2002 “D” Bed Program2002 “D” Bed Development Plan Submission Process 1-1 1.0 Introduction...

Ontario Ministry of Health and Long-Term Care - Bed Program

2002 “D” Bed Program

Development Plan Submission ProcessJanuary 2002

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General Overview of the Program Section 1 : ● Development Plan Submission Process (3 pages) ● Program Overview (13 pages)

Submissions Guidelines and Forms Section 2 :● Submission Guidelines (9 pages) ● Attachment 2A : Finance Schedule Completion Guide (8 pages)

Section 3 :● Submission Package (31 pages) ● Election to Remain “D” (1 page)

“D” Bed Development Options and Supports Section 4 :● Redevelopment Option Guidelines (1 page) ● Long-Term Care Facility Design Manual (85 pages) ● Policy for Funding Construction Costs of Long-Term Care Facilities. (11 pages)

Section 5 : ● 5.1 Retrofit Option Overview (12 pages) ● 5.2 Long-Term Care “D” Facility Retrofit Design Manual (100 pages) ● 5.3 Policy for Funding Construction Costs of Retrofitting “D” Long-Term Care Facilities (9 pages)

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Ontario Ministry of Health and Long-Term Care - Bed Program

Section 6 : ● Upgrade Option Guidelines (10 pages)

Section 7 : ● Transition Support Program Guidelines (9 pages)

Section 8 : ● Requests to Adjust Bed Numbers Guidelines (5 pages)

Reference and Support Documents Section 9 : ● Appendices (1 page) ● 9.1 Glossary (5 pages) ● 9.2 Frequently Asked Questions (5 pages) ● 9.3 Contacts and Resources (3 pages) ● 9.4 Information Session Registration Form (2 pages) ● 9.5 Sample Development Agreements (31 pages) ● 9.6 Summary of “D” Retrofit Design Standards (22 pages) ● 9.7 Retrofit Per Diem Calculation Forms (12 pages)

Ministry of Health and Long-Term CareLong-Term Care Redevelopment Project415 Yonge Street, 10th FloorToronto, ON M5B 2E7Tel : Toll-free 1-877-767-8889. In Toronto, call 416-326-6485Fax : 416-326-5533

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Development Plan Submission Process

Ministry of Health and Long-Term Care

January 2002

Ministry of Health and Long-Term Care, Long-Term Care Redevelopment Project 2002 “D” Bed Development Plan Submission Process

2002 “D” Bed Program Binder This binder is organized as follows: General Overview of the Program Section 1: Program Overview Section One contains an overview of the Options available to “D” bed Operators and a description of the 2002 “D” Bed Development Plan Submission Process. Information about how to contact the Ministry concerning this Process is also provided. Submissions Guidelines and Forms Section 2: Submission Guidelines Section Two contains guidelines and instructions for submitting a response to the Ministry. Section 3: Submission Package Section Three contains all of the forms and templates required for submission, as well as the Election to Remain “D” form. “D” Bed Development Options and Supports Section 4: Redevelopment Option Guidelines Section Four contains the 1998 Long-Term Care Facility Design Manual and the Policy for Funding Construction Costs of Long-Term Care Facilities. Section 5: Retrofit Option Guidelines Section Five contains an overview of the Retrofit Option, the Long-Term Care “D” Facility Retrofit Design Manual, and the Policy for Funding Construction Costs of Retrofitting “D” Long-Term Care Facilities. Section 6: Upgrade Option Guidelines Section Six contains Guidelines for the Upgrade Option. Section 7: Transition Support Program Guidelines Section Seven contains Guidelines for the Transition Support Option. Section 8: Requests to Adjust Bed Numbers Guidelines Section Eight contains Guidelines for increasing or decreasing the number of beds in a facility.


Reference and Support Documents Section 9: Appendices Section Nine contains a glossary, questions and answers, a list of contacts and resources, details and registration forms for the Information Sessions, sample Development Agreements, a summary of “D” Retrofit Design Standards, and Retrofit Per Diem Calculation Forms.


