HOME AND COMMUNITY CARE SERVICES

CONTENTS 1. Home and community care services 2. Interpretation 3. Accessibility 4. Consent 5. Continuity of care, etc. 6. Factors to be considered 7. Provision of services 8. Indigenous services 9. Patient Bill of Rights 10. Access to services 11. Professional services 12. Personal support services 13. Homemaking services 14. Exemptions from certain eligibility criteria 15. Reassessment and care plan revision 16. Assessment and care planning considerations 17. Assessments and reassessments 18. Care planning 19. Professional services 20. Requirement to provide service in reasonable time 21. Waiting list 22. Co-ordination of services 23. Referral 24. Notice 25. Explanation 26. Transition plan for termination 27. Quality management 28. Abuse prevention 29. Charges 29.1 French language services 30. Complaints 31. Appeals 32. Provision of funding to purchase a home and community care service 33. Exemptions 34. Transition Home and community care services 1. For the purposes of the Act and this Regulation, the following are home and community care services: 1. Professional services. 2. Personal support services. 3. Homemaking services. 4. Community support services. 5. Indigenous services. 6. Care co-ordination services. 7. Home and community care services that include residential accommodation. Interpretation 2. (1) In this Regulation, “accessible format” may include, but is not limited to, large print, recorded audio and electronic formats, braille and other formats usable by persons with disabilities, within the meaning of the Accessibility for Ontarians with Disabilities Act, 2005; (“format accessible”) “care co-ordination services” means the services required to facilitate access to and co-ordinate the provision of home and community care services to patients, including, (a) assessing and reassessing patient requirements, (b) making determinations of eligibility, (c) developing, evaluating, and revising care plans, (d) making referrals to other providers, and (e) terminating the provision of a service; (“services de coordination des soins”) “care plan” means the care plan developed, evaluated and revised by a health service provider or Ontario Health Team under sections 10 and 15; (“plan de soins”) “caregiver support and respite services” means counselling, training, visiting and providing information, respite and other assistance to caregivers to support them in carrying out their caregiving responsibilities; (“services de soutien et de relève aux fournisseurs de soins”) “client intervention and assistance services” means providing support to patients to assist them to cope with activities of everyday living; (“services d’intervention et d’assistance destinés aux clients”) “community support services” means the following services: 1. Meal services. 2. Transportation services. 3. Caregiver support and respite services. 4. Adult day programs. 5. Home maintenance and repair services. 6. Friendly visiting services. 7. Security checks or reassurance services. 8. Social or recreational services. 9. Client intervention and assistance services. 10. Emergency response services. 11. Foot care services. 12. Home help referral services. 13. Independence training. 14. Palliative care education and consultation services. 15. Psychogeriatric consulting services relating to Alzheimer’s disease and related dementias. 16. Public education services relating to Alzheimer’s disease and related dementias. 17. Services for persons with blindness or visual impairment. 18. Services for persons with deafness, congenital hearing loss or acquired hearing loss. 19. Bereavement services. 20. Behavioural supports. 21. Education, prevention, and awareness services pertaining to, i. home and community care services, ii. mental health and addictions, iii. chronic disease management, iv. aphasia and communication disorders, and v. vocational training and education for persons with a cognitive or physical impairment to assist them to enter the work force or education system in the community; (“services de soutien communautaire”) “emergency response services” means installing electronic devices in homes to connect patients with emergency response centres; (“services d’intervention en cas d’urgence”) “home and community care services that include residential accommodation” means those services that include both community services provided under the Home Care and Community Services Act, 1994 and accommodation that was funded by the Agency immediately before the coming into force of this subsection; (“services de soins à domicile et en milieu communautaire qui comprennent un hébergement”) “home help referral services” means referring a patient who requires home help services to a person who provides such services; (“services d’aiguillage en matière d’aide ménagère”) “homemaking services” means the following services: 1. Housecleaning. 2. Laundry. 3. Shopping. 4. Banking. 5. Paying bills. 6. Planning menus. 7. Preparing meals. 8. Caring for children. 9. Assisting a patient with any of the activities referred to in paragraphs 1 to 8. 10. Training a person to carry out or assist with any of the activities referred to in paragraphs 1 to 8; (“services d’aides familiales”) “incapable” means unable to understand the information that is relevant to making a decision concerning the subject-matter or unable to appreciate the reasonably foreseeable consequences of a decision or a lack of decision; (“incapable”) “independence training” means teaching the skills to improve independent functioning in the community, including the effective use of personal support services; (“formation à l’autonomie”) “Indigenous services” means the following services: 1. Traditional healing. 2. Indigenous cultural support services; (“services pour les Autochtones”) “long-term care home” means a long-term care home under the Fixing Long-Term Care Act, 2021, and “resident of a long-term care home” means a resident of such a home within the meaning of that Act; (“foyer de soins de longue durée”) “long-term mental health impairment” means a cognitive impairment that, (a) is continuous or recurrent, (b) is expected to last one year or more into the future, and (c) has the direct and cumulative effect of substantially restricting the individual’s ability to carry out one or more activities of daily living; (“déficience mentale à long terme”) “meal services” means delivering nutritious meals to a patient’s home or providing them in other locations in the community; (“services relatifs aux repas”) “Patient Bill of Rights” means the bill of rights set out in subsection 9 (1); (“déclaration des droits des patients”) “patient who is educated at home” means a patient who is receiving satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act; (“patient qui reçoit un enseignement au foyer”) “personal support services” means the following services: 1. Personal hygiene activities. 2. Routine personal activities of living. 3. Assisting a patient with any of the activities referred to in paragraphs 1 and 2. 4. Training a person to carry out or assist with any of the activities referred to in paragraphs 1 and 2; (“services de soutien personnel”) “private school” means a private school as defined in subsection 1 (1) of the Education Act; (“école privée”) “professional services” means the following services: 1. Nursing services. 2. Occupational therapy services. 3. Physiotherapy services. 4. Social work services. 5. Speech-language pathology services. 6. Dietetics services. 7. Training a person to provide any of the services referred to in paragraphs 1 to 6. 8. Diagnostic and laboratory services. 9. Medical supplies, dressings and treatment equipment necessary to the provision of nursing services, occupational therapy services, physiotherapy services, speech-language pathology services or dietetics services. 