About City-Operated Long-Term Care Homes

Accreditation

We have been Accredited with Commendation for going beyond the requirements of Accreditation Canada’s Qmentum accreditation program and demonstrating an ongoing commitment to quality improvement.

Prior to our next full accreditation survey in 2022, we completed a supplementary survey of Required Organizational Practices (ROPs) in June 2021 and met all of the requirements.

Accreditation Canada is a not-for-profit, independent organization accredited by the International Society for Quality in Health Care (ISQua).

Annual Report (2021)

The 2021 Annual Report was distributed to all stakeholders via email in February 2022.

Seniors Services and Long-Term Care 2021 Annual Report

Behavioural Support Programs

As recognized leaders in behavioural support programs, we have a long history of demonstrated knowledge of dementia, delirium and mental health in the delivery of care.

Staff and medical professionals are knowledgeable in the most prevalent types and related causes of behavioural issues, understand disease processes, stages and progression, diagnostic and assessment process, cognitive or neurological symptoms, treatment interventions, appropriate communication to address resident needs, strategies to promote optimal quality of life and experience of the behaviour(s) from the perspective of the resident, family members and other partners in care.

All City of Toronto long-term care homes have behavioural support programs. In addition:

• Cummer Lodge has a Ministry-designated 16-bed Behavioural Support Unit which receives enhanced funding.
• Bendale Acres has received Behavioural Specialized Unit pilot funding to provide accommodation, care, services, programs and goods for residents with heightened responsive behaviours.

Capital Renewal Plan

In November 2015, Toronto City Council approved the Long-Term Care Homes & Services Capital Renewal Plan. The plan allows the division to proceed with the staged redevelopment of five long-term care homes to meet new design standards, explore affordable housing opportunities and advance the vision to be leaders in excellence and ground-breaking services for healthy aging. The Capital Renewal Plan promotes and preserves partnerships, responds to emerging community needs, serves vulnerable individuals and ensures residents will continue to receive excellent care and services, throughout redevelopment, in City-operated long-term care homes.

The Capital Renewal Plan is an exciting opportunity to modernize and improve the design of homes while advancing our vision to be leaders in excellence and ground-breaking services for healthy aging. The plan keeps beds in service at each site for as long as possible in order to minimize disruption. Residents will continue to receive excellent care and service throughout the redevelopment program. City Council has directed:

1. Proceed with the recommended staged approach to address mandatory redevelopment;
2. Enter into discussions with the Ministry of Health and Long-Term Care and Local Health Integration Networks to negotiate bed allocations and movements between locations, and to schedule redevelopment projects;
3. Enter into discussion with Humber College Lakeshore Campus regarding opportunities for a teaching long-term care centre of excellence; and
4. Explore opportunities to add affordable housing on the sites being redeveloped.

Receiving approval of City Council is very encouraging and will allow us to move forward with planning. However, it is important to note that funding still needs to be allocated, so final Council approval of the Capital Renewal Plan is subject to budget approval.

In addition to approving the Capital Renewal Plan, Council adopted the George Street Revitalization plan which will include a long-term care home, emergency shelter, transitional assisted living and affordable housing units to better meet the needs of homeless, vulnerable and elderly individuals.

The Capital Renewal Plan is based on the following Guiding Principles:

• Deliver current level of service (2,641 Ministry approved beds) to support high-quality specialized resident-focused care while seeking to maximize cost savings and efficiencies.
• Promote and preserve partnerships, including ethnocultural, volunteer and community linkages.
• Respond to emerging community needs and serve vulnerable individuals.
• Minimize resident disruption related to capital renewal.
• Advance the Toronto Seniors Strategy with a City-wide commitment to CARE (Compassion, Accountability, Respect and Excellence) by strategically locating its homes throughout the City and by providing community hub space in support of healthy aging.

The five (5) City of Toronto long-term care homes identified for mandatory redevelopment are:

• Carefree Lodge
• Castleview Wychwood Towers
• Fudger House
• Lakeshore Lodge
• Seven Oaks

In May 2018, City Council adopted the goal to maximize the potential number of long-term care beds which could be located on the sites requiring redevelopment. Based on the sites identified at the time, this would represent an increase of 978 beds to the existing inventory of 2,641 beds, and would be the first increase (37 per cent) in City-operated long-term care beds in approximately 30 years.

COVID-19 Resources for LTC Residents, Caregivers & Volunteers

These downloadable resources have been made possible by funding support from Healthcare Excellence Canada and the collaboration of a working group representing the City’s directly-operated LTC homes.

Welcome-COVID-19 Resource Guide

Art-COVID-19 Resource Guide

Communication-COVID-19 Resource Guide

Community Connections-COVID-19 Resource Guide

Mealtimes-COVID-19 Resource Guide

Music-COVID-19 Resource Guide

Physical Activity-COVID-19 Resource Guide

Sensory Activities-COVID-19 Resource Guide

Small Groups-COVID-19 Resource Guide.pdf

Spiritual Care-COVID-19 Resource Guide

Virtual Visits-COVID-19 Resource Guide 

And this video shows the Resource Guide being used within the long-term care home setting.

 

End of Life and Palliative Care

What is end of life care?

End of life care is adopted when death is expected within six months. The aim is to provide comfort and quality of life by relieving the symptoms and stresses experienced at the end of life.

What is palliative care?

Palliative care is a type of specialized care for residents and their families who are facing a serious, life-limiting illness. It is resident-centred, coordinated care that aims to relieve suffering and improve quality of life for residents and their families at all stages of the illness. This type of care aims to treat active issues and to prevent new ones from occurring. Where possible, opportunities for meaningful and valuable experiences are promoted with a focus on personal and spiritual growth.

