All long-term care homes in Ontario operate according to general principles and specific guidelines and requirements outlined in the following :

• Laws — statutes passed through a vote in the Ontario Legislature and the regulations associated with those statutes
• Service Agreements — contracts between the home and the Government of Ontario
• Standards — standards and policies, set by the government, that all homes must meet or follow

Long-term care homes provide a home-like setting where a resident's physical and care needs are met, and where his or her psychological, social, cultural and spiritual needs are met as well. The government's guiding principle with respect to long-term care in the province states that all homes must meet the needs of its residents.

A home that fails to uphold standards or comply with regulations or policies is referred to as being "non-compliant”. Non-compliance may or may not put residents at risk, and usually indicates that a home is not meeting its residents' needs in some way.

The ministry may learn of a home's non-compliance because a resident, family member or member of the public has made a complaint. Non-compliance may also be identified by staff at a home, or through the ministry's regular reviews and inspections.

Once the ministry has received a complaint or been alerted to a problem, a process is set in motion. This process gives the home an opportunity to address the problem, depending on its nature, within a certain period of time. It also allows the government to take steps to enforce the standards and policies, should the home not act soon enough or take adequate measures.

• Residents' rights
• The ministry's regular inspections and reviews
• How the government enforces its standards
• What happens when you make a complaint
• How to make a complaint
• Public Reporting on LTC Homes

Residents of long-term care homes deserve to be cared for in a respectful and compassionate way. They can and should expect their lives to be free from abuse and neglect.

Each of the three acts that govern long-term care homes provides for the rights of residents. The Nursing Homes Act, for example, includes a "Residents' Bill of Rights”, which sets out the following :

• The residents' right to be treated with courtesy and respect
• The right to be adequately sheltered, fed, clothed, groomed and cared for, according to one's needs
• The right to privacy in treatment and the tending to one's personal needs
• The right to be informed of one's medical condition, treatment and proposed treatment
• The right to consent to or refuse treatment, and to obtain an independent medical opinion
• The right to have medical records and other aspects of one's treatment kept confidential
• The right to receive visitors
• The right, when a resident's death appears to be near, to have family members present 24 hours a day

When a home fails to meet its residents' needs, whether intentionally or unintentionally, the resident, a family member, friend or a member of the public can report the problem to the ministry, whose staff will address the matter with the home.

The government conducts regular annual reviews of all long-term care homes in Ontario. As of January 2004, the government has improved its annual review process by making these inspections unannounced.

Each regional ministry office has on staff one or more inspectors known as "compliance advisors.” The compliance advisor, who is a registered nurse, carries out the annual reviews for homes in her or his region. Compliance advisors look to ensure that each home is operating according to its service agreement (i.e. contract), the relevant legislation and regulations, and the standards outlined in the program manual for long-term care homes.

The annual review covers all aspects of a homes operations, including :

• The general condition of the residents (including matters of personal hygiene)
• Residents' care plans (when a resident is admitted to a home, a registered nurse prepares a care plan for that resident, based on his or her medical, dietary and other needs; these plans are updated quarterly and when a resident's needs change)
• Programs and services offered
• Health and safety issues
• Any areas of non-compliance identified in previous visits

This yearly inspection also includes on-site visits, during which the compliance advisor will interview residents and family members, caregivers and administrative staff in each home. This part of the review examines the following :

• Standards of resident care
• Interactions between residents and staff
• Physical environment

As part of the annual review, the compliance advisor also reviews a sampling of residents' clinical records, and data related to complaints and what are called "unusual occurrences.” (These occurrences include, suspicious deaths, allegations of abuse, and falls or other injuries that require hospitalization.)

When a compliance advisor completes a home's annual review, she or he prepares a written report — which is a public document — and sends copies to the home. All long-term care homes must post the results of their most recent annual review in a public place on the premises. Residents, those considering becoming residents, and their families can obtain a copy of the report directly from a home.

If an annual review identifies standards that are not being met — or other problems — the compliance advisor will conduct a follow-up inspection(s) to ensure that the matter is resolved.

A compliance advisor may wish to bring along a team during an annual review, which may include a dietary advisor and/or an environmental health advisor.

