Peterborough and the Ontario Retirement Homes Act

THE ONTARIO RETIREMENT HOMES ACT

Tina J Cumby

Trent University

Keywords:

Ontario Retirement Homes Act, Regulation, Retirement, Standards, Quality of Care, Cost of Care, Retirement Homes Regulatory Authority, RHRA

Table of Contents

Abstract…………………………………………………………………...…………… p. 3

Introduction………………………………………………………………….………… p. 4

Literature Review……………………………………………………………………… p. 4

Methodology………………………………………………………….……………… p. 18

Participants…………………………………………………………………... p. 18

Data collection procedures…………………………………………………... p. 18

Data analysis procedure……………………………………………………... p. 19

Findings………………………………………………………………………………. p. 19

Discussion……………………………………..……………………………………... p. 37

Recommendations……………………………………………………………………. p. 39

Acknowledgements…………………………………………………………………... p. 40

References...………………………………………………………………………….. p. 42

Appendix A: Interview Protocol……………………………………………………... p. 45

Appendix B: Informed Consent……………………………………………………… p. 48

Abstract

The present project aimed to analyzed the impact of the Ontario Retirement Homes Act on the Peterborough retirement community, by conducting semi-structured interviews with retirement home Executive Directors, members of Resident Councils, and seniors’ advocates. The project sought to address the Acts impact on quality of care and cost of care, as well as the impact of the Retirement Homes Regulatory Authority (RHRA) on Peterborough retirement homes. The overall impression of the Act draws positive and negative tones, with some major concerns that need immediate addressing. Provincial regulation is regarded positively, in general, but there are concerns about the quality and costs of care due to the Act and the lack of the RHRA presence in Peterborough thus far. This research needs to be readdressed in a year or two, in order to understand the full impact of the Act on local retirement communities, as it is too early to tell at this point. Nonetheless, certain issues are brought up and addressed, and recommendations are made for the mean time, including making the Act information more accessible, mandatory implementation of Resident Councils in every retirement home, revising the issue of tenant fee subsidies, and increasing collaboration among all stakeholders.

Peterborough and the Ontario Retirement Homes Act

Prior to 2010, retirement homes in Ontario were largely unregulated. Facilities either opted for voluntary accreditation with external regulatory bodies or had their own internal regulatory policies, if any at all. After a long push from seniors’ advocates, seniors, and retirement home communities, the Ontario Retirement Homes Act was finally introduced in 2010, as a means to bring all Ontario retirement homes up to a provincial standard. Although the Act has only been operation for three years, little or no research has been conducted on this very important topic. It is the purpose of this particular study to provide the first in-depth analysis of the Ontario Retirement Homes Act that is known to date, as well as the impact that the Act has had thus far on local communities. Focusing specifically on the retirement homes in Peterborough Ontario, I seek to assessthe impact that the Act has had on the quality and cost of care, as well as how the Act’s third-party regulating body – the Retirement Homes Regulatory Authority (RHRA) – has impacted local homes. In general, I seek to understand what the overall impression of the Act and the RHRA is in the Peterborough retirement community so far.

Literature Review

According to Chappell, McDonald, and Stones (2008), “retirement did not exist prior to the industrialization of Canada” (p. 329). During the pre-industrial, agrarian era, people worked into old age. If people were no longer able to carry out the tasks required by their jobs, they would be moved to jobs that fit their capabilities (Chappell, McDonald, & Stones, 2008). Most people continued to work until they could not cope anymore or until they died. Historians agree that the industrialization of Canada was a crucial factor in the development of “retirement” as a recognized and institutionalized phase of life (Chappell, McDonald, & Stones, 2008). However, the effects of the industrial revolution in Canada were gradual.

World War I required an unprecedented speed of production of munitions and other war supplies, which aided in the development of the assembly line manufacturing process – a process that, eventually, revolutionized the commercial industry (“Our First Old Age Pension,” n.d.). Indeed, after the war, many wartime factories remained open to produce consumer products for the masses. As a result, factories exploded in urban areas, causing the labour force to grow exponentially. However, the new industrial factories were designed with the young body in mind. Specifically, a specialized division of labour broke jobs into small, repetitive tasks that required physical speed and manual dexterity (Chappell, McDonald, & Stones, 2008) – skills that many older workers no longer possessed. This, in concert with the fact that many of the jobs that were traditionally performed by older workers were disappearing, led to the impoverishment of many older workers, as they were pushed out of the workforce and into the poorhouse (“Our First,” n.d.). It is precisely this group of older workers who compelled Canadian social activists to fight for pensions, eventually leading to the establishment of the Old Age Pensions Act in 1927 (Chappell, McDonald, & Stones, 2008), which established a “national noncontributory,means-tested pension” (“Our First,” n.d., p. 12) for British descendants aged 70 years and above, who had resided in Canada for at least 20 years, and who made less than $365 per year (including pension), for the cost of $20 per month. This was the first, albeit modest, step towards nationalized benefits for individuals who were no longer able to work, which came into effect in January of 1952 (“Demanding More,” 2002), at which point, under the provisions of Old Age Security (OAS), pensions were provided for all Canadian men and women aged 70 years and older, who had lived in Canada for 20 years or more. Later amendments were made with the creation of the Canada Pension Plan (CPP) in 1966 and the Guaranteed Income Supplement (GIS) in 1967, at which point our current retirement income system was officially in place (“Reducing Poverty,” 2002). It was at this point that retirement became a fact of life. However, it has been argued that the “pension advocates” largely overestimated the effects of pensions on the lives of the “needy elderly,” as they were not sufficient to raise this group of individuals out of poverty (“The History of,” n.d.). This was the major catalyst in the development of retirement homes, but in order to understand the full-story one needs to consider the history of long-term care.

