Moving from your family home to a long-term care home can be a challenging transition for older adults and their families. Understanding how the long-term care placement process works can help you make informed decisions and prepare for what lies ahead.

Ontario has hundreds of long-term care homes providing 24-hour nursing and personal care for people whose needs can no longer be safely met at home or through community-based supports.

Who is eligible for long-term care?

Long-term care is intended for people who have significant care needs that cannot be adequately met through a combination of community services, family caregiving and other supports.

To be eligible for admission as a long-stay resident, a person generally must:

• Be 18 years of age or older.
• Be insured under Ontario’s Health Insurance Act.
• Require 24-hour nursing care on site, frequent assistance with activities of daily living, or frequent on-site supervision or monitoring to ensure their safety or well-being.
• Have care needs that cannot be sufficiently met through available publicly funded community services and other caregiving or support arrangements.
• Have care needs that can be appropriately met in a long-term care home.

An Ontario Health atHome care coordinator will assess your needs and help determine whether you meet the eligibility requirements for long-term care.

How does the placement process work?

If you are eligible for long-term care, your Ontario Health atHome placement coordinator can help you understand your options, including the homes you can apply to and the placement categories that apply to your circumstances.

Applicants are prioritized according to their care needs, urgency and circumstances. Ontario’s rules establish several placement categories.

Category 1 – Crisis

This category is for people who require immediate admission to long-term care because their needs can no longer be safely met at home. It can also apply to certain people who are in hospital during a crisis situation and require long-term care.

Category 1 can be particularly important when a person’s health or circumstances have changed suddenly and remaining at home is no longer a safe option.

Category 2 – Spousal or Partner Reunification

This category applies to people who need to be reunited with a spouse or partner who is already living in a long-term care home, subject to the eligibility and placement requirements.

Spousal reunification recognizes the importance of keeping couples together when one partner has moved into long-term care.

Categories 3A and 3B

These categories include people seeking placement in a long-term care home that serves a particular religion, ethnic origin or culture.

Category 3A can also apply in certain circumstances to people with higher care needs who can continue to be supported at home while waiting for a suitable bed, as well as residents seeking a transfer to another long-term care home.

Category 3B applies to people who have care needs but are currently able to remain at home with supports while waiting for placement.

Categories 4A and 4B

These categories apply to people who are able to remain at home while waiting for a long-term care bed.

Category 4A generally applies to people with higher care needs who can continue to be supported at home.

Category 4B applies to people with care needs who are currently managing at home with available supports.

Veteran priority

Special placement provisions apply to eligible veterans seeking admission to long-term care homes with Veteran Priority Access Beds.

Your Ontario Health atHome placement coordinator can explain how veteran priority applies to your circumstances.

Placement categories can be complicated, and your category may change if your circumstances or care needs change. Talk to your Ontario Health atHome placement coordinator if your situation changes while you are waiting.

What if my spouse or partner is already in long-term care?

For couples, the possibility of being separated can make the decision to enter long-term care especially difficult.

Ontario has policies and placement provisions designed to support spousal and partner reunification. In certain circumstances, a person who can no longer safely remain at home may be able to seek admission to the same long-term care home where their spouse or partner lives.

The Ministry of Long-Term Care has also increased the availability of Reunification Priority Access Beds in long-term care homes with long-stay beds. These beds are intended to support Category 1 applicants who are experiencing a crisis and whose spouse or partner is already living in the home.

This can be particularly important for couples who have been living together for many years and do not want a long-term care placement to mean permanent separation.

If you are in this situation

If your spouse or partner is already living in a long-term care home and you are experiencing a crisis because you can no longer safely remain at home, speak with your Ontario Health atHome placement coordinator.

Explain that your spouse or partner is already a long-stay resident and that you are seeking reunification. Your placement coordinator can explain whether you meet the requirements and what options may be available.

Choosing a long-term care home

Families can identify homes that may be appropriate for their needs and discuss their choices with their Ontario Health atHome placement coordinator.

When considering a home, you may want to look at:

• Location and distance from family and friends.
• Whether the home offers the type of care required.
• Cultural, religious or language considerations.
• Room options and accommodation costs.
• Programs and activities.
• Visiting arrangements.
• The home’s inspection and performance information.
• Current wait-list information.

It is important to understand that choosing a preferred home does not necessarily mean that a bed will be available immediately. Wait times can vary considerably between homes and circumstances.

You don’t have to navigate the process alone

Applying for long-term care can feel overwhelming, particularly when a family is already dealing with declining health, a hospital stay or a sudden change in circumstances.

Your Ontario Health atHome placement coordinator can help you understand the process, assess your care needs and explain your placement options.

If your circumstances change while you are waiting, let your placement coordinator know. A significant change in health, safety or caregiving circumstances may affect your placement category or urgency.

Resources

Making the Move to Long-Term Care
A practical navigation guide for Ontario families published by Family Councils Ontario. Family Councils Ontario (FCO) works with long-term care home residents’ families, Family Councils, and home staff across Ontario to enable them to cultivate positive relationships, build effective Family Councils, and improve the long-term care experience.

Ontario Health atHome – Long-Term Care in Ontario
Information about long-term care, choosing homes and the placement process.

Ontario Health atHome – Guide to Placement in Long-Term Care Homes
A detailed guide to eligibility, applications, placement categories and choosing a home.

Ontario Government – Long-Term Care Homes
Information about long-term care homes across Ontario, including home details and placement information.

Ontario legislation – Long-Term Care Homes Act, 2021 and O. Reg. 246/22
The legislation and regulations governing long-term care eligibility and placement in Ontario.

Information in this article is intended as a general guide and was current at the time of publication. Long-term care eligibility, placement categories, wait times and policies can change. Speak with your Ontario Health atHome placement coordinator for advice about your individual circumstances.