Ontario's Regulatory Registry

Proposal to inform regulations

Proposal

Health and Supportive Care Providers Oversight Authority Act, 2021

The government recognizes that high-quality care is the cornerstone of our healthcare system and personal support workers (PSWs) play an important role. There are over 100,000 PSWs in Ontario that provide a variety of services to Ontario's most vulnerable populations, including children, older adults, seniors, and people with physical and/or cognitive disabilities. PSW services are delivered in a variety of health care settings, including long-term care homes, hospitals, retirement homes and home and community care organizations. PSW services may be privately or publicly funded directly or indirectly within some of these healthcare settings.

PSWs are currently unregulated in Ontario. While there are some sectors with minimum education qualifications identified in regulation (i.e., long-term care), employers are responsible for validating credentials, education, training, employment history, and criminal background checks. This creates inconsistency in competencies within the PSW workforce and uncertainty for the public on the expected quality and safety of care to be received from a PSW. Public recourse and complaints related to a PSW's competencies or behaviour are typically directed to the employer for resolution.

Ontario is addressing these challenges by establishing an Authority to strengthen PSW oversight. This oversight balances the need to have safe, competent, and ethical care while retaining the PSW workforce to deliver services. Regulation supports public protection and assurances that recipients receive high quality care. Regulatory oversight builds a framework to hold registered PSWs accountable for the services they provide.

The HSCPOA Act allows for the establishment of the Authority. The Authority is a regulatory body independent from government that will provide oversight to PSWs. The new proposed regulatory framework is grounded on the idea that regulatory interventions should be proportionate to the potential risk of harm as well as being targeted, transparent, accountable, consistent, and nimble.

The statutory and proposed regulatory framework under the HSCPOA Act is different from the framework established under the Regulated Health Professions Act, 1991 (RHPA) and companion Acts specific to each regulated health profession (e.g., Medicine Act 1991, Nursing Act 1991, Psychotherapy Act, 2007, etc.). Unlike the RHPA and companion Acts, the HSCPOA Act does not provide title protection or a defined scope of practice. As an alternative to title protection, a visual mark will assure the public that the registrant is registered and subject to oversight by the Authority.

This approach recognizes that there are several titles, tasks, job descriptions, and roles that describe what PSWs do and what they call themselves and that the RHPA is not fit for purpose to govern a diverse group of providers with a broad range of services.

Registration with the Authority is not proposed to be mandatory to provide personal support services in any health care setting. However, the Ministry of Health and the Ministry of Long-Term Care would be able to require PSW services be provided by registered PSWs depending on the circumstances. For example, where a specific vulnerable population is receiving services, or a health care environment needs enhanced consistency in PSW competencies. Also, employers may adopt policies that existing and/or new PSW hires be registered with the Authority. This will ensure that implementation of registration does not unduly disrupt the PSW workforce.

The Authority will be governed by a Board whose members are appointed based on competencies rather than professional affiliation which enhances decision-making that is in the public interest.

The HSCPOA Act provides a mandate for the Authority through prescribed objects and an overarching structure for organizational governance and accountability, committees, registration, the public register, complaint resolution, and discipline and appeals. This proposal provides details of the regulatory framework that will apply to all classes of registrants with elements specific to the varied health care settings and environments for which PSWs work.

Any Class of Registrant - Application Processes
The Authority will provide an application form that is appropriate for each class of registrant. Each class of registrant will provide their application electronically through the Authority's website. Any supporting forms, such as those related to education and/or experience assessments (e.g., a competency assessment) or for applicants registering under a transitional pathway (i.e., legacy pathway) will also be provided on the Authority's website.

Applications received by the Authority will receive an acknowledgement within 15 days that the application is complete or requires other information or supporting documents. The Authority will make a decision on registration within 30 days of receiving a complete application; however, the assessment of an applicant's documentation or competencies, where applicable for equivalency, may surpass the 30-day timeline.

Payment of Applicable Fees
The Authority is expected to eventually self-fund its operations. The ministry will provide funding to the Authority to support administration of legislative and regulatory functions in the short term. The Authority will develop a funding strategy, including a Minister of Health approved process and criteria to set a fee, and then implement a fee schedule. The oversight framework of the HSCPOA Act is expected to lower cost to administer, resulting in lower registrant fees than what is typically charged by a health regulatory college.

