Long-Term Care Home Licensing Framework - Capital Planning Branch Foundational Briefing September 2020 - Ontario's Long-Term Care COVID-19 ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Ministry of Long-Term Care Long-Term Care Home Licensing Framework Capital Planning Branch Foundational Briefing September 2020
Highlights of the Licensing Program
The foundation of the Licensing Framework is a legislated risk based assessment that
underlays any licence or approval issued by the Ministry.
• The Long-Term Care Homes Act, 2007 (LTCHA) and Ontario Regulation 79/10 requires that
all long-term care (LTC) beds be licensed or approved by the Ministry and also establishes
the framework for this process.
• As of May 2020, there are 627 long-term care (LTC) homes in Ontario with approximately
78,890 beds.
• The Licensing Program is currently focused on:
• Licensing activity relating to 210 LTC homes of which:
• 60% is attributed to creating new licensed capacity through re/development
projects
• 40% relates to licence transfers, changes in controlling interest, temporary
licences and licence amendments, management contracts, beds in abeyance,
and specialized units
• Identifying measures that would reduce processing times to further support the
Premier’s commitment to end hallway medicine and expand LTC by 15,000 in the
next five years.
• Transformation of the licensing program to improve stakeholder confidence, align
with Ontario’s Digitization Strategy and burden reduction efforts;
• Strategizing approaches to sustain bed capacity as the expiration of over 26,000
beds approaches in 2025.
2
LTC Licences and Approvals
The Ministry is able to address immediate and longer-term capacity needs through
distinct licensing approaches.
Approval Licence
- Issued by the Minister - Issued by the Director
-Authorizes premises to be used - Applies to for-profit and
for a Municipal or First Nations non-profit homes
Homes only for a specified # of - Transferrable (subject to
beds Ministry approval)
-No fixed term - Term of up to 30 years
-Cannot be transferred
Temporary Licence Temporary Emergency
-Issued by the Director to a LTC Licence
home or stand alone home -Issued by the Director to
-Used to authorize: any LTC home or stand alone
1. Premises to be used as a - Used to authorize:
LTC home on a temporary 1. Premises to be used as
basis a LTC home on a
2. Temporary additional beds temporary basis
at a LTC home 2. Temporary additional
- Term of up to 5 years and beds at a LTC home
3 cannot be transferred. - Term of up to 1 year
Principles of the LTC Licensing Framework
The LTCHA, Regulation and related policies provide for a robust LTC licensing
framework.
• A LTC Home Licence provides the Licensee with:
1. The rights to operate the home; and,
2. A committed funding stream (under current Ministry funding policies); and,
3. The ability to monetize the licence by (transferring/selling the licence, subject to Ministry
approval)
all for up to 30 years (in accordance with the LTCHA and Regulation 79/10 and subject to Ministry
approval where required.)
• The licensing framework enables a due diligence process to determine the competency of the Licensee
to operate a LTC home without compromising the delivery of care and services to residents.
• At the core of the licensing framework are three key decision variables:
1. An assessment of the competency of the Applicant/Licensee
2. Public interest tests
3. A decision by the Director to issue a licence
• These elements also ensure that the safety and security of residents, remains critical when deciding on
the issuance of a licence.
4
Licensing Framework – At A Glance
With the exception of temporary emergency licences, the LTCHA stipulates the same
approval requirements regardless of the scale or magnitude of activity.
The Minister agrees that there is a need for beds in the
area.
A licence or approval
can only be issued by
the Ministry once these
requirements are met. The Minister establishes that the impacts of
concentration of ownership and sector balance are in
the public interest.
Changes to the
The Director reviews the past conduct, operational and
ownership or financial competency of the proposed licensee, including
controlling interest of a any individual with controlling interest in the licensee.
licence, location of
beds, or management
of a home, will trigger
a licence review. The Director has considered any feedback from a public
consultation relating to the licensing proposal.
5 *See Appendix D for further information.
Licence Review Process
Licence activity and requirements of the LTCHA vary by the type of LTC home provider:
some or all of the activities below will be included in the ministry’s licence review
process.
