Consultation on Amendments to Ontario Regulation 246/22 Under the Fixing Long-Term Care Act, 2021
Regulation Number(s):
Ontario Regulation 246/22
Instrument Type:
Regulation - LGIC
Bill or Act:
Fixing Long-Term Care Act, 2021
Summary of Proposal:
The Ministry of Long-Term Care (the ministry) proposes to amend Ontario Regulation 246/22 under the Fixing Long-Term Care Act, 2021, as part of an ongoing evolution of the governing framework intended to enhance the quality of care and life for residents in long-term care.
Proposed amendments include:
Amendments to qualification requirements for personal support workers (if approved, proposed December 1, 2024, in-force date):
Personal support workers make up the largest segment of the long-term care workforce, representing over 70% of direct care staff in the sector. Currently, the long-term care sector is the only health sector in Ontario that defines staffing qualifications for personal support workers in regulation.
The Ministry of Health filed regulations in June 2024 under the Health and Supportive Care Providers Oversight Authority Act, 2021, with voluntary registration opening for personal support workers starting December 1, 2024, once the regulations come into force.
The ministry is proposing amendments to section 52 for full alignment with the Health and Supportive Care Providers Oversight Authority (HSPCOA) registration pathways for personal support workers to foster consistency across sectors, boost labour mobility, and address health human resource staffing challenges, without negatively impacting personal support workers already in the system.
The amendments proposed to section 52 of the Regulation would allow personal support workers to work in long-term care if:
o They are registered in the class of personal support workers with the HSPCOA; OR
o They meet one of the HSPCOA registration pathways; OR
o They meet one of the current long-term care specific exemptions proposed to be maintained in the regulation (for example, for nurses, nursing students, or current personal support worker students).
Under this approach, long-term care home licensees could decide whether registration with the HSPCOA is compulsory to work as a personal support worker in their home.
The Ministry of Health previously consulted via the Regulatory Registry on this approach from December 1,2023 to January 15, 2024, and received feedback that was generally supportive or neutral.
Amendments to section 52 to provide long-term care home licensees flexibility in leveraging resident support personnel (if approved, proposed December 1, 2024, in-force date):
Under the ministry's current legislative and regulatory framework, only persons who meet the educational qualification requirements in section 52 or meet a listed exception can be hired by a long-term care home licensee as a personal support worker or to provide personal support services.
The ministry understands that since the pandemic, resident support personnel have been employed in long-term care homes to safely assist with providing some personal support services to lower-risk residents (for example, helping brush a resident's hair or teeth, helping open containers at mealtime).
To stabilize the role of resident support personnel as part of broader care teams, the ministry is proposing a permanent exemption to allow staff who do not meet the section 52 qualification requirements to provide personal support services if the long-term care home licensee is of the reasonable opinion that the individual has the proper skills and qualifications to perform the job, and the Director of Nursing and Personal Care is of the reasonable opinion that the individual can safely provide services based on an assessment of the resident's care plan, needs and risk-level. The Director of Nursing and Personal Care would be responsible for ensuring a process is in place for the assignment of low-risk tasks, informed by a resident risk-assessment.
The transitional staffing flexibility provision, currently set to expire on July 1, 2025, would be revoked, if approved, and replaced with the permanent exemption, with a proposed December 1, 2024 in-force date).
The ministry previously consulted on this approach via the Regulatory Registry from September 29, 2023, to November 20, 2023, and from May 1, 2024, to June 15, 2024. Feedback received was generally supportive or neutral.
For information on how the approach would work in practice, see 2. Addendum: Resident Support Personnel Approach in Practice - Flow Chart.
Amendments for registered dietitians (if approved, proposed January 1, 2025, in-force date):
Registered dietitians are one of the only non-supervisory roles required to be onsite for a specified amount of time.