Who provides the care?

Each City LTC home has a care team made up of professionals that includes: physicians, nurses, personal support workers, social work counsellors, physiotherapists, occupational therapists, dietitians, complementary care assistants, spiritual and religious care, volunteer coordinators, music and art therapy and recreation.

What type of care is provided?

Palliative care services may include:

• Physician and nursing services to assess and manage the progression of the illness. This includes providing pain and symptom management to improve comfort and quality of life
• Psychological, social, spiritual and bereavement support services
• Other services such as physiotherapy, occupational therapy, caregiver support, pharmacy and volunteer supports

What is Advance Care Planning?

Advance Care Planning is a process that encourages residents, family members and health care providers to talk about a resident’s health care wishes, in case there comes a time when the resident may not be able to make their own health care decisions. While Advance Care Planning conversations can be difficult, they help support resident-centred palliative care and help friends and family by taking away some of the stress and uncertainty that comes at an already emotional time.

A palliative care plan determines how to provide care that reflects the resident’s physical, intellectual, social, emotional, and spiritual needs and preferences. The resident’s values, strengths, and desires will also be considered. Palliative care plans are unique to each resident and are created in collaboration with the resident, the substitute decision-makers/family and the care team. The resident’s level of function will be assessed by looking at: how much they walk; their activity level and evidence of disease; their ability to care for self; how much they eat and drink; and their mental alertness. Looking at these factors will help guide a discussion with the resident and their family regarding building a palliative care plan.

Grief and Bereavement Support

Grief is a natural and personal reaction to transitions, such as moving into a long-term care home or Advance Care Planning. It is important to provide opportunities for expressing feelings and thoughts that are common in grieving. Staff, including a social work counsellor is available to speak with you and your family members when needed.

Health Information Statement

Statement of Information Practices

Seniors Services and Long-Term Care (SSLTC), a Division of the City of Toronto is the Health Information Custodian for ten (10) long-term care homes. This means, under the Personal Health Information Protection Act, 2004 (PHIPA), SSLTC has the responsibility to ensure that personal health information is collected, used, stored and shared with full regard for the protection of privacy and the confidentiality of personal health information. This obligation to protect the privacy of personal health information extends to persons who act as agents of the Ministry of Healthy (MOH) and Ministry of Long-Term care (MLTC).

Access

Individuals who wish to access or correct their personal health information, or have questions about how it is collected, maintained, used or disclosed, are encouraged to contact the long-term care home’s management team.

Individuals may also make a written request for access or to correct personal health information under PHIPA.

Complaints

SSLTC is committed to resolving all concerns or complaints and encourages individuals to first contact the department involved. An individual’s concerns or complaints about access or privacy practices within SSLTC may be directed to the Department Manager. For general concerns or complaints about privacy practices, individuals are encouraged to contact the SSLTC Privacy Office at SSLTCPrivacy@toronto.ca

Individuals may also submit a complaint regarding access or privacy practices of SSLTC directly with the Office of the Information and Privacy Commissioner (IPC):

Information and Privacy Commissioner / Ontario

2 Bloor St. E., Suite 1400

Toronto, Ontario M4W 1A8

Phone: 416-326-3333

Email: commissioner@ipc.on.ca

Contact Information

If you have any questions about our information practices, feel free to contact:

Manager, Privacy and Clinical Information Management

1530 Markham Road, Unit #502 – 5th Floor

Toronto, Ontario M1B 3G4

Phone: 416-392-8490

Fax: 416-392-8457

SSLTCPrivacy@toronto.ca

Leading and Learning with Pride

Download the 2022 Tool Kit

Leading & Learning WITH PRIDE A Revitalized Tool Kit on Supporting 2SLGBTQI+ Seniors (8 MB)

Watch the Video

Leading & Learning with Pride – Supporting 2SLGBTQI+ Seniors on International Day of Older Persons (YouTube)

Project History

2004: Seniors Services and Long-Term Care (SSLTC) becomes one of the first providers in North America to embrace a model of long-term care that affirms Two-Spirit, Lesbian, Gay, Bisexual, Transgender (Trans), Queer, Intersex, and additional gender- and sexually-diverse communities (2SLGBTQI+).

2008: SSLTC releases the LGBT Tool Kit: For Creating Lesbian, Gay, Bisexual and Transgender Culturally Competent Care at Toronto Long-Term Care Homes & Services

2017: SSLTC revises the Tool Kit to share lessons about the delivery of sensitive care to 2SLGBTQI+ seniors across the City’s 10 LTC homes and community programs and provide a framework for inclusive and affirming service provision

2018: Toronto City Council adopts the Toronto Seniors Strategy 2.0; Recommendation 22 directs the City to work with community partners (The 519 and Senior Pride Network) to raise awareness and educate against homophobia, biphobia, and transphobia affecting seniors

2021: SSLTC assembles a working group of community members, service providers, allies, and advocates to revitalize the 2SLGBTQI+ Tool Kit and advance recommendation 22 in the Toronto Seniors Strategy

2022: SSLTC releases Leading & Learning WITH PRIDE: A Revitalized Tool Kit on Supporting 2SLGBTQI+ Seniors.

