05/20/2010

The agreements are to be Negotiated with Local Health Integration Networks.
Local Health Integration Networks (LHINs) are bound by the Local Health System Integration Act, 2006 to have service accountability agreements in place with all their Health Service Providers (HSP), including municipal long term care homes. The Long Term Care Service Accountability Agreements (LSAA) are the Agreements by which LHINs will flow funding to providers of long term care services including municipalities.

The LSAA template Agreement for LTC homes was developed on behalf of all LHINs by a steering committee co-chaired by Ministry and LHIN staff, in consultation with organizations representing service providers and funders. The LSAA consultation process began in the fall of 2009 and continued through to May 2010. AMO was a member of the consultation table along with the City of Toronto, the Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS), the Ontario Long Term Care Association (OLTCA) and the Ontario Hospital Association (OHA).

The LSAA was developed under challenging circumstances that include the introduction of thenew Long Term Care compliance regulations. Both the LSAA and the regulations come into effect with the proclamation of the Long Term Care Homes Act in July.

While, some improvements from earlier LHINs funding Agreements are captured in the LSAA,for example, relaxing restrictions on subcontracting, removing the LHINs ability to terminate the Agreement without cause and recognizing municipal insurance obligations, overall, the LSAA does not reflect the mature relationship cultivated between the province and AMO and municipalities in recent years. AMO remains concerned with the “one size fits all” approach that does not recognize municipalities as a responsible and accountable order of government.

AMO is also concerned with the broad termination powers granted the LHINs while relievingthem from any obligations to provide transitional funding in the event of a termination of the Agreement. The imbalanced nature of the LSAA may put municipal councils and long-term care homes at risk.

Following are a number of additional concerns AMO has raised:

  • The LSAA binds the HSP to policies, standards, requirements and performance indicatorsthat are not yet defined; 
  • The LSAA provides the LHINs the opportunity to impose additional obligations, which would require increased municipal contributions without the benefit of appropriate budget planning while creating increased costs for compliance; 
  • The LHIN has the unilateral discretion under the LSAA to determine whether a breach of the LSAA has occurred, and thereafter to terminate funding, no appeal process nor any dispute resolution process is contained in the LSAA;
  • Some uncertainty remains with respect to the areas of Ministry versus LHIN jurisdiction and their respective roles and responsibilities; 
  • The LSAA requires that every sub-contract which the HSP enters into in respect of the services shall contain terms enabling the LHIN and the Auditor General to audit the subcontractor with respect to its use of the funds; this clause may be concerning to some subcontractors; 
  • The LSAA contains onerous reporting requirements and strict reporting timelines that, if not complied with, can result in the termination, cease or interruption of funding. These pressures are coming at a time when the new regulations under the Long Term Care Homes Act will also require additional resources to comply with.
The LSAAs are three year Agreements that are in effect from July 1, 2010 through to March 31, 2013. It is important to note that choosing not to sign the LSAA will put funding for long term care services at risk.

AMO has been assured that the LHINs are fully aware of the need for the LSAA to be revisited and refined following the first three-year commitment and that dialogue with stakeholders will continue as the process unfolds.

Despite the assurances, AMO and municipalities will be paying close attention to the days after the regulations and the Agreement come into effect to understand how we can continue to move forward on this important service.