According to FATE (Foundation Aiding The Elderly), in their piece entitled “The History of Nursing Homes” (n.d.):

…before the nineteenth century, no age-restricted institutions existed for long-term care. Rather, elderly individuals who needed shelter because of incapacity, impoverishment, or family isolation often ended their days in an almshouse. Placed alongside the insane, the inebriated, or the homeless, they were simply categorized as part of the community's most needy recipients. (Para. 1).

Early in the nineteenth century, in response to this social problem, women and church groups began to organize facilities for the aged (“The History of,” n.d.). However, even these facilities selected residents on the basis of monetary means and certification of “good character.” Because of this, the vast majority of elderly individuals continued to spend the rest of their days confined to the almshouse – 33 percent in 1880 and up to 67 percent by 1927. This sudden increase of elderly individuals in almshouses in the twentieth century urged the government to finally step in, as described previously. However, as mentioned, these social security initiatives were not enough to raise people out of poverty. Thiswas because only a small proportion (15 percent) of elderly individuals in almshouses were there because of financial need (“The History of,” n.d.). The vast majority was there because they were sick and too frail to take care of themselves, which lead to the institutionalization of the aged in long-term care “nursing homes” and the subsequent eradication of the poorhouses (“The History of,” n.d.). However, it was quickly realized that not all elderly individuals needed round-the-clock medical care. Some just simply needed assistance with the tasks of daily living, yet could not qualify for admittance into nursing care facilities. With almshouses largely out of the picture, this played a role in cueing the development of “retirement residences,” as distinct from nursing homes.

According to Chartwell, in their publication entitled “How to Choose a Residence” (2009), retirement residences are primarily for elderly individuals who need minimal to moderate support in the tasks of daily living. They typically involve apartment-like amenities that are rented on a monthly basis, many of which include meal plans and other services, such as social activities, and are paid out of pocket. Furthermore, there are two different types of retirement residences: independent living and assisted living. As the name suggests, assisted living facilities offer more support in the form of nursing care or supervision, as required, but still less than that found in nursing homes. Anyone in the community is eligible to apply to live in either of these types of residences (“How to Choose,” 2009). Until recently, however, retirement homes were largely unregulated and unlicensed by either provincial or federal governments or third-party regulating bodies, which is quite distinct from nursing homes.

Nursing homes (long-term care facilities) are designed for elderly individuals who require 24 hour nursing care and supervision (“How to choose,” 2009). Partial provincial funding is provided for individuals who require this service, and residents pay the rest through a co-payment, which is also set by the province and is determined on the basis of an income assessment. The Ministry of Health and Long-Term Care (MOHLTC) provide funding for these services in Ontario. Each of the provincial governments regulate admissions, which depend on the individual’s needs and whether or not those needs match up with what the residence has to offer. Standards of care are typically much higher than those found in retirement residences and are regulated and inspected annually by provincial regulating bodies, which, in Ontario, encourage (but do not require) facilities to become accredited through the Commission on Accreditation of Rehabilitation Facilities (CARF) (“How to Choose,” 2009). It is important to note that most provinces also offer privatized retirement facilities, which are independently regulated and funded. Nonetheless, this issue of regulation is the primary difference between nursing homes and retirement residences. This concern has recently come to the forefront of government discussions about how to deal with the retirement home and aging “problem,” which sparked the development of the Ontario Retirement Homes Act in 2010 (Phillips, 2010).

Elder abuse in retirement homes is a particularly relevant issue in the public discourse about why the government needed to regulate retirement homes. According to Welsh (2012), the licensing rules developed by the Ontario Retirement Homes Act have been utilized to target 50 Ontario retirement homes for suspected elder abuse and neglect. In 2011, 150 homes were investigated for similar claims, with 50 homes having unresolved or multiple problems. In 2010, an undercover reporter for the Toronto Star went to live in a Toronto retirement home and uncovered “filthy living conditions, terrible food, untrained and illegally paid staff, and residents so sick that they needed medical attention from a government-funded nursing home” (“Licensing of Ontario,” 2012, Para. 13). This is just one of several such undercover operations that revealed the same sorts of conditions in other retirement homes. Indeed, this was a major catalyst in the development of the new regulations under the Ontario Retirement Homes Act. However, the most pressing reason for the Act’s development had to do with Canada’s aging population.

