O. Reg. 250/09: PROVISION OF COMMUNITY SERVICES


Published: 2009-06-29

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ontario regulation 250/09

made under the

LOng-Term Care Act, 1994

Made: June 17, 2009
Filed: June 29, 2009
Published on e-Laws: July 2, 2009
Printed in The Ontario Gazette: July 18, 2009


Amending O. Reg. 386/99

(Provision of Community Services)

1. (1) Subsection 1 (1) of Ontario Regulation 386/99 is amended by adding the following definitions:

“local health integration network” means a local health integration network as defined in section 2 of the Local Health System Integration Act, 2006;

“long-term care home” means a nursing home under the Nursing Homes Act, an approved charitable home for the aged under the Charitable Institutions Act or a home under the Homes for the Aged and Rest Homes Act.

(2) The definition of “long-term care home” in subsection 1 (1) of the Regulation, as made by subsection (1), is revoked and the following substituted:

“long-term care home” means a long-term care home under the Long-Term Care Homes Act, 2007.

2. The Regulation is amended by adding the following section:

Additional Community Support Services

1.1 (1) For the purpose of paragraph 10 of subsection 2 (4) of the Act, the following are prescribed as additional community support services:

1. Aboriginal support services.

2. Client intervention and assistance services.

3. Emergency response services.

4. Foot care services.

5. Home help referral services.

6. Independence training.

7. Palliative care education and consultation services.

8. Psychogeriatric consulting services relating to Alzheimer disease and related dementias.

9. Public education services relating to Alzheimer disease and related dementias.

10. Services for persons with blindness or visual impairment.

11. Services for persons with deafness, congenital hearing loss or acquired hearing loss.

(2) In subsection (1),

“client intervention and assistance services” means providing support to persons to assist them to cope with activities of everyday living;

“emergency response services” means installing electronic devices in homes to connect persons with emergency response centres;

“home help referral services” means referring a person who requires home help services to a person who provides such services;

“independence training” means teaching the skills to improve independent functioning in the community, including the effective use of personal support services;

“psychogeriatric consulting services” means providing psychogeriatric consultation, training and support to staff of long-term care homes, community care access centres and other approved agencies;

“services for persons with blindness or visual impairment” means providing rehabilitation, visual orientation, counselling, referrals and technology to persons with blindness or visual impairment;

“services for persons with deafness, congenital hearing loss or acquired hearing loss” means providing rehabilitation and communication training, counselling, technology and education to persons with deafness, congenital hearing loss or acquired hearing loss.

3. (1) Section 2 of the Regulation is revoked and the following substituted:

2. (1) A community care access centre shall not provide homemaking services to a person unless the following eligibility criteria are met:

1. The person must be an insured person under the Health Insurance Act.

2. The person,

i. must require personal support services along with the homemaking services,

ii. must receive personal support and homemaking services from a caregiver who requires assistance with the homemaking services in order to continue providing the person with all the required care, or

iii. must require constant supervision as a result of a cognitive impairment or acquired brain injury and the person’s caregiver must require assistance with the homemaking services.

3. The place in which the homemaking services are to be provided must have the physical features necessary to enable the services to be provided.

4. The risk that a service provider who provides the homemaking services to the person will suffer serious physical harm while providing the services must not be significant or, if it is significant, the service provider must be able to take reasonable steps to reduce the risk so that it is no longer significant.

(2) In subsection (1),

“caregiver” means a family member, friend or other person who,

(a) has primary responsibility for the care of an applicant for homemaking or personal support services or of a person who receives such services, and

(b) provides that care without remuneration. 

(3) A person is not eligible to receive homemaking services if the person is a tenant in a care home within the meaning of the Residential Tenancies Act, 2006 or is a resident in a nursing home under the Nursing Homes Act, an approved charitable home for the aged under the Charitable Institutions Act or a home under the Homes for the Aged and Rest Homes Act.

(2) Subsection 2 (3) of the Regulation, as remade by subsection (1), is revoked and the following substituted:

(3) A person is not eligible to receive homemaking services if the person is a tenant in a care home within the meaning of the Residential Tenancies Act, 2006 or is a resident of a long-term care home under the Long-Term Care Homes Act, 2007.

4. Section 2.1 of the Regulation is revoked and the following substituted:

2.1 A community care access centre shall not provide personal support services to a person unless the following eligibility criteria are met:

1. The person must be an insured person under the Health Insurance Act.

2. The place in which the services are to be provided must have the physical features necessary to enable the services to be provided.

3. The risk that a service provider who provides the services to the person will suffer serious physical harm while providing the services must not be significant or, if it is significant, the service provider must be able to take reasonable steps to reduce the risk so that it is no longer significant.

5. Subsection 3 (4) of the Regulation is amended by striking out “personal support school services” and substituting “school health personal support services”.

6. The Regulation is amended by adding the following sections:

Additional Professional Services

3.1 For the purpose of paragraph 9 of subsection 2 (7) of the Act, the following are prescribed as additional professional services:

1. Diagnostic and laboratory services.

2. Medical supplies, dressings and treatment equipment necessary to the provision of nursing services, occupational therapy services, physiotherapy services, speech-language pathology services or dietetics services.

3. Pharmacy services.

4. Respiratory therapy services.

5. Social service work services.

Service Providers

3.2 (1) A service provider that provides professional services shall ensure that there is a written plan of care for each person receiving the services.

(2) If the professional services provided to a person involve treating or advising the person within the scope of practice of a health profession as defined in subsection 1 (1) of the Regulated Health Professions Act, 1991, the service provider shall ensure that the plan of care is developed, evaluated and revised as necessary by a member of the College that relates to the professional services provided as defined in subsection 1 (1) of that Act.

(3) Subsections (1) and (2) do not apply to the provision of nursing services to a person who resides in a long-term care home.

Eligibility for Professional Services

3.3 Sections 3.4 and 3.5 do not apply to the provision of professional services by a community care access centre to a person who resides in a long-term care home.

3.4 A community care access centre shall not provide professional services to a person unless the following eligibility criteria are met:

1. The person must be an insured person under the Health Insurance Act.

2.   The services must be necessary to enable the person to remain in his or her home or enable him or her to return home from a hospital or other health care facility.

3. Except in the case of pharmacy services, the services must be reasonably expected to result in progress towards,

i. rehabilitation,

ii. maintenance of functional status, or

iii. palliation, in the case of a person who is in the last stages of life.

4. The place in which the services are to be provided must have the physical features necessary to enable the services to be provided.

5. The risk that a service provider who provides the services to the person will suffer serious physical harm while providing the services must not be significant or, if it is significant, the service provider must be able to take reasonable steps to reduce the risk so that it is no longer significant.

6. In the case of pharmacy services,

i. the person must be taking three or more prescription medications,

ii. the person must be at risk of medication complications due to complex medical needs, and

iii. the person must be unable to access the services in a setting outside the person’s home because of his or her condition.

7. In the case of physiotherapy services and medical supplies, dressings and treatment equipment necessary to the provision of physiotherapy services,

i. if the services are provided in the person’s home in accordance with clause 3.5 (3) (a), the person must be unable to access the services in a setting outside the home because of his or her condition, or

ii. if the services are provided in a congregate or group setting in accordance with clause 3.5 (3) (b),

A. the person must be 65 years of age or older, or

B. the person must have been recently discharged as an inpatient of a hospital and the services must be directly connected to the condition, illness or injury for which the person was admitted to the hospital.

8. In the case of respiratory therapy services, the person must be ventilator-dependent, have artificial airways or be receiving home oxygen services under the Assistive Devices Program administered by the Ministry.

9. In the case of services described in paragraph 1 or 2 of section 3.1, the person must be in need of nursing services, occupational therapy services, physiotherapy services, speech-language pathology services or dietetics services.

Location of Professional Services

3.5 (1) Subject to subsections (2) and (3), a community care access centre may provide a professional service to a person in the person’s home or in a congregate or group setting.

(2) A community care access centre may provide pharmacy services to a person only in the person’s home.

(3) A community care access centre may provide physiotherapy services and medical supplies, dressings and treatment equipment necessary to the provision of physiotherapy services to a person,

(a) in the person’s home, if the eligibility criterion in subparagraph 7 i of section 3.4 is met; or

(b) in a congregate or group setting, if one of the eligibility criteria in sub-subparagraph 7 ii A or B of section 3.4 is met.

Eligibility for Professional Services in a Long-Term Care Home

3.6 (1) A community care access centre may provide only the following professional services to a person who is a resident of a long-term care home:

1. Nursing services that are provided as part of the Nurse-led Long-Term Care Outreach Team program funded by the Ministry or a local health integration network.

2. Occupational therapy services.

3. Physiotherapy services.

4. Respiratory therapy services.

5. Speech-language pathology services.

6. Training a person to provide nursing services to persons who are residents of a long-term care home.

(2) A community care access centre shall not provide the professional services listed under subsection (1) to a person who is a resident of a long-term care home unless the following eligibility criteria are met:

1. The person must be an insured person under the Health Insurance Act.

2. Except in the case of nursing services, the person must be unable to access the services in a setting outside the person’s home because of his or her condition.

3. The services must be reasonably expected to result in progress towards,

i. rehabilitation,

ii. maintenance of functional status, or

iii. palliation, in the case of a person who is in the last stages of life.

4. In the case of respiratory therapy services, the person must be ventilator-dependent, have artificial airways or be receiving home oxygen services under the Assistive Devices Program administered by the Ministry.

7. (1) Subsection 4 (1) of the Regulation is revoked and the following substituted:

(1) A community care access centre shall not provide a person with more than the lesser of the following amounts of nursing services:

1. 120 visits to or from a registered nurse, a registered practical nurse or a registered nurse in the extended class in a 30-day period.

