – $2474.34 – $2701.55
Rates vary by the age and classification of the home. Classification is determined by age and depending on new design standards. A ‘new’ bed (higher rate) is a class A building. An ‘older’ bed (lower rates) are considered class B, C, and D buildings.
As you may already be aware, there is limited availability in LTC facilities. Since the government significantly funds these beds to an average cost of $149.95 per resident per day, most facilities have lengthy waitlists. The global Covid-19 pandemic in 2020 also had a serious effect on the availability of beds across the province and this remains into 2021. Aside from the horrific reporting out of many Toronto area establishments and some Ottawa homes where Infection Prevention and Control (IPAC) failed, any facility that had even one case of Covid (staff or resident) was unable to accept any new admissions. This bottlenecked the process and has ultimately led to only those in a ‘crisis’ situation being considered for immediate placement and admission. Right now ‘immediate’ can equal several months wait.
Regardless of the wait or the availability, to be considered for LTC, you must meet a minimum health care requirement to qualify for admission. This is done through a referral with the LHIN (formerly CCAC) to complete an assessment. A LHIN Care Coordinator will connect with you and your loved one to complete an assessment. Once you qualify, you then complete their application form and select your top 5 LTC facilities.
Depending on the LTC facilities selected and your priority level, for some, this can now mean a wait time of up to 4-5 years. While you are waiting, many families look at transitional support and alternative options. Having all the facts and information while trying to manage a loved one’s declining needs is key to helping with caregiver stress and the quality of life of your loved one.
Alternative Options while in Transition to LTC:
Since many will be waiting for LTC admission for quite some time, it is important to have a plan. The most familiar options are to age at home with support coming in, or to relocate to a retirement residence. Both options can provide the personal and cognitive support and care while waiting for a bed to become available.
Aging at Home
Many seniors and caregivers are already aging at home. For many, they have the support of a caregiver who may be living with them, such as a spouse or even a close family member who visits frequently. The situation may become more pressing if the senior experiences a rapid cognitive and/or physical decline. This can be taxing on the caregiver and additional supports may be required. Again, having a plan in place for this type of situation is key to your success. Waiting for a crisis does not mean that they will get into the LTC facility you have selected faster. It may mean a hospital admission and/or caregiver burnout. Being proactive and not reactive is also key here.
The LHIN (formerly CCAC) can offer some aging at home support services for personal care, such as help bathing, dressing, transferring etc. Once you have completed the LTC admissions paperwork, a care coordinator is assigned to you. Your care coordinator should also be able to coordinate some funded services as home. It is important to note that these services are typically for personal care and are limited in hours. Meaning, there is a limit on the number of hours one can be granted for funded (free) services depending on need. These services also do not typically cover one-on-one companionship and homemaking services. Instead, they are usually helping in the morning and evening with dressing, personal hygiene and a bathing assistance option once/twice a week.
It is important to have a strategy to supplement what the LHIN can provide. This can include some additional municipal support programs such as Community Support Services (CSS). These programs offer reduced rates on transportation, housecleaning, maintenance etc. Veterans Affairs also has a program known as the Veterans Independence Program (VIP) where they offer funded support services. Unfortunately, many CSS physical programs have also been impacted by Covid (transportation, in home services, group gatherings at resource centres etc). and they have had to stop while the province regulates on Covid guidelines and protocols.
Once you have exhausted the funded programs, you can then look at private pay agencies. These agencies will fill in the gaps and supplement what you are receiving from the funded programs. However, one thing to consider is that having many different people and/or organizations coming into the home can be confusing and disruptive, so if you have the funds, using one private pay caregiver can provide more consistent, ongoing support. It is also very prudent with Covid to ensure the caregiver is not attending to many other people and that they are super diligent in wearing personal protective equipment (PPE) and adhering to strict IPAC while with you. Rates for a certified PSW range from $30-$35/hr. There is no HST added to these services if you are already receiving support from the LHIN. They also tend to have a minimum amount of hours they will attend in any one shift, usually three.
Many have selected a retirement residence as a transitional option while waiting for a LTC bed. The difference here is that there is no funding and the fees can range depending on the home and care levels. Retirement home rates range from $1900 – $7500+ and depend on size of accommodations and the level of care and support required.
A retirement residence can certainly offer assisted living and memory care support, at a cost. A small number can offer heavier levels of care and support including accommodating mechanical lifts and specialized care plans (feeding tubes). However, not all retirement communities are alike, and the services and rates will range drastically from place to place.
It is important to speak to a knowledgeable, independent expert in advance who can help you narrow down which options would be the best fit based on your individual needs, preferences and budget. These industry professionals have first hand experience in the senior housing sector, and can help you make important informed decisions and strategic financial plans.
Solva Senior Living can offer independent guidance, support and referrals to the care you need entirely unbiased and entirely for free under their Rapid Resources Program. www.solvaseniorliving.ca or 613-421-6073. Above and beyond these services, Solva can also offer an Advanced Senior Living ElderCare Plan which can outline strategies, services and a budget for a variety of scenarios that could be required in the future while you wait.
- There are 626 homes licensed to operate as LTC facility in Ontario (Feb 2019)
- 58% of homes are privately owned, 24% are non-profit/charitable, 16% are municipal
- About 40% of long-term care homes are small, with 96 or fewer beds
- Of these small homes, about 45% are located in rural communities that often have limited home care or retirement home options
- 77,257 long-stay beds are allocated to provide care, accommodation and services to frail seniors who require permanent placement
- Approximately 300 of the province’s long-term care homes are older and need to be redeveloped (more than 30,000 beds)
- The average time to place in long-term care, as of Feb 2019 was 161 days*
- The number waiting for long-stay beds, as of Feb 2019 is 34,834*. This is an increase of 2059 since Oct 2017
Provincial funding for long-term care in 2018:
- $4.28 billion (7.7% of the overall provincial health budget)
- $149.95 per resident, per day ($54,730 per year)
- Approximately $100.91 per day for nursing and personal care (such as assistance with personal hygiene, bathing, eating, and toileting)
- $12.06 per day for specialized therapies, recreational programs, and support services
- $9.54 per day for raw food (ingredients used to prepare meals)
About the Author:
Christine Forget grew up in the senior housing sector here in Eastern Ontario where she has ultimately pursued and spent the last 25 years working in, managing and operating seniors housing communities and LTC facilities. She is a respected member of faculty on the Retirement Management Communities Program at Algonquin College. In 2013, she started Solva Senior Living, the first private sector independent consulting firm in Ottawa; specifically to help families find the right options for their loved ones at no cost.
*these are the latest official figures published that we are able to find. Covid has had a huge impact on these numbers and the waiting times are no longer accurate.
*information provided from Long-Term Care Utilization Report, February 2019, Ontario Ministry of Health and Long-Term Care; Ontario Long Term Care Association, internal database, 2019.