Ontario proposes to allow nurse practitioners to oversee LTC medical care

A long term care facility is shown in a rural area of Burlington, Ont., on May 2, 2024. THE CANADIAN PRESS/Nathan Denette

Ontario long-term care homes could soon have nurse practitioners overseeing residents' medical care instead of physicians, a move applauded by nurses and the homes but not supported by doctors.

The plan to replace the requirement for homes to have a medical director, who must be a physician, with a requirement for a clinical director, who could be a physician or nurse practitioner is among the proposed changes in recently introduced long-term care and seniors legislation.

The bill would also require homes to have a dementia care program and create new offences for the abuse and neglect of residents.

Long-Term Care Minister Natalia Kusendova-Bashta said operators were allowed to fill the medical director role with nurse practitioners during the pandemic, and she is now making that permanent.

"This function is largely an administrative function, so we have full confidence that nurse practitioners can perform this function," she said.

"At the same time, we are giving physicians more time to focus on the care needs of our residents instead of doing paperwork."

The Registered Nurses' Association of Ontario had pushed for the change, and president Lhamo Dolkar said it will improve collaboration among health professionals in long-term care homes and help retain nurses in Ontario by giving them more career pathways.

"Having NPs authorized to work as clinical directors is a win on many counts," Dolkar wrote in a statement.

"It’s a win for residents and families that will see the benefit of clinical directors in all 670 LTC homes, a win for health professionals who will feel more supported; and a win for nurses who will see more opportunities to build their careers in Ontario."

Dr. Dominik Nowak, president of the Ontario Medical Association, said doctors, nurses and all other health professionals play important roles in the health system, but the oversight of medical care in long-term care homes must be performed by doctors.

"(Residents) are oftentimes some of our most vulnerable, our most medically complex, older adults, oftentimes people who are 80, 90 or more years old, people on 10 or more different medications, with 10 or more different health conditions going on," he said.

"I think of the role of the medical directors in these homes, and it's really to be that stopgap for other doctors, other nurses, other members of the care team, and be that clinical leadership role, that medical leadership role. And it really does take the years of training, the thousands of hours of experience and expertise that doctors bring to the table to do this."

Lisa Levin, the CEO of AdvantAge Ontario, representing the province's non-profit long-term care homes, said operators are supportive of the change.

"There are difficulties recruiting and retaining medical directors for homes, and particularly in the north and in rural and remote areas, so having the flexibility to be able to have nurse practitioners play this role is really going to be very, very helpful," she said.

Jane Meadus, a lawyer with the Advocacy Centre for the Elderly, said she is concerned about the proposed clinical director requirement.

"Have they done any studies?" she said. "Do they have any empirical evidence that it's sufficient?...The concerns that I have is what is the effect on the residents? Are they going to be missing things? You've got to remember that people in long-term care today are extremely complex."

Kusendova-Bashta's announcement of the bill also came with a promise of funding for several dementia care and seniors programs, including $20 million over three years to expand adult day programs.

It also comes with funding to launch two pilot programs that Levin called "game changers."

A Community Access to Long-Term Care pilot program will give seniors still living in their own homes access to certain services in long-term care homes, such as personal care, clinical services, and recreational and social programming.

Another pilot project will train staff at up to 15 homes in emotion-based models of care, which prioritize relationships and empathy in a culture of dignity and respect when caring for residents living with dementia.

"It is beyond my wildest dreams that they are finally doing that," Levin said.

Some homes are already using that model, which focuses more on emotions and less on tasks, as people with dementia hold on to their feelings after their cognitive skills have diminished, Levin said.

"They're really focused on their feelings and their emotions," she said.

"That's how one could relate best with people with dementia when they're further along, and this kind of model basically embraces that and works with it, and it's incredibly transformational."

Donna Duncan, CEO of the Ontario Long-Term Care Association, also praised the emotion-focused care pilot, and said the funding to help seniors in the community get some long-term care services will help keep them in their homes longer.

"The ability to access services in long-term care can help to manage symptoms, reduce distress for both the resident and caregivers, delay admission to long-term care, and ultimately support a smoother transition for residents and families who have become familiar with long-term care," she wrote in a statement.

This report by The Canadian Press was first published Dec. 11, 2024.