Ending Long-Term Care Residency

Ending Residency

General Rule

A resident may choose to end their residency for a variety of reasons. The right to terminate residential care is set out in the legislation. It states that a care facility cannot prevent a resident from leaving the facility if the resident is capable of making the decision about ending their residency. If the resident has been assessed as incapable of such a decision, then the person authorized to act as their substitute decision-maker may remove them from the care facility. A facility must ensure that a resident is not released or removed from the facility by anyone except the person’s representative, substitute decision-maker, or someone authorized in writing by the resident. (1)

Voluntarily Leaving Long-term Care

There are two circumstances where a care facility must initiate an assessment of capability of a resident who has expressed a desire to leave a long-term or extended care facility:

• When a facility operator doubts a resident’s capacity to make a decision about continuing or ending their residency they must, within a reasonable amount of time, have the resident assessed for incapacity. (2)
• When a resident has previously been assessed as incapable and does not have a substitute decision-maker, but the facility operator believes the resident may be capable of making a decision about continuing or ending their residency, then the facility must have the resident reassessed in a reasonable time. (3)

Determinations of incapability must be made by a medical practitioner or a prescribed health care provider. (4) The Residential Care Regulation sets out how assessments must be done.

There are exceptions to the two circumstances outlined above. A resident must remain at the facility if:

• a resident assessed as incapable expresses the desire to leave the facility within 30 days of being admitted; or
• if consent to the continued accommodation of the resident was given by the substitute decision-maker within the last 90 days. (5)

When an adult leaves a residential care facility, operators are required to ensure the resident’s needs will be met in their chosen accommodation. The resident or their substitute decision-maker should give the facility advance notice of the decision to leave. This will ensure that the facility can follow discharge procedures and organize a care plan meeting where care staff can inform the resident and/or family or substitute decision-maker about what ongoing care will be needed. If the adult’s needs are not met, this may lead to a situation of abuse or neglect, for which caregivers are responsible under the Adult Guardianship Act (see Chapter 7, Abuse and Neglect).

Eviction

There may be circumstances in which a long-term care facility evicts a resident. The law is silent regarding evictions from long-term care, other than the rule against evictions or discharge as retaliation for complaints. The Residential Tenancy Act does not apply to care facilities. However, long-term care facilities may have policies regarding eviction, and if so, these should be explained to the resident upon admission. In addition, the Home and Community Care Policy Manual specifies some reasons for no longer qualifying for a care facility. (6)

The most common reason for eviction is the failure to pay fees. Ideally this should not occur for those receiving subsidized care as their fees are based on income, but it may occur due to the resident being incapable of issuing payments or where another person managing their finances has failed to make payments. This issue may arise, for example, when a resident and their substitute decision-maker share a joint account and the substitute decision-maker uses the funds for something else. In these circumstances the facility or a concerned person should find out whether the resident has appointed someone to manage their finances. If no such person is identified, or if the appointed person is mismanaging finances, then the Public Guardian and Trustee should be notified that the resident is having difficulties handling their financial affairs. For more information on how to contact the PGT and what they will do, see Chapter 7.1.6 of this guide, and the PGT’s website.

If the Public Guardian and Trustee becomes involved, they may appoint someone to manage the person’s finances. Note: In BC there is a non-profit organization called the Bloom Group which will manage the finances of low-income individuals for a nominal fee.

Another reason for eviction is when a care facility ends their agreement with the regional health authority to provide subsidized beds, and residents in those subsidized beds are forced to move out. In this case, the resident or concerned person should contact the health authority, as they will likely take on the responsibility of finding an alternate care facility.

While it is uncommon, it is possible for an individual to be discharged from long-term care if they no longer require the level of support provided by the facility. This is most common with short-term stays where the person has been receiving care to recover from an injury or illness until they can live more independently. When this occurs, the resident or family caregivers should communicate with the health care team for instructions regarding follow-up care. They may also wish to contact the local Home and Community Care Office to arrange an assessment for home care if the adult will require help while continuing to recover at home.

Palliative Care

An older adult may receive palliative care if they are diagnosed with a life-limiting illness or condition. They can receive palliative care in long-term care if they wis, in a hospital, or in hospice. A diagnosis is usually determined by the adult’s family physician, and palliative services are coordinated by the Home and Community Care Office of the regional health authority. Palliative care can be provided alongside therapeutic treatment and has been shown to improve quality of life when started early after a diagnosis.

A palliative designation means that the Medical Services Plan will cover costs for certain palliative medications, supplies and services, which can be provided at home, in a care facility, or in a hospice. Palliative care also includes support to family members and addresses the social, emotional, and spiritual needs of the patient.

References

1. Health Care (Consent) and Care Facility (Admission) Act, RSBC 1996, c 181, s 25, online: <canlii.ca/t/842m>; Residential Care Regulation, BC Reg 96/2009, s 58, online: <canlii.ca/t/89ln>.
2. Health Care (Consent) and Care Facility (Admission) Act, RSBC 1996, c 181, s 25, online: <canlii.ca/t/842m>.
3. Residential Care Regulation, BC Reg 96/2009, s 50.1, online: <canlii.ca/t/89ln>.
4. Health Care (Consent) and Care Facility (Admission) Act, RSBC 1996, c 181, s 26, online: <canlii.ca/t/842m>.
5. Residential Care Regulations, BC Reg 96/2009, s 50.1, online: <canlii.ca/t/89ln>.
6. British Columbia, Ministry of Health, Home and Community Care Policy Manual, (6 February 2023) at chs 5-6, online: <www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Seniors First BC, February 2024.

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