September 8, 1999
To:Community Services Committee and Board of Health
From:Commissioner of Community and Neighbourhood Services
Medical Officer of Health
Subject:Retirement Homes
Purpose:
To outline short-term and longer-term steps that can be taken to investigate, report back on and help to address the health,
social and legal issues arising from unregulated retirement homes.
Source of Funds:
Resource implications in 1999 pertain to establishment of a telephone hotline for concerned members of the public, along
with the possible need to reallocate staff within a number of City divisions to handle an increased volume of complaints
investigations. In the short-term, in order to take immediate action, Toronto Public Health will require $527,500 for 6
months (October 1, 1999 - March 31, 2000) to hire staff to cover the increased volume of site visits and to cover the
expansion of a hotline for concerns regarding retirement homes. This will be absorbed in the Community and
Neighbourhood Services 1999 approved Operating Budget, subject to a report to the Budget Advisory Committee on
underexpenditures in 1999 that may be reallocated for this purpose, as part of the 1999 Operating Budget Variance
Reporting process.
The funding implications of a longer-term solution will be subject to a report to the Budget Advisory Committee for
consideration with the year 2000 Operating Budget process.
Finance staff have been consulted and concur with this approach.
Recommendations:
It is recommended that:
(1)a Retirement Homes Advisory Committee be established, comprised of Councillors Ootes (Deputy Mayor), Johnston
(Seniors Advocate), Filion (Chair, Board of Health), Duguid (Chair, Community Services Committee) and Flint (Chair,
Planning and Transportation Committee);
(2)a Retirement Homes Action Team led by Public Health, be established with membership from Homes for the Aged,
Municipal Standards and Licensing, Fire, Ambulance, Buildings, Legal Services, Shelter Housing and Support, Toronto
Police, and Social Development. This team will immediately implement a short-term action plan to address complaints and
concerns from the public regarding retirement homes;
(3)the City of Toronto fully apply its existing legal powers to investigate complaints related to the health and safety of
residents in retirement homes across the City;
(4)the Commissioner of Community Services and the Commissioner of Urban Planning and Development, in
consultation with the Medical Officer of Health and City Solicitor, establish an interdepartmental working group
comprised of staff from Police, Fire, Ambulance and Legal as well as other appropriate stakeholders. This working group
will report back to the Retirement Homes Advisory Committee by November 1999 and by December 1999 to the Board of
Health, the Community Services Committee and the Planning and Transportation Committee on the scope of the problem,
issues related to the development and monitoring of mechanisms for ensuring quality and standards of care, and possible
roles for the City, the Province and other stakeholders in this regard;
(5)this report be forwarded to the Planning and Transportation Committee and the Policy and Finance Committee;
(6)the estimated funding of $527,500.00 required for the short-term solution be absorbed in the Community and
Neighbourhood Services 1999 approved Operating Budget, and that a report be submitted to the Budget Advisory
Committee on the details of this expenditure, and the underexpenditures in 1999 that may be reallocated for this purpose,
as part of the 1999 Operating Budget Variance reporting process.
(7)the funding implications of a longer-term solution be subject to a report to the Budget Advisory Committee, for
consideration with the year 2000 Operating Budget process.
(8)the appropriate City officials be authorized and directed to take the necessary action to give effect hereto.
Background:
Following media attention on the welfare of residents in a particular retirement home, the Mayor requested that a
Retirement Homes Action Team be established and that action be taken by city staff to ensure such problems are properly
addressed. This report outlines an initial plan of action in response to that request.
Comments:
What are Retirement Homes?
Retirement homes are privately owned and operated. There are both for profit and not-for-profit facilities operating in
Toronto with services ranging from minimal assistance to comprehensive health and personal services. However, residents
entering such facilities are usually able to look after most of their personal care needs. Retirement homes usually have
health care aides and/or nursing staff who can provide supervision with medication administration. Meals, housekeeping
and recreational programs are generally included in the monthly cost. Accommodation ranges from wards to semi-private
and private rooms. Most retirement homes enable extra personal care to be purchased on an hourly basis, often from an
external agency. While most facilities that are termed retirement homes house seniors, there are no age restrictions for
entry; persons of any age who require support may live in such a facility.
For people needing more care, a nursing home or long-term care facility is required and placement into these facilities can
be done through one of the six Community Care Access Centres (CCACs) in Toronto. CCACs can allocate Home Care
hours to residents living in retirement homes. Nursing homes and homes for the aged are subject to provincial regulations
enacted under the 1993 Long Term Care Act.
How Many Are There?
Since the definition of a retirement home is so unclear and there is no mandatory licensing or accreditation system in place,
it is not known how many retirement homes there are in the City of Toronto. Existing resource directories indicate about 73
as follows: 54 in the former City of Toronto, 6 in Etobicoke, 8 in Scarborough and 5 in North York. There are no registered
retirement homes that we know of in the former Borough of East York and the former City of York.
