Home Care and Senior Housing Residents' Bill of Rights

Residents’ Bill of Rights

Facilities are very importantly the person’s home in which health care, assistance, and other support are provided on a regular, ongoing basis. They are where the resident lives and continues to have relationships with family and friends. It is important for residents to be able to enjoy everyday activities freely and with dignity.

However, while being the residents’ home, these facilities are also collective settings, and the exercise of an individual resident’s rights must be balanced against the health or safety of that resident and the rights of other residents and facility staff.

The Community Care and Assisted Living Act includes a Residents’ Bill of Rights for adults in care.(1) The Residents’ Bill of Rights applies to assisted living, long-term care, private hospitals and extended care facilities.(2) Although the Act does not generally apply to private hospitals and extended care facilities, the Resident’s Bill of Rights does. This is because it has been adopted under the Hospital Act, which governs these types of facilities.

The Residents’ Bill of Rights aims to ensure that residents know their right to:

• receive individualized care based on their unique needs and preferences;
• live in an environment that supports their health, safety and dignity;
• participate in their own care planning and express concerns through accessible internal and external processes; and
• transparency and accountability from the operator – including access to information about the facility, full information about services and fees, refunds, and information about laws and policies affecting services.(3)

The Residents’ Bill of Rights must be prominently posted in the facility in a form that is acceptable to the Minister of Health.(4)

The Residents’ Bill of Rights is meant to address situations specific to assisted living, long-term care and extended care. It supplements the broader rights that are protected by the caselaw, human rights protections, and the Canadian Charter of Rights and Freedoms.

This section will focus on key principles in the Residents’ Bill of Rights:

Commitment to Care (section 1)

Adults in care have the right to a care plan that is developed specifically for them based on their unique abilities, needs, and cultural and spiritual preferences. It must be a personalized plan that recognizes the diversity of residents and their needs.

The law requires facilities to review care plans at least once a year, but this is a minimum standard. A care plan should be reviewed whenever there are significant changes in the resident’s circumstances, preferences, or health care needs.

If there is a concern that a resident’s care plan is not meeting their needs, the resident, their representative, or an advocate who has obtained their permission, can request and participate in a care conference to review the plan.(5)

Rights to Health, Safety, and Dignity (section 2)

These broad rights cover many issues that arise in care facilities. These rights includes:

(a) to be treated in a manner, and to live in an environment, that promotes the person's health, safety and dignity;

(b) to be protected from abuse and neglect;

(c) to have the person's lifestyle and choices respected and supported, and to pursue social, cultural, religious, spiritual and other interests;

(d) to have the person's personal privacy respected, including in relation to the person's records, bedroom, belongings and storage spaces;

(e) to receive visitors and to communicate with visitors in private;

(f) to keep and display personal possessions, pictures and furnishings in the person's bedroom.(6)

Access to an Interpreter (section 2a)

People have a right to be treated in a way that promotes their health, safety, and dignity.(7) In the health care context, people have a right to be communicated with in a manner that fits their communication abilities.(8) If the resident’s first language is not English, it is important to provide an interpreter or a staff person who speaks the resident’s language, particularly in personal care situations where the resident may not understand what is happening and their dignity or safety may be compromised.

Interpretation services can be requested in advance through a provincial online booking system. However, this service may be difficult to access for daily living in care facilities as it is designed primarily for helping with scheduled appointments or meetings.

For more information see PHSA’s Provincial Language Service. Interpretation service can be booked online or through the Provincial Health Service Authority phone line: 604-297-8400; toll-free: 1-877-BCTalks (228-2557).

In-person interpreters are not currently available for those outside the lower mainland health authorities (Fraser Health, Vancouver Coastal Health). Individuals outside the Lower Mainland will likely have to rely on virtual or telephone interpretation.

Right to be protected from abuse and neglect (section 2b)

Chapter seven addresses abuse and neglect and how to respond to it. See chapter seven for more details. The rest of this section provides an overview of substandard care.

Residents and their family members or representatives may have concerns about a variety of issues that fall within the scope of quality of care and ensuring the “health, safety and dignity” of residents. This may include substandard care such as poor housekeeping, delayed treatment, slow responses to call bells, lack of ambulatory care, lack of help with using the washroom, being forced to use incontinence products and being left for long periods without changing them, lack of attention to hygiene, infrequent baths, inadequate pain management, poor nutrition or rushed mealtimes. These are forms of neglect that adversely affect not only the health of the resident, but also their overall dignity and well-being.