Advancing Respectful, Inclusive & Affirming Care

We define respectful, inclusive and affirming care as: a set of practices, policies, and principles that acknowledge the diverse experiences of 2SLGBTQI+ seniors and respond to their physical, psychological, emotional, social, and spiritual needs

• Respect is the foundation – Respect means considering the experiences of 2SLGBTQI+ seniors and upholding their rights to dignity and freedom from discrimination.
• Inclusion is the next step up – Inclusion means providing equitable access to resources and opportunities for 2SLGBTQI+ seniors, who may otherwise experience barriers and marginalization
• Affirmation goes one step further – Not only are 2SLGBTQI+ seniors respected and included, but their lived experiences and participation are actively encouraged, supported, and celebrated

Purpose of the Tool Kit

This revitalized Tool Kit strives to:

1. Advance respectful, inclusive and affirming care for 2SLGBTQI+ seniors in Toronto by
   1. Building individual knowledge and skills among SSLTC staff and other service providers in the delivery of support to 2SLGBTQI+ seniors
   2. Building organizational capacity among SSLTC and other seniors support organizations in the creation of inclusive environments for 2SLGBTQI+ seniors
2. Reduce stigma, discrimination, and other barriers in LTC, healthcare, retirement, homecare, and community-based services for 2SLGBTQI+ seniors in Toronto
3. Meaningfully improve the lives of 2SLGBTQI+ seniors in Toronto by treating them with empathy, compassion, and dignity

Who is this Tool Kit For?

This revised Tool Kit is hosted by the City of Toronto’s Senior Services and Long-Term Care (SSLTC) division.

It includes useful examples and lessons from the 10 City long-term care homes and various community programs, but is a resource for any and all service providers and care partners working to support 2SLGBTQI+ seniors (e.g., long-term care homes, retirement homes, hospitals, social service settings, homecare agencies, other community-based organizations).

Content might also be relevant to those providing support and allyship to 2SLGBTQI+ seniors, such as family, friends, community members, caregivers, and substitute decision makers.

A Note on Acronyms, Initialisms & Language

This Tool Kit uses the initialism ‘2SLGBTQI+’ and the shorthand ‘Queer and Trans’ to describe diverse and expanding communities of gender- and sexual-minority seniors. The ‘2SLGBTQI+’ initialism was adopted following close consultation with the working group and reflects a modest step in centering the lived experiences of Two-Spirit people and LGBTQI+ Indigenous communities.

Acronyms, initialisms and language related to sex, gender, and sexual orientation are context-sensitive, imperfect, and continually evolving.

A Note on Intersectionality

2SLGBTQI+ seniors may experience stigma, discrimination, and oppression related to their age, sexual orientation, gender, race, religion, ability, socioeconomic status, and a host of other factors. These experiences can overlap and intersect to create unique barriers and challenges for different 2SLGBTQI+ seniors.

Intersectionality is a theory developed Dr. Kimberlé Crenshaw that helps us describe and analyze how the different pieces of our identity (e.g., age, race, gender, sexual orientation) intersect to create distinct experiences of privilege and disadvantage. This Tool Kit adopts an intersectional, person centered approach.

A Note on Family

In this Tool Kit, ‘Family’ is defined to include both families of origin (i.e. legal and/or biological relatives) and chosen families or found families. A chosen/found family consists of people who have intentionally chosen to embrace, nurture, love, and support one another, regardless of blood or marriage.

Preview of Section I – Building Individual Knowledge & Skills

This section of the Tool Kit provides the foundational knowledge necessary to support 2SLGBTQI+ seniors.

Specifically, this section will:

• Familiarize you with important language and terminology relevant to the care of 2SLGBTQI+ seniors
• Provide an overview of current research with 2SLGBTQI+ seniors, including their needs and experiences in LTC, healthcare, retirement, homecare, and social support settings
• Introduce the concept of 2SLGBTQI+ Allyship and outline some concrete steps you can take to practice being an ally

Language & Terminology

• Provides definitions for language and terminology related to sex, gender, and sexual orientation (e.g., Gender Identity, Gender Expression, Cisgender, Transgender, ‘Coming Out,’ Genderqueer, Intersex, Non-binary, Asexual, Pansexual, Transition, Two Spirit)
• Provides definitions for language and terminology related to Stigma, Discrimination, and Oppression Against 2SLGBTQI+ Seniors (e.g., Cissexism, Transphobia, Transmisogyny, Heterosexism, Homophobia, Biphobia, Pathologization, Colonization)

2SLGBTQI+ Seniors Today – A Snapshot of Current Research

• Explores experiences shared by some 2SLGBTQI+ seniors and provides an overview of current research on their needs and challenges.
• Topics Include:
  • Historical Context for 2SLGBTQI+ Seniors – A Life Course Perspective
  • Physical Health for 2SLGBTQI+ Seniors (e.g., pain, disability, asthma, certain cancers, chronic conditions)
  • Sexual Health & Intimacy for 2SLGBTQI+ Seniors
  • HIV/AIDS for 2SLGBTQI+ Seniors (e.g., historical trauma, stigma)
  • Social Isolation and Mental Health for 2SLGBTQI+ Seniors
  • Elder Abuse Against 2SLGBTQI+ Seniors
  • Religious- and Faith-based Discrimination Against 2SLGBTQI+ Seniors
  • Experiences of 2SLGBTQI+ Seniors during COVID-19
  • Memory Loss and Cognitive Disability (e.g., dementia, HIV-Associated Neurocognitive Disorders, unique experiences of Trans people with memory loss)
  • End-of-Life Care for 2SLGBQTI+ Seniors
  • Barriers to Care for 2SLGBTQI+ Seniors

Practising Allyship with 2SLGBTQI+ Seniors

• Presents 6 Ways to Practise Allyship with 2SLGBTQI+ Seniors:
  1. Use Inclusive Language and Appropriate Terminology
  2. Challenge your own Biases and Assumptions
  3. Listen to Others and Lean into Discomfort
  4. Engage in Ongoing Education
  5. Have Challenging Conversations with Colleagues
  6. Advocate, Advocate, Advocate!