Actual numbers may be much higher. Public Health staff estimate that the number of facilities that could fit a definition of
retirement home/boarding home/lodging house (including those in the former Cities of Toronto and Etobicoke which are
currently licensed) might be approximately 250 (24 in North York, 35 in East York and Scarborough, 28 in Etobicoke and
York and 165 in the former City of Toronto).
Continuum of Care:
Retirement homes represent one element in the continuum of care and services which range from independent living at one
end to long-term care in a Nursing Home or Home for the Aged facility at the other. They serve a population varied in both
income and care needs. However, there is an acute shortage of long-term care and supportive housing beds in Toronto,
combined with chronic under-supply of low-income housing. Therefore, retirement homes and related facilities
(e.g.,boarding homes, lodging houses) play an important role in Toronto=s housing supply for low-income, vulnerable and
disabled persons, including seniors.
Lack of Standards or Regulations:
There are no Provincial standards or regulations regarding retirement homes in Ontario, although they are subject to basic
public health standards, fire and building regulations and local zoning restrictions. No municipal business licence is
required to operate a retirement home in Toronto although some former municipalities had local by-laws covering these
establishments (see below).
The Ontario Residential Care Association (ORCA) is an industry organization in which retirement homes can voluntarily
become members after paying a fee and meeting certain standards. Assessment is done through a peer review accreditation
system.
The issue of regulation and standards of care in retirement and rest homes is not new. The Province of Ontario,
municipalities and a range of community organizations and seniors advocates have been grappling with the issue for
decades. For example, in September 1987, Anne Johnston Associates presented a report to the provincial Minister of
Senior Citizens Affairs outlining municipal views and concerns regarding this issue. In April 1989, the Advisory
Committee on Rest Homes was established to advise the Minister of Senior Citizens Affairs on the most effective means to
ensure adequate standards of care and that rest homes be subject to appropriate legislation. In May 1992, Ernie Lightman
presented the report of a Commission of Inquiry into unregulated residential accommodation to the Lieutenant-Governor of
the Province of Ontario. All these reports identified problems arising from the lack of regulation and standards
enforcement and unclear definitions of the different care facilities.
Existing By-Laws in the City of Toronto:
There are currently two by-laws in place in the City of Toronto that could pertain to retirement homes; the Personal Care
Rooming House By-Law (only in the former City of Toronto) and the Lodging Houses By-Law (only in the former City of
Etobicoke). The Personal Care Rooming House By-Law outlines a set of standards pertaining to rooming houses or other
buildings where people reside and where the owner provides meals and services related to health and/or personal needs.
The Lodging Houses By-law requires that a licence be obtained from the Board of Health to operate a lodging house,
defined as a dwelling where the proprietor supplies accommodation (with or without food and/or personal care) for more
than two persons. Both by-laws were enacted as a result of human tragedy (in the former City of Toronto in the aftermath
of the Rupert Hotel fire and in Etobicoke after the death of a resident of an unlicensed lodging house).
Currently City staff inspect 102 Personal Care Rooming Houses three times per year, in the former City of Toronto under
the Personal Care Rooming House By-law. (It is important to note that only 11 of the 54 retirement homes that are
members in ORCA are inspected within these 102 rooming houses.) In Etobicoke, staff inspect 20 lodging homes under the
Lodging Homes By-Law. In addition, when a complaint is received, Public Health enters the premises (under the Health
Protection and Promotion Act) to determine if a health hazard exists, as well as to determine if the premises meet the
definition of the Personal Care Rooming House as outlined in the by-law. In addition, requirements under the Food
Premises Regulations can be applied to premises with 10 or more residents. While on the premises, inspectors look out for
other concerns including abuse, neglect and fire hazards, and potential problems are referred to other appropriate agencies
such as fire, buildings, licensing, buildings, police and social services.
The chart in Appendix A describes the current regulatory and enforcement powers within the City of Toronto, broken down
by former municipality. The City's levers to enforce standards in retirement homes are limited and inconsistent. With the
exception of special provisions for rooming houses in the former City of Toronto, the Municipal Act currently does not
permit municipal licensing of rental accommodation.
Current Retirement Home Information and Complaints Systems:
Undoubtedly many retirement homes are excellent, well-managed facilities. However some operators will need assistance
in addressing the needs of their clients and in understanding and meeting their legal obligations.
There is currently no single number to call to obtain information about the full range of retirement home and nursing home
options. Community Care Access Centres (CCAC's) provide comprehensive information and placement co-ordination
services for Ministry of Health funded facilities and some information on other options. The Ontario Residential Care
Association produces a consumer directory of retirement residences across Ontario and Esther Goldstein Associates
produces a guide to retirement living in the Greater Toronto and surrounding area.
For complaints about potential elder abuse, the public can anonymously call the police-operated Crime Stoppers Line
which has a service dedicated to seniors and people can also call the elder abuse hot-line operated by the police. Public
Health has a hotline for complaints pertaining to smoking issues which sometimes result in actions by inspections staff.
The Division also manages an AIDS hotline that has been successfully used in the past for other communicable disease
issues (e.g., meningitis). Hence the technology is in place for Public Health to establish an additional hotline for complaints
and concerns related to retirement homes and other unregulated facilities.
