Bill 140, Long-Term Care Homes Act, 2006 AMO s Presentation to the Standing Committee on Social Policy January 16, 2007 Association of Municipalities of Ontario 393 University Avenue, Suite 1701 Toronto, ON M5G 1E6 Canada tel: 416-971-9856 fax: 416-971-6191 email: amo@amo.on.ca website: www.amo.on.ca
INTRODUCTION AMO Presentation on Bill 140, Long-Term Care Homes Act, 2006 Good morning, ladies and gentlemen. My name is Doug Reycraft. I am the Mayor of the Municipality of Southwest Middlesex, Councilor with the County of Middlesex and the President of the Association of Municipalities of Ontario. I want to begin my presentation by making a few observations that AMO believes are very important. First, I believe we all recognize that the quality of life, safety and well-being of residents in Ontario s long-term care facilities is a top priority for the Province, for our communities and for the people of Ontario. Second, I know we agree that individuals, private and not-for-profit agencies, and governments providing services to vulnerable populations, must be truly accountable for the quality of care they provide. Third, I think it is widely recognized that municipally operated homes for the aged do an excellent job, under the current legislative framework, of providing the highest quality services that routinely exceed provincial standards. Fourth, and perhaps less widely recognized, Ontario s municipal governments go far beyond what they are required to do in law by investing a net $270 million a year of municipal resources in the provincial long-term care system through the funding and operation of homes for the aged. They do so because they recognize the need for services in their communities and because provincial funding for the provincial longterm care system is woefully inadequate. In Middlesex County, the municipal subsidy to this provincial program will be over $825,000 in 2007 for 160 beds. My final observation is that, given what I have just said, it is surely not the intent of this Bill to encourage municipal governments to vacate the industry to the greatest extent possible. Page 1
Yet, that is the concern that is being expressed among municipal governments today. While we believe the Government s intentions are laudable, our assessment of the Bill itself is that it is excessively heavy-handed when it comes to regulating the operation of municipal homes for the aged with many of the measures having nothing whatsoever to do with the quality of life, safety or well-being of residents. In the case of municipally-operated homes for the aged, this Bill sets out to fix something that is not broken. The result is a level of liability exposure for municipal councillors and property tax payers that is unprecedented in Ontario s legislative history. As the Bill reads currently, municipalities would be well advised to reduce services and investment in Ontario s long-term care system and provide only the minimum mandated level of service in their communities. And there is another result. By compounding the current administrative responsibilities of those operating homes for the aged, without increasing provincial funding in the system, the Bill will require administrators to reallocate resources away from patient care to administration with a consequence of reduced services. Surely, it is not anyone s intention to reduce the number of beds in our communities by taking a heavy-handed approach to addressing a problem that does not seem to exist in the municipal operation of provincial long-term care services. Page 2
THE MUNICIPAL CONTEXT AND LONG-TERM CARE Before I address a number of specific concerns, I would like to provide the Committee with some contextual information. Municipal governments operate over 16,500 beds in long-term care homes in Ontario. That is nearly a quarter of the total beds in the province. In any given year, that is over 6 million days of care. As I mentioned earlier, municipalities also invest a net $270 million of property tax revenues per year into the operation and capital development of their long-term care homes. As the most accountable of the three orders of government, municipalities operate under significant scrutiny. As a mayor and municipal councillor, I can tell you that poor service or poor standards in a municipal facility would not escape this scrutiny. As the Minister has acknowledged, municipalities are not only leaders in long-term care but committed to the provision of quality long-term care services. Yet, over the years, municipalities have seen the increased cost of new standards without the corresponding provincial funding support. And finally, by way of context, the Government s commitment to increase operating funding to $6,000 per resident has not been achieved. Page 3