Any Class of Registrant - Registration Requirements
Each class of registrant will be required to provide evidence to the Authority of good character. The Authority will determine the manner deemed appropriate to determine good character based on the settings for which the registrant typically works and the vulnerability of recipients that receives their services.

Each class of registrant will provide with their application any supporting diploma, certificate, or other proof of successful completion of a health-related program for the class for which they are applying unless using an alternative pathway that does not have an education component. Applicants would also be required to provide an assessment to determine equivalent competencies expected of the related class of registrant and any applicable forms, if required.

The applicant must have reasonable fluency in either English or French. Applicants can demonstrate this language proficiency through completion of a health-related program taught in English or French, experience in a health care-related setting where English or French is the primary language or through formal testing.

Any applicant that is a member of a professional health-related oversight body or an organization with an agreement with a government to maintain a registry or directory are required to support their application with a letter of good standing.

The healthcare system relies on a number of health professionals with unique expertise to provide services that meet the health needs of Ontarians. Ontario's health regulatory Colleges are required under the RHPA to collect standard, consistent and comparable demographic, registration, geographic, educational and employment information on all health professionals.

Similarly, the Authority, on behalf of the Ministry, will also be collecting comparable information from registrants for the purpose of health-related human resources planning and research. A unique identifier for each registrant will be connected to the health information to ensure data is anonymous. This provides a representative snapshot of Ontario's regulated healthcare workforce.

Personal Support Workers - Registration Requirements

1. Primary Registration Pathway
The primary pathway for PSW registration will be successful completion of a PSW program that meets the program requirements set by the Ministry of Colleges and Universities (MCU) from an Ontario postsecondary institution, district school board or Indigenous institution and received a PSW certificate. The program must be a minimum of 600 hours in duration, including both class and practical experience time.

2. Pan-Canadian Registration Pathway
Applicants with health-related education from outside Ontario but within Canada that are not on a provincial registry or directory noted in the Labour Mobility Registration Pathway would follow a proposed alternative pathway to register for the class of PSW. This includes an assessment to determine if the applicant meets the competencies expected of an Ontario PSW. This program must be a minimum of 600 hours in duration, including both class and practical experience time.

3. Labour Mobility Registration Pathway
Applicants from outside Ontario but within Canada that are on a provincial health-related registry or directory are proposed to be able to register for the class of PSW without an assessment. Currently, this includes health workers on the British Columbia Care Aide & Community Health Worker Registry, Alberta Health Care Aide Directory and Nova Scotia's Continuing Care Assistant Registry.

4. Internationally Educated Registration Pathway
Applicants that have health-related education from outside Canada are proposed to have similar requirements to the Pan-Canadian Registration Pathway. This includes an assessment to determine if the applicant meets the competencies expected of an Ontario PSW. This program must be a minimum of 600 hours in duration, including both class and practical experience time.

5. Legacy Registration Pathways
Persons hired and employed as PSWs, or providing personal support services, that do not meet the Ontario educational requirements in the primary pathway may apply for registration through transitional legacy provisions. This includes:

a) PSWs employed based on a health-related education received outside of Ontario that results in a certificate, diploma, or other proof of program completion. This program must be a minimum of 600 hours in duration, including both class and practical experience time.

b) PSWs employed based on successful completion of a PSW program that meets the requirements set out in the vocational standards established by the Ministry of Colleges and Universities, the standards established by the National Association of Career Colleges, or the standards established by the Ontario Community Support Association. This program must be a minimum of 600 hours in duration, counting both class and practical experience time, and completed by July 1, 2018.

c) A person employed as a PSW that does not meet the above criteria can undergo an assessment. The applicant would need to accumulate a minimum number of hours of PSW work experience to be set out in regulation prior to undergoing an assessment to be eligible to register.

The employer(s) would be expected to verify the employment history and the circumstance for which the applicant was hired under these legacy pathways to support their application. The applicant would need to provide their post-secondary diploma, certificate, or other proof of program completion under pathways 5 a) and b). The Authority will provide guidance and a legacy form to be signed by the applicant and the employer on its website.

The proposed regulation will provide a three-year transitional period for PSWs or persons providing personal support services to register under registration legacy pathways. This transitional period is proposed to start on the day the provisions under the regulation come into force.

