1. Advocacy Centre for the Elderly - May 1, 2009 1 Family Council Network – Regional Meeting – LHIN 13 “Access to Justice” in Long-Term Care Homes Consultation

2. Advocacy Centre for the Elderly - May 1, 2009 2 The Research Project The Law Commission of Ontario (LCO) has a multi-year project to develop a new framework to analyze and understand the impact of the law on older persons More information can be found at the LCO’s website: http://www.lco- cdo.org/en/olderadults.htmlhttp://www.lco- cdo.org/en/olderadults.html

3. Advocacy Centre for the Elderly - May 1, 2009 3 The Research Project ACE has been awarded a research grant to research the best ways of enforcing the rights of older adults in institutional settings (e.g., hospitals, long-term care homes and retirement homes). ACE is speaking to different stakeholders (residents, staff at institutions, families, lawyers) to find out what they think what works, what does not work and how the system can be improved

4. Advocacy Centre for the Elderly - May 1, 2009 4 Access to Justice: Myth or Reality? On paper, there appears to be many protections available to older adults in long-term care homes But, can these rights be easily exercised or enforced?

5. Advocacy Centre for the Elderly - May 1, 2009 5 Barriers to Justice Access to justice for older persons is a huge obstacle in the administration of both civil and criminal justice. Older adults are often confronted with many barriers, such as: Ageism; A lack of awareness of legal rights; Financial barriers; An insufficient number of lawyers practicing elder law;

6. Advocacy Centre for the Elderly - May 1, 2009 6 Barriers to Justice Lengthy court proceedings; Physical barriers in attempting to access the legal system; The lack of rights advice for residents of long-term care homes; Failure of legal system to recognize the value of older adults; and Inadequate legal protections.

7. Advocacy Centre for the Elderly - May 1, 2009 7 Common Problems No informed consent for treatment Residents are not involved in meetings, care conferences, etc. Inadequate staffing levels or staff who are not properly trained Residents are not allowed to leave the long- term care home Accessibility issues and physical barriers

8. Advocacy Centre for the Elderly - May 1, 2009 8 Resident’s Bill of Rights The Resident’s Bill of Rights for is included in the statute(s) governing long-term care homes CLEO and ACE publication – “Every Resident” reviews these rights: http://www.cleo.on.ca/english/pub/onpub/P DF/seniors/everyres.pdf http://www.cleo.on.ca/english/pub/onpub/P DF/seniors/everyres.pdf Current versus new legislation: Nursing Homes Act = 19 rights New Long-Term Care Homes Act = 27 rights Very few areas of change

9. Advocacy Centre for the Elderly - May 1, 2009 9 Resident’s Bill of Rights Treated with courtesy and respect and in a way that fully recognizes the resident’s dignity and individuality and to be free from mental and physical abuse. Properly sheltered, fed, clothed, groomed and cared for in a manner consistent with his or her needs. Told who is responsible for and who is providing the resident’s direct care.

10. Advocacy Centre for the Elderly - May 1, 2009 10 Resident’s Bill of Rights Afforded privacy in treatment and in caring for his or her personal needs. To keep in his or her room and display personal possessions, pictures and furnishings in keeping with safety requirements and other residents’ rights.

11. Advocacy Centre for the Elderly - May 1, 2009 11 Resident’s Bill of Rights Informed of his or her medical condition, treatment and proposed course of treatment, Give or refuse consent to treatment, including medication, in accordance with the law and to be informed of the consequences of giving or refusing consent, Have the opportunity to participate fully in making any decision and obtaining an independent medical opinion concerning any aspect of his or her care, including any decision concerning his or her admission, discharge or transfer to or from a nursing home, and Have his or her records of personal health information within the meaning of the Personal Health Information Protection Act kept confidential in accordance with the law.

12. Advocacy Centre for the Elderly - May 1, 2009 12 Resident’s Bill of Rights Receive reactivation and assistance towards independence consistent with his or her requirements. Fully informed about the procedures and the consequences of receiving or refusing restraint. Communicate in confidence, to receive visitors of his or her choice and to consult in private with any person without interference.

13. Advocacy Centre for the Elderly - May 1, 2009 13 Resident’s Bill of Rights Where death is likely to be imminent, the resident has the right to have members of the resident’s family present twenty-four hours per day. Designate a person to receive information concerning any transfer or emergency hospitalization of the resident and where a person is so designated to have that person so informed forthwith.