10. Pharmacy services. 11. Respiratory therapy services. 12. Social service work services. 13. Psychology services; (“services professionnels”) “psychogeriatric consulting services” means providing psychogeriatric consultation, training and support to staff of long-term care homes and to health service providers and Ontario Health Teams funded under section 21 of the Act to provide home and community care services; (“services de consultation en psychogériatrie”) “responsive behaviours” means behaviours that often indicate, (a) an unmet need in an individual, whether cognitive, physical, emotional, social, environmental or other, or (b) a response to circumstances within the social or physical environment that may be frustrating, frightening or confusing to an individual; (“comportements réactifs”) “school” means a school as defined in subsection 1 (1) of the Education Act and includes a private school as defined in subsection 1 (1) of that Act; (“école”) “services for persons with blindness or visual impairment” means providing rehabilitation, visual orientation, counselling, referrals and technology to persons with blindness or visual impairment; (“services destinés aux personnes aveugles ou ayant une déficience visuelle”) “services for persons with deafness, congenital hearing loss or acquired hearing loss” means providing rehabilitation and communication training, counselling, technology and education to persons with deafness, congenital hearing loss or acquired hearing loss; (“services destinés aux personnes sourdes ou ayant une déficience auditive congénitale ou acquise”) “transportation services” means providing transportation to patients who are unable to use existing transportation or assisting patients to obtain access to existing transportation. (“services de transport”) O. Reg. 187/22, s. 2 (1), 35 (1, 2); O. Reg. 245/24, s. 1. (2)-(4) Revoked: O. Reg. 187/22, s. 35 (3, 5). Accessibility 3. Where this Regulation requires a notice, plan, report, decision or other information to be in writing and given to a patient or other person, and where the patient or person requests that the notice, plan, report, decision or other information be given in an accessible format, a health service provider or an Ontario Health Team shall ensure the notice, plan, report, decision or other information is also given in an accessible format that meets the needs of the patient or other person. Consent 4. A health service provider or an Ontario Health Team shall not provide a home and community care service, and shall ensure a home and community care service is not provided, without obtaining the patient’s consent or, if the patient is incapable, the consent of the person who is lawfully authorized to make a decision on behalf of the patient concerning the service. Continuity of care, etc. 5. In deciding whether to provide home and community care services other than care co-ordination services directly or indirectly, a health service provider or an Ontario Health Team shall ensure that its decision supports continuity of care, equitable access to care, an integrated experience of care, system stability and sustainability of service delivery. Factors to be considered 6. A health service provider or an Ontario Health Team that is funded by the Agency under section 21 of the Act to provide a home and community care service or to provide funding to or on behalf of an individual to purchase a home and community care service shall consider and promote the following in the provision of services and in the provision of the funding to purchase services: 1. The effective and efficient management of human, financial and other resources involved in the delivery of the services. 2. Equitable access to the services through the application of consistent eligibility criteria and uniform rules and procedures. Provision of services 7. (1) Where a health service provider or an Ontario Health Team provides a community support service indirectly, the provider or Team shall ensure that the service is provided by a not-for-profit entity, except where the community support service is, (a) a transportation service; (b) a security check or reassurance service; or (c) a service provided by a for-profit entity for the duration of an agreement for the purchase of the service that was in existence immediately before the coming into force of this section. O. Reg. 187/22, s. 7 (1). (2) A health service provider or an Ontario Health Team may provide care co-ordination services indirectly. O. Reg. 187/22, s. 35 (6). (2.1) The health service provider or Ontario Health Team may obtain the care co-ordination services indirectly from another person or entity that is not a health service provider or an Ontario Health Team only if, (a) before obtaining the services, the provider or Team determines that the person or entity is capable of meeting the requirements for the provision of the care co-ordination services set out in this Regulation and in the terms and conditions of funding that the Agency considers appropriate and in accordance with the funding that the Agency receives under section 18 of the Act and the Agency’s accountability agreement; (b) the person or entity has the appropriate digital resources, data sharing arrangements and infrastructure in place to enable secure and effective data and other information exchanges between the provider or Team, the person or entity and any other person or entity, as needed; (c) the arrangement supports equitable access to care and the appropriate use of public resources; (d) the arrangement includes a process for reviewing a patient’s needs and adjusting the patient’s care plan, as appropriate, to support responsive care provision; (e) the provider or Team maintains effective oversight over and responsibility for the care co-ordination decisions of the person or entity; and (f) the person or entity providing the services on behalf of the health service provider or Ontario Health Team is prohibited from purchasing or otherwise obtaining the services from any other person or entity. O. Reg. 187/22, s. 35 (6). (3) For greater certainty, any reference in this Regulation to the provision of a home and community care service by a health service provider or an Ontario Health Team includes the provision of those services either directly by the provider or Team or indirectly where the provider or Team is not prohibited from providing them indirectly. O. Reg. 187/22, s. 7 (3). Indigenous services 8. A health service provider or an Ontario Health Team that is funded under section 21 of the Act to provide traditional healing shall only provide that service if the provider, Team or their provider of traditional healing is an Indigenous person or entity. Patient Bill of Rights 9. (1) Every health service provider and Ontario Health Team shall ensure that the following rights of patients are fully respected and promoted: 1. A patient has the right to be dealt with by the provider of the home and community care service in a respectful manner and to be free from physical, sexual, mental, emotional, verbal and financial abuse by the provider. 2. A patient has the right to be dealt with by the provider of the home and community care service in a manner that respects the patient’s dignity and privacy and that promotes the patient’s autonomy and participation in decision-making. 3. A patient has the right to be dealt with by the provider of the home and community care service in a manner that recognizes the patient’s individuality and that is sensitive to and responds to the patient’s needs and preferences, including preferences based on ethnic, spiritual, linguistic, familial and cultural factors. 