Preview of Section II – Building Organizational Capacity

This section focuses on organizational-level approaches to promote inclusion and address systemic barriers affecting 2SLGBTQI+ seniors.

Building organizational capacity means creating and implementing concrete policies, procedures, programs, and overall environments that explicitly respect, include, and affirm 2SLGBTQI+ communities.

Specifically, this section will:

• Identify and describe 10 recommendations for creating respectful, inclusive, and affirming organizations
• Provide practical examples and additional resources to accompany each recommendation that will empower staff to lead or support organizational change efforts

1. Look, Listen & Feel – Check the Pulse of the Organization

• Describes how to use your senses to start the process of creating a respectful, inclusive, affirming organization
  • Look for signs of 2SLGBTQI+ inclusion
  • Listen for 2SLGBTQI+ inclusive language
  • Feel the general atmosphere of the organization

2. Spread the Word – Communicate Intentions to Stakeholders

• Provides guidance on how to identify and communicate with all the stakeholders who may be involved in or impacted by efforts to make your organization more respectful, inclusive, and affirming for 2SLGBTQI+ communities
• Emphasizes the value of framing your message using relevant policy and legislation (e.g., the Ontario Human Rights Commission) to clarify the legal obligation to provide care and support free from homophobic, biphobic, and transphobic discrimination

3. Open Up – Create Welcoming Policies, Procedures & Environments

• Outlines how to critically review your organization’s policies, procedures, and environments to ensure that they are inclusive, affirming, and respectful of 2SLGBTQI+ communities
• Provides specific instructions on embedding 2SLGBTQI+ inclusion in the following policies:
  • Anti-violence, harassment, and discrimination policies
  • Human resources and staffing policies
  • Policies specific to long-term care and retirement settings (e.g., Resident’s Bill of Rights, Living Environments and Rooming Policies, Visiting Policies)
• Discusses 2SLGBTQI+ considerations in the following procedures:
  • Intake & Assessment
  • Power of Attorney and advance care planning with 2SLGBTQI+ long-term care residents
  • Care planning and Essential Caregiver designations
• Highlights various visual/environmental indicators that represent an organization’s commitment to 2SLGBTQI+ inclusion, including:
  • Flags
  • Gender inclusive washrooms
  • Promotional materials

4. Light the Spark – Identify 2SLGBTQI+ Champions

• Explores the importance of 2SLGBTQI+ champions in supporting organizational change efforts
• Provides specific guidance to those in decision-making or leadership roles, who often have the organizational influence and resources to promote meaningful change

5. Come Together – Create Formal 2SLGBTQI+ Organizing Groups

• Presents successful examples of Steering Committees and Gender-Sexuality Alliances (GSAs) from two long-term are homes, which can serve as models for other organizations wishing to establish formal 2SLGBTQI+ organizing groups

6. Build Bridges – Engage Partners and Create Communities

• Explores the value of partnerships with local 2SLGBTQI+ community groups and organizations and provides an example of successful community engagement in the development of a ‘Rainbow Unit’ at the Rekai Centres

7. Hit the Books – Promote Ongoing 2SLGBTQI+ Education & Training

• Presents suggestions for ongoing education and training around 2SLGBTQI+ topics and provides recommendations on:
  • Who should coordinate the training?
  • Who should deliver the training?
  • Who should attend the training?
  • When should the training be delivered?
  • What should the training include?

8. Walk the Talk – Develop and Deliver 2SLGBTQI+ Affirming Programs & Services

• Provides an overview of how to design and deliver programs and services through the lens of 2SLGBTQI+ inclusion, with a specific focus on:
  • Social Support & Recreation Services
  • Spiritual & Faith-based Services
  • Intergenerational Programming

9. Raise Your Voice – Advocate Widely

• Discusses the importance of advocacy to shape public debate and influence policy in ways that address persistent and systemic threats to the health of Queer and Trans seniors. Presents four advocacy activities for organizations to engage in.

10. Be Accountable – Evaluate Processes & Systems for 2SLGBTQI+ Inclusion

• Highlights the critical importance of ongoing systematic evaluations to assess whether efforts to improve supports for 2SLGBTQI+ seniors are working, how, and for whom
• Explores the responsibility of an organization’s leadership and management to ensure evaluation takes place and that results actively inform strategic planning for improvement
• Draws on the learning objectives and content covered throughout the Tool Kit to develop the Respectful, Inclusive, and Affirming Care Evaluation Framework

Mission, Vision, Strategic Priorities and Values

Quality Improvement Plans

• For 2022/23, each of the City of Toronto’s 10 long-term care homes have voluntarily submitted a Quality Improvement Plan (QIPs) to Ontario Health.
• The QIPs demonstrate our commitment to collaborate with residents, families, caregivers and external stakeholders to improve healthcare outcomes.
• Each of the QIPs are posted on the Ontario Health website and include a narrative, work plan and targets to improve resident outcomes and experiences.

Research

Thank you for your interest in research at Seniors Services and Long-Term Care. We welcome opportunities to enhance our knowledge in pursuit of excellence in the services that we provide. We know that research is an integral component of knowledge building in pursuit of that excellence.

To that end, we have developed formalized processes related to the submission of research proposals these are based on our ethics statement and ethics decision-making principles. This framework guides us to ensure that any research that is approved to be conducted within our division meets the highest standards for health care research and also meets the more specific criteria established by Seniors Services and Long-Term Care.

