1. ORCA Accreditation Standards to Retirement Home Regulations in Ontario, The Impact on Operations Millie Christie, Regional Manager Eastern Canada Diversicare Canada Management Services Co., Inc.

2. AGENDA  Background  Regulation - scope, definition of retirement home, etc.  ORCA Accreditation to Regulation  What Changed and What Were Costs? (phased implementation)  Conclusion

3. BACKGROUND  Residents are 100% private pay  Services within sector go from no services through to assistance with activities of daily living, self medication, medication administration, memory care, etc.

4. Pre 2010 and Regulation  Tenant Protection Act, Public Health, Fire Code and Building Code  Ontario Residential Care Association (ORCA) accreditation standards

5. CBC Marketplace - “Law of the jungle regulates retirement homes” CBC MARKETPLACE: HOME » RETIREMENT HOMES 'Law of the jungle' regulates retirement homes Broadcast: March 14, 2000 | Producer: Harvey Berkal; Research: Laura Boast Between living in your own home and requiring a nursing home there's a murky area of seniors' homes called "retirement homes." They're meant for seniors who need just a little help with meals and maybe some personal care. But in Canada, retirement homes are poorly regulated and in some of them, life for elderly, vulnerable people has become a nightmare. But there are things you can do to avoid bad retirement homes. At 82, Werner Gumprich is shopping for a retirement home. He's about to become one of the tens of thousands of Canadians living in one. But he must choose carefully. Other seniors have found poor care, neglect - even abuse - in places that promised they were good homes……..

6. CBC news - Elder abuse warrants tighter rules for retirement homes,…. Elder abuse warrants tighter rules for retirement homes, aides: police CBC NewsCBC News Posted: Nov 18, 2008 5:51 PM ET Last Updated: Nov 18, 2008 5:44 PM ET Seniors risk being abused because of the lax regulations concerning retirement homes and the personal support workers who help care for seniors, says a detective with the Ottawa police elder abuse unit. Det. Christina Wolf said 81 of the 468 suspected elder abuse cases investigated by her unit since 2005 took place at private, unregulated retirement homes. She added that there may be cases that don't come to the attention of police because there's no obligation to make those reports.

7. Factors Contributing to Pressure to Regulate Retirement Home Sector  Aging population  Increasing care needs  Pressure on public system of healthcare  Public pressure to protect seniors  Pressure from stakeholders and advocacy groups

8. Public Consultation Suggestions to Government (Sept 7, 2007 News Release)  Establish mandatory provincial-wide standards  Establish a new agency, independent from government, to enforce these standards  Build on the existing voluntary standards of the Ontario Retirement Communities Association (ORCA), refined over the past 13 years, and  Provide education and training for all retirement home staff so they can understand and meet the new service standards.

9. Retirement Homes Act – June 8, 2010  Phased proclamation of the Act  Allowed operators time to understand and put in place requirements  Heavier costs in final phase

10. Legislation and Ministry  BC MOH Community Care and Assisted Living Act AL Registrar Community Care Facilities Assisted Living

11. Legislation and Ministry  Ontario MOHMinister Responsible for Seniors Retirement Home Regulatory Authority Long-Term CareRetirement Homes

12. The Fundamental Principle of the Act :  The fundamental principle to be applied in the interpretation of this Act and any regulation, order or other document made under this Act is that a retirement home is to be operated so that it is a place where residents live with dignity, respect, privacy and autonomy, in security, safety and comfort and can make informed choices about their care options.

13. Summary Definition from RH Act, of a Retirement Home in Ontario  A retirement home is a building, group of buildings, or a part of a building (with one or more rental units):  Occupied primarily by persons who are 65 years of age or older;  Occupied or intended to be occupied by at least six (6) persons who are not related to the operator of the home; and  Where the operator of the home makes at least two care services available (directly or indirectly) to residents.

14. Care Services The Act lists 13 different types of care services and the regulation sets out the standards for those care services. Care services:  Nursing service (provided by a registered nurse)  Medical service (provided by a registered physician)  Pharmacy service (provided by a registered pharmacist)  Administration of a drug  Assistance with feeding  Assistance with bathing  Assistance with dressing  Assistance with personal hygiene  Assistance with ambulation  Continence care  Provision of a meal,  Dementia care  Skin and wound care.

15. Mandate of the RHRA :  To license and regulate retirement homes  Maintain public registrar of retirement homes  Handling of complaints about retirement homes  Educating retirement home operators, consumers, and public about the Act.