4. A patient has the right to receive home and community care services free from discrimination on any ground of discrimination prohibited by the Human Rights Code or the Canadian Charter of Rights and Freedoms. 5. A patient who is First Nations, Métis or Inuk has the right to receive home and community care services in a culturally safe manner. 6. A patient has the right to clear and accessible information about their home and community care services. 7. A patient has the right to participate in the assessment of their needs, development of their care plan, reassessment of their needs and revision of their care plan. 8. A patient has the right to designate a person to be present with them during assessments. 9. A patient has the right to designate a person to participate in the development, evaluation and revision of their care plan. 10. A patient who receives more than one home and community care service has the right to receive assistance in co-ordinating their services from the health service provider or Ontario Health Team. 11. A patient has the right to give or refuse consent to the provision of any home and community care service. 12. A patient has the right to raise concerns or recommend changes in connection with the home and community care service provided to them and in connection with policies and decisions that affect their interests, to the provider of the home and community care service, the Agency and its employees, government officials or any other person, without fear of interference, coercion, discrimination or reprisal. 13. A patient who receives a home and community care service has the right to be informed of the laws, rules and policies affecting the operation of the provider of the home and community care service, including this Patient Bill of Rights, and to be informed, in writing, of the procedures for initiating complaints about the provider. (2) Every health service provider or Ontario Health Team shall ensure a copy of the Patient Bill of Rights is posted in their business premises and on their website, and at the business premises and on a website of their providers of home and community care services. (3) The Patient Bill of Rights does not apply with respect to the provider of a home and community care service that has been purchased by an individual with funding provided by a health service provider or an Ontario Health Team under subsection 21 (1.1) of the Act. Access to services 10. When a patient applies to a health service provider or an Ontario Health Team for any of the home and community care services, other than care co-ordination services, that the provider or Team is funded to provide under section 21 of the Act, the provider or Team shall, before providing the service, (a) assess the patient’s requirements; (b) determine the patient’s eligibility for the services that the person requires; and (c) for each patient who is determined to be eligible, develop a care plan in accordance with the requirements for care plans. Professional services 11. (1) A health service provider or an Ontario Health Team shall not provide professional services to a patient unless the following eligibility criteria are met: 1. The patient must be an insured person under the Health Insurance Act. 2. The services must be necessary to enable the patient to remain in their home or enable them to return home from a hospital or other health care facility. 3. Except in the case of pharmacy services, the services must be reasonably expected to result in progress towards, i. rehabilitation, ii. maintenance of functional status, or iii. palliative care goals or other end-of-life care goals, in the case of a patient who is in the last stages of life. 4. The place in which the services are to be provided must have the physical features necessary to enable the services to be provided. 5. The risk that an individual who provides the services to the patient will suffer serious physical harm while providing the services must not be significant or, if it is significant, the provider of the services must be able to take reasonable steps to reduce the risk so that it is no longer significant. 6. In the case of pharmacy services, i. the patient must be taking three or more prescription medications, ii. the patient must be at risk of medication complications due to complex medical needs, and iii. the patient must have difficulty accessing the services in a setting outside their home because of the patient’s condition or circumstances. 7. In the case of physiotherapy services and medical supplies, dressings and treatment equipment necessary to the provision of physiotherapy services, i. if the services are provided in the patient’s home, the patient must have difficulty accessing the services in a setting outside the home because of the patient’s condition or circumstances, or ii. if the services are provided in a congregate or group setting, A. the patient must be 65 years of age or older, or B. the patient must have been recently discharged as an inpatient of a hospital and the services must be directly connected to the condition, illness or injury for which they were admitted to or treated for in the hospital. 8. In the case of respiratory therapy services, the patient must be ventilator-dependent, have artificial airways or be receiving home oxygen services under the Assistive Devices Program administered by the Ministry. 9. In the case of diagnostic and laboratory services and the medical supplies, dressings and treatment equipment necessary to the provision of nursing services, occupational therapy services, physiotherapy services, speech-language pathology services or dietetics services, the patient must be in need of nursing services, occupational therapy services, physiotherapy services, speech-language pathology services or dietetics services. 10. In the case of psychology services, the patient must require the services to manage, i. a long-term mental health impairment, or ii. responsive behaviours that the patient, A. had before receiving the services, or B. would be at risk of developing without the services. (2) Subject to the following, a health service provider or an Ontario Health Team may provide a professional service to a patient in the patient’s home or in a congregate or group setting: 1. Pharmacy services may only be provided in the patient’s home. 2. Physiotherapy services and medical supplies, dressings and treatment equipment necessary to the provision of physiotherapy services to a patient may be provided, i. in the patient’s home, if the patient is having difficulty accessing the services in a setting outside the home because of their condition or circumstances, or ii. in a congregate or group setting, if the patient is 65 years of age or older, or the patient has been recently discharged as an inpatient of a hospital and the services are directly connected to the condition, illness or injury for which they were admitted to or treated for in the hospital. (3) Despite subsections (1) and (2), but subject to subsection (4), a health service provider or an Ontario Health Team may provide the following professional services, and only the following professional services, to a patient who is a resident of a long-term care home: 1. Nursing services that are provided as part of the Nurse-led Long-Term Care Outreach Team program funded by the Ministry or the Agency. 2. Occupational therapy services. 3. Physiotherapy services. 4. Respiratory therapy services. 5. Speech-language pathology services. 