Applicants employed as PSWs after the three-year transitional period ends that have not already registered under a legacy pathway may be subject to a new assessment framework developed by the Authority.

Health workforce disruption should be minimal as registration with the Authority is not required to provide personal support services. Decisions on a requirement for a PSW to be registered with the Authority will be left to employer retention and hiring policies.

No pathway for Regulated Health Professionals or for Student Registration
The proposed regulations will not provide prescribed pathways for regulated health professionals registered with an Ontario health regulatory College (e.g., a nurse registered with the College of Nurses of Ontario) to register with the Authority as a PSW.

Regulated health professionals are expected to work within the scope of practice and practice standards of their respective professions when providing personal support services.

There is no student registration as registration is limited to individuals who have completed the necessary education or assessment to be a registrant.

Employers that require registration with the Authority as a condition of employment may make the necessary adjustments to hiring policies to allow exceptions for regulated health professionals and students according to operational needs or arrangements with educators.

Please see the "Registration Pathways" in the supporting documents section for more information.

Any Class of Registrant - Codes of Ethics
The proposed regulatory framework includes a prescribed Code of Ethics that would apply to all classes of registrants. The Code of Ethics was created with consideration to the health environments associated with PSWs and related ethical implications (e.g., working with vulnerable populations in home and institutional settings). The proposed Code of Ethics would be used by the Authority to assess complaints for potential contraventions by a registrant and determine if further actions need to be taken. It is meant to guide the work of registrants within an ethical framework and serves to protect the public as the foundation for the Authority's complaints and discipline process.

Please see "Code of Ethics" in the supporting documents section for the complete proposed Code of Ethics.

Any Class of Registrant - Complaints, Discipline & Appeals Process
The proposed regulatory framework includes a complaints resolution process. This process supports the legislative powers of the CEO, Discipline Committee and Appeals Committee in determining actions to resolve complaints.

When a complaint is filed against a registrant, the HSCPOA Act provides that the CEO can investigate the complaint, appoint an investigator, and request further information from anyone, including the registrant who is the subject of the complaint. A complaint must be in writing or recorded electronically by the Authority if received orally. The CEO must inform the complainant about the Authority's processes, the role of the Discipline and Appeals Committees, and provide relevant sections of the Act.

The CEO must provide the registrant within 14 days of receiving the complaint, information about the complaint, relevant sections of the Act, and previous decisions involving the registrant. The CEO is not required to provide the same notice to registrants if the CEO imposes conditions on a registrant's registration through an interim urgent action following the receipt of a complaint or following the appointment of an investigator.

A registrant who is the subject of a complaint can submit written responses within 30 days of receiving notice. The CEO may specify a shorter time frame for submissions if there are reasonable grounds to believe that the registrant's conduct may pose a risk of harm to the public.

The CEO may withdraw a complaint at the request of the complainant if it is in the public interest. The CEO must notify the complainant and the member if a complaint is withdrawn. The CEO can take urgent interim action to suspend or impose conditions on a registrant's registration at any time following the receipt of a complaint if the member's conduct poses a public risk. The urgent interim action remains in force until it is changed by the CEO, Discipline or Appeals Committee or until the matter is resolved.

If the CEO or Discipline Committee orders revocation, suspension, or conditions, it takes effect immediately, regardless of any appeal. An order cannot be made without notice to the registrant except in the case of urgent interim action. After investigation, or at any time, the CEO can attempt to mediate or resolve the complaint, impose conditions on the registration, refer allegations of misconduct to the Discipline Committee, refer the member for further educational courses or training, caution the member through a written warning, or take any other appropriate action the CEO considers appropriate consistent with the Act, Code of Ethics, regulations, or by-laws.

At the point a matter is referred to the Discipline Committee, a panel of between 3 to 5 members of the Discipline Committee will be established. The panel will hold a hearing to establish if the registrant violated their Code of Ethics. The panel will have the same jurisdiction as the Discipline Committee while conducting a hearing. The Discipline Committee can make an order requiring the CEO to revoke, suspend or impose conditions if there is a determination that the registrant has breached the Code of Ethics. The Discipline Committee can also take other action as prescribed. If there has been no established violation of the Code of Ethics, the Discipline Committee can determine that no disciplinary action is needed. Only orders of the Discipline Committee can be brought to the Appeals Committee.

