Documentation

When you think the time has come to apply to a long-term care facility contact the LHIN in the community where you, or your family member lives or is hospitalized. Your local LHIN will arrange for a Care Coordinator/Case Manager to come to your home or the hospital to assess your health-care needs and determine if you are eligible for a long-term care facility. During the application process the following forms must be completed.

• Health Report. This form can be filled out by your family doctor, a registered nurse or a nurse practitioner.
• Evaluator Questionnaire re: Capacity to Make Admission Decisions. This form must be completed by a health care or social service professional (doctor, nurse, physiotherapist, social worker, etc.). If you are assessed as capable of making your own decisions regarding placement, then you will sign the Consent form. (Should the application be submitted on behalf of an individual who has been assessed as being incapable of making a decision regarding their housing needs, the individual's Power of Attorney for Personal Care must sign the form on the applicant's behalf.)
• Placement Application Form. You or a family member can fill out this form. Please include personal information which will help us get to know you and identify your needs.
• Facility Choice Sheet for Placement. You need to fill out both sides of this form. We strongly recommend you or a family member tour each facility before making your final decision. Please number your first, second and third choices. If you choose more than three, you will only be waitlisted on the first three. Make sure you sign and date the back of the sheet. (If the Consent form has been signed by the Substitute Decision Maker then they must also sign the Facility Choice Sheet for Placement.)

Mail the completed forms to your local LHIN. We advise you to make a copy of all forms before mailing.

Why does a person applying for admission to a facility need a Health Report? Will I have to pay to have the form completed?

It is important for the Local Health Integrated Network for Home and Community Care (LHIN) to have the most up-to-date medical information (as well as financial and social information) to make sure that you are eligible for admission to your chosen facilities. We want to make sure that when we offer you accommodation, it will be a good fit with your personal care needs. You do not have to pay for your Health Report to be completed.

POWER OF ATTORNEY INFORMATION

Should this be the time to discuss Power of Attorney with my family?

A person who holds a Power of Attorney has legal authority to make decisions on your behalf if you become incapable of doing so yourself. There are two forms of Power of Attorney: Power of Attorney for Property and Power of Attorney for Personal Care. The first acts for you with respect to finances, the second with respect to your medical and housing needs. If you haven't already assigned someone as your Power of Attorney, it is probably the right time to do so. You can assign each Power of Attorney to the same individual or to different people. Those you appoint should be individuals you trust and who know your preferences and will act upon them, even in stressful situations. You can obtain a copy of the Power of Attorney kit by contacting:

Ministry of the Attorney General Office of the Public Guardian and Trustee

595 Bay Street, Suite 800
Toronto, ON M5G 2M6

Website: https://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/
Telephone: 416-314-2800
Toll-free: 1-800-366-0335
Fax: 416-314-2698

The Office of the Public Guardian and Trustee is also available to advise you if you do not have a designated Power of Attorney.

The publication A Guide to the Substitute Decisions Act will give you a good description as to how a decision-maker may be appointed for a mentally incapable person.