16. ORCA Accreditation Standards to Act - Ontario

17. ORCA Accreditation Standards to Regulations – Ontario

18. ORCA Accreditation Standards to BC Seal of Approval

19. Section 75 – Mandatory Reporting  75 (1) A person who has reasonable grounds to suspect that any of the following has occurred or may occur shall immediately report the suspicion and the information upon which it is base to the Registrar:  Improper or incompetent treatment or care of a resident that resulted in harm or a risk of harm to the resident.  Abuse of a resident by anyone or neglect of a resident by the licensee or the staff to the retirement home of the resident if it results in harm or a risk of harm to the resident.  Unlawful conduct that resulted in harm to a resident.  Misuse or misappropriation of a resident’s money.

20. Top 5 Areas of Non- Compliance in Mandatory Reporting Inspections  Failure to protect residents from abuse and neglect (RHA, s. 67 )  Failure to train staff before they begin working in the home [O. Reg. 166/11, s. 14 (4)]  Failure to report harm or risk of harm to Registrar (RHA, s. 75)  Failure to follow home’s abuse policy  No complaint procedures and or failure to respond to complaints under section 74

21. Fees 100 Suite RHOntarioBC (AL only) Registration/License Fee * note this is a one time cost $1200 (HST does not apply) $250 Annual suite fee $12,204 (inclusive of HST)$1250 Total $13,404$1500

22. RHRA Application Review The RHRA reviewed the application using criteria that are set out in the Act. The criteria relate to:  past conduct  your ability to provide care services, and  your competency to operate the home in a responsible manner in accordance with the Act

23. RHRA Application Review The RHRA used a risk-based approach to review applications. This approach recognizes that homes applying for a license will have different levels of readiness to comply with the Act. Homes that the RHRA considers lower risk may proceed more quickly through the process and with fewer steps than other homes. Factors the RHRA will use to assess risk include, for example, whether you have:  a “no restraint” policy  a policy to protect residents from abuse  an emergency plan  Other factors include past compliance with fire safety and public health standards, and procedures for staff training.

24. Public Registry The Act requires the RHRA to keep a public register that contains information about applicants and licensees.  Starting on April 15, 2012 the RHRA will post the register on its website, www.rhra.ca. Information in the register includes, for example, basic information such as the name and address of the retirement home, care services provided, and number of residents in the home. The register will also include summaries of inspection reports and any orders under the Act with respect to licensed homes.

25. Sample List of Additionally Required Resident Information  Introduction  Role of the Retirement Homes Regulatory Authority  Information about the Licensee  Residents’ Bill of Rights  Licensee Policies  Zero Tolerance Abuse and Neglect Policy and Mandatory Reporting Obligations  Whistle Blower Protection  Infection Prevention and Control  Policies Related to Services  Community Care Access Corporation  External Care Providers and Non-Arm’s Length Relationships with Service Providers  Personal Assistance Services Devices  Privacy and Personal Health Information  Reducing the Risks of Falls  Reductions or Discontinuation of Care Services  Resident Assessments  Secure Units  Trust Accounts  Transferring a Residency  Programs, Activities and Services  Special Programs, Activities and Service  Residents’ Council  Residency Agreement  Language Services 30  Acknowledgement Form – RESIDENT PLEASE SIGN

26. Training Before Start of Work  The residence abuse policy  Whistle-blowing protection  Policy on personal assistive devices (PASDs)  Injury prevention (falls)  Fire prevention and safety  Emergency plan  Acts/regulations/policies relevant to the person’s duties.

27. Complaints  Respond to complaints within 10 days  Keep a record of complaints, with the date, response, action, etc.  Review the record of complaints quarterly, for trends  And complaints apply to verbal and written complaints with the exception of verbal complaints that are resolved within 24 hrs.

28. Phase 3 – January 1, 2013  Resident council assistant  Care service standards  Plan of care and assessments  Alternatives to retirement homes  Safety plans  General standards  Records  TB testing

29. Phase 4 – July 1, 2013  Ceasing to operated as a retirement home  On-going and additional training for staff  Training of volunteers  Trust accounts

30. Phase 5 – January 1, 2014  Hiring staff (background checks)  Complaints to the Registrar  Approval of plans of care  Emergency fund  Complaints officer  Risk officer  Extra expense insurance

31. Conclusion …embrace safety standards as set out in your BC Seal of Approval, encourage others to do the same, and always work together to raise the bar!