A registrant has the ability to appeal the decision of the Discipline Committee to the Authority's Appeals Committee. When an appeal is initiated, the Appeals Committee will convene a panel of 3 to 5 members of the Appeals Committee to hold a hearing to adjudicate the appeal. Following the hearing, the Appeals Committee has the power to overturn, affirm, or modify the Discipline Committee's decision and/or make an order for the CEO to revoke, suspend or impose conditions on a registrant's registration with the same powers as the Discipline Committee.

Any Class of Registrant - Discipline & Appeals Committees
The Discipline Committee is composed of at least 7 members appointed by the Board of Directors. Similarly, the Board will also appoint 7 different individuals to the Appeals Committee. Individuals are eligible to be appointed to the Discipline Committee or the Appeals Committee if they meet the following criteria:
• Are not a current or former registrant;
• Have not previous applied for registration but had their application refused by the CEO;
• Reside in Ontario;
• Are not a member of the Authority's Board of Directors; and,
• Are not currently employed by the Authority and have not been employed by the Authority within the previous 12 months.
• Are not currently, and have not been within the preceding 5 years, a director, owner, board member, officer or employee of a professional association or a director, board member, officer or employee of a trade union representing any class of registrants;
• Are not currently, and have not been within the preceding 5 years, a member of the council or board of a health regulatory college;
• Are not the subject of any professional disciplinary, incompetency or incapacity proceeding in any jurisdiction;
• Have not been the subject of any professional misconduct, incompetence or incapacity finding in any jurisdiction in the preceding six years;
• Are not currently nor previously been a plaintiff in a lawsuit or an applicant in an application against the Authority; and
• Have not have been removed from a board or a committee of the Authority within the preceding three years.
The Discipline Committee and Appeals Committee will both operate based on some of the administrative and procedural rules for proceedings outlined in the Statutory Powers Procedure Act.

Personal Support Workers - Public Register
The proposed Public Register regulation models after Ontario's health regulatory College public register framework as set out in Section 23(2) of Schedule 2 under the RHPA. Registrants of the Authority will be on a public registry like other regulated health professionals (e.g., registered nurses, physicians, massage therapists, etc.).

The registry would enhance trust by allowing the public to easily distinguish between PSWs that meet a minimum level of education from unregistered professionals where there is uncertainty of education and/or credentials. Additionally, PSW employers (e.g., hospitals, long-term care facilities, retirement homes and home and community care agencies) can reference the public register and be assured that PSWs registered with the Authority will deliver safe, competent, ethical, high-quality care to patients, clients and residents.

The Public Register regulation would also outline provisions related to the retention of registrant personal information by the Authority. This would allow the Authority to retain information as deemed necessary to support with future applications or in cases of discipline.

Please see "Public Register - Proposed Fields" in the supporting documents section for the complete list of the information that will appear on the Public Register.

Personal Support Worker - Advisory Committee
The HSCPOA Act requires an Advisory Committees for each class of registrant (e.g., PSWs). Advisory Committee members will advise and make recommendations to the Board and the CEO about issues pertaining to registrants in that class of registration.

The Act requires that the Advisory Committee include registrants, individuals who represent the interests of persons who receive services from registrants or caregivers of such individuals, and educators of registrants. Advisory Committee members will advise and make recommendations to the Board and the CEO about issues pertaining to registrants in that class of registration. The HSCPOA Act also provides for inclusion of other representatives in Advisory Committees. The proposed regulatory framework includes additional membership for the PSW class of registrants.
The PSW Advisory Committee is proposed to be composed 14 to 19 members:
• 4 to 6 registered personal support workers, including at least 1 PSW who provides care each of the following settings: public hospitals, long-term care, a retirement homes, and home/community care;
• 1 to 4 individuals who represent the interests of patients and their caregivers;
• 2 to 3 representatives of educational institutions that provide PSW education including public colleges, private career colleges, district school boards and Indigenous institutions;
• 1 to 2 individuals who represent organizations that advocate for organizations that employ PSWs;
• 4 individuals who represent organizations that employ PSWs, including at least 1 individual who represents each of the following care settings: public hospitals, long-term care, retirement homes, and home/community care; and,
• 2 to 4 representatives from trade unions and professional associations.

Individuals are eligible to be appointed to the Advisory Committee if they meet the following criteria:
• Reside in Ontario;
• Are not a member of the Authority's Board of Directors; and,
• Are not currently employed by the Authority and have not been employed by the Authority within the previous 12 months.

Personal Support Worker - Visual Mark
A visual mark will be designated to all registrants who are registered with the Authority. Each professional class of registrant will have their own visual mark. The visual mark for PSWs will be provided on the Authority's website and appear on registration documents. The visual mark issued to registrants by the Authority is a distinctive symbol or image established and maintained by the Authority. It serves as an official identification for registrants under the Authority's oversight. Registrants authorized to use the visual mark must provide valid proof of registration and eligibility upon request.

The official visual mark will be legally protected under the federal Trademarks Act and will be accessible for reference on the Authority's official website and the regulations. The dates on which the visual mark is officially registered with the Authority will be reflected in the proposed regulation, specifying when it comes into effect. The visual mark is a symbol denoting trust and quality, exclusively available for use by registrants who have achieved full compliance with the Authority's registration requirements.

Registrants are granted the privilege to use this mark in professional contexts and in documentation directly associated with their services, ensuring it represents the high standards established for health and supportive care services they are authorized to provide. The visual mark is restricted to usage exclusively to the registrants' authorized practice; any unauthorized use is strictly prohibited.

The visual mark provides registrants with a recognizable symbol of their commitment to excellence and adherence to the Authority's standards. Registrants have a responsibility to use the visual mark judiciously and without misuse. Inappropriately leveraging this privilege may result in penalties such as the revocation of registration. Registrants are strongly encouraged to use the visual mark to elevate their professional reputation, inspire confidence in their care recipients, and uphold the rigorous standards set by the Authority. This not only serves to bolster the registrants' professional standing but also fosters overall trust and advances the broader interests of the public.

Any Class of Registrant - Funding for Therapy and Counselling
The HSCPOA Act requires the Authority to establish a fund for the purposes of providing therapy and counselling for persons who allege that sexual abuse has been committed by registrants and provide other types of supports in relation to allegations of sexual abuse by registrants.

The proposed regulation establishes this program, covering therapy costs equivalent to 200 half-hour sessions with a psychiatrist under OHIP. Eligible individuals can receive funding for up to five years from the start of therapy or eligibility. The Chief Executive Officer oversees program administration.

Funding applies to individuals alleging sexual abuse during care services, and eligibility is determined promptly, regardless of registrant outcomes. No psychological assessments are needed, and recipients choose their therapist with some restrictions. Payments go directly to the therapist for therapy purposes only. It can cover therapy at any time post-abuse. If other insurance is in place, funding is reduced, and the Authority can recover funds in legal cases. Claimants aren't required to participate in legal proceedings, ensuring their well-being and privacy.

The proposed Funding for Therapy and Counselling regulation provides a structured and supportive framework for individuals who have experienced sexual abuse, while also ensuring a fair and respectful process for registrants, promoting transparency and accountability.

Continuous Quality Improvement Activities Program
The Authority will implement a continuous quality improvement activities program for each class of registrant after the related Advisory Committee has been established and an appropriate amount of time has passed for the Authority to collect data on registrants and recipients of their services, including complaints, emerging issues and trends.

There is no anticipated regulatory cost impact associated with the proposed regulations. The Ministry of Health is proposing a new, voluntary approach for the oversight of PSWs that is separate and distinct from the traditional self-regulatory model under the Regulated Health Professions Act, 1991 and where the regulatory impacts are commensurate with the anticipated benefits of public protection. The proposed approach of establishing a new Authority is anticipated to cost less than establishing health regulatory colleges under the RHPA for new health professions.

  Proposed Code of Ethics Accessible Version    (Download Adobe Reader)
  Proposed Public Register Accessible Version    (Download Adobe Reader)
  Proposed Registration Eligibility Process Maps Accessible Version    (Download Adobe Reader)
  Regulatory Registry Posting Accessible Version    (Download Adobe Reader)

23-HLTC058

December 1, 2023

January 15, 2024

438 University Ave, 10th Floor, Toronto, Ontario