Amending Ontario Regulation 246/22 under the Fixing Long-Term Care Act, 2021 titled "General" to advance the plan to fix long-term care in the areas of: staffing, medication management and drug administration, and resident experience.
Ontario Regulation 246/22
Regulation - LGIC
Bill or Act:
Fixing Long-Term Care Act, 2021
Summary of Decision:
On April 11, 2023, changes to Ontario Regulation 246/22 (the "Regulation") under the Fixing Long-Term Care Act, 2021 (the "Act") came into effect.
Informed by engagement with key partners and stakeholders, as well as feedback from the public, the Ministry of Long-Term Care (the "Ministry") has refined the regulatory framework with consideration of the lived experience of residents and long-term care homes and emerging needs in the sector.
The regulatory amendments:
- Amend staffing qualifications for some roles specified within the Regulation to make requirements proportionate with the responsibilities and accountabilities of the role.
- Extend the transitional staffing qualifications provision by six-months.
- Modernize medication management and drug administration requirements to allow registered health practitioners to practice to their full scope of practice.
- Enable Personal Support Workers to administer drugs where they have received training, if it is not a controlled act or substance and only when assigned and supervised by a member of the registered nursing staff in accordance with the College of Nurses of Ontario's practice guidelines.
- Embed in regulation the key components of the Minister's Directive: Glucagon, Severe Hypoglycemia and Unresponsive Hypoglycemia.
- Add COVID-19 vaccines to the list of immunizations that must be offered to long-term care residents.
- Bolster the resident experience and safety by updating air conditioning requirements and holding licensees accountable for failure to comply; requiring licensees to always ensure that a post-fall assessment is completed when a resident falls; and clarifying when a dietitian is required to assess a resident's skin condition(s).
- Clarify requirements related to administrative monetary penalties, alternate level of care placements and the role of medical directors in long-term care homes.
- Remove some expired transitional provisions.
Analysis of Regulatory Impact:
The Ministry has completed a regulatory impact assessment of direct compliance costs that would be incurred by long-term care licensees (the primary subjects of compliance under the Act and Regulation) resulting from the regulatory amendments.
The regulatory amendments constitute new or revised provisions in the Regulation that apply to all 627 long-term care home licensees in Ontario (municipal, for-profit, not-for profit, and First Nation homes). The amendments are intended to benefit the approximately 71,500 residents living in long-term care, their families and caregivers.
It is anticipated that direct compliance costs imposed by these amendments would vary by licensee, based on a long-term care home's size and existing procedures and policies. Some of the amendments may result in savings for homes, which are also anticipated to vary.
In this context, and without accounting for differences in home size and existing procedures and policies, the amendments are anticipated to generate average direct compliance costs for licensees (within operational funding) of approximately $15,900 in the first year of implementation and $4,200 per year in subsequent years. This equates to a total estimated direct compliance cost for all licensees across the province of approximately $33.5 million over a ten-year period (or just over $53,000 per licensee over ten years).
An estimated $7.3 million would consist of one-time costs that would be incurred by licensees in year 1 of implementation and are associated primarily with additional staff time required to learn about and comply with the new provisions, commensurate with regular activities for remaining apprised of Ministry requirements.
An estimated $26.2 million would consist of annual ongoing costs that would be incurred by licensees from years 1 to 10. These anticipated costs are largely administrative in nature and associated with ongoing staff costs related to enhanced medication management procedures.
Benefits for long-term care residents, staff and licensees:
- Immediately provide long-term care licensees with ongoing operational flexibility and support the ongoing delivery of quality care to long-term care residents in Ontario.
- Benefit long-term care residents, families, caregivers and licensees through a strengthened regulatory framework that clarifies requirements in key areas directly related to resident experience and safety including medication management and drug administration, air conditioning, falls prevention and management, skin and wound care, among others.
- Complement or progress ongoing ministry and broader government initiatives intended to implement innovative, long-term solutions to address chronic health human resources staffing pressures.
The regulatory amendments are responsive to recommendations from a range of stakeholders.
February 3, 2023
Summary of Proposal:
The Ministry proposes to amend Ontario Regulation 246/22 as part of an ongoing evolution of the legislative framework intended to enhance quality of care and quality of life for residents in long-term care homes.
Proposed amendments include:
-Amend staffing qualifications for some roles specified in the regulation to ensure requirements are proportionate with the responsibilities and accountabilities of the role (please see Staffing Qualification Addendum - link below).
-Revise the transitional staffing qualifications provision (proposed 6-month extension).
-Include nursing students from Indigenous Institutes in provisions that allow nursing students from colleges and universities to administer drugs to residents under the supervision of a member of the registered nursing staff.
-Provide that all regulated health professionals may administer drugs in long-term care homes according to their scope of practice and as authorized under the Regulated Health Professions Act, 1991 (including pharmacists administering COVID-19 and flu vaccines to residents).
-Provide that a personal support worker who has received training in the administration of drugs and who has been authorized by a member of the registered nursing staff may administer drugs to residents where it is not a controlled act.
Medication Management and Drug Administration:
-Clarify requirements of the 24-hour admission care plan including adding reference to: clinical use of medications, adverse drug reactions, and medication reconciliation.
-Modernize medication acquisition, storage and destruction requirements.
-Embed in regulation the Minister's Directive: Glucagon, Severe Hypoglycemia and Unresponsive Hypoglycemia.
-Add COVID-19 vaccines to immunizations that must be offered to residents.
-Update exemption criteria for air conditioning requirements in resident rooms and further clarify the Director's existing authority when considering exemption requests.
-Refine the definition of air conditioning.
-Add air conditioning in designated cooling areas to the list of functions generators are required to support during a power failure.
-Create a new Administrative Monetary Penalty (up to $25,000) for not meeting the requirement to have air conditioning in all resident rooms.
-Require licensees to ensure a post-fall assessment is always completed when a resident falls.
-Clarify when a dietitian is required to assess a resident's skin condition(s).
-Clarify rules regarding applicability of Administrative Monetary Penalties in instances of non-compliance.
-Clarify that the medical director has a role in oversight of medical care (and not all clinical care).
-Clarify requirements that support placement of an ALC patient into preferred accommodation, when basic accommodation has been selected.
-Identify other critical situations where a lack of availability in basic accommodation may warrant temporary placement in preferred accommodation.
-Remove some expired transitional provisions.
The Ministry continues to engage key partners and the public to refine the proposal prior to seeking the approval.
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April 11, 2023