6. Training a person to provide the services referred to in paragraph 1 to patients who are residents. (4) A health service provider or an Ontario Health Team shall not provide the professional services listed in subsection (3) to a patient who is a resident of a long-term care home unless the following eligibility criteria are met: 1. The patient must be an insured person under the Health Insurance Act. 2. Except in the case of nursing services, the patient must be unable to access the services in a setting outside the home because of their condition. 3. The services must be reasonably expected to result in progress towards, i. rehabilitation, ii. maintenance of functional status, or iii. palliative care goals or other end-of-life care goals, in the case of a patient who is in the last stages of life. 4. In the case of respiratory therapy services, the patient must be ventilator-dependent, have artificial airways or be receiving home oxygen services under the Assistive Devices Program administered by the Ministry. (5) Despite subsections (1) to (4), but subject to subsection (6), a health service provider or an Ontario Health Team may provide the following professional services, and only the following professional services, to a patient who is attending school: 1. Dietetics services. 2. Nursing services. 3. Occupational therapy services, when provided to a patient who is enrolled as a pupil at a private school or to a patient who is educated at home. 4. Physiotherapy services, when provided to a patient who is enrolled as a pupil at a private school or to a patient who is educated at home. 5. Speech-language pathology services, when provided to a patient who is enrolled as a pupil at a private school or to a patient who is educated at home. 6. Medical supplies, dressings and treatment equipment necessary to the provision of the services referred to in paragraphs 1 to 5. 7. Training of school personnel to provide any of the services referred to in paragraphs 1 to 5. (6) A health service provider or an Ontario Health Team shall not provide the professional services listed in subsection (5) to a patient who is attending school unless the following eligibility criteria are met: 1. The patient must be an insured person under the Health Insurance Act. 2. The patient must be enrolled as a pupil at a school or must be a patient who is educated at home. 3. The patient must require the services in order to be able to, i. attend school, participate in school routines and receive instruction, or ii. receive satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act. 4. The place in which the services are to be provided must have the physical features necessary to enable the services to be provided. 5. The risk that an individual who provides the services to the patient will suffer serious physical harm while providing the services must not be significant or, if it is significant, the provider of the services must be able to take reasonable steps to reduce the risk so that it is no longer significant. (7) In this section, “attending school” means, (a) in the case of a patient who is enrolled as a pupil at a school, (i) attending on the school premises, (ii) being transported to or from the school on a school bus or other school vehicle, (iii) participating in a school trip or activity outside the school premises, (iv) participating in remote learning during a full or partial school closure or during or in relation to the COVID-19 pandemic, and (v) participating in online learning that is mandated by the Ministry of Education, and (b) in the case of a patient who is educated at home, receiving instruction at home. Personal support services 12. (1) Subject to subsection (2), a health service provider or an Ontario Health Team shall not provide personal support services to a patient unless the following eligibility criteria are met: 1. The patient must be an insured person under the Health Insurance Act. 2. The place in which the services are to be provided must have the physical features necessary to enable the services to be provided. 3. The risk that an individual who provides the services to the patient will suffer serious physical harm while providing the services must not be significant or, if it is significant, the provider of the services must be able to take reasonable steps to reduce the risk so that it is no longer significant. (2) A health service provider or an Ontario Health Team shall not provide personal support services to a patient who is a resident of a long-term care home unless all of the following eligibility criteria are met: 1. It has been less than 21 days from the day on which the patient moved into the long-term care home. 2. The patient has responsive behaviours. 3. The patient was eligible for and receiving personal support services as a home and community care service immediately before moving into the long-term care home. 4. The services are to be provided by the same worker or workers who were providing personal support services on a continuous basis to the patient before the patient moved into the long-term care home and the patient is familiar with the worker or workers. 5. The patient would be likely to have difficulty transitioning into the long-term care home without the services. 6. The patient would be likely to successfully transition into the long-term care home with the services. (3) Despite subsections (1) and (2), but subject to subsection (5), a health service provider or an Ontario Health Team may provide the following personal support services, and only the following personal support services, to a patient who is attending school: 1. Personal hygiene activities. 2. Routine personal activities of living. (4) A health service provider or an Ontario Health Team may also provide the following ancillary services: 1. Medical and personal equipment necessary to the provision of the services referred to in paragraphs 1 and 2 of subsection (3). 2. Training of school personnel of a private school to provide any of the services referred to in paragraphs 1 and 2 of subsection (3) to patients enrolled as pupils at the school, and assisting the personnel in providing them. (5) A health service provider or an Ontario Health Team shall not provide the services listed in subsections (3) and (4) to a patient who is attending school unless the following eligibility criteria are met: 1. The patient must be an insured person under the Health Insurance Act. 2. The patient must be enrolled as a pupil at a private school or be a patient who is educated at home. 3. The patient must require the services in order to be able to, i. attend school, participate in school routines and receive instruction, or ii. receive satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act. 4. The place in which the services are to be provided must have the physical features necessary to enable the services to be provided. 5. The risk that an individual who provides the services to the patient will suffer serious physical harm while providing the services must not be significant or, if it is significant, the provider of the services must be able to take reasonable steps to reduce the risk so that it is no longer significant. (6) In this section, “attending school” means, (a) in the case of a patient who is enrolled as a pupil at a school, (i) attending on the school premises, (ii) participating in a school trip or activity outside the school premises, (iii) participating in remote learning during a full or partial school closure or during or in relation to the COVID-19 pandemic, and (iv) participating in online learning that is mandated by the Ministry of Education, and (b) in the case of a patient who is educated at home, receiving instruction at home. Homemaking services 13. (1) A health service provider or an Ontario Health Team shall not provide homemaking services to a patient unless the following eligibility criteria are met: 1. The place in which the services are to be provided must have the physical features necessary to enable the services to be provided. 