Canada: Top 5 Things To Know When A Loved One Is In A Nursing Home In Ontario

Last Updated: July 23 2018
Article by Melissa Miller

When an elderly person contemplates entering a long-term care facility, they may have some fairly significant fears. They will be leaving behind the home they know. They may be possibly moving away from a neighbourhood or community where they have friends and existing support networks. Most of all, there is the realization that living independently is not something they can or should do any longer – that is, they require some level of assistance to more closely monitor their well-being.

Acknowledging that this assisted support is necessary also means thinking about what will happen if your loved one does not receive appropriate care and are unable to alert their caregivers or family.

In a previous blog post, Top 5 Things to Consider When Looking for a Nursing Home in Ontario, I listed the top five things to consider when deciding on a nursing home or long-term care facility for an elderly parent or loved one. In this post, I outline an addition five things you should know once your loved one is in care. The common thread throughout is knowledge, communication and awareness of the potential for neglect or abuse so you can properly advocate for your loved one's best interests.

1) The Care Plan

A resident's care plan is the most important document associated with their stay in a long-term care facility. In fact, it forms part of the residents' Bill of Rights as part of the provincial regulations under the Long-Term Care Homes Act, 2007. Within 24 hours of being admitted, regulations require an initial care plan to be created and communicated to the facility's staff. During a two-week period, a minimum of 23 different assessments are conducted to help prepare a more complete initial plan of care within three weeks of residency. A full written plan of care is required within six weeks of residency.

The assessments used to create the care plan can include:

  • Physical and functional ability. This assessment determines the appropriate kind of assistance required for activities related to daily living, such as hygiene and grooming;
  • Mood and behaviour. Assessments may gauge patterns of wandering, variations of function based on time of day, responsive behaviours, potential behavioural triggers and risks the resident poses to themselves or others.
  • Nutrition and medications. An assessment will record vital statistics, note risks and restrictions relating to nutrition care, and outline required drugs and treatments.
  • Continence. Assessing a resident's ability to control their bladder and bowel.
  • Cultural, religious, spiritual, and/or age-related preferences and needs. These assessments support comfort by identifying customary care.

The creation of the plan requires input from the resident or a substitute decision maker and any other person a resident or substitute decision-maker requests to be a part of the process. Combined with information obtained through assessments on their needs, this involvement ensures their goals, preferences and directives are made known to facility staff and other care providers.

The care plan must be assessed for effectiveness and revised as needed, and at a minimum, the plan must be reviewed twice a year. Once your loved one is in care, you should observe whether their appears to be compliance with this plan of care, ask to be made aware of any updates, and express a desire to see the plan updated if you or a supplementary caregiver identifies a changing need or circumstance.

If you believe the care plan is inadequate or that a facility is not complying with directives or fulfilling their responsibilities, you can lodge a complaint with the Ministry of Health and Long-Term Care.

2) Nanny/Granny Cams

While the province of Quebec has recently created regulations to govern the use of recording devices in its long-term care facilities and nursing homes, Ontario does not have anything comparable and no guidelines appear to be imminent. This is a shame, since there are many legal complexities to take into account if you are considering taking this step to monitor your loved one's care – too many complexities to adequately cover in this blog.

Installing a camera may help you identify if your loved one is being neglected or abused by staff, other residents, or anyone else with access to the facility. However the right to privacy of other people within the facility (or roommates sharing a space) is a concern, and it is a criminal offense to record the audio of a private conversation unless at least one party present consents. If a resident is not present when a conversation is recorded, or not able to consent to an audio recording, there may be legal consequences. This can be further complicated by the fact that a resident may not have the capacity to consent to the audio recording in the first place.

There may be pushback from the home about the presence of the camera, but for the time being, as long as there is no audio recording, the camera should be allowed. Many cameras will only turn on and record when movement is sensed in the room. Lack of movement in the room can sometimes be an indication in and of itself about lack of care.

3) Substitute Decision-Making And Consent

It advisable for a resident in care to consider designating a power of attorney or substitute decision-maker to ensure the residents' wishes are respected and that their caregivers act in their best interests if they are not in a position to give consent. I discussed this further in a previous blog, Top 5 Things to Consider When Looking for a Nursing Home in Ontario.

An acting attorney for personal care or substitute decision-maker has the right to be informed of changes to a residents' plan of care, and to be consulted in the case of certain medical interventions. However, an individual's capacity to make a decision relating to health care is not a blanket consideration. An individual's capacity to make their own health care decision is specific to the decision being made. For example, someone may have the capacity to decide what they wish to eat, or whether they need to use the restroom, but not be able to understand and appreciate the benefits or risks of a procedure or medication. It is important to monitor whether the staff at the home make an effort to determine what your loved one's wishes are to the best of their ability and avoid blanket assumptions of incapacity.

4) Physical Checks

When you, supplementary care providers or the residents' other loved ones visit them in a nursing home or long-term care facility, you may consider doing a physical 'check-in' with them to check for any signs of neglect.

Pressure ulcers (bedsores) appear when pressure against a portion of skin reduces blood flow to the tissue, causing damage. People most at risk of developing them tend to have conditions which severely limit mobility or constrain the ability to shift positions. These ulcers can develop quickly, and the presence of one does not immediately mean your loved one is not receiving adequate care and attention. However, multiple sores, poor healing of sores,severe or frequent sores are a cause for concern that should be addresses with staff.

While some residents will be able to communicate quite clearly if they are unhappy with the care, many residents are not able to communicate at all. In situations where communication is an issue (such as after a stroke or a loved one with dementia or Alzheimer's) it is important to monitor your loved one's demeanour for signs of distress. Changes in mood, emotional reactions to certain staff members or other residents, and other subtle changes in behaviour may be an indication of neglect or abuse.

Monitoring for signs of weight loss among residents is also an important task. Although weight loss may be a sign of an underlying medical condition, often it relates to malnutrition and dehydration. Sometimes staff will note that a resident is "refusing food." But this refusal may not be intentional. Staff may not be providing the resident with enough time to chew, swallow, or decide to eat. They may come across a resident sleeping during meal time and not waking them up or returning later with food. Moreover, the resident may be having difficulty feeding themselves, which could look to staff as if the resident does not want to eat it. Observed weight loss should prompt a discussion about whether nutrition or a diet plan requires changing, including blending food to make consumption easier, or supplementing meals with enriched products such as Ensure.

5) Communicate With The Treatment Team

If you are concerned that your elderly loved one may be suffering from neglect by staff, your first course of action might be to talk with them to learn why this might be the case. The vast majority of personal support workers and long-term care facility staff members choose these occupations because they genuinely care about helping people.

If a staff member is falling short of the standard of care they should be providing, it can suggest they are overworked. Moreover, high turnover in staff or management may indicate larger institutional problems which can eventually adversely affect residents. Become an advocate for your loved one. Rather than only identifying problems within a facility or the management of your loved one's care, try to offer solutions and provide support to staff when possible. If you believe that the care plan should be changed or updated, request a meeting with the director of care.

If you are still unsatisfied with the level of care after communicating with the treatment team, consider a transfer through LHIN to a different home, or lodging a complaint with the Ministry of Health and Long-Term Care.


In spite of your best efforts to choose a nursing home or care facility that best meets the needs of your loved one, or advocating on their behalf with staff if you identify problem areas with their care, you may find your elderly parent or loved one is living in an unhealthy environment with abuse or neglect.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on

Click to Login as an existing user or Register so you can print this article.

Similar Articles
Relevancy Powered by MondaqAI
In association with
Related Topics
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of

To Use you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions