Today’s post was written by guest blogger, Melissa Miller, Partner at Howie, Sacks & Henry LLP.

Ask anyone whether admission to a nursing home is part of their retirement plan and they will likely say, “I’ll never go to one of those places”, or something worse. As we all know, the best laid intentions do not always go as planned. Many of us will have family with complex health issues as they age or will find ourselves in that boat. Sometimes, believe it or not, a nursing home is the most appropriate place to be. But what is a “nursing home”? It is a colloquial term that many people use to describe various types of congregate living for seniors, or those with disabilities, and can include assisted living facilities, retirement homes or long-term care homes.

Long-Term Care Home vs Retirement Home

There are many differences between retirement homes and assisted living facilities, and long-term care homes. The main difference is that retirement homes and assisted living facilities are completely private, where long-term care homes are subsidized by the government and cap what a resident will have to pay on top of the government contribution. The other major difference is the level of care that is provided in each. Long-term care homes provide the highest level of care for the most complex needs outside of an acute hospital care setting. Retirement homes and assisted living facilities are sometimes a distinction without a difference. Most refer to retirement homes as “independent living” within a retirement community. There may be hospitality services like housekeeping and meals offered, but otherwise the resident lives independently. However, many retirement homes offer various levels of care, that are paid for by the resident, completely private and “a la carte”, which make it more of an “assisted living facility”. Many are able to handle fairly complex needs, but certainly for a price!

On average, a resident may pay anywhere from $1200 to $2,500 per month for long-term care (depending on whether they have a shared or private room, and their level of income). Retirement homes have a drastic range of monthly costs and can exceed $15,000 per month, if the care needs are on the higher end.

Long-term care homes are governed by the Fixing Long-Term Care Act[1], where retirement homes are governed by the Residential Tenancies Act, 2006[2] and Retirement Home Act, 2010[3]. Residents of a retirement home are tenants to the landlord and adhere to a rental agreement, which means residents have the same rights as any other tenant to a landlord.

Both types of homes are governed by a “Bill of Rights” in their respective legislation that covers everything from protecting independence and relationships, to protection from abuse (which could be physical, emotional, sexual, verbal and/or financial) and negligence. The FLTCA states at its outset the fundamental principle that a long-term care home is “primarily the home of its residents and is to be operated so that it is a place where they may live with dignity and in security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs met.”

No matter the type of home, residents have the right to have a “Plan of Care” or care plan that dictates every aspect of their needs, for which the home is responsible. Most negligence cases derive from either an inadequate care plan, a breach of a care plan, or both. It is essential to be on the lookout for signs of any neglect or abuse as early as possible.

Signs of Neglect or Abuse

The most common signs of neglect or abuse are:

• Unexplained and/or untreated injuries – pressure injuries (“bed sores”), cuts, bruises
• Poor personal hygiene
• Unsanitary conditions
• Malnourished/dehydrated
• Over-medicated
• Sudden decline in health
• Fear/complaints
• Belongings or money go missing

Steps if suspect negligence or abuse:

If you suspect neglect or abuse, you can take steps to protect the resident, depending on the level of urgency:

• Very urgent – 911
• Urgent – Long-Term Care Family Support and Action Line – 1-866-434-0144
• Non-urgent – Ministry of Long-Term Care complaint or Retirement Home Regulatory Authority

Many fear filing a complaint with the regulating body of a home (Ministry of Long-Term Care for long-term care homes and the Retirement Home Regulatory Authority for retirement homes), but in reality, lodging a complaint typically enhances the care of the resident. Further, if the complaint results in an inspection, it is public record. Homes take these complaints seriously and often take corrective measures following a complaint.

Tips for Prevention:

Of course, we all hope that our loved ones will never have to face any neglect or abuse. There are things families can put in place to either prevent or limit abuse and neglect. Unsurprisingly, the best thing families can do is be actively involved in their loved one’s care from the outset. Clear communication with the care team, and where necessary, expressing concerns in writing, is always the best starting point. The staff have to get to know the residents, and help from the family (especially if the resident is unable to effectively communicate preferences) is key.

This also means frequent visits. This is a challenge for some families where the care responsibilities fall on one individual, there are competing childcare or work responsibilities, or distance is a factor. In this case, it is worth considering hiring another care worker to be an extra set of eyes and ears, if budget allows. These homes are not a “set it and forget it” environment – many homes are understaffed and rely on involvement from the family.

Finally, having a “granny cam” in the resident’s room is another good idea. There are even some where there can be video chat interaction that can facilitate easier touchpoints than relying on a phone. It is perfectly legal to have video streaming without sound. Video with sound is debatable. The law requires the consent of at least one person being recorded and where the resident lacks capacity, it is undetermined whether that person can be the substitute decision maker. Also, if the room is shared with another resident, ensuring the other resident’s privacy is protected, or that they consent, is key.

Ultimately, there is no easy solution when someone we love requires nursing home care but there is power in knowledge and we know that an ounce of prevention is worth a pound of cure!

[1] S.O. 2021, c. 39, Sched. 1 [“FLTCA”].

[2] 2006, S.O. 2006, c. 17.

[3] 2010, S.O. 2010, c. 11.