2. The risk that an individual who provides the services to the patient will suffer serious physical harm while providing the services must not be significant or, if it is significant, the provider of the services must be able to take reasonable steps to reduce the risk so that it is no longer significant. O. Reg. 187/22, s. 13 (1). (2) A patient is not eligible to receive homemaking services if the patient is a tenant in a care home within the meaning of the Residential Tenancies Act, 2006 or is a resident of a long-term care home. O. Reg. 187/22, s. 13 (2). (3) Despite subsection (1), the Service Organization shall not provide homemaking services to a patient unless the following eligibility criteria are met: 1. The patient must be an insured person under the Health Insurance Act. 2. At least one of the following must apply: i. The patient requires personal support services along with the homemaking services. ii. The patient receives personal support services and homemaking services from a caregiver, and the caregiver requires assistance with the homemaking services in order to continue providing care to the patient. iii. The patient requires constant supervision as a result of a cognitive impairment or acquired brain injury and the patient’s caregiver requires assistance with the homemaking services. 3. The place in which the services are to be provided must have the physical features necessary to enable the services to be provided. 4. The risk that an individual who provides the services to the patient will suffer serious physical harm while providing the services must not be significant or, if it is significant, the provider of the services must be able to take reasonable steps to reduce the risk so that it is no longer significant. O. Reg. 245/24, s. 2. Exemptions from certain eligibility criteria 14. (1) A patient is exempt from any eligibility criterion of this Regulation requiring them to be an insured person under the Health Insurance Act if the patient, (a) is in the last stages of life; (b) is living in Ontario; (c) immediately before living in Ontario was a resident of another province or territory of Canada and was an insured person under the publicly funded health care insurance plan of that province or territory; and (d) has submitted an application to the General Manager under the Health Insurance Act to establish their entitlement to be an insured person under that Act, in accordance with the regulations under that Act. (2) Nothing in this Regulation affects the eligibility for a home and community care service of a patient who was previously determined to be eligible for a community service under the Home Care and Community Services Act, 1994. Reassessment and care plan revision 15. If a patient is receiving a home and community care service, other than care co-ordination services, provided by a health service provider or an Ontario Health Team, the provider or Team shall, (a) reassess the patient’s requirements when appropriate, depending on the patient’s condition and circumstances; and (b) evaluate the patient’s care plan and revise it as necessary when the patient’s requirements change. Assessment and care planning considerations 16. In assessing a patient’s requirements, determining eligibility and developing a care plan, or in reassessing a patient’s requirements and evaluating and revising a care plan, a health service provider or an Ontario Health Team shall consider, (a) the availability and capacity of family and other caregivers to provide care to the patient; (b) the availability of publicly-funded services that would meet the patient’s needs; and (c) opportunities for referrals to providers of non-health services. Assessments and reassessments 17. In assessing and reassessing a patient’s requirements, a health service provider or an Ontario Health Team shall, (a) take into account all assessments and information that are provided to the provider or Team relating to the patient’s capacity, the patient’s impairment or the patient’s requirements for home and community care services or other health care; (b) where the assessment process reveals that a person has additional information about the patient’s capacity, the patient’s impairment or the patient’s requirements for home and community care services or other health care that is relevant to the provider or Team’s assessment or reassessment of the patient’s requirements related to home and community care services, make reasonable efforts to obtain that information; (c) provide an opportunity to participate in the assessment and reassessment to, (i) the patient, and (ii) if the patient is incapable, the person who is lawfully authorized to make a decision on behalf of the patient concerning the assessment or reassessment; and (d) provide an opportunity to the patient to designate a person to be present with them during the assessment or reassessment. Care planning 18. In developing, evaluating, and revising a care plan, a health service provider or an Ontario Health Team shall, (a) include in the care plan, at a minimum, (i) the amount of the home and community care service, (ii) the duration of the service, (iii) whether the service is to be provided in person or virtually using electronic means, and (iv) the care goals for the patient, including targeted clinical and functional outcomes for the patient; (b) provide an opportunity to participate fully in the development, evaluation and revision of the care plan to, (i) the patient who is the subject of the care plan, (ii) if the patient who is the subject of the care plan is incapable, the person who is lawfully authorized to make a decision on behalf of the patient concerning the service in the care plan, and (iii) the person, if any, designated by the persons referred to in subclauses (i) and (ii); (c) take into account the patient’s preferences, including preferences based on ethnic, spiritual, linguistic, familial and cultural factors; and (d) consider clinical best practices in the provision of a service and the costs and benefits of providing the service, (i) in different locations in which the service could be provided if the patient is eligible to receive the service in more than one location, and (ii) in person or virtually using electronic means. Professional services 19. (1) The provider of a professional service shall ensure that, if the professional services provided to a patient involve treating or advising the patient within the scope of practice of a health profession as defined in subsection 1 (1) of the Regulated Health Professions Act, 1991, the provision of the service is planned and documented, and, as necessary, reviewed and revised by a member of the College that relates to the professional services provided. (2) The requirement in subsection (1) does not apply to the provision of nursing services to a patient who resides in a long-term care home. Requirement to provide service in reasonable time 20. A health service provider or an Ontario Health Team shall ensure that the home and community care services outlined in a patient’s care plan are provided to the patient within a time that is reasonable in the circumstances. Waiting list 21. If a home and community care service outlined in a patient’s care plan is not immediately available, the health service provider or Ontario Health Team shall ensure the patient is placed on a waiting list for that service and shall advise the patient when the service becomes available. Co-ordination of services 22. If a patient is receiving more than one home and community care service, the health service provider or Ontario Health Team or providers or Teams, as applicable, shall ensure that the patient and a