The ministry is proposing amendments to exempt licensees from the onsite requirement for a registered dietitian under section 80(2), if the licensee has first made all reasonable attempts to meet the onsite delivery of clinical and nutritional care duties, and can ensure that, in the reasonable opinion of the licensee, the registered dietitian has taken steps to ensure the appropriate use of virtual care and technology for each resident, including whether clinical and nutritional care duties should be performed onsite by a regulated health professional working within their scope of practice.
Skin assessments will continue to be done in person by registered dietitians, with the proposed regulatory flexibility to enable licensees to use hybrid registered dietitian care (appropriate use of virtual care and technology) for certain clinical and nutritional care duties in collaboration with another onsite registered health professional working within their scope of practice.
For draft text of the proposed amendments, see 1. Addendum: Draft Regulatory Amendments.
Proposed amendments include:
Amendments to qualification requirements for personal support workers (if approved, proposed December 1, 2024, in-force date):
Personal support workers make up the largest segment of the long-term care workforce, representing over 70% of direct care staff in the sector. Currently, the long-term care sector is the only health sector in Ontario that defines staffing qualifications for personal support workers in regulation.
The Ministry of Health filed regulations in June 2024 under the Health and Supportive Care Providers Oversight Authority Act, 2021, with voluntary registration opening for personal support workers starting December 1, 2024, once the regulations come into force.
The ministry is proposing amendments to section 52 for full alignment with the Health and Supportive Care Providers Oversight Authority (HSPCOA) registration pathways for personal support workers to foster consistency across sectors, boost labour mobility, and address health human resource staffing challenges, without negatively impacting personal support workers already in the system.
The amendments proposed to section 52 of the Regulation would allow personal support workers to work in long-term care if:
o They are registered in the class of personal support workers with the HSPCOA; OR
o They meet one of the HSPCOA registration pathways; OR
o They meet one of the current long-term care specific exemptions proposed to be maintained in the regulation (for example, for nurses, nursing students, or current personal support worker students).
Under this approach, long-term care home licensees could decide whether registration with the HSPCOA is compulsory to work as a personal support worker in their home.
The Ministry of Health previously consulted via the Regulatory Registry on this approach from December 1,2023 to January 15, 2024, and received feedback that was generally supportive or neutral.
Amendments to section 52 to provide long-term care home licensees flexibility in leveraging resident support personnel (if approved, proposed December 1, 2024, in-force date):
Under the ministry's current legislative and regulatory framework, only persons who meet the educational qualification requirements in section 52 or meet a listed exception can be hired by a long-term care home licensee as a personal support worker or to provide personal support services.
The ministry understands that since the pandemic, resident support personnel have been employed in long-term care homes to safely assist with providing some personal support services to lower-risk residents (for example, helping brush a resident's hair or teeth, helping open containers at mealtime).
To stabilize the role of resident support personnel as part of broader care teams, the ministry is proposing a permanent exemption to allow staff who do not meet the section 52 qualification requirements to provide personal support services if the long-term care home licensee is of the reasonable opinion that the individual has the proper skills and qualifications to perform the job, and the Director of Nursing and Personal Care is of the reasonable opinion that the individual can safely provide services based on an assessment of the resident's care plan, needs and risk-level. The Director of Nursing and Personal Care would be responsible for ensuring a process is in place for the assignment of low-risk tasks, informed by a resident risk-assessment.
The transitional staffing flexibility provision, currently set to expire on July 1, 2025, would be revoked, if approved, and replaced with the permanent exemption, with a proposed December 1, 2024 in-force date).
The ministry previously consulted on this approach via the Regulatory Registry from September 29, 2023, to November 20, 2023, and from May 1, 2024, to June 15, 2024. Feedback received was generally supportive or neutral.
For information on how the approach would work in practice, see 2. Addendum: Resident Support Personnel Approach in Practice - Flow Chart.
Amendments for registered dietitians (if approved, proposed January 1, 2025, in-force date):
Registered dietitians are one of the only non-supervisory roles required to be onsite for a specified amount of time.