Public Consultation
s.106 For non-municipal
(if required) homes, Director
Decision on Issuance of
a Licence/ Undertaking
Minister’s Determination
s.96 and s.97 Review Decision
- On the need for beds, process process
sector balance and
concentration of ownership
For municipal homes, the
Director’s Determination s.98 Minister’s decision on
- Licensee Attestations undertaking or any
-Financial Review municipal approvals.
-Review from: Legal Services Branch, LTC
Inspections Branch, Financial Management Branch,
Ontario Health Oversight Branch
6
Applying the Licensing Principles during Pandemic
The Ministry is able to leverage provisions relating to temporary emergency licences
and management contracts to support LTC Homes during the pandemic.
• Temporary emergency licences enable the Director to respond to needs for immediate LTC bed
capacity for up to one year.
• As hospitals were preparing for an influx of COVID-19 related intakes, temporary
emergency licences quickly enabled the creation of additional bed capacity and the
subsequent transfer of ALC patients from hospitals to LTC homes.
• A total of 97 spaces were created in 69 LTC homes.
• LTC homes identified unlicensed rooms or family rooms/palliative care rooms that could
be repurposed for resident accommodation.
• Management contracts
• To date, 10 LTC homes engaged with hospitals for management of the home while in a
COVID related outbreak and for infection control support.
• This represented the first time for hospitals to provide management services to LTC
homes.
• Provisions in the emergency order enabled the Director to approve the management
agreement within days of Homes/Hospitals identifying a proposed management
arrangement.
7
LTC Licensing – Chronology of Pandemic Response
Actions
Working with LTC homes, LHINs and hospitals to enable capacity and professional expertise to LTC
homes facing extreme Covid-19 challenges.
Mar 16, 2020
Commence outreach to Mar 22, 2020 - Apr 23, 2020
LHINs to identify 97 temporary emergency licences
unused LTC bed capacity issued to 69 LTC homes May 29, 2020 - Jun 17, 2020
in LTC homes Execution of agreements to approve management
of 10 LTC homes by hospitals
Mar 1, 2020
Apr 2, 2020
Jun 30, 2020
LTC Capacity Form released to
sector (alongside Memo
from Minister Fullerton)
for homes to pro-actively identify
Mar 22, 2020 any unused capacity available
Commence outreach to LTC Licensees
directly on potential additional capacity
identified by LHINs – Jun 15, 2020
Commence issuing temporary Hawthorne and
emergency licences. North York General Hospital
Jun 1, 2020 Jun 13, 2020
Jun 4, 2020 Jun 17, 2020
Downsview and Orchard Villa and
Camilla Care and Woodbridge Vista Care and
Humber River Hospital Lakeridge Health
Trillium Health Partners May 29, 2020 - Jun 17, 2020 William Osler
Execution of agreements to approve management
of 10 LTC homes by hospitals
Jun 5, 2020 Jun 12, 2020
Forest Heights and Extendicare Guildwood and
Jun 16, 2020
May 29, 2020 St. Mary's Hospital Scarborough Health Network
Eatonville and
River Glen Haven and Unity Health Centre
Southlake Regional Health Centre
Jun 8, 2020
8 Altamont and
Scarborough Health Network
LTC Home Temporary Emergency Capacity Form 9
LTC Licensing Priorities 10
Context for Transformation
The current LTC sector landscape presents opportunities for the Ministry to move
forward with changing how licensing reviews are conducted.
• Since 2010, Licensing, Policy and Development Branch (LPDB) has processed an
estimated 2,940 licence related transactions.
• Stakeholders have expressed concern with the current process citing it is time
intensive, not transparent, timelines are non-committal, and that application
requirements are not consistent with the scope of the transaction (i.e. transferring 5
beds vs. building a new home).
• Stakeholder confidence during the development process may be low as the timing of
Ministry approvals can adversely impact construction/building timelines.
