Ontario Canada Care Community Coverage: Know the Rules
The Ontario government strictly regulates all care communities, including privately run retirement communities and publicly funded nursing homes. This has some major benefits. For one, no matter where in Ontario you or your loved ones live, you can expect the same standard of treatment, at the same price. But regulations can also be difficult to navigate. You might have a few questions about cost, access to healthcare, levels of service and how to get help with financing.
Read on for more information about how nursing homes and retirement communities in Ontario operate.
The Ontario Health Insurance Plan (OHIP) covers all medical expenses for nursing home residents, including medications from the government pharmacy. Retirement communities generally include some medical expenses in their fees, but what is and isn’t included depends on the community.
Most services are provided directly onsite by medical professionals, but there are no restrictions on outside medical services, so you can continue to see your family doctor even after you move into a care community. The reason that many seniors decide to use the in-house medical services is simply convenience. If you choose to retain your family physician or any preferred specialists, you will either have to arrange your own transportation or grant the doctor visiting privileges so that they can visit you at the care community.
You should also be aware that according to the Ontario Ministry of Health, patients who leave a nursing home to visit the hospital must return within 30 days or they may be discharged. Residents can only be out of their nursing home for a maximum of 21 days per year (not including weekends). If you plan on making frequent overnight trips to see your preferred medical professional, make sure that you do not exceed an absence from your community of 21 days per year.
Who Pays For Outside Medical Care?
OHIP still applies when receiving medical services outside of your retirement community or nursing home. If OHIP covered your doctor visits before you moved into the care community, those visits will still be covered. Services that are not covered by OHIP will also not be covered by your care community. These exclusions extend to glasses, dentures and some pharmaceuticals.
Who Operates and Regulates Care Communities?
The Long-Term Care Homes Act, 2007, and Ontario Regulation 79/10 governs all long-term care communities. According to these regulations all “long-term care homes must provide residents safe, consistent, high-quality and resident-centered care.” Ontario’s Ministry of Health is responsible for ensuring that these standards are met by regulating and inspecting all long-term care homes. The Ministry also sets all accommodation fees. The government, non-profit organizations and private companies can operate long-term care homes as long as they adhere to government standards.
The current fee structure set by the Ontario Ministry of Health is:
- Long-stay basic (three or more beds per room): $59.82 per day
- Long-stay, semi-private (only two beds per room): $72.12 per day
- Long-stay private (a single bed in a single room): $85.45 per day
Every long-term care home will also provide the following amenities:
- A shared dining room, TV room, and living areas
- 24-hour nursing and care
- Medical services and access to health professionals
- Housekeeping services
- Religious services
- Furniture, linens, personal hygiene products and services, and bedding
- Meals (including accommodations for dietary restrictions)
- Laundry services
- Personal hygiene supplies
- Medical supplies like wheelchairs and walkers
- Recreational and social activities
- Daily assistance
Many communities also offer additional services like cable television, hairdressing, telephone services, and transportation.
What If You Can’t Afford Care?
If you are worried that you might not be able to afford living in a care community, then you can apply for a government subsidy known as a rate reduction, which is your right as a low-income Ontario senior. Many care communities will help you fill out the paperwork to ensure that you get the care that you need. Or, you can call the Ministry of Health and Long-Term Care Homes Action Line at (866) 434-0144 to learn more.
Do you have personal experience with senior living in Ontario? Share your experiences with us in the comments below.
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