All research proposals must have prior ethical approval from an accredited university, teaching hospital or national granting agency before the proposal will be submitted to the division’s own Ethics and Research Committee for consideration. All approved research must be conducted in a way that ensures minimal disruption to residents, clients, families and staff and provides learning and potential future benefit related to the enhancement of long-term care. All approved research must comply with the requirements of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) and the Personal Health Information Protection Act (PHIPA).

If you are interested in collaborating with us in research that would build knowledge in the pursuit of excellence in long-term care, email ltc-ho@toronto.ca subject line Research for more details about the application process.

 

Residents' Bill of Rights

Fundamental Principle

Fixing Long-Term Care Act, 2021
Home: the fundamental principle
The fundamental principle to be applied in the interpretation of this Act and anything required or permitted under this Act is that a long-term care home is primarily the home of its residents and is to be operated so that it is a place where they may live with dignity and in security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.

Seniors Services and Long-Term Care fully respects that the following rights of residents are fully respected and promoted:

Residents’ Bill of Rights

Right to be treated with respect
1. Every resident has the right to be treated with courtesy and respect and in a way that fully recognizes the resident’s inherent dignity, worth and individuality, regardless of their race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability.
2. Every resident has the right to have their lifestyle and choices respected.
3. Every resident has the right to have their participation in decision-making respected.

Right to freedom from abuse and neglect
4. Every resident has the right to freedom from abuse.
5. Every resident has the right to freedom from neglect by the licensee and staff.

Right to an optimal quality of life
6. Every resident has the right to communicate in confidence, receive visitors of their choice and consult in private with any person without interference.
7. Every resident has the right to form friendships and relationships and to participate in the life of the long-term care home.
8. Every resident has the right to share a room with another resident according to their mutual wishes, if appropriate accommodation is available.
9. Every resident has the right to meet privately with their spouse or another person in a room that assures privacy.
10. Every resident has the right to pursue social, cultural, religious, spiritual and other interests, to develop their potential and to be given reasonable assistance by the licensee to pursue these interests and to develop their potential.
11. Every resident has the right to live in a safe and clean environment.
12. Every resident has the right to be given access to protected outdoor areas in order to enjoy outdoor activity unless the physical setting makes this impossible.
13. Every resident has the right to keep and display personal possessions, pictures and furnishings in their room subject to safety requirements and the rights of other residents.
14. Every resident has the right to manage their own financial affairs unless the resident lacks the legal capacity to do so.
15. Every resident has the right to exercise the rights of a citizen.

Right to quality care and self-determination
16. Every resident has the right to proper accommodation, nutrition, care and services consistent with their needs.
17. Every resident has the right to be told both who is responsible for and who is providing the resident’s direct care.
18. Every resident has the right to be afforded privacy in treatment and in caring for their personal needs.
19. Every resident has the right to,
i. participate fully in the development, implementation, review and revision of their plan of care,
ii. give or refuse consent to any treatment, care or services for which their consent is required by law and to be informed of the consequences of giving or refusing consent,
iii. participate fully in making any decision concerning any aspect of their care, including any decision concerning their admission, discharge or transfer to or from a long-term care home and to obtain an independent opinion with regard to any of those matters, and
iv. have their personal health information within the meaning of the Personal Health Information Protection Act, 2004  kept confidential in accordance with that Act, and to have access to their records of personal health information, including their plan of care, in accordance with that Act.
20. Every resident has a right to ongoing and safe support from their caregivers to support their physical, mental, social and emotional wellbeing and their quality of life and to assistance in contacting a caregiver or other person to support their needs.
21. Every resident has the right to have any friend, family member, caregiver or other person of importance to the resident attend any meeting with the licensee or the staff of the home.
22. Every resident has the right to designate a person to receive information concerning any transfer or any hospitalization of the resident and to have that person receive that information immediately.
23. Every resident has the right to receive care and assistance towards independence based on a restorative care philosophy to maximize independence to the greatest extent possible.
24. Every resident has the right not to be restrained, except in the limited circumstances provided for under this Act and subject to the requirements provided for under this Act.
25. Every resident has the right to be provided with care and services based on a palliative care philosophy.
26. Every resident who is dying or who is very ill has the right to have family and friends present 24 hours per day.

Right to be informed, participate, and make a complaint
27. Every resident has the right to be informed in writing of any law, rule or policy affecting services provided to the resident and of the procedures for initiating complaints.
28. Every resident has the right to participate in the Residents’ Council.
29. Every resident has the right to raise concerns or recommend changes in policies and services on behalf of themself or others to the following persons and organizations without interference and without fear of coercion, discrimination or reprisal, whether directed at the resident or anyone else:
i. the Residents’ Council.
ii. the Family Council.
iii. the licensee, and, if the licensee is a corporation, the directors and officers of the corporation, and, in the case of a home approved under Part IX, a member of the committee of management for the home under section 135 or of the board of management for the home under section 128 or 132.
iv. staff members.
v. government officials.
vi. any other person inside or outside the long-term care home.

