Tuesday, October 15, 2024 Submission to the Ontario Ministry of Long Term Care Calls for Amendments to the Fixing Long Term Care Act, 2021 Proposed Amendments to Ontario Regulation 246/22 under the Fixing Long Term Care Act, 2021 Policy Briefs The Ministry of Long Term Care (the ministry) is proposing amendments to Ontario Regulation 246/22 under the Fixing Long Term Care Act, 2021. These amendments are part of an ongoing evolution of the governing framework intended to enhance the quality of care and life for residents in long term care. CLAC, an independent labour union, represents approximately 9,000 healthcare workers in Ontario, with its members currently caring for over 5,000 Ontarians in 45 homes across the province. CLAC has a concentration of homes in the Central Region (Niagara, Brantford, St. Catharines, Ft. Erie), Southwest Region (Chatham, London, Cambridge, etc.), and GTA (Scarborough, Newmarket, Barrie). At least 50 percent of the workers are personal support workers (PSWs), with the remainder being cooks, cleaners, registered staff, and other essential personnel in these homes. CLAC has represented workers in the long term care (LTC) sector for over 50 years, across both for profit and non-profit homes. While CLAC is generally supportive of the proposed regulatory changes, there are two key areas of concern: 1. Proposed Amendments to Section 52 – Alignment with HSPCOA Registration Pathways for PSWs CLAC supports the proposed alignment with the Health and Supportive Care Providers Oversight Authority (HSCPOA) registration pathways for personal support workers. This alignment fosters consistency across the sector, boosts labour mobility, and addresses healthy human resource staffing challenges. This said, there are details that are not clear in what is being proposed that cause some concern for existing PSWs working in long term care homes. Continued employment of experienced PSW staff: while the alignment of the PSW qualifications between the section 52 of the O. Reg. 246/22 with the Health and Supportive Care Providers Oversight Authority (HSPCOA) registration pathways is welcome, it is imperative to avoid the unintended consequence of creating an employment or labour mobility barrier for existing PSWs. Section 52 (1) 2 of the proposed regulation permits that an employer may elect to employ a person who would meet the requirements to be registered in the personal support worker class set out in subsections 5(2) to (7) and section 6 of Ontario Regulation 217/24 (Registration) made under the Health and Supportive Care Providers Oversight Authority Act, 2021 (HSCPOA). The bolded “and” results in cumulative, rather than alternative prerequisite conditions for continued employment. If adopted in its present form, proposed Ontario Regulation 246/22 will detrimentally impact PSWs who have worked in long term care for many years in the following ways: The proposed regulation provides that a licensee may elect to employ PSWs who would meet the requirements in subsections 5(2) to (7) of the HSCPOA’s Registration regulation. However, those subsections, and several of others in that regulation, will be revoked on December 1, 2027. By invoking provisions of another regulation that are scheduled to be revoked, there will be no conditions for a licensee to elect to rely on, after 2027. o Similarly, proposed changes to the current O.Reg. 246/22, removes the current subsection 52 (3) (b), which provides as follows: “a person who was working or employed at a long term care home as a personal support worker at any time in the 12-month period preceding July 1, 2011, if, the person was working as a personal support worker on a full-time basis for at least three years during the five years immediately before being hired, or the person was working as a personal support worker on a part-time basis for the equivalent of at least three full-time years during the seven years immediately before being hired. The cumulative effect of the planned revocation of subsections 5(2) to (7) of the HSCPOA regulation, and the removal of the current 52 (3) (b), create the likely possibility that experienced PSWs or healthcare aides (HCAs) who are not registered, cannot continue their employment in long term care after 2027. It’s unclear whether an employee might continue to be employed after 2027 in the home they are employed in at that time. It will become impossible for such an employee to become employed at another facility after that date. Example: a PSW currently works in a long term care home under the provision of the current O, section 52(3)(b). She does not elect to register under the HSCPOA. In 2028, the family relocates to another town, and the local long term care home requires registration as a condition of hire. This PSW, despite working in the role since 2005 in a similar facility, is no longer eligible to apply for registration as those legacy pathway provisions are revoked, and so is section 52(3)(b) of the current regulation. It is unreasonable to expect this highly skilled and likely older individual to revisit their education, yet that appears to be her only option to be eligible for registration after 2027. That outcome cannot be the ministry’s intent. Recommendations Correct what appears to be an error in the proposed DRAFT regulation: The proposed new 52 (1) 2, should read […] subsections 5 (2) to (7) or 6 […], since 6 is a specific exemption from 5 (2). Clear guidance to licensees on the requirement to grandfather current PSWs/HCAs, regardless of where they are or have been previously employees, should be expressed in the regulatory exclusions. CLAC recommends that the current subsection 52(3)(b) be preserved. This provides a clear approach for homes with regard to the existing workforce, specifically long tenured, experienced staff. Ensure ongoing access to employment for all existing PSWs, notwithstanding the planned changes to HSCPOA regulations. The provisions from subsections 5 (3), 5 (5), 5 (6), 5 (7) of the Ontario Regulation 217/24 (Registration), which at present are scheduled to be revoked in 2027, should be enshrined in the Ontario Regulation 246/22 (General) independently and not only by reference. It would ensure that the labour pool of PSWs does not shrink even when HSCPOA amends its own processes. 