person designated by the patient, if any, are assisted in co-ordinating the services the patient receives, in accordance with the patient’s needs and with consideration of the patient’s preferences. Referral 23. When a person applies to a health service provider or an Ontario Health Team for a home and community care service the provider or Team is not funded to provide, the provider or Team shall refer the person to another health service provider or Ontario Health Team funded to provide the home and community care service the person is seeking. Notice 24. (1) A health service provider or an Ontario Health Team shall ensure that the notice described in subsection (2) is given to each of their patients, to any person who is lawfully authorized to make a relevant decision concerning a home and community care service on behalf of an incapable patient and to anybody designated by the patient or authorized person. (2) The notice shall, (a) set out the rights listed in the Patient Bill of Rights and shall state that the health service provider or Ontario Health Team is obliged to ensure those rights are fully respected and promoted; (b) set out the procedures for making complaints or suggestions respecting the provision of home and community care services; (c) state that a request for access to a record of personal health information, including assessment information and the care plan, may be made by a person entitled to the access under the Personal Health Information Protection Act, 2004, and shall specify the person to whom the request must be made; and (d) state that a person making a request under clause (c) for access to assessment information or the care plan may request a clear and accessible explanation of the assessment information and the care plan. Explanation 25. (1) A health service provider or an Ontario Health Team shall ensure that a patient is provided with clear and accessible information about the home and community care services provided to the patient. (2) If a person is entitled access to a record of personal health information referred to in clause 24 (2) (c) and the person also requests an explanation of the assessment information or care plan, the health service provider or Ontario Health Team shall ensure that the person is provided with a clear and accessible explanation of the assessment information or care plan, as the case may be. Transition plan for termination 26. (1) Before terminating all home and community care services in a patient’s care plan, a health service provider or an Ontario Health Team shall ensure that, (a) in participation with the patient, or, if the patient is incapable, the person who is lawfully authorized to make a relevant decision on the patient’s behalf, or a designate of the patient or the authorized person, if they so wish, a written transition plan is developed that, (i) considers the patient’s goals and preferences, (i) identifies the information required to safely transition from receiving home and community care services from the provider or Team, and (iii) supports a seamless transition to the next care provider, if any; and (b) the portions of the plan within the control of the provider or Team are implemented. (2) The health service provider or Ontario Health Team shall ensure that, (a) a copy of the transition plan is provided to the patient, or, if the patient is incapable, to the person who is lawfully authorized to make a relevant decision on their behalf, and to anybody designated by the patient or authorized person; and (b) an explanation of the plan is provided to the patient, or, if the patient is incapable, to the person who is lawfully authorized to make a relevant decision on their behalf, and to anybody designated by the patient or authorized person, upon request. Quality management 27. A health service provider or an Ontario Health Team shall ensure that a quality management system is developed and implemented for monitoring, evaluating and improving the quality of the home and community care services provided by the provider or Team. Abuse prevention 28. (1) A health service provider or an Ontario Health Team shall develop and implement a plan for preventing, recognizing and addressing physical, sexual, mental, emotional, verbal and financial abuse of patients who receive home and community care services provided by the provider or Team. O. Reg. 187/22, s. 28 (1). (2) A health service provider or an Ontario Health Team shall ensure that their provider of home and community care services develops and implements a plan for preventing, recognizing and addressing physical, sexual, mental, emotional, verbal and financial abuse of patients who receive home and community care services provided by their provider. O. Reg. 187/22, s. 35 (8). (3) The plans required under subsections (1) and (2) shall provide, at a minimum, for the education and training of employees and volunteers in methods of preventing, recognizing and addressing physical, sexual, mental, emotional, verbal and financial abuse. O. Reg. 187/22, s. 35 (8). Charges 29. (1) Subject to subsections (2) and (3), if a health service provider or an Ontario Health Team provides a homemaking service or community support service the provider or Team may require payment from the patient for the service and may accept a payment made by or on behalf of the patient for the service. (2) A health service provider or an Ontario Health Team shall not require payment from the patient or accept payment made by or on behalf of the patient if the homemaking service is provided to the patient in the following circumstances: 1. The patient requires personal support services along with the homemaking services. 2. The patient receives personal support services and homemaking services from a caregiver, and the caregiver requires assistance with the homemaking services in order to continue providing care to the patient. 3. The patient requires constant supervision as a result of a cognitive impairment or acquired brain injury and the patient’s caregiver requires assistance with the homemaking services. (3) A health service provider or an Ontario Health Team shall not require payment from the patient or accept payment made by or on behalf of the patient if the patient is receiving security checks or reassurance services together with a professional service, a personal support service or a homemaking service described in subsection (2) provided by the provider or Team. (4) Despite anything else in this section, where a health service provider or an Ontario Health Team provides home and community care services that include residential accommodation before March 31, 2023, the provider or Team may require payment from the patient for the accommodation and may accept a payment made by or on behalf of the patient for the accommodation. (5) In this section, “caregiver” means a family member, friend or other person who, (a) has primary responsibility for the care of an applicant for homemaking or personal support services or of a person who receives such services, and (b) provides that care without remuneration. French language services 29.1 (1) When a person applies to a health service provider or an Ontario Health Team that is funded to provide professional services, personal support services, homemaking services for which the provider or Team may not charge or accept payment or the care co-ordination services for these services, and the person indicates a preference to receive services in French, the provider or Team shall provide the services in French or refer the patient to another health service provider or an Ontario Health Team that offers the services in French. O. Reg. 187/22, s. 35 (9). (2) An obligation under subsection (1) does not in any way alter an obligation that otherwise exists in law on a health service provider or an Ontario Health Team to provide home and community care services in French. O. Reg. 187/22, s. 35 (9). (3) An obligation under subsection (1) is subject to such limits as circumstances make reasonable and necessary, if all reasonable measures to comply with the requirements have been taken or made. O. Reg. 187/22, s. 35 (9). (4) A health service provider or an Ontario Health Team that is funded to provide professional services, personal support services, homemaking services for which the provider or Team may not charge or accept payment or the care co-ordination services for these services shall take reasonable and appropriate measures, including providing signs, notices and other information on the services and initiating communication with the public, to make it known to members of the public that the services may be received in French in accordance with this section. O. Reg. 187/22, s. 35 (9). Complaints 30.

