**Written by: Rachel Merucci, Licensed Paralegal**

**Note: Information applies to residents of Ontario, Canada only.**

*About 6 years ago (2018), I was faced with the challenge of jumping into caregiving together with my dad, who was quickly losing the ability to care for my mom (his wife) later diagnosed with severe dementia (suspected Alzheimer's). My parents refused all help, and by the time I was "allowed" into their world my mother was not "mentally capable" of creating a Power of Attorney (POA) of any kind.* 

*With much research, pieces of information eventually led me to the idea of "Adult Guardianship". It was (and still is) difficult to find a lawyer providing this service. And the legal fee to attempt the Guardianship process was much higher than my father or I could afford. 
Inspired by my experience as a caregiver, I recently became an Ontario licensed Paralegal. Equipped with this knowledge, I want to share how Adult Guardianship can support your caregiving journey.*

Ideally, every adult should have a legal Will and Powers of Attorney properly prepared and in place, but unfortunately many adults do not. Sometimes, people who suffer from various forms of dementia are diagnosed "too late" and the individual is no longer mentally capable of creating Powers of Attorney. Sometimes our care recipients develop or are born with a developmental disability and therefore may not have the mental capacity to create Powers of Attorney. In either of these scenarios, caregivers, or Substitute Decision Makers (SDM) of the individual should be referred to information regarding how to obtain "Adult Guardianship" to ensure their care recipient's personal care and their property finances are properly and securely managed. 

# There are two types of Powers of Attorney:
1. Continuing Power of Attorney for Personal Care
2. Continuing Power of Attorney for Property

You must be considered "mentally capable" to create these documents, and the definition of "mentally capable" is different for each document. When Powers of Attorney have not been, or cannot be created, Adult Guardianship may be the solution. 

Adult Guardianship is when someone steps in, of their own volition, and is appointed by the Office of the Public Guardian and Trustee, or appointed by a judge in court, to make decisions for the adult person who is incapable. 

# There are two main types of Adult Guardianships
1. Guardian of Personal Care
2. Guardian of Property

These guardianships essentially "mirror" the purpose of Powers of Attorney. To date, legal fees for seeking Guardianship of Personal Care, Guardianship of Property, or both which is called Guardianship of the Person, can cost caregivers up to approximately $25,000.00. 

Fortunately, for a resident of Ontario, Canada, a default "Substitute Decision Maker" is AUTOMATICALLY appointed to them for medical decisions they are incapable of making, under the Health Care Consent Act. Having an "Automatic SDM" gives the caregiver the opportunity to decide if obtaining Guardianship of Personal Care (or Guardianship of the Person) is necessary since medical decisions can and are made without this legal documentation. 

To learn more about Substitute Decision Maker in Ontario, please review [the Ontario Making Substitute health Care Decisions document](https://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/ISBN-0-7794-3016-6.pdf).

## But what happens to the incapable adult's property? 

"Property" in this context means not only real estate, but also managing the incapable adult's bills, belongings, bank accounts, taxes, etc. It contains many required, daily tasks the incapable adult cannot manage. Without legal documentation such as a POA/or Guardianship of Property, caregivers are unable to act on behalf of the incapable adult, REGARDLESS of their relationship. That means even spouses cannot step in to act on behalf of their husband/wife, and parents cannot step in to act on behalf of their incapable adult child once they are 18 years old. 

## There are two ways to become someone's Guardian:

1. Through a judge in court - for one or both guardianship types. (If seeking both guardianships, together it is called "Guardian of the Person")
2. Through the Office of the Public Guardian and Trustee (PGT) by application - only available for certain individuals, and only available for Guardian of Property. 

## Things to keep in mind: 

- It is difficult to obtain Guardianship of Personal Care or Guardianship of the Person without the help of a lawyer who specializes in the area of healthcare. (ie: a health lawyer)
- You should thoughtfully consider whether obtaining this is necessary for the benefit of your incapable care recipient.

Process for obtaining Guardianship of the Person through a lawyer can be:
- Lengthy in time,
- Involves extensive paperwork,
- A significant out of pocket expense in legal fees/disbursements. 

For most caregivers and SDMs, Guardianship of Property is the one type of Guardianship that is needed and will ultimately save them much unnecessary hardship. *NOTE: If the incapable adult will be admitted to Long Term Care, POA of Property or Guardian of Property is required to apply for the government of Ontario's Long-Term Care Home Rate Reduction Program.*

Having been in your shoes, my goal is to help caregivers understand and obtain "Adult Guardianship of Property" at an affordable fee. Service is available and applicable to residents of Ontario, Canada only. 

**For more information, please email info@tbhlegal.ca, visit [www.tbhlegal.ca](www.tbhlegal.ca/adultguardianship) or call Rachel Merucci, Licensed Paralegal at 519-777-9303.** 


What Caregivers need to know about Adult Guardianship

You need to file a complaint about something in a long-term care home, how do you do it?

# How do I file a complaint about long-term care?

1. File the complaint with the long-term care home.
2. Contact the Long-Term Care Family Support and Action Line.
3. Escalate your complaint to the Patient Ombudsman.

## 1. File the complaint with the long-term care home

The first step is filling the complaint with the home.  Every long-term care home is required to post the process to file a complaint in a place where it is easy for residents and the public to see.  If you can't find the process, speak to office staff at the home. If your complaint is in regard to harm or risk of harm to a resident, the home must investigate the complaint right away. They must also immediately send the complaint to the Ministry of Long-Term Care.