2. The following number of hours of service in a 30-day period:

i. 184 hours of service, if the services are provided by either or both registered nurses or registered nurses in the extended class,

ii. 227 hours of service, if the services are provided by registered practical nurses, or

iii. 206 hours of service, if the services are provided by,

A. both registered nurses and registered practical nurses,

B. both registered practical nurses and registered nurses in the extended class, or

C. all of registered nurses, registered practical nurses and registered nurses in the extended class.

(2) Subsection 4 (2) of the Regulation is amended by adding the following definition:

“registered nurse in the extended class” means a registered nurse who holds an extended certificate of registration under the Nursing Act, 1991;

(3) Subsection 4 (3) of the Regulation is amended by striking out “school services” and substituting “school health professional services”.

8. (1) The heading before section 5 of the Regulation is revoked and the following substituted:

Eligibility for School Health Professional Services

(2) Subsection 5 (1) of the Regulation is amended by adding the following definition:

“school health professional services” means the following professional services that are provided to a person who is enrolled as a pupil at a school on the school premises or while the pupil is being transported to or from the school on a school bus or other school vehicle or participating in a school trip or activity outside the school premises or that are provided to a person who is receiving satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act

and are necessary in order for the person to be able to receive instruction:

1. Dietetics services.

2. Nursing services.

3. Occupational therapy services.

4. Physiotherapy services.

5. Speech-language pathology services.

6. Medical supplies, dressings and treatment equipment necessary to the provision of the services referred to in paragraphs 1 to 5.

7. Training of school personnel to provide the services referred to in paragraphs 1 to 5 to persons enrolled as a pupil at the school.

(3) The definition of “school services” in subsection 5 (1) of the Regulation is revoked.

(4) Subsection 5 (2) of the Regulation is amended by striking out “school services” in the portion before paragraph 1 and substituting “school health professional services”.

(5) Paragraph 5 of subsection 5 (2) of the Regulation revoked and the following substituted:

5. The risk that a service provider who provides the service to the person will suffer serious physical harm while providing the service must not be significant or, if it is significant, the service provider must be able to take reasonable steps to reduce the risk so that it is no longer significant.

9. (1) The heading before section 6 of the Regulation is revoked and the following substituted:

Maximum Amount of School Health Professional Services

(2) Section 6 of the Regulation is amended by striking out “school services” wherever it appears and substituting in each case “school health professional services”.

10. (1) The heading before section 7 of the Regulation is revoked and the following substituted:

Eligibility for School Health Personal Support Services

(2) The definition of “personal support school services” in subsection 7 (1) of the Regulation is revoked.

(3) Subsection 7 (1) of the Regulation is amended by adding the following definition:

“school health personal support services” means the following personal support services that are provided to a person who is enrolled as a pupil at a school on the school premises or during

a school trip or activity outside the school premises or that are provided to a person who is receiving satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act and are necessary in order for the person to be able to receive instruction:

1. Personal hygiene activities.

2. Routine personal activities of living.

3. Medical and personal equipment necessary to the provision of the services referred to in paragraphs 1 and 2.

4. Training of school personnel to provide the services referred to in paragraphs 1 and 2 to persons enrolled as pupils at the school and assisting the personnel in providing them.

(4) Subsection 7 (2) of the Regulation is amended by striking out “personal support school services” in the portion before paragraph 1 and substituting “school health personal support services”.

(5) Paragraph 5 of subsection 7 (2) of the Regulation is revoked and the following substituted:

5. The risk that a service provider who provides the service to the person will suffer serious physical harm while providing the service must not be significant or, if it is significant, the service provider must be able to take reasonable steps to reduce the risk so that it is no longer significant.

(6) Subsection 7 (3) of the Regulation is amended by striking out “personal support school services” and substituting “school health personal support services”.

11. The Regulation is amended by adding the following section:

Exemptions

8. (1) When a community care access centre provides nursing services to a person who is a resident of a long-term care home, the community care access centre is exempt from section 22 of the Act in respect of that person.

(2) When a community care access centre manages the placement of a person into a chronic care or rehabilitation bed in a hospital, the community care access centre is exempt from clause 22 (1) (c) and subsections 22 (2), (3), (4) and (6) of the Act in respect of that person.

(3) When a community care access centre manages the admission of a person into an adult day program, the approved agency providing the adult day program is exempt from subsection 22 (1) of the Act in respect of that person.

(4) When a community care access centre manages the admission of a person into a supportive housing program, the approved agency providing the supportive housing program is exempt from subsection 22 (1) of the Act in respect of that person.

12. (1) Subject to subsection (2), this Regulation comes into force on the later of,

(a) September 18, 2009; and

(b) the day this Regulation is filed.

(2) Subsections 1 (2) and 3 (2) come into force on the latest of,

(a) September 18, 2009;

(b) the day section 1 of the Long-Term Care Homes Act, 2007 comes into force; and

(c) the day this Regulation is filed.