The ministry is proposing amendments to exempt licensees from the onsite requirement for a registered dietitian under section 80(2), if the licensee has first made all reasonable attempts to meet the onsite delivery of clinical and nutritional care duties, and can ensure that, in the reasonable opinion of the licensee, the registered dietitian has taken steps to ensure the appropriate use of virtual care and technology for each resident, including whether clinical and nutritional care duties should be performed onsite by a regulated health professional working within their scope of practice.
Skin assessments will continue to be done in person by registered dietitians, with the proposed regulatory flexibility to enable licensees to use hybrid registered dietitian care (appropriate use of virtual care and technology) for certain clinical and nutritional care duties in collaboration with another onsite registered health professional working within their scope of practice.
For draft text of the proposed amendments, see 1. Addendum: Draft Regulatory Amendments.
Analysis of Regulatory Impact:
The proposed amendments are anticipated to be beneficial for long-term care residents and licensees, most notably through the continued delivery of safe, high-quality care to long-term care residents-a paramount consideration informing the ministry's regulatory reform initiatives. The amendments will support greater clarity, consistency, and alignment in the regulation.
The proposed amendments are largely refining or clarifying in nature and anticipated to result in a net minor or neutral regulatory impact to licensees. Based on a preliminary assessment, the majority of costs and/or savings associated with this proposal would be primarily administrative in nature and associated with staff time expended or saved to comply with the amended requirements. Any regulatory impact of this proposal would vary based on home size and existing policies and procedures.
Proposed amendments are responsive to recommendations from a range of stakeholders including the voices of residents and families, as well as the perspectives of professional and sector associations and long-term care licensees, among others.
If approved, the proposal would benefit long-term care residents, staff and licensees by:
Supporting the ongoing delivery of quality care to long-term care residents in Ontario by enabling innovative and flexible staffing solutions while staffing continues to stabilize.
Clarifying licensee obligations and streamlining administrative requirements so that licensees can focus on what matters most: the safety and well-being of long-term care residents.
The Ministry will continue to engage key partners to further explore the regulatory impacts associated with this proposal.
If approved, the regulatory amendments are proposed to come into effect on January 1, 2025, with the exception of amendments related to personal support workers (regarding alignment with the HSPCOA and providing licensees with flexibility to leverage resident support personnel), which are proposed to come into effect on December 1, 2024.
The proposed amendments are largely refining or clarifying in nature and anticipated to result in a net minor or neutral regulatory impact to licensees. Based on a preliminary assessment, the majority of costs and/or savings associated with this proposal would be primarily administrative in nature and associated with staff time expended or saved to comply with the amended requirements. Any regulatory impact of this proposal would vary based on home size and existing policies and procedures.
Proposed amendments are responsive to recommendations from a range of stakeholders including the voices of residents and families, as well as the perspectives of professional and sector associations and long-term care licensees, among others.
If approved, the proposal would benefit long-term care residents, staff and licensees by:
Supporting the ongoing delivery of quality care to long-term care residents in Ontario by enabling innovative and flexible staffing solutions while staffing continues to stabilize.
Clarifying licensee obligations and streamlining administrative requirements so that licensees can focus on what matters most: the safety and well-being of long-term care residents.
The Ministry will continue to engage key partners to further explore the regulatory impacts associated with this proposal.
If approved, the regulatory amendments are proposed to come into effect on January 1, 2025, with the exception of amendments related to personal support workers (regarding alignment with the HSPCOA and providing licensees with flexibility to leverage resident support personnel), which are proposed to come into effect on December 1, 2024.
Further Information:
1. Addendum: Draft Regulatory Amendments (Download Adobe Reader) 2. Addendum: Resident Support Personnel Approach in Practice Flow Chart (Download Adobe Reader)Proposal Number:
24-HLTC026
Posting Date:
September 11, 2024
Comments Due Date:
October 11, 2024
Contact Address:
6th Floor, 400 University Avenue
Toronto ON
M5G 1S5
Toronto ON
M5G 1S5
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