For all complaints, a member of staff must let you know that the home has received your complaint within 10 business days.

If the home finds your complaint is valid, they must call or write to let you know:

- what they are doing to resolve your complaint now
- what they plan to do to resolve your complaint in the future
- when you can expect the complaint to be resolved

If the home believes there is no cause for complaint, they must explain why.

## 2. Contact the Ministry of Long-Term care with your complaint 

If you are not happy with the home’s response to your complaint, the next step is to contact the Ministry of Long-Term Care.  For the quickest response, call the Long-Term Care Family Support and Action Line at: 1-866-434-0144.  The Long-Term Care Family Support and Action Line is available 7-days a week from 8:30 a.m. – 7:00 p.m.

If your concern is not time sensitive, you can contact the Ministry of Long-Term Care by email, at mltc.correspondence@ontario.ca, or by mail, at:

Director
Long-Term Care Inspections Branch
Long-Term Care Operations Division
Ministry of Long-Term Care
438 University Avenue, 8th floor
Toronto, ON M7A 1N3

## 3. Escalate to the Patient Ombudsman

If you weren't satisfied after speaking to the home, and the Long-Term Care Family Support and Action Line didn’t resolve the issue, you can escalate it to the Patient Ombudsman.  You submit your complaint online [HERE](https://www.patientombudsman.ca/Complaints/Make-a-complaint/Submit-Complaint) or call 1-888-321-0339.  The Patient Ombudsman acts as a neutral body of last resort for complaints about the healthcare system in Ontario.


*Find more information about filing a complaint about something happening in a long-term care home in Ontario on [Ontario.ca.](https://www.ontario.ca/page/long-term-care-home-complaint-process)*

How to file a complaint about long-term care in Ontario? Test

Long-Term care and Retirement homes may appear similar when you begin your elder care search, but they differ in many important areas that are important to understand when considering your care options.

## Long-Term Care

Long-Term Care homes, sometimes referred to as nursing homes, are designed to provide care and support to people who require a high level of medical and/or personal care. Most residents are elderly, though in Ontario you are eligible for long-term care once you turn 18 years old.

Features of Long-Term Care:

- 24-hour nursing and personal care services.
- Assistance with daily activities such as bathing, dressing, and eating.
- Medical and healthcare services, including medication administration.
- Specialized care for residents with dementia or other cognitive impairments.
- Regular supervision and monitoring of residents' health conditions.

Funding for long-term care is subsidized by the Provincial Government, and admission is based on an assessment of the individual's care needs and eligibility criteria. Long-Term Care homes may be for-profit or not-for-profit.

The maximum rate a Long-Term Care home can charge is set by the provincial government. As of July 1, 2023 the maximum rates for Long-Term Care in Ontario are:

- $2,838.48/month for a Private Room
- $2,395.32/month for a Semi-Private Room
- $1,986.82/month for a Basic Room

## Retirement Home

Retirement homes are typically intended for seniors who are relatively independent and do not require 24/7 medical care. Retirement homes aim to provide a community living environment for seniors who may need help with day-to-day tasks, are looking to downsize, or are seeking a socially engaging lifestyle at their fingertips.

In Ontario Retirement Homes are regulated by the [Retirement Homes Act, 2010 (RHA)](https://www.ontario.ca/laws/statute/10r11). Retirement homes that meet the definition in the RHA are required to be licensed by the [Retirement Home Regulatory Authority (RHRA)](https://www.rhra.ca/en/) to operate as a retirement home. The RHA defines a retirement home as a residential complex or part of a residential complex that is:

- occupied primarily by persons who are 65 years of age or older, AND
- occupied or intended to be occupied by at least six persons not related to the operator, AND
- where the operator makes at least two care services (listed in the RHA and its regulation, [O.Reg. 166/11](https://www.rhra.ca/en/)) available to residents

According to the RHA “care service” means:

- Assistance with bathing
- Assistance with personal hygiene
- Assistance with ambulation
- Assistance with feeding
- Provision of skin and wound care
- Continence care
- Administration of drugs or another substance
- Provision of a meal
- Dementia care program
- Assistance with dressing
- Any service that a member of the Ontario College of Pharmacists provides while engaging in the practice of pharmacy
- Any service that a member of the College of Physicians and Surgeons of Ontario provides while engaging in the practice of medicine
- Any service that a member of the College of Nurses of Ontario provides while engaging in the practice of nursing

Features of Retirement Homes:

- Independent living with private apartments or suites.
- Some assistance with daily living activities may be available, but not to the same extent as in long-term care.
- Social and recreational activities to promote an active lifestyle.
- Various amenities such as dining services, housekeeping, and transportation.

Retirement homes are free to set their own rates for occupancy and services, which are not Provincially subsidized. Rates vary based on the retirement home, the suite being rented, and the services required. Residents have the choice to purchase a care service from the retirement home if offered, or to access external care (publicly funded, e.g. home and community care, or private pay) and these options must be allowed by a home.

It's important to note that while retirement homes offer a more independent lifestyle with some medical support, they are not typically equipped to provide the same level of medical care and assistance as Long-Term Care homes.

The choice between long-term care and a retirement home depends on the individual's health needs, budget, level of independence, and preferences for community living.



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