• Through process improvement, LPDB has identified and implemented strategies that
will better align the program with provincial priorities that focus on generating LTC
capacity, eliminating hallway healthcare, improving stakeholder experience and
reducing red tape.
11Licensing Transformation Roadmap Transformation of the licensing program relies on a critical analysis of each program, policy and process element to identify how it can be made more effective and efficient. 12
Continuous Improvement
The Ministry continually reviews and refines the LTC Licensing Framework to meet the
needs of internal and external stakeholders.
• Stakeholder feedback has centered on the length of approval processes, which is perceived as a barrier to moving
capital projects from the planning to the building phase.
• Additional changes are being considered to further streamline the licensing review process including regulatory
changes related to the requirement to consider LHIN input on licensing requests and minimizing administrative
burden for the ministry and stakeholders (e.g. bed in abeyance, financial reviews - see Appendix D).
Improvements to Date
Multi-Stream Licensing Improving Transparency Public Consultation
Review and Licensee Experience Modernization
• Evolving from a “one size fits all • Kick-off meeting with Licensee • Legislative amendment as of July 1,
review model” to a “risk-based outlining the licence review 2019 modernize the way the
multi-stream licensing model” for process. ministry seeks public feedback on
LTC development projects, resulting • Acknowledgement Letters sent to licensing activities by allowing
in rapid progress for eligible low- Licensee to clearly outline project additional/alternative formats; and
risk LTC Projects from the LTC details, required documents and provide discretion to the Director
planning to building phase next steps. to determine the best format for
• (See Appendix E). each individual circumstance.
132025 Licence Expirations
The program area is identifying strategic options to mitigate risks of disruption to LTC
care and capacity.
Critical Dates
Licences for approximately 26,531 beds in 257
Planning, data gathering and options LTC Homes will expire.
2020 - 2021 June 30, 2025
June 30, 2022
LTCHA Requirement: Three years before a licence
expiration, the Ministry must provide notice of
it’s intention to provide a new licence or not.
• Building on the ministry’s successful approach for licenses expiring in 2020, the Licensing, Policy &
Development branch has initiated strategic planning for licenses expiring in 2025 with the aim of:
• Creating opportunity in the sector and strengthening sector partnerships;
• Reallocating any LTC beds before they are expected to come out of operation in 2025; and
• Ensuring the Ministry and sector’s legislative compliance while maintaining continuity and
quality care for all LTC residents in Ontario.
14Appendices 15
Appendix A: Licensing Sector Profile
Sector Breakdown
Market Concentration
For-profit beds: 41,856
57 %
Provincial Index 375
Non-profit beds: 37,028
43 % IndexesAppendix B - LTC Licence Term issued in 2010
• In accordance with the LTCHA, all LTC homes must be licensed or approved.
• A Licence can have a fixed term of up to 30 years.
• The terms of licences issued in July 2010 varied by the structural classification of the LTC home.
Structural Classification* Term of Licence
New Beds** - Built since 1998 to current design standards 30 years**
A Beds** – Built prior to 1998, but almost meets current standards 25 years**
B Beds – Substantially exceed 1972 standards but do not meet A-bed criteria. 15 years
C Beds – Meets 1972 design standards 15 years
Upgraded D – Upgraded through the 2002 D Bed program but do not meet the 10 years
1972 design standards
D Beds – Do not meet 1972 design standards, and were not upgraded. Upon 4 years
expiration, these beds did not receive a new licence unless they redeveloped to
meet current design standards.
Note:
* For the purpose of issuing licence terms in 2010, the LTCHA also outlined the term of a licence for homes with more than
one structural classification, these are not reflected in the above table.
** In January 2015, the LTCHA was amended and licence terms were extended by an additional five years for “New” and
“A” subject to the requirements of the LTCHA (s.193.1)
17Appendix C: Minister & Director Requirements for
Licensing Activities
Minister’s Public
Public Meeting(s)/ Director’s Determination of Eligibility of
Licensing Activity Interest
Consultation the Licensee/Applicant
Determination(s)
Regular Licence Yes Yes Yes
Municipal/First Nation No
Approval Note: Director provides the Minister with
input received from the LHIN and the
Yes (s. 96 only) Yes
Service Area Offices (for compliance and
inspection information) to support the
Minister decision on issuing an Approval.