Source: Fixing Long-Term Care Act, 2021

Service Accountability Agreements

Long-Term Care Home Service Accountability Agreement (L-SAA)

Service Accountability Agreements outline the responsibilities of local health service providers and the Local Health Integration Network (LHIN) with each of the City’s ten long-term care homes and community programs situated across the boundaries of five LHINs:

• Central East LHIN: Bendale Acres and Seven Oaks
• Central LHIN: Carefree Lodge and Cummer Lodge
• Toronto Central LHIN: Castleview Wychwood Towers, Fudger House, Lakeshore Lodge and True Davidson Acres
• Central West LHIN: Kipling Acres
• Mississauga-Halton LHIN: Wesburn Manor

Multi-Sector Service Accountability Agreements (M-SAA)

The M-SAA is a multi-year agreement that supports a collaborative relationship between the LHIN and the health service provider to improve the health of Ontarians through better access to high-quality health services, to co-ordinate health care in local health systems and to manage the health system at the local level effectively and efficiently. Stated as a matter of record for public viewing, the following is a copy of the M-SAA between City of Toronto:

• Central LHIN
• Mississauga Halton
• Toronto Central LHIN

Service Plan

In the Service Plan, we provide a framework to guide budget and resource allocations over the next five years to support how the City will provide, improve and prioritize long-term care services to a diverse, aging population with complex care and social needs.

Aligned with the service principles specified in the Toronto Seniors Strategy – Equity, Respect, Inclusion and Quality of Life – the Service Plan will:

• Support residents in long-term care homes and clients living in their own homes for as long as possible through enhanced programs and services.
• Meet the increasingly complex and diverse needs of those we serve.
• Be recognized as a leader in the long-term care sector and within the City by supporting seniors.

Within the context of a rapidly changing long-term care landscape, the Service Plan captures current service levels, and notes where enhancements can be initiated and identifies opportunities where new services are needed, pending City Council approval and/or funding.

The Service Plan is part of a holistic approach to broader planning initiatives that include the divisional Strategic and Capital Renewal Plans, the City’s Strategic Actions, Toronto Seniors Strategy, other City initiatives and plans, as well as the priorities of provincial and partner organizations.

Preparation was collaborative, involving all stakeholder groups. Throughout the research, consultations, information gathering and sharing exercises, three overall themes and priorities emerged:

1. Deliver exemplary care and services through a continuum of care;
2. Serve vulnerable individuals and respond to emerging community needs; and
3. Lead advances in long-term care and support services to seniors.

Within the Service Plan, further context is provided on what we do in terms of service delivery, who our residents and clients are and how we operate within the broader healthcare sector.

This Service Plan will differentiate between actions that are going to build on or enhance current service (which can be pursued within the existing budget) – and those which we will monitor and would represent “new” activities or programs, which would be subject to funding and Council approval.

Deliver

Seniors Services and Long-Term Care provides a variety of exemplary, high-quality services along a comprehensive and flexible continuum of care – from enabling vulnerable individuals to continue living in the community to healthy aging and quality end of life care in our homes – to help seniors at different stages of their long-term care journey. The goal is to provide Torontonians in need of long-term care with the right services, at the right time, and in the right place. There is a need for:

• increased and strengthened community programs and supports to help seniors remain in their homes longer;
• improved end-of-life and palliative care;
• behavioural support/specialized units to support complex care needs and mental health issues;
• a range of services and supports to better serve individuals in long-term care; and
• staff to be skilled and trained in order to meet the needs of those entrusted to their care.

Deliver exemplary care and services through a continuum of care

To support residents in long-term care homes and clients living in their own homes for as long as possible through enhanced programs and services.

Pursue within the existing budget:

• Provide a continuum of high-quality long-term care services in the City’s long-term care homes and community programs.
• Provide a variety of bed types, e.g. convalescent care, short-stay, long-stay and specialized programs such as behaviour support
• Provide Adult Day Programs (ADP), Homemakers and Nurses Services (HMNS) and Supportive Housing Services (SHS)
• Pursue new funding to support identified populations such as Aboriginals, homeless seniors, Veterans and former, older inmates leaving prison.
• Adopt the Palliative Performance Scale and Symptom Management Tool
• Early identification of residents requiring palliative care
• Accommodate family needs, e.g. overnight stays.
• Through enhanced data sharing and increased opportunities for benchmarking
• Identify and develop specific opportunities within the division and with other community partners, e.g. Toronto Community Housing Corporation and Community Agency Notification Program.
• Continue to develop, based on research and evidence-based best practice, the division’s end-of-life strategy and palliative care program.
• Expand and strengthen existing partnerships to generate new initiatives and service integration opportunities.

Subject to future approval by City Council:

• Pursue funding opportunities to support delivery of care and services.
• Pursue provincial Nurse Practitioner program.
• Explore co-location of services (internal and external)
• Expand assisted living for high-risk seniors in the community.
• Enhance ADP capacity with extended hours and expanded services
• Develop ADP for specialized needs, e.g. dual diagnosis, developmentally delayed
• Expand HMNS to eliminate or reduce the waitlist.
• Increase resident/client outing opportunities
• Expand alternative therapies and services, e.g. complementary care, art and music therapies.
• Support Service Hub development.
• Expand care and services provided in the Adult Day Programs and Homemakers and Nurses Services Programs.
• Support quality of care and life for residents and clients.
• Respond to community need/demand for expansion of long stay beds and services.
• Implement the division’s Capital Renewal Plan.

Serve

Seniors Services and Long-Term Care serves a diverse population, from young adults with severe disabilities to seniors with cognitive impairments, medical complexities and behavioural challenges.

Residents and clients represent an increasingly diverse range of spoken languages, cultures and ethnicities, food preferences, faiths, sexual orientations, gender identities and expression. As a municipal service provider, we fills a gap in service for hard-to serve or under-served Torontonians, who may lack family support, struggle with poverty, homelessness, substance abuse or social isolation and lack resources to access long-term care.