Many of these issues are related to understaffing or inadequate staff training. Licensing and registration regulations(9) set out minimum requirements regarding “sufficient staffing” and staff skills and training, but do not specify staff to resident ratios or hours of individualized care.

When a facility fails to comply with these minimum requirements, a resident or representative can complain to the Home and Community Care Office, to Licensing, or to the Patient Care Quality Office. Where poor quality of care amounts to abuse or neglect, steps should be taken to intervene by reporting to a Designated Agency. However, it is usually faster and more effective to approach the facility operator or Director of Care to attempt to resolve quality of care issues internally.

Lifestyle and social, cultural, religious/spiritual interests (section 2c)

Care facility staff must respect and accommodate residents’ social identities and cultural, religious, and spiritual interests. This includes supporting an Indigenous resident’s wish to follow traditional practices or a non-binary or LGBTQIA+ resident’s free expression of their gender identity or sexual orientation.(10)

Privacy (section 2d)

Residents have the right to personal privacy, including with respect to their medical records, personal possessions, and items stored at the facility. They have a right to privacy when receiving visitors, making phone calls. Facilities must provide a private phone and location for residents’ phone calls and a private area for visiting if the resident shares a room.(11)

The use of video surveillance has become a privacy issue in care facilities over recent years. Whether initiated by the facility or by a resident’s family member or substitute decision-maker, the use of surveillance raises several ethical and legal concerns which continue to be debated. The Assisted Living Regulation now requires assisted living care homes to inform potential residents of any surveillance technology used on their site as a part of their residency agreement.(12) The Residential Care Regulation(13) states that any long-term care facility that records images of residents or visitors must place a notice in a prominent place to notify people about the surveillance.

The use of “nanny cams” triggers privacy issues regarding the patient, staff, and visitors, and potentially lead to criminal charges. Relatives with concerns about the treatment of an older advice should consider less invasive measures, check the facilities’ policies and seek legal advice before using a videorecording device.

Some care facilities have developed policy on the use of surveillance cameras on their premises. These generally require consent by the resident, prior approval by the facility operator, and notices posted at entrances to inform those entering that surveillance cameras are in operation. The policies usually recommend trying all other options for resolving concerns before resorting to a method that involves such an intrusion on privacy.

Visitor access (section 2e)

The Bill of Rights gives residents have a right to have visitors and spend time with them in private.(14) This is confirmed in the Residential Care Regulations:

(2)A licensee must, to the greatest extent possible while maintaining the health, safety and dignity of all persons in care, ensure that a person in care may

(a)receive visitors of the person in care's choice at any time, and

(b)communicate with visitors in private.(15)

Disagreements may arise over visitation rights. For example, a resident may disagree with their family member or representative about visitors, or care facility staff may restrict visiting times or bar specific people from visiting. The guiding principle is the resident’s wishes and their right to health, safety, and dignity.

The facility can restrict access to someone who they believe poses a risk to the safety or well-being of any resident or staff. This is an infringement of the resident’s right to have visitors, so this should not be done lightly. The facility is required to show that there is a reasonable basis for the belief that the visitor poses a risk, and the response must be proportionate to the actual risk present at that time.

If a family member or representative advises a facility to restrict a visitor’s access, it is important for the facility to determine whether the family member or representative has the authority to make such a decision for the resident. For example, someone with Power of Attorney to handle financial and legal matters does not have the authority to make personal decisions about visitors; nor does a temporary substitute decision-maker for health care decisions. A representative may have such authority if it is written in the Representation Agreement.

Anyone with the authority to make decisions about visitors on a resident’s behalf must exercise the authority according to the values, wishes, beliefs, and best interests of the resident. Remember that a substitute decision-maker only needs to step in when a resident does not have the capacity to make a specific decision for themselves. Most often residents do have the capacity to make a decision regarding visitation, and the best approach is for staff to ask the resident if they wish to see a particular visitor on a specific occasion.

If there is a court order barring a person from contacting the resident, the facility must comply with the court order and restrict that person’s access to the resident.

If the facility operator has a strong reason to believe that a visitor poses a risk to the health, safety, or dignity of the resident, the facility can apply for an interim court order to restrict the person’s visitation rights for up to 90 days under the Adult Guardianship Act. Such an application must be based on a belief that the resident is being abused or neglected by the person. Chapter seven provides more details on responding to abuse and neglect.