2. Proposed Amendments to Section 52 – Flexibility for Long Term Care Licensees to Leverage Resident Support Personnel (Effective December 1, 2024) CLAC is concerned about the lack of clarity and accountability surrounding the proposed deployment of resident support personnel (RSPs) in comparison to PSWs. While we understand the intent to address staffing shortages by broadening the roles within homes, there are several key concerns: Unqualified and Unregulated Personnel: There is a risk with the proposed changes that unqualified and unregulated individuals provide a greater than intended amount and scope of care, undermining the goal of ensuring high-quality care. The establishment of the Oversight Authority (HSCPOA) aimed to ensure proper regulation of care providers, accountability, professional standards, and “public protection.“ Welcoming individuals with less training than most PSWs to provide an ill-defined and discretionary scope of care goes against the intent of HSCPOA. Licensee Discretion: Allowing the licensee, in consultation with the Director of Nursing and Personal Care, to determine who performs specific tasks introduces ambiguity and inconsistency. This discretion could potentially lead to variations in the quality of care provided across homes. Calculation of Hours of Care: It is yet unclear if hours or work performed by the “resident support personnel” would be included for the purposes of achieving targets set out in section 8 of the Fixing Long Term Care Act, 2021, S.O. 2021, or how this workforce would be funded. Compensation – the PSW PWE (permanent wage enhancement) elevated PSW wages across the province. Notwithstanding some unintended consequences, the policy has had a very positive impact on PSWs across Ontario. Resident support personnel wages lagged PSWs’ by about $3/hour prior to the introduction of PWE, so the resulting compensation differential is currently approximately $6/hour. Given the similarities in the work of PSWs and “resident support personnel,” and the vast wage discrepancy between these groups of workers, it is important for the ministry to clarify whether the PWE will apply to the “resident support personnel” if these amendments are implemented. CLAC agrees with the need to address staffing shortages, but it is important to recognize that the Long Term Care Commission results highlighted that quality of care is driven more by the qualifications of staff than simply the number of workers. Ensuring that PSWs are not displaced or devalued in favour of unregulated personnel is critical. Recommendations Objective Criteria for RSP Roles: The regulation should be expanded to amend the definition of “personal support services” as found in Sec. 11 in the Fixing Long Term Care Act, 2021, by creating a distinction on what work can be performed by as RSP relative to a PSW. Protect the Role of PSWs: PSW provide the vast majority of daily care in LTC. Any amendments must ensure that the role of PSWs remains attractive to potential workers and continues to retain current staff. The LTC sector is already facing recruitment challenges, and further erosion of the PSW role could exacerbate this issue. Continuity of Care: From making the decision to utilize “resident support personnel” to creating job routines and assigning work tasks, homes should be compelled through an accountability mechanism to prioritize continuity of care and focus on the needs of residents. This approach will help ensure that the amendments do not lead to a reduction in the quality of care residents receive. No Changes to the Calculation of Four Hours of Care – We propose that no changes are made to determination of the licensee’s progress toward the hours of care targets set out in the Fixing Long Term Care Act. The statute clearly includes personal support workers, registered nurses, or registered practical nurses as workers whose hours are counted toward the target (s. 8). The proposed regulation amendments must not lead to changes in that legislative intent. As a result, this work should not be funded by the Nursing and Personal Care funding envelope. Compensation: Ensure that the PSW PWE is applicable to the “resident support personnel.” Excerpt from the LTC Commission Report – Staffing A Chronic Crisis: An unregulated health profession – Pg. 55 “Despite comprising the largest staffing category in long term care homes and providing vital services to vulnerable Ontarians – many of whom cannot express a complaint about how they are treated by the staff caring for them – PSWs, unlike their registered nursing staff colleagues, are unregulated. In fact, the Commission was told that PSWs are the largest unregulated workforce in Ontario. The Commission heard that being an unregulated workforce has contributed to the lack of recognition of the important role PSWs play in the provision of long term care, which in turn adds to the recruitment and retention issues facing the sector” Quote: [N]ot anyone can just be a PSW. … [T]hey are not servants. They are not maids. Not anyone can walk in and know how to use a Hoyer lift and know exactly how to do a proper bathing technique. It is a skilled profession. –Ian DaSilva, Human Resources Director, Ontario Personal Support Workers Association and Canadian Support Workers Association Conclusion While CLAC supports the overarching goals of the proposed amendments, particularly regarding the alignment of registration pathways, we urge the ministry to address the concerns raised to ensure that the workforce is not negatively impacted and that the quality of care in Ontario’s long term care homes remains a priority. You might be interested in The Power of Asking for Help 20 Jul 2026 How to Manage an Insecure Leader 16 Jul 2026 Heat of the Moment 13 Jul 2026 The Power Within Is No Yolk! 13 Jul 2026