(1) The process for reviewing complaints required by section 43.10 of the Act must include, at a minimum, review of the following types of complaints received from any person: 1. An allegation of abuse or neglect of a patient that resulted in harm or a risk of harm to the patient, or improper or incompetent service delivery to a patient that resulted in harm or a risk of harm to the patient by any of the following: i. The health service provider or Ontario Health Team. ii. A staff member of the health service provider or Ontario Health Team. iii. A provider of home and community care services of the health service provider or Ontario Health Team, including any employee or contractor of that provider. 2. A decision that the patient is not eligible to receive a particular home and community care service. 3. A decision to exclude a particular home and community care service from the patient’s care plan. 4. A decision respecting the amount of any particular home and community care service set out in the patient’s care plan. 5. A decision to terminate the provision of a home and community care service to the patient. (2) A complaint under paragraph 1 of subsection (1) may not include a complaint about a decision in paragraph 2, 3, 4 or 5 of that subsection. (3) A health service provider or an Ontario Health Team that receives a complaint about a matter described in paragraph 1 of subsection (1) must ensure the following occurs: 1. Immediate acknowledgement of the complaint to the person making the complaint, if known. 2. Immediate commencement of an investigation of the complaint. 3. Provision of a response to the complainant, if known, within 10 days of receipt of the complaint, that includes, at a minimum, the steps taken to address the complaint. 4. Within a reasonable time following the commencement of the investigation, i. conclusion of the investigation, and ii. creation of a written report documenting the findings of the investigation and, if the investigation shows the complaint to be founded, the steps taken or planned to be taken to prevent a similar incident from occurring. (4) Within 60 days after a complaint is made to a health service provider or an Ontario Health Team about one of the decisions referred to in paragraph 2, 3, 4 or 5 of subsection (1), the provider or Team shall, (a) affirm the decision and give a written notice of the affirmation to the persons referred to in subsection (5); (b) rescind the decision and give a written notice of the rescission to the persons referred to in subsection (5); or (c) rescind the decision, substitute a new decision in its place and give a copy of the new decision to the persons referred to in subsection (5). (5) The persons to whom notices or copies are to be given for the purposes of subsection (4) are, (a) the patient to whom the decision relates; and (b) if the patient to whom the decision relates is incapable, the person who is lawfully authorized to make a decision on behalf of the patient concerning the home and community care service. (6) Where a health service provider or an Ontario Health Team does not take any action to respond to a complaint to which subsection (4) applies within the 60 days, the provider or Team is deemed to affirm the original decision. (7) Where a health service provider or an Ontario Health Team affirms a decision to which subsection (4) applies or rescinds the decision and substitutes a new decision in its place, the provider or Team shall ensure that the person to whom the notice or decision must be given is informed, in writing, that the decision may be appealed to the Appeal Board. (8) Within 60 days of receiving a complaint, other than a complaint described in subsection (1), a health service provider or an Ontario Health Team shall ensure that the complaint is reviewed and a response is provided to the person who made the complaint, if known. (9) A response to a complaint described in subsection (8) must include, at a minimum, (a) the steps taken to address the complaint; or (b) if the complaint has not been addressed, why it has not been addressed and when the person who made the complaint can expect the complaint to be addressed. (10) A health service provider or an Ontario Health Team shall ensure that practices are in place for recording, monitoring and analyzing data relating to complaints. (11) A health service provider or an Ontario Health Team shall ensure that its process for reviewing complaints required by section 43.10 of the Act is made available upon request. (12) A health service provider or an Ontario Health Team shall ensure that their provider of home and community care services establishes a process for reviewing complaints respecting the services that includes, at a minimum, (a) a process for immediately reporting to the provider or Team any incident that resulted in harm or a risk of harm to a patient; and (b) in the case of a complaint described in paragraph 1 of subsection (1), requirements to, (i) immediately report the complaint to the provider or Team, (ii) provide a written record of the complaint to the provider or Team as soon as practicable, (iii) inform the provider or Team of the response to the complaint, and (iv) if requested by the provider or Team, provide written status updates on any investigation commenced by the provider of the home and community care services. Appeals 31. (1) For the purposes of section 43.11 of the Act, the following are the prescribed decisions of a health service provider or an Ontario Health Team that may be appealed to the Appeal Board: 1. A decision that the patient is not eligible to receive a particular home and community care service. 2. A decision to exclude a particular home and community care service from the patient’s care plan. 3. A decision respecting the amount of any particular home and community care service set out in the patient’s care plan. 4. A decision to terminate the provision of a home and community care service to the patient. (2) For the purposes of subsection (1), when a health service provider or an Ontario Health Team provides funding to or on behalf of a patient to purchase a home and community care service, (a) a decision about eligibility for a service does not include a decision about eligibility to receive funding to purchase the service; (b) a decision to exclude a particular service does not include a decision to exclude funding to purchase that service; (c) a decision about an amount of service does not include a decision about the amount of funding to purchase that service; and (d) a decision to terminate a service does not include a decision to terminate funding to purchase that service. (3) Where a decision that is described in subsection (1) is made by a provider of a home and community care service, it is a decision of the original health service provider or Ontario Health Team. (4) For the purposes of section 43.11 of the Act, the following are requirements that must be met to appeal a decision that is described in subsection (1) to the Appeal Board: 1. The person appealing a decision to the Appeal Board must be the patient to whom the decision relates. 2. The patient to whom a decision relates may appeal a decision to the Appeal Board if the patient made a complaint to the health service provider or Ontario Health Team, and i. the patient or, if the patient is incapable, the person who is lawfully authorized to make a decision on behalf of the patient concerning the home and community care service received a notice of the affirmation of the decision, or ii. neither the patient nor the person who is lawfully authorized to make a decision concerning the home and community care service on behalf of an incapable patient received a notice of affirmation or of rescission or a copy of a substituted decision within 60 days after the complaint was made. 3. The patient to whom a decision relates may appeal a decision that was substituted for an original decision if either the patient or, if the patient is incapable, the person who is lawfully authorized to make a decision on behalf of the patient concerning the home and community care service received a copy of the new decision. (5) A patient making an appeal under section 43.11 of the Act shall give the Appeal Board a notice requiring a hearing. (6) For the purposes of section 43.12 of the Act, the following are the requirements for the holding of a hearing: 1. The hearing shall begin within 30 days after the day the Appeal Board receives the notice requiring the hearing, unless the parties agree to a postponement. 2. The Appeal Board shall give each of the parties and the Minister at least seven days notice of the time and place of the hearing. 3. The parties to a proceeding before the Appeal Board are, i. the patient appealing the decision, ii. the health service provider or Ontario Health Team whose decision is being appealed, and iii. any other person specified by the Appeal Board. 4. The Minister is entitled to be heard by counsel or otherwise in a proceeding. 5. The Appeal Board shall render its decision within three days after the end of the hearing and shall provide written reasons to the parties as soon as possible after rendering the decision. 6. The Appeal Board shall give the Minister a copy of its decision and reasons. Provision of funding to purchase a home and community care service 32. Where a health service provider or an Ontario Health Team provides funding to or on behalf of an individual to purchase a home and community care service under subsection 21 (1.1) of the Act, the following provisions of this Regulation do not apply, or do not apply as specified: 1. Section 5. 2. Section 7. 3. Sections 10, 15, 16, 17 and 18 with respect to the provision of funding to purchase a home and community care service. 4. Sections 12 and 13 with respect to the purchase of attendant services in accordance with the Direct Funding Program of the Ministry. 5. Section 19. 6. Section 20. 7. Section 21. 8. Section 22, with respect to home and community care services purchased by or on behalf of a patient. 9. Section 26. 10. Section 27, with respect to the provision of funding and with respect to home and community care services purchased by or on behalf of a patient. 11. Section 28, with respect to the provider of the home and community care service purchased by or on behalf of a patient. 12. Section 29. 13. Section 30 with respect to the provider of the home and community care service purchased by or on behalf of a patient. Exemptions 33. (1) Where a health service provider or an Ontario Health Team provides nursing services or personal support services to a patient who is a resident of a long-term care home, the provider or Team is exempt from sections 10, 15, 16, 17, 18 and 22 of this Regulation in respect of that patient. O. Reg. 187/22, s. 33 (1). (2) Where the Service Organization manages the admission of a patient into an adult day program, the health service provider or Ontario Health Team funded to provide the adult day program is exempt from section 10 of this Regulation in respect of that patient. O. Reg. 245/24, s. 3 (1). (3) Where the Service Organization manages the admission of a patient into a supportive housing program, the health service provider or Ontario Health Team funded to provide the supportive housing program is exempt from section 10 of this Regulation in respect of that patient. O. Reg. 245/24, s. 3 (1). (4) A health service provider or an Ontario Health Team is exempt from sections 12 and 13 of this Regulation with respect to, (a) the provision of assisted living services in accordance with the assisted living services and supportive housing programs of the Ministry; and (b) the provision of attendant outreach services in accordance with the attendant outreach services program of the Ministry. O. Reg. 187/22, s. 33 (4). (5) A health service provider or an Ontario Health Team that provides personal support services or homemaking services to patients with acquired brain injuries is exempt from sections 12 and 13 of this Regulation with respect to those services. O. Reg. 187/22, s. 33 (5). (6) Where the Service Organization determines that a patient who requires personal support services should receive those services from a health service provider that is not the Service Organization, the Service Organization may refer the patient to such a health service provider, and the Service Organization is exempt from sections 10, 15, 16, 17, 18 and 22 of this Regulation in respect of that patient. O. Reg. 245/24, s. 3 (2). (7) Where a health service provider that is not the Service Organization determines that a person who requires personal support services should receive those services from the Service Organization, the health service provider may refer the person to the Service Organization, and the provider is exempt from sections 10, 15, 16, 17, 18 and 22 of this Regulation in respect of that patient. O. Reg. 245/24, s. 3 (2). Transition 34. (1) Where the Minister imposed terms and conditions on an approval given under subsection 5 (1) or 6 (1) of the Home Care and Community Services Act, 1994 in accordance with section 7 of that Act to a health service provider funded by the Agency to provide community services under that Act, the terms and conditions on the approval that existed immediately before this section came into force are deemed to be, with necessary modifications, terms and conditions of the service accountability agreement between the Agency and the health service provider until such time as the service accountability agreement is terminated, expires or is amended. (2) Where the Minister imposed terms and conditions on an approval given under subsection 28.5 (1) of the Home Care and Community Services Act, 1994 to a health service provider funded by the Agency before this section came into force, the terms and conditions of the approval that existed immediately before this section came into force are deemed to be, with necessary modifications, terms and conditions in the service accountability agreement between the Agency and the health service provider until such time as the service accountability agreement is terminated, expires or is amended. 35. (1-6) Omitted (provide for amendments to this Regulation). O. Reg. 187/22, s. 35 (1-6). (7) Revoked: O. Reg. 245/24, s. 4. (8), (9) Omitted (provide for amendments to this Regulation). O. Reg. 187/22, s. 35 (8, 9). (10) Revoked: O. Reg. 245/24, s. 4. 36. Omitted (provides for coming into force of provisions of this Regulation).