Membership and Role of the Retirement Home Advisory Committee, the Retirement Homes Action Team and the
Inter-Departmental Working Group:
The Retirement Homes Advisory Committee, comprised of Councillors Ootes (Deputy Mayor), Johnston (Seniors
Advocate), Filion (Chair, Board of Health), Duguid (Chair, Community Services Committee) and Flint (Chair, Planning
and Transportation Committee) will provide advice and direction to the Retirement Homes Action Team and to the
Inter-Departmental Working Group, to ensure that the City takes action on issues pertaining to retirement homes.
Immediate Strategy:
The Retirement Homes Action Team, led by the Medical Officer of Health, will include staff representatives of Public
Health, Social Development, Homes for the Aged, Ambulance, Planning, Legal, Police, Fire and Buildings. The team will
immediately establish an interim expanded system for complaints investigations and enforcement of the limited City
powers that exist at this time.
A key first step will be a hot-line for people to call with their concerns pertaining to suspected abuse in facilities. The
capacity of an existing Public Health hotline will be expanded to accomplish this task. Experience in the former Cities of
Etobicoke and Toronto indicate that the initial volume of calls will be high. The interim hotline service will need to be
promoted through local media and agencies working with seniors and other people requiring support in daily living as well
as referral agencies. The expected additional costs for this will be a one-time cost of $40,000.00 to promote the line and
three staff counsellors for a period of six months at a cost of $97,500.00. It is expected that after six months this service
could be covered by 1 FTE at a total annualized cost of $65,000.00 once the initial volume of calls is reduced.
Additional public health inspectors will also be hired to undertake the increased demand stemming from the hotline calls
and act on the City's ability to utilize existing mechanisms to enhance inspection. Should the City choose to immediately
expand the former Toronto by-law City-wide using Section 104 of the Municipal Act, it is estimated that about 250
establishments will need to be inspected. At an estimated 1 FTE for 20 facilities (including inspection, public health nurses
and administration), this would require 12 additional Public Health FTE's for six months at a cost of $390,000.00.
Municipal Standards inspectors will be assigned to the team to address property standards and related by-law issues. This
will be done from within existing resources. Property standards by-laws are different in each of the former municipalities.
A draft harmonized property standards by-law has been developed and will be sent to the Planning and Transportation
Committee and City of Toronto Council for review this fall.
The Retirement Homes Action Team will report to the Advisory Committee on their progress on an ongoing basis and as
part of the staff working group final report in November of 1999.
Long-Term:
The Inter-Departmental Working Group co-ordinated by the Commissioners of Community and Neighbourhood Services
and Urban Planning and Development Services, in consultation with the Medical Officer of Health, police, fire, ambulance
and legal services will co-ordinate the necessary research and planning for the longer-term, and consult with key
stakeholders to accomplish their task. The City's longer-term direction regarding retirement homes will complement the
immediate strategies such as the complaints hotline developed by the Retirement Homes Action Team. The
Inter-Departmental Working Group will work with the Retirement Homes Advisory Committee to develop a balanced
approach that protects residents while ensuring that this type of housing can continue to exist.
Specifically the working group will:
(1)assess the scope of the problem and clarify definitions;
(2)determine how retirement home issues fit with other long-term care issues faced by seniors and other people requiring
supports for daily living;
(3)clarify appropriate roles for the different levels of government and the private sector;
(4)develop options for establishing appropriate mechanisms for supporting quality and standards of care and propose
strategies for action;
(5)propose an effective public information system (to field complaints and to obtain information about accommodation
options for people requiring personal care support);
(6)assess the impact of proposed strategies on the service and support system as a whole; and
(7)define and implement an effective consultation process with key community stakeholders and the Province of Ontario.
After developing their recommendations, the Inter-Departmental Working Group should negotiate transfer of lead roles to
appropriate agencies for implementation.
The Inter-Departmental Working Group will present their final report to the Advisory Committee in November, 1999 and
thereafter to the Board of Health and Community Services Committee.
To be effective, it is essential that the advisory committee, the action team and the working group collaborate with key
community service providers and seniors advocates who have considerable experience in this issue. In addition, it is
essential that the city give close consideration to the appropriate municipal and provincial roles in any proposals for future
direction. The City of Toronto is pleased that the Province of Ontario is in the process of looking into the problem of lack
of standards and accreditation for retirement homes.
Conclusion:
This report outlines short-term and longer-term actions to resolve the issue of how to ensure adequate standards in
retirement homes. It must be stressed that there are many complex policy issues underlying the chronic lack of mandatory
standards and regulations in this sector, and that the Province, the private sector and key community stakeholders are
essential players in their development. As a first step, City staff will support concerned members of the public by
investigating complaints arising from these establishments and by outlining a plan of action for consideration by the Board
of Health and City Council.
Contact:
Dr. Sheela Basrur
Medical Officer of Health
Toronto Public Health
Tel: 392-7402/Fax: 392-0713
Appendix A
Retirement Homes: Tools for Enforcement
