Bill 160, the Strengthening Quality and Accountability for Patients Act, 2017 (the Act), was enacted by the Government of Ontario on December 12, 2017. The Act will repeal five pieces of legislation, amend seven pieces of legislation, and create three new pieces of legislation when all is said and done.
The purpose of this blog post is to provide an overview of the significant amendments the Act brought to the Long-Term Care Homes Act, 2007 (the LTCHA) and the Retirement Homes Act, 2010 (the RHA). Generally, (i) the amendments to the LTCHA add to the enforcement powers under such act and establish a consent-based framework to protect residents who need to be secured in such homes for safety reasons, and (ii) the amendments to the RHA strengthen the oversight powers of the Retirement Homes Regulatory Authority (the Authority) and increase accountability with respect to the Authority. The amendments to the LTCHA will come into force on a day to be named by proclamation of the Lieutenant Governor. The majority of the amendments to the RHA have come into force, with certain exceptions, including Section 70 relating to confinement as detailed below, that will come into force on a day to be named by proclamation of the Lieutenant Governor.
Long-Term Care Homes Act, 2007
Schedule 5 of the Act amends the LTCHA. Long-term care homes in Ontario are governed by the LTCHA and their operations are overseen by the Ministry of Health and Long-Term Care.
As a result of the amendments to the LTCHA, the Minister will have the power to (i) suspend a licence for the operation of a home under the LTCHA and (ii) issue operational and policy directives to long-term care homes. In addition, the Director who oversees the regulation of long-term care homes will also have the ability to suspend a licence for the operation of a home under the LTCHA, which is in addition to his or her pre-existing power to revoke such a licence. The Director and inspectors acting pursuant to the LTCHA will also have the ability to impose administrative monetary penalties of up to $100,000 when the amendments come into force.
In recent developments, the Ministry of Health and Long-Term Care is also proposing to amend Ontario Regulation 79/10 (the Rate Reduction Program) under the LTCHA. If approved, the proposed amendments would come into effect on the later of (i) May 1, 2018 and (ii) the date on which they are filed. At the present time, applicants of the Rate Reduction Program are required to submit a Notice of Assessment (NOA) with their application for a reduced co-payment rate. However, not all applicants are able to readily obtain a copy of their NOA as the Canada Revenue Agency (CRA) only issues it once a year. As a result, applicants frequently experience delays in submitting their application. The proposed changes would allow applicants to submit a Proof of Income Statement (Option-C Print) (which is a document provided by the CRA upon receiving a request from a person for a lost/new NOA document) or provide consent to have their income information verified electronically as an alternative to submitting their paper-based NOA form.
Retirement Homes Act, 2010
Schedule 10 of the Act amends the RHA. The RHA governs retirement homes in Ontario, which are regulated by the Authority. The Act gives more powers to the Authority in its oversight of retirement homes by expanding the Authority’s ability to deal with unlicensed homes. Inspectors acting pursuant to the RHA and on behalf of the Authority can now (i) enter retirement homes that are unlicenced to ensure compliance with orders to cease to operate and (ii) enter retirement homes where they believe there might be harm to the residents resulting from such homes operating without a licence or failing to comply with the RHA.
The Act also amends the confidentiality provisions of the RHA. Information can now be disclosed by the Authority to a person that administers or enforces another act (e.g., a health regulatory college) if the purpose of the disclosure is to “aid an inspection, investigation or similar proceeding” and if the information is related “to compliance with [the RHA] or the regulations or related to a serious incident relating involving a retirement home.”
As a result of the enactment of the Act, the Authority is now subject to audits conducted by the Auditor General of Ontario. The Minister of Seniors Affairs’ powers are also expanded to include the power to order that policy, legislative or regulatory reviews be carried out in relation to the powers and duties of the Authority.
Confinement of a Resident or Patient
The Act contemplates changes to the conditions for confinement of a patient or resident under the RHA, the LTCHA and the Health Care Consent Act, 1996 (the HCCA). These provisions have not yet come into force. Once enacted, these provisions will modify the regime for confinement under the RHA and the LTCHA, including the conditions in which it is permissible for a resident to be restrained or confined. The amendments introduce a consent-based system and provide for rules on who may give consent to confine on behalf of an incapable person under the HCCA.
Once such provisions come into force, a decision to confine a resident under the LTCHA will automatically be reviewable by the Consent and Capacity Board on request from the resident. Similar changes are contemplated for the RHA, where the resident will not have an automatic right of review by the Consent and Capacity Board but a right to apply for review. Residents of a retirement home will also be entitled to receive specific information in cases of confinement under the RHA.
The above summary provides a general overview of some of the changes to the LTCHA and RHA that have now become law or will become law once proclaimed into force.