At the same time, there is an increase in the complexity of residents’ and clients’ physical and mental health conditions and behaviours, requiring an investment in increased training, specialized services, and new approaches to care. Further, with the growing movement to support Torontonians to age at home for as long as possible and large wait-lists for long-term care homes, many individuals entering the City’s long-term care homes are older, frailer and have more complex needs than in the past. As the challenges of complex care needs, growing poverty and diversity intersect, we will continue to provide exemplary care that is responsive to the emerging needs of Toronto’s diverse and vulnerable adults.

Serve vulnerable individuals and respond to emerging community needs

To meet the increasingly complex and diverse needs of those we serve.
Pursue within the existing budget:

• Support residents and clients with specialized health care needs.
• Refresh the LGBT Tool Kit for creating culturally competent care for lesbian, gay, bisexual and transgender persons
• Hire, recruit and retain staff with specialized skills
• Enhance training for dementia, mental health, substance abuse disorders, complex behavioural and medical conditions, diversity and sensitivity, and end-of-life and palliative care.
• Identify and serve individuals that are not well-served within long-term care, e.g. special populations such as those with challenging behaviours
• Co-lead George Street Revitalization project
• Increase healthy aging/healthy lifestyle education
• Support the City’s Seniors Strategy
• Support the City’s Poverty Reduction Strategy
• Support the Toronto Strong Neighbourhoods Strategy (TSNS 2020).
• Expand the Volunteer Program and develop meaningful volunteer opportunities.
• Create a Volunteer Recruitment, Development and Retention strategy
• Increase evening and weekend programs for more flexible scheduling
• Introduce volunteer opportunities in community programs.
• Plan services that support and address the needs of the socially-isolated, poor, homeless, frail, under-served and vulnerable individuals.

Subject to future approval by City Council:

• Enhance and expand culturally relevant meals, programming, services and support.
• Explore cultural food requests/requirements and seek provincial funding
• Facilitate resident and client use of emerging technology.
• Explore and develop innovative services, e.g. memory clinics.
• Provide support for increasing acuity and complex care needs.
• Specialized nursing resources to support clients with mental illness.
• Develop and pilot dementia specific programs and services.
• Pursue opportunities for additional programs, services and specialized units.
• Expand Mental Health Program to additional Supportive Housing sites.

Lead

Seniors Services and Long-Term Care strives to be recognized leaders in excellence and ground-breaking services for healthy aging, to make contributions that shape and influence public policy, and to improve the overall long-term care system and better serve the people of Toronto. We will continue to strengthen Toronto’s communities and the wider long-term care sector through a range of research, innovation and leadership initiatives.

The rising complexity of care needs and acuity of clients will require skill and competency training for staff at all levels.

Given the relative size of Toronto’s seniors population and the size and scope of Toronto as a municipal long-term care service provider, the City’s influence and leadership has the potential to have a far-reaching and positive impact on the wider long-term care sector. This could contribute to ‘improved quality of life and care’ for all seniors, enhance the appeal of long-term care as a career choice for future generations, and contribute to a thriving, age-friendly Toronto. It is important that this leadership role be highlighted as a key priority for the next five years.

Lead advances in long-term care and support services to seniors

To be recognized as a leader in the long-term care sector and within the City by supporting seniors.

Pursue within the existing budget:

• Undertake research opportunities and actively participate in sharing and implementing innovations and best practices related to healthy aging, quality of life and long-term care and service delivery.
• Expand and share quality practices, care and services, e.g. Quality Fair
• Publish leading practices and share news on award winning programs, e.g. Accreditation Canada’s Leading Practices and Quality Conference
• Develop new and/or improve on innovative approaches in care and services delivery.
• Increase number and breadth of students and interns within the division.
• Provide expertise and experience at decision-making tables, e.g. advancing service and capital planning, promoting funding and regulatory reforms.
• Introduce initiatives, e.g. academic partnerships.
• Provide the community with senior-friendly space to socialize and network
• Provide education events and programs
• Host events related to healthy aging and culture, e.g. Seniors’ Wellness Symposium.
• Strengthen and broaden opportunities for internships and student placement programs.
• Influence provincial policy, initiatives and directions to effect positive changes within long-term care.
• Promote careers in long-term care and be recognized as an employer of choice.
• Promote the City’s long-term care homes as places of quality living and resources within the community.

Subject to future approval by City Council:

• Pursue provincial designation as a Centre for Learning, Research and Innovation in Long-Term Care.

Spiritual and Religious Care

The City’s long-term care homes provide spiritual and religious care as part of its inter-disciplinary approach to resident care and service.

Within each of our homes there is a contracted Coordinator of Spiritual and Religious Care available to support residents and families in meeting their spiritual and religious care needs. The Coordinators work with multi-faith community leaders to ensure that residents’ traditions and beliefs are respected. Homes have regularly scheduled worship services for residents and it is possible to make additional arrangements for spiritual and religious care for another community faith leader or a lay visitor.

Visiting Policy

In response to COVID-19, there may be screening requirements and some restrictions when visiting residents in long-term care homes.

In line with our CARE values, the presence of family, friends, and the community support a home-like environment and contribute to a high quality of life for those residing in long-term care.

There are four types of essential visitors:

• people visiting very ill or palliative residents who are receiving end-of-life care for compassionate reasons, hospice services, etc.
• government inspectors with a statutory right of entry.
• support workers provide support to the critical operations of the home or to provide essential services to residents.
• caregivers provide direct care to meet the essential needs of a particular resident. Caregivers must be at least 16 years of age and must be designated by the resident or their substitute decision-maker.

Essential caregivers may visit even if the long-term care home is in outbreak.

General visitors include those persons visiting for social reasons as well as visitors providing non-essential services such as personal care services, entertainment, or individuals touring the home.