SPECIFIC CONCERNS AMO Presentation on Bill 140, Long-Term Care Homes Act, 2006 New Administrative & Operational Requirements This Bill places great emphasis on the enforcement of standards. AMO agrees that the administrators of homes for the aged must be accountable. But the Bill will require administrators to spend a great deal more of their time and resources on compliance and documentation and, unless the Government provides additional funding, homes will be forced to apply even more of their limited resources to meeting all the new administrative requirements. Without provision for additional funding from the Province, the Act will lead to existing staff resources being reallocated to administrative and other non-resident care activity. That means less money will be getting to the care of residents. Excessive Liability for Municipal Councillors and Municipal Governments Bill 140 would create unprecedented liability for municipal councillors, municipal governments and property tax payers through its heavy-handed approach to the issue of duty of care. Section 67 is a remarkably blunt instrument. It would set out a requirement that a committee of management or board of management for a municipal home for the aged will take all reasonable care to ensure that the operation of the home for the aged complies with all requirements under this Act. Every person who fails to do so would be guilty of an offence. That means, without any exaggeration, that if a municipal councillor or a member of a board of management cannot demonstrate reasonable care to ensure that the administration of the home meets even the most minuscule administrative requirement of a Regulation that we have not yet seen the councillor or board member is guilty of an offence. Page 4
This section is not about offences related to the specific wrongdoing such as failing to report an incident of abuse. Those serious matters are dealt with directly in the Bill. In fact, this section is not about safeguarding the rights or interests of long-term care residents. This section is a catchall of liability that would make anyone think twice about operating a home for the aged or running for a seat on council. The penalty set out in the Bill includes a fine of up to $25,000 or imprisonment of up to 12 months for a first offence. Furthermore, this section will likely be a significant barrier to recruiting and retaining directors. Interestingly, the penalties far exceed similar accountability sanctions for members of hospital boards under the Public Hospitals Act, imposing harsher offence provisions on the Board members of homes than those serving on hospital Boards. If this is the road the Province is choosing to travel, it would seem reasonable to align the offence provision under Bill 140 with the Public Hospitals Act 1. Increased Risk to the Viability of Municipal Homes I want to turn for a moment to issues of standards and licensing. AMO appreciates the need for the ongoing upgrading of homes. But the fact of the matter is that there is no evidence that there is any problem with the maintenance or upkeep of facilities in the municipally-operated homes sector. This begs the question of why Bill 140, sections 150, 151, 156, would provide ministry officials with the authority to order municipalities to undertake upgrading and other work as a condition of licensing. 1 The Public Hospitals Act has general offence provisions but the penalty on a conviction is minor ($50 and not more than $1,000). Page 5
This authority could be used by the ministry to require municipal governments to make any number of unbudgeted and perhaps unnecessary expenditures without recourse. If this Committee agrees that municipal governments are accountable and responsible, then surely giving such sweeping authority to the ministry is unnecessary. CONCLUSION These provisions that I have raised act as disincentives to the expansion of long-term care services, and fail to recognize that it is municipalities and municipal revenues - and not provincial standards - that are what is holding the provincial long-term care system together and filling a quarter of a billion dollar gap in provincial health care funding. The future is clear regarding long-term care in Ontario. For the municipal role in the Province s long-term care system, Bill 140 appears to be moving the sector towards fewer beds, reduced funding for care, greater risk and greater costs. AMO and many others in the sector foresee an overall erosion of quality residentfocused long-term care in the province. What is clearly missing in Bill 140 is a statement that commits the Province to preserving and promoting long-term care through adequate and sustainable funding. The Government must consider that any new or enhanced standards must be accompanied by appropriate operating funding, and must consider the added financial burden that will be placed on homes for the aged and municipalities as a result of the new requirements. The Government must at a minimum, increase operating funding by that amount. Page 6
AMO s position on which order of government should be funding provincial health care services is well known. Until we have achieved our goal of good public policy and good fiscal policy in Ontario, please do not undermine our ability to deliver provincial services effectively. Implementation of Bill 140 without appropriate and sustained provincial funding bodes poorly for the future of long-term care in Ontario. Finally, let us not undo the good and productive work between AMO, municipalities, and the Province as a result of legislation that, on the face of it, is designed to fix a problem that does not exist legislation that fails to recognize the municipal contribution to the long-term care system in Ontario. We look forward to building on our successes to ensure that long-term care legislation meets the needs of our vulnerable residents in a sustainable and realistic manner. And we urge the committee to consider the important matters we have raised today. Page 7