Consent to Admission in Long-Term Care

Consent to Admission

Once a person agrees to enter a particular care facility, they or their substitute decision-maker will be asked to confirm their consent to admission based on the information provided.<ref>Health Care (Consent) and Care Facility (Admission) Act, RSBC 1996, c 181, s 20-22, online: <canlii.ca/t/842m>. </ref>

The law is silent on the question of written residency agreements for long-term care. However, to ensure prospective residents are given the opportunity to make an informed decision about admission, facilities are required provide the following information:

• what care will be provided;
• what services are available to the resident; and
• when the resident can leave the facility.<ref>Health Care (Consent) and Care Facility (Admission) Act, RSBC 1996, c 181, s 21(1)(d), online: <canlii.ca/t/842m>.</ref>

The Residential Care Regulation details what information long-term facilities must provide to ensure the resident or their substitute decision-maker makes an informed decision:

• all charges, fees, or other payments that the person in care may have to pay in return for accommodation and services provided by the care facility;
• the policies of the care facility regarding expressing concerns, making complaints, and resolving disputes;<ref>Residential Care Regulation, BC Reg 96/2009, s 60, online: <canlii.ca/t/89ln>.</ref> and
• how the person, or the person's representative, may express concerns or make complaints to the medical health officer, or if applicable, to the Patient Care Quality Office and PCQ Review Board<ref>Residential Care Regulation, BC Reg 96/2009, s 48, online: <canlii.ca/t/89ln>.</ref> (under the Patient Care Quality Review Board Act<ref>Patient Care Quality Review Board Act, SBC 2008, c 35, online: <canlii.ca/t/84pj>.</ref>).

The care facility operator must ensure that they communicate in a way that fits the skills and abilities of the person or the person's representative. However, this does not necessarily mean providing a written version of the above information.<ref>Health Care (Consent) and Care Facility (Admission) Act, RSBC 1996, c 181, s 21, online: <canlii.ca/t/842m>. </ref>

Long-term care facilities must document the resident’s consent to admission in writing. This may be done on a standard Care Facility Admission Consent form (HLTH 3909) or an adapted form that includes the following:

• the name of the adult being admitted;
• the name of the specific care facility for which consent to admission has been given;
• the form of consent given – i.e. oral, written, or inferred from conduct;
• signature of the resident to indicate consent, or of their substitute to indicate consent; and
• signature of care facility operator or manager if consent has been given by the resident orally or by inferred conduct or given by a substitute decision-maker.<ref>British Columbia, Ministry of Health, Home and Community Care Policy Manual, (6 February 2023) at ch 6.D.2, online: <www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.</ref>

The completed consent form must be provided to the facility prior to admission.

An older adult is not required by law to provide any of the following to be admitted to long-term care:

• A designated substitute decision-maker in case the resident is assessed in the future as incapable of making health care or personal care decisions. In some cases, individuals have been asked to “nominate” someone on admission. This nomination process does not meet the legal requirements of appointing a representative or an attorney under a POA. If the resident has no legally appointed substitute decision-maker, the legislation specifies how the care facility is to identify an appropriate substitute decision-maker and what that person’s responsibilities are.<ref>Health Care (Consent) and Care Facility (Admission) Act, RSBC 1996, c 181, s 16, online: <canlii.ca/t/842m>.</ref>
• A guarantor to pay the resident’s fees if they default on payments. If a substitute decision-maker is managing the resident’s finances and is paying the fees from the resident’s funds, they are not personally liable for any fees the resident cannot pay. A resident who is unable to pay their monthly fee can apply to the health authority for a temporary fee waiver.<ref>British Columbia, Ministry of Health, Home and Community Care Policy Manual, (6 February 2023) at ch 7.D, online: <www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.</ref>
• Advance planning documents, such as an advance directive, representation agreement, power of attorney document, or committee appointment. While such information can be helpful for a care facility, it is not a requirement for admission. Residents are not required to sign an advance directive as a condition of receiving services.<ref>Health Care (Consent) and Care Facility (Admission) Act, RSBC 1996, c 181, s 19.91, online: <canlii.ca/t/842m>.</ref>

Operators may request some of the above information when an adult is being admitted to long-term care. The adult is not required to provide this information. This is an area where an advocate can ensure that admission requirements are met by the facility but do not include (or pressure the adult to include) conditions that are not legally required.

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References

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

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