Limitations related to number of visitors are subject to applicable directives, orders, advice or recommendations issued by provincial Ministry, Chief Medical Officer of Health or Toronto Public Health.

Tips when visiting a long-term care home operated by the City of Toronto:

• There is no requirement to schedule your visit and there are no limitations on the length or frequency of visits, you are welcome at any time
• Participate in and pass screening and testing requirements, as applicable
• Adhere to all posted Ministry and City of Toronto guidelines and policies
• Stay out of non-resident areas such as the nursing station, staff rooms, storage rooms, utility rooms, etc.
• Non-family members need to be expressly invited into a resident room by the resident or family
• Children are to be supervised by a responsible adult at all times
• Pets must be leashed, well-mannered and have updated rabies vaccination.

Maintaining a healthy and safe environment for all:

• Please do not visit the long-term care home if you feel ill, unwell or have symptoms that are not related to pre-existing health conditions
• Please clean your hands frequently, cover coughs or sneezes with tissue or crook of arm, refrain from touching your face.
• Participate in training on infection prevention and control (IPAC) practices and adhere to required use of personal protective equipment (PPE), as required
• Please refrain from wearing scented products
• Visitors who are legally prohibited from contacting a resident are not permitted to visit
• If Infection Control Precaution signage is posted, please check with the nursing staff for further direction prior to entering the resident room
• During an outbreak, visitors are expected to adhere to any restrictions put into effect by Toronto Public Health
• Follow staff instruction in the event of an emergency
• Visitors will refrain from providing personal care to residents for which knowledge, education, and certification may be required. Do not bring in medications and leave in resident room, always give to the nurse
• During winter months, visitors are asked to take care to ensure they have removed excess snow from clothing and footwear; resulting puddles could become a hazard.

Health Information and Privacy

• Staff are only able to provide updates on a resident’s specific condition to a documented designated person
• Visitors, including family, must not take pictures or video recordings of any other visitors, staff or other residents without the express consent of the individuals involved
• Visitors may be requested to leave a resident’s room when care is being provided.

Other

• Food and fluids are available for resident consumption only. Meal tickets can be purchased from the Administration Office
• Supplies and equipment re not available for use by visitors without the express permission from management
• Smoking is prohibited in the long-term care home and nine metres surrounding any entrance/exit. Smoking is only permitted in designated areas on the grounds.
• The consumption of alcohol is prohibited by visitors.
• Possession and use of street drugs and/or weapons is prohibited.

Unacceptable behaviour on the part of a visitor such as loud and disruptive behaviour, verbal abuse, physical abuse, violence, interference with the care of a resident, and infringement of the guidelines for visitors will not be tolerated, and may result in visiting restrictions or visiting prohibition.

Zero Tolerance for Abuse

Zero Tolerance for Abuse applies to any person who has contact with a resident or client, including staff, agents, volunteers, family members, substitute decision makers (SDMs), visitors, paid trainees and paid companions. Seniors Services and Long-Term Care adheres to and enforces zero tolerance of abuse by any person.

Seniors Services and Long-Term Care strictly adheres to and enforces zero tolerance of abuse of residents and clients by any person.The policy Zero Tolerance for Abuse applies to any person who has contact with a resident or client, including staff, agents, volunteers, family members, substitute decision makers (SDMs), visitors, paid trainees and paid companions.The definition of zero tolerance for abuse is defined by the Ministry of Health and Long-Term Care as:

“Zero tolerance” means within this policy, that the Long-Term Care Home Operator shall:

• Uphold the right of the residents of Long-Term Care Homes to be treated with dignity and respect within those homes, and to live free from abuse and neglect.
• Neither abuse, nor allow the abuse of any resident in the Operator’s Long-Term Care Home by Staff or volunteers, nor condone the abuse of any resident by any other person(s) at the home.
• Provide information and education regarding abuse and the prevention of abuse.
• Treat every allegation of abuse as a serious matter.
• Investigate every allegation of abuse.
• Take corrective action, including sanctions or penalties against those who have committed abuse against a resident.
• Report to the Ministry of Health and Long-Term Care every suspected or confirmed incident of abuse.
• Make every effort to eliminate abuse through the quality and risk management programs.

For the purpose of this policy, staff includes any permanent, part-time and contracted:

• Employees
• Physicians
• Agency staff
• Contracted health-care professionals
• Paid trainees
• Students under clinical placements
• Paid companions (paid by the resident, family member or substitute decision-maker).

This definition does not imply or create an employer/employee relationship where none exists, and it is used solely in the context of this policy to clarify that abuse will not be tolerated from any source.

Abuse can take many forms. Seniors Services and Long-Term Care will not condone any resident abuse. The Standards of Employee Conduct, Standard Respect for Others, 6.1 Resident Abuse, clearly defines staff expectations regarding resident abuse.

Abuse is defined as:

“Abuse” of a resident means any action or inaction, misuse of power and/or betrayal of trust or respect by any person against a resident, that the person knew or ought to have known, would cause (or could reasonably be expected to cause) harm to the resident’s health, safety or well-being.

Abuse includes, but is not limited to:

• Physical Abuse
• Sexual Abuse and Sexual Assault
• Emotional Abuse
• Verbal Abuse
• Financial Abuse
• Exploitation or a Resident’s Property or Person
• Neglect
• Prohibited Use of Restraints
• Measures Used to Discipline a Resident

Residents have the right to dignity, respect and freedom from abuse and neglect. Seniors Services and Long-Term Care has a zero tolerance for abuse; therefore, abuse will not be tolerated by any person entering the Home and corrective action will be taken in all instances of resident abuse.