Right to keep possessions and furnishings (section 2f)

Residents have a right to keep possessions and furniture in their room. Residents are allowed to decorate their room, including putting up personal photographs and art.(16)

Rights to Participation and Freedom of Expression (section 3)

Residents have a right to participate in their care planning. Residents also have the right to express concerns and complaints. These rights can be exercised by the resident, their family, or their representative(17)

Care Planning

The Bill of Rights specifies that adults in care have the right to participate in their own care planning including how the care is carried out. It is not enough for care providers to simply develop and communicate a care plan to the resident and their family member or representative. The resident and a family or representative must be given a meaningful opportunity to participate in developing the personalized care plan.(18)

Complaints

Residents have a right to express concerns or complaints, and care facilities must have a fair and effective process for resolving them. This resolution process must be communicated to residents and their families or representatives. Care facilities must also inform residents of how to make a complaint to an authority outside the facility if their concern is not resolved internally.(19)

Resident and Family Councils

Residents of long-term care and their family members or representatives have the right to establish and participate in resident and family councils. The residents or family members must create these themselves.(20)

Resident and family councils provide an opportunity for residents and their representatives to work together to improve the lives of residents, identify concerns, strategize solutions, and make recommendations to decision-makers. Residents may choose to have a separate residents’ council and family council, or to combine both functions together in a single council.

The Residential Care Regulation(21) sets out additional requirements for long-term care operators. To support resident and family councils, long-term care operators are required to:

• provide meeting space for up to three hours for as many meetings as the council requests;
• provide administrative support to the counsel from an employee who is approved by the council;
• provide equipment for electronic participation, if requested;
• provide printed meeting minutes to residents and participants;
• provide information on policies and law as requested;
• meet with council members at least twice a year to address issues and recommendations; and
• receive, on behalf of the council, informational materials directed to the council from a health authority and forward the informational materials to council members in electronic or paper form, as requested by the council.(22)

Operators and staff are not to attend meetings unless invited by the council members, and they cannot prevent a resident from attending a council meeting. Resident and family councils do not have decision-making authority, but facility operators are required to consider and make a written response to council recommendations in a timely manner.(23)

Each health authority hosts a regional resident and family council network, and every resident and family council within the region is welcome to send a representative to participate in the regional council network. This gives participants the opportunity to communicate directly with local health authorities, to identify common concerns, and to develop broader, regional solutions. Regional councils in turn meet in a provincial group to discuss system-wide issues and propose systemic change to the Ministry of Health.(24)

If there is no resident and family council at a particular facility, the facility staff should work with residents or family members and representatives to coordinate an initial meeting. The provincial government provides guidance on creating and maintaining a resident or family council in the Resident and Family Councils Booklet, available online.(25)

Note that unlike long-term care facilities, assisted living facilities are not required to support resident and family councils.

Transparency and Accountability (section 4)

The Residents’ Bill of Rights requires facility operators to be transparent and accountable. Operators must provide access to copies of relevant laws, policies, and recent facility inspection reports. In addition, they must inform residents in advance of fee changes and must provide a written record of any prepayments and the terms for refunding such payments.(26)

Limits to Residents’ Rights (section 5)

All rights set out in the Residents’ Bill of Rights may be limited by the need to protect a resident’s health and safety or those of other persons in care, and in consideration of what is reasonable and practical given the resident’s physical, mental, and emotional circumstances.(27)

Many of the issues discussed above regarding health, safety and dignity are also addressed specifically in the Community Care and Assisted Living Act, the Health Care (Consent) and Care Facility (Admissions) Act,(28) or in health authority policies. The most common issues are medications, care planning, the use of restraints, access to palliative care and MAiD, and moving out of the care facility. Abuse and neglect are discussed in Chapter 7.

References

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, online: <http://canlii.ca/t/84lk>

1. “Hospital Act,” RSBC 1996, c 200, s 4, online: <http://canlii.ca/t/843c>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, online: <http://canlii.ca/t/84lk>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, s 57, online: <http://canlii.ca/t/84lk>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(1), online: <http://canlii.ca/t/84lk>; “Residential Care Regulation,” BC Reg 96/2009, s 81, online: <http://canlii.ca/t/89ln>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(2), online: <http://canlii.ca/t/84lk>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(2)(a), online: <http://canlii.ca/t/84lk>.

1. “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, s 8, online: <http://canlii.ca/t/842m>.

1. “Residential Care Regulation,” BC Reg 96/2009, s 42, online: <http://canlii.ca/t/89ln>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(2)(c), online: <http://canlii.ca/t/84lk>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(2)(d), online: <http://canlii.ca/t/84lk>.