14. Advocacy Centre for the Elderly - May 1, 2009 14 Resident’s Bill of Rights Exercise the rights of a citizen and to raise concerns or recommend changes in policies and services on behalf of himself or herself or others to the residents’ council, nursing home staff, government officials or any other person inside or outside the nursing home, without fear of restraint, interference, coercion, discrimination or reprisal. Form friendships, to enjoy relationships and to participate in the residents’ council. Meet privately with his or her spouse in a room that assures privacy and, where both spouses are residents in the same nursing home, they have a right to share a room according to their wishes, if an appropriate room is available.

15. Advocacy Centre for the Elderly - May 1, 2009 15 Resident’s Bill of Rights Pursue social, cultural, religious and other interests, to develop his or her potential and to be given reasonable provisions by the nursing home to accommodate these pursuits. Informed in writing of any law, rule or policy affecting the operation of the nursing home and of the procedures for initiating complaints.

16. Advocacy Centre for the Elderly - May 1, 2009 16 Resident’s Bill of Rights Manage his or her own financial affairs where the resident is able to do so, and where the resident’s financial affairs are managed by the nursing home, to receive a quarterly accounting of any transactions undertaken on his or her behalf and to be assured that the resident’s property is managed solely on the resident’s behalf. Live in a safe and clean environment. Given access to protected areas outside the nursing home in order to enjoy outdoor activity, unless the physical setting makes this impossible.

17. Advocacy Centre for the Elderly - May 1, 2009 17 Access to Justice: Myth or Reality? Examples of other rights include: Criminal charges under the Criminal Code of Canada for suspected crimes; Lawsuits (e.g., civil lawsuits for negligence or breach of contract); Complaints to different professional colleges (e.g., College of Physicians and Surgeons of Ontario, College of Nurses, College of Social Workers, College of Physiotherapists);

18. Advocacy Centre for the Elderly - May 1, 2009 18 Access to Justice: Myth or Reality? Proceedings before the Consent and Capacity Board to challenge findings of incapacity and placement in long-term care homes; Human rights complaints to the Human Rights Tribunal of Ontario; The ACTION telephone service operated by the Ministry of Health and Long-Term Care to investigate complaints in long-term care homes; Compliance, sanctions and enforcement in long-term care homes;

19. Advocacy Centre for the Elderly - May 1, 2009 19 Access to Justice: Myth or Reality? Complaints to the Ombudsman of Ontario if residents or their representatives are dissatisfied with the way in which the Compliance Adviser or the Ministry of Health and Long-Term Care deals with their concerns; Assistance from the Information and Privacy Commissioner of Ontario if there are issues regarding privacy or access to personal health information; and Residents and Family Councils.

20. Advocacy Centre for the Elderly - May 1, 2009 20 The Problem Many people contend that Ontario has an inadequate legal structure for older adults residing in institutional settings have their complaints heard and resolved in a timely and satisfactory manner. These residents are particularly vulnerable as they are dependent on those very institutions that have violated their rights, in addition to the fact that they are “out of sight” and public scrutiny is lacking.

21. Advocacy Centre for the Elderly - May 1, 2009 21 A Better System? ACE will be examining different legal mechanisms in other provinces and countries respecting the enforcement of rights and remedies for older adults in institutions to see what “works”, such as: Ombudsman models; Tribunals/administrative boards; Government regulatory bodies;

22. Advocacy Centre for the Elderly - May 1, 2009 22 A Better System? More education; Advisory councils comprised of older adults; Industry regulation; Legal supports; Alternative dispute resolutions; Advocate programs; Court proceedings; and Other models.

23. Advocacy Centre for the Elderly - May 1, 2009 23 Feedback from Families We want your feedback Please complete the document entitled “Access to Justice Consultation” and send it to ACE

24. Advocacy Centre for the Elderly - May 1, 2009 24 Contact Information Lisa Romano, Research Lawyer – romanol@lao.on.ca romanol@lao.on.ca Jane Meadus, Institutional Advocate – meadusj@lao.on.ca meadusj@lao.on.ca Advocacy Centre for the Elderly 2 Carlton Street, Suite 701 Toronto, ON M5B 1J3 416.598.2656 www.acelaw.ca

25. Advocacy Centre for the Elderly - May 1, 2009 25 Thank You! We will send a copy of our final report to the LCO to your group