Temporary Licence Yes No Yes
Temporary Emerg. Yes
No No
Licence
Acquisition of Controlling
Yes (s. 97 only) No Yes
Interest
Agreement to Approve a Yes (s. 97 only)
No Yes
Management Contract
18Appendix D: Licensing Activities Requiring Ministry
Approval
The LTCHA requires the same approval processes regardless of the scale or magnitude of
activity.
New licence,
Transfer a Relocation of Transfer Hiring/
Activity
change in
LTC home or LTC home for shares of a Retaining a Closing a LTC
bed capacity
beds under a redevelopme LTC home management Home
or licence
LTC licence nt licensee company
term
A Closure
Agreement is
required
Requires the with the
Results in a Results in a
issuance or May results
change in change in ministry.
amendment in a change
Implications
the licensee location of Management Approval is
Licensing
of a licence/ in controlling
or location of the beds and contracts also required
temporary interest,
beds and requires require if the closure
licence/ which
reissuance or reissuance of approval notice is less
temporary requires
amendment licence/ than five
emergency approval
of licence(s) approval years and
licence before the
licence
expiry.
19Appendix E: LTC Long-Stay and Short-Stay Program
• Long-Term Care homes can offer Long-Stay and Short-Stay Programs.
• Long-Stay and Short-Stay programs can be offered under all Approval and Licence Types
(i.e. Approval, Licence, Temporary Licence, Temporary Emergency Licence, Short-Stay
Authorization).
• The Act and Regulation outline specific requirements for each of the programs (e.g.
admission criteria, wait list rules etc.)
Program Usages Descriptions
Long-Stay Long-Stay Beds Created to enable occupancy by residents who need long-term care on a
continuous basis.
Short-Stay Interim Beds Created to provide increased LTC capacity for Alternate Level of Care (ALC)
patients (i.e., no longer require acute hospital care), and who are eligible
for long-stay admission but are on a waiting list for a LTC home.
Convalescent Created for persons who need time to recover strength, endurance or
Care Beds functioning and who are expected to return to the community within 90
days.
Respite Beds Created for persons who have caregivers who require temporary relief
from their caregiving obligations or persons who require temporary care in
order to continue to reside in the community. Residents in respite beds are
expected to return to their residences within 60 days after admission.
20Appendix F: Financial Review Policy Refinements
Evaluation of the financial framework is critical to ensure that it functions as efficiently as possible without
compromising the level of risk assessment. This allows us to keep pace with internal and external trends.
Refinements Current Status
First Pilot: Early 2018
1. Process: Modified financial reviews for public companies.
Implemented: April 2018
2. Process: Utilize previously submitted financial information in place of requesting all documents for subsequent
Implemented early 2018
financial reviews. Transition to requesting financial information in soft copy only.
3. Policy: Updated financial requirements for redevelopment projects
• Removed provisions relating to disclosure of 3 highest salaries and insurance requirements
Implemented May 2019
• Removed requirement for accountant review of financial Projections to align with Canadian accounting
guidelines
4. Process: Lender Support- consultations with lenders to explore potential overlap of analysis processes. Completed (May 2019)
5. Policy and Process: Consultations with Deloitte to identify areas of continuous improvement in the financial
Ongoing
reviews.
6. Policy: Further refinements to financial requirements
• Remove requirements to disclose material credit agreements and to identify any risk of loss of charitable
status as these would be disclosed in audited financial statements.
• Remove requirements to submit year to date financial statement. Completed January 2020
• Remove requirements to disclose occurrences of bankruptcy/insolvency and shift requirement to Deloitte to
perform bankruptcy search.
• Remove calculation of ratios
Refresh the Financial Guidelines For Licensing Reviews to incorporate any changes from #3 and #5 above. (The Target completion (June 2020
Financial Guidelines are the detailed policy guidelines for licence transfers)
21You can also read