1. “Assisted Living Regulation,” BC Reg 189/2019, s Sch C, s 3(e), online: <http://canlii.ca/t/9lrn>.

1. “Residential Care Regulation,” BC Reg 96/2009, s 19(3), online: <http://canlii.ca/t/89ln>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(2)(e), online: <http://canlii.ca/t/84lk>.

1. “Residential Care Regulation,” BC Reg 96/2009, s 57(2), online: <http://canlii.ca/t/89ln>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(2)(f), online: <http://canlii.ca/t/84lk>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(3), online: <http://canlii.ca/t/84lk>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(3)(a), online: <http://canlii.ca/t/84lk>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(3)(d), (e), online: <http://canlii.ca/t/84lk>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(3)(b), (c), online: <http://canlii.ca/t/84lk>.

1. “Residential Care Regulation,” BC Reg 96/2009, s 59.1, online: <http://canlii.ca/t/89ln>.

1. “Residential Care Regulation,” BC Reg 96/2009, s 59.1, online: <http://canlii.ca/t/89ln>

1. “Residential Care Regulation,” BC Reg 96/2009, s 59.1(3), online: <http://canlii.ca/t/89ln>.

1. Vancouver Coastal Health, “Resident and Family Councils,” online: <http://www.vch.ca/en/service/resident-and-family-councils#short-description--15281>;

1. British Columbia, Ministry of Health, “Developing, Supporting and Maintaining Resident Councils and Resident and Family Councils” (2022), online (pdf): <http://www2.gov.bc.ca/assets/gov/health/accessing-health-care/finding-assisted-living-residential-care-facilities/resident_and_family_councils_booklet.pdf>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(4), online: <http://canlii.ca/t/84lk>.

1. “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(5), online: <http://canlii.ca/t/84lk>.

1. “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, online: <http://canlii.ca/t/842m>.

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

Under the old Divorce Act, the schedule of a parent's time with their children under an order or agreement, replaced with "parenting time" and "contact" in the new Divorce Act. Access usually referred to the schedule of the parent with the least amount of time with the child. See "contact," "custody" and "parenting time."

In law, the re-examination of a term of an order or agreement, usually to determine whether the term remains fair and appropriate in light of the circumstances prevailing at the time of the review. In family law, particularly the review of an order or agreement provided for the payment of spousal support. See "de novo," "family law agreements," "order" and "spousal support."

(1) A lawyer or a person other than a lawyer who helps clients with legal issues, or (2) to argue a position on behalf of someone.

In family law, this usually refers to one party obtaining a part of any property at issue before the property has been finally divided by court order or the parties' agreement, usually in order to help pay for that person's legal fees.

In law, to formally deliver documents to a person in a manner that complies with the rules of court. Service may be ordinary (mailed or delivered to a litigant's address for service), personal (hand-delivered to a person), or substituted (performed in a way other than the rules normally require). See "address for delivery," "ordinary service," "personal service" and "substituted service."

A kind of legislation that provides supplemental rules for a particular act. Regulations are created and amended by the government, not by the legislature, and as a result the legislature has no say in how or what regulations are imposed by government. See "act."

In law, (1) a judge's conclusions after hearing argument and considering the evidence presented at a trial or an application, (2) a judgment, or (3) the judge's reasons. A judge's written or oral decision will include the judge's conclusions about the relief or remedies claimed as well as their findings of fact and conclusions of law. A written decision is called the judge’s "reasons for judgment." See "common law," "conclusions of law" and "findings of fact."

(1) In real property law, a piece of property and a building situated on it, usually including the area of the property surrounding a building on that property. (2) In law generally, a premise is an assumption that founds a logical argument. See "argument" and "real property."

(1) Agreement, or (2) the giving of permission for a thing to happen or not happen.

In law, (1) the physical railing separating the public gallery in a courtroom from the area where the judge and lawyers sit, (2) lawyers as a group, or (3) the place where lawyers go after work.

A mandatory direction of the court that is binding and enforceable upon the parties to a court proceeding. An "interim order" is a temporary order made following the hearing of an interim application. A "final order" is a permanent order, made following the trial of the court proceeding or the parties' settlement, following which the only recourse open to a dissatisfied party is to appeal. Failing to abide by the terms of an order may constitute contempt of court. See "appeal," "consent order," "contempt of court," "decision" and "declaration."

A request to the court that it make a specific order, usually on an interim or temporary basis, also called a "chambers application" or a "motion." See also "interim application" and "relief."

(1) A lawyer, or (2) the advice given by a lawyer to their client.