Regulation 79/10 specifies that Licensees are responsible to have a staffing plan in place and implemented for their organized program of nursing services and organized program of personal support services. The legislation and regulation do not contain requirements around the proportion of staff, or the number of hours of direct care provided to residents. This is determined by yearly staffing plans developed by the homes based on the residents’ care needs.

Case Mix Measurement and methodologies are used to determine the level of resources required to care for a population. Case Mix Index (CMI) is a numeric value assigned to a home which is calculated by summing a variety of factors, including the severity of medical diagnoses, per resident, and dividing by the total number of residents. This is then weighted across the province.

Each year, the Ministry of Long- Term Care calculates a home’s Case Mix Index, which is used to calculate the Nursing and Personal Care per diem amount funded to Long Term Care Homes. Each resident is clinically evaluated through the Resident Assessment Instrument (RAI MDS) and given a rating using guidelines as set by the Ministry. Residents who require more care and resources are categorized in a higher resource utilization group (RUG). The higher the level of care required for a resident, the higher the RUGs score, which translates into higher Case Mix Index ranking, resulting in increased funding from the Ministry. Conversely, if the RUGs and correlating CMI decrease, the funding may also decrease.

The amount of funding available in the province under the CMI methodology is limited. Long term care facilities submit their assessments annually, but are not necessarily able to receive the full 100% of their request. The province recalculates the allocation based on available funding and considering the submissions from all other homes. All funding received under the CMI calculation is for direct resident care , based on the level of residents’ needs.

The last Case Mix Index (CMI) evaluation identified a higher acuity of need of residents at Huron Lodge, thereby requiring a greater amount of resources for their care. The Ministry of Long-Term Care announced the revised CMI in July 2020 and subsequently adjusted the funding amount for Huron Lodge.

Discussion:

The Emergency Management Order of March 23, 2020 clearly states: “The health service providers shall and are authorized to take with respect to work , deployment and staffing, any reasonably necessary measure to respond, prevent and alleviate the outbreak of the corona virus (COVID- 19)( the “Virus” ) for residents.”

Notwithstanding the decline in the health of residents as evidenced by the CMI, long-term care residents, who are older and frailer than the general population with more complex medical needs, were significantly impacted by COVID-19 in 2020. A high concentration of outbreaks and mortality occurred within Ontario’s long -term care homes. In Ontario LTC homes, 9045 residents and 3549 staff had COVID and 2341 residents and 8 staff died.