According to the Canada Mortgage and Housing Corporation, there are currently about 40,000 seniors living in approximately 700 retirement Homes in Ontario. In the next 25 years the senior population is expected to double to almost 4.1 million and, by 2017, seniors will account for a larger proportion of the population than children under 14 years of age for the first time in our history (“Stronger Protections,” 2010). Because more and more people are living into old age, we need stronger protections for them to ensure they will be taken care of in environments that meet their needs, especially considering the number of retirement homes with recently issued complaints about abuse and neglect. This is precisely the role that the Ontario Retirement Homes Act was designed to fulfill.

According to the Act, a “retirement home” is:

…a residential complex or the part of a residential complex that is occupied primarily by persons who are 65 years of age or older,that is occupied or intended to be occupied by at least the prescribed number of persons who are not related to the operator of the home, andwhere the operator of the home makes at least two care services available, directly or indirectly, to the residents. (Part I, “Definitions”).

Part I of the Act stipulates that all retirement homes are to be operated in a way that residents can live with “dignity, respect, privacy, and autonomy”in a secure, safe, and comfortable environment, and in a way that residents can make informed choices about their care options. It also sets the definitions for abuse, administrative penalty, authority, care service, Complaints Review Officer, external care provider, fund, incapable, inspector, license, licensee, Minister, neglect, operator, personal health information, personal information, plan of care, prescribed, Registrar, regulations, resident, residential complex, Residents’ Bill of Rights, Residents’ Council, retirement home, rights advisor, Risk Officer, secure unit, staff, substitute decision-maker, Tribunal, volunteer, related person, controlling interest, associate, spouse, requirement under this Act, living quarter, final decision or order, refusal to issue a license, and condition on a license.

Part II of the Act establishes the Retirement Homes Regulatory Authority (RHRA) as the official regulatory body of the Retirement Homes Act, and defines such an Authority as a “corporation without share capital.” This section also establishes the conditions of the regulatory authority. First, only a minority of the members of the Authority are to be appointed by the Lieutenant Governor in Council. Second, the Authority must appoint a Risk Officer, a Registrar, and a Complaints Review Officer. Third, the Authority has the power to set and charge fees. Fourth, any moneys that are collected by the Authority belong to the Authority and are not public moneys. Finally, there must be a Retirement Homes Regulatory Authority Emergency Fund to be used to pay any claims made by residents under the Act.

Part III of the Act stipulates the condition that retirement homes must have a license issued by the Registrar in order to continue or begin operating. This section also provides the Registrar with the power to conduct inspections before a license is issued and to enforce conditions on issued licenses. Applicants have the right to make a submission to the Registrar prior to licensing refusal or conditional licensing, and have a right to appeal their licensing issues with the License Appeal Tribunal.

Part IV of the Act defines the Resident’s Bill of Rights. First, licensees are required to submit a written agreement with every single resident prior to the resident taking up occupancy in the home, and are also required to provide every single resident with an information package that details the resident’s rights upon taking up occupancy in the home. This information package is also required to be available in the home. Second, residents in the retirement home have the right to name a Residents’ Council, who has the power to inform residents of their rights and obligations, as defined by the Act, as well as to mediate any disputes that arise between the licensee and the residents. Third, under provisions for care and safety in the retirement home, licensees are barred from preventing residents from accessing external care services. Furthermore, the licensee must provide information for such services at the behest of the residents, as well as information about alternatives to retirement home living in response to external evaluations. The licensee must also make necessary contacts to alternative options, at the request of the resident. The licensee must assess all potential occupants prior to taking up occupancy in the home to ensure a proper plan of care is developed, based on the principles outlined in the Act. Fourth, licensees are required to screen all employees and volunteers before they initiate physical contact within the home, including a police background check (unless the individual is under the age of 18 years). All employees and volunteers must also meet minimum standards of skills and qualifications. The licensee is required to protect all residents from abuse and neglect. The restraint of residents using a physical device or administration of a drug, or the confinement of residents to secure units of the home is expressly prohibited, except under certain, specified conditions. Finally, licensees must make available a written complaint protocol that allows residents to formalize any complaints about the operation of the home, as well as specifications for how the licensee needs to deal with such complaints. When reasonable grounds for wrongdoing have been established, a formal report must be issued to the Registrar.

Part V of the Act provides Registrars with several rights. First, the Registrar has the right to hire inspectors, without a warrant, in response to complaints of wrongdoing. All complaints must be reviewed by the Registrar. The Complaints Review Officer has the right to review the complaint, on the behalf of the complainant, if the Registrar does not take action. Second, the Registrar has the right to act on the basis of reasonable grounds, independent of receiving a complaint, including ordering the licensee to do something, to refrain from doing something, or to pay a penalty, as well as revoking the license altogether.