The annual review is not the only inspection a long-term care home undergoes within the course of a year. Compliance advisors conduct site visits anytime someone makes a complaint against a home, or when a problem comes to their attention through some other means. Depending on the nature of the complaint or problem, a compliance advisor may investigate the matter alone, or may consult with one or both of the following colleagues :

• Dietary Advisor — a registered dietitian who ensures that a home is meeting the special dietary needs of its residents, and inspects all aspects of the preparation and presentation of the residents' food
• Environmental Health Advisor — a certified public health inspector (with a background in long-term care) who inspects the design and maintenance of the home, including : heating and ventilation, infection control, the handling and storage of foods, and the resident-to-washroom ratio

The compliance advisor may request that either or both the dietary advisor and the environmental health advisor participate in a home's annual review.

When a home fails to address identified problems or other issues of non-compliance, the government can impose sanctions on that home. In order to bring a home up to standard or back into compliance with the regulations and policies, the government can :

• Suspend admissions — meaning that the home cannot admit any new residents until the problem is resolved
• Suspend or revoke the home's license or approval for a license
• Refuse to renew a license — this applies only to nursing homes, which must renew their licenses each year
• Take over the operation of a home

Homes against which enforcement measures are taken undergo increased monitoring to ensure that the needs of existing residents are being met.

Once the ministry receives a complaint about a long-term care home, a process is set in motion. The appropriate regional office of the ministry will begin an investigation within 20 working days of receiving a complaint.

Complaints that indicate that residents are at risk are investigated immediately by the ministry.

The investigation of a complaint may involve an interview with the person who made the complaint and a visit to the home. If the inspector finds evidence of the problem identified, the ministry documents the matter and gives the home 14 days to develop a plan of action to fix the problem. Often, a home will correct the problem or bring itself up to standard within that time.

In situations where a long-term care home does not address a problem adequately or quickly enough, or if continued non-compliance threatens to put residents at risk, the government can resort to other measures to enforce the standards or guidelines. (See the above for "How the government enforces its standards”.)

Once a complaint has been investigated fully, the ministry will notify the person or persons who made the complaint that the matter has been investigated. Concerns about privacy may limit the information that the ministry can share with the original complainant.

Any member of the public — a resident's family member, someone employed by a home, or a member of the public — can register a complaint about a long-term care home. All complaints are investigated.

The government and its staff treat complaints as strictly confidential. It is helpful during ministry investigations when those who are lodging a complaint identify themselves, because the investigators usually interview the person making the complaint to verify the facts. Ministry staff (including INFOline agents, compliance advisors and administrative staff) take great care to protect the identity of the complainant and the resident(s) involved. (Policies also exist to protect employees of long-term care homes who lodge complaints against their employers.)

You have several options for making a complaint :

1. Contact the home directly



2. Call the toll-free Long-Term Care ACTION Line at 1-866-434-0144.
   
   An INFOline agent will speak with you, assess the urgency of the situation, and forward your information to the appropriate regional office. A compliance advisor — a registered nurse with authority under law to investigate complaints — will contact you within two business days. Complaints of an urgent nature will be investigated immediately.

   The Long-Term Care ACTION Line is open 7 days a week,
   from 8:30 a.m. to 7:00 p.m.



3. Send a written letter of complaint, by mail, to the following address :
   
   
   Director, Long-Term-Care Homes Branch
   Ministry of Health and Long-Term Care
   5 ^th Floor, Hepburn Block
   80 Grosvenor Street
   Toronto, Ontario
   M7A 1R3
   

You will receive an acknowledgement of your written complaint.

4. If you are used to contacting your regional office directly with complaints or other concerns, you may continue to do so. Each long-term care home posts the phone number and mailing address for the compliance advisor for the region. Any resident, family member or other concerned individual may contact the compliance advisor directly.
   
   A list of phone numbers for the ministry's regional offices appears below :
   • Toronto : 416-327-8952
   • North : 705-564-7280 or 1-800-663-6965
   • East : 613-569-5602 or 1-877-779-5559
   • Central East (Newmarket) : 905-954-4700 or 1-800-486-4935
   • Central West (Mississauga) : 905-897-4610, or 1-866-716-4446
   • Central South (Hamilton) : 905-546-8294 or 1-800-461-7137
   • Southwest (London) : 519-675-7680 or 1-800-663-3775

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