Section 1

Program Overview


January 2002

Table of Contents 1.0 Introduction.......................................................................................... 1

2.0 Who Should Submit............................................................................ 3

3.0 Program Overview............................................................................... 3

4.0 Choosing Your Development Path ................................................... 5

5.0 Making Your Submission................................................................... 8

6.0 Important Dates ................................................................................... 9

7.0 Information and Communications.................................................... 9

8.0 Other Notes........................................................................................ 10

Ministry of Health and Long-Term Care, Long-Term Care Redevelopment Project 2002 “D” Bed Development Plan Submission Process 1-1

1.0 Introduction The 2002 “D” Bed Program was announced in 1998 as a major component of the province’s commitment to a fully modernized Long-Term Care (LTC) facility system. Operators of “D” class facilities were made eligible for the same construction funding incentive available to those developing new long-term care beds and were expected to redevelop to the 1998 LTC facility standards by 2006. Additional support and flexibility is now being introduced in recognition of the unique challenges associated with improving an existing LTC facility. These new approaches are: • Two additional Development Options: a Retrofit Option and an Upgrade Option; • A Transition Support Program for Operators choosing to Redevelop or Retrofit their

facilities; • The opportunity to request an increase or decrease in the number of beds at your

facility, where this is essential to the success of a Redevelopment or Retrofit project; and

• The option for Operators to indicate their intent not to participate in the 2002 “D” Bed

Program. Firm Development Plans should be in place by fall, 2002 at the latest for those “D” Operators who intend to improve their facilities in order to meet the objectives of reconstructing “D” facilities by March 2006 or completing upgrades by December 2003. Ministry Objectives The purpose of the 2002 “D” Bed Program - Development Plan Submission Process is to facilitate and support active Development Planning for “D” class facilities. The objectives of the Ministry, within this Submission Process, are as follows: • To receive an indication from “D” bed Operators of their intentions with respect to

participation in the program; • To understand and assess the viability of Operators’ proposed Development Paths,

in order to work with Operators to implement Development Plans consistent with the Program’s time frame;

• To establish Development Agreements with “D” bed Operators where these are not

yet in place;


• To plan and allocate Transition Support and adjust bed numbers where applicable; • To plan for future support and facilitation for the 2002 “D” Bed Program; and • To identify those Operators who will not be participating in the 2002 “D” Bed

Program. The Development Plan Submission Process This Development Plan Submission Process is streamlined to allow Operators who are at an early stage in the development process to indicate their intent to proceed by way of an initial Submission Package (contained in this binder). Your completed Submission Package, which is due March 7, 2002, will provide you with an opportunity to identify the Development Path you believe best suits your facility. The Ministry will assess your Submission and work with you to confirm the most suitable Development Path. This will lead to a Development Agreement, setting out requirements and milestone dates for your project. Your Account Manager will work with you regarding any additional submission requirements relevant to your particular Development Path. Election to Remain “D” If you elect not to participate in the Program, your facility will remain in the “D” facility class. You will thereby give up your eligibility for construction funding and other incentives and supports available to “D” Operators who are proceeding under the 2002 “D” Bed Program. To remain a “D” class facility, you must complete and submit the ‘Election to Remain “D” Form’ at the front of Section 3: Submission Package. Deemed Election to Remain “D”: If you do not respond to this Development Plan Submission Process by March 7, 2002, you will be deemed to have elected to have your facility remain in the “D” category and will thereby give up your eligibility for current construction funding and other incentives and supports under the 2002 “D” Bed Program.


2.0 Who Should Submit Those Operators who do not already have executed Development Agreements as of January 9, 2002 are required to respond by returning the entire Submission Package in Section 3. Those Operators who already have executed Development Agreements as of January 9, 2002 are not required to submit a Package. These Operators may still apply for Transition Support, and should contact their Account Managers to discuss the application process.

3.0 Program Overview Development Options 1. Redevelopment Option (Existing)

The Redevelopment Option requires redevelopment to the standards set out in the 1998 Long-Term Care Facility Design Manual. Some possible development scenarios for this Option include: • demolishing your existing facility and rebuilding a new one on the same site; • building a new facility adjacent to the existing one; • building a new facility on a new and separate site; or • renovating your facility to 1998 standards. “D” facilities choosing the Redevelopment Option are subject to the submission and review processes outlined in the 1998 Long-Term Care Facility Design Manual and the Policy for Funding Construction Costs of Long Term Care Facilities (1998). Construction funding of up to $10.35 per bed, per day for 20 years is available for facilities completing the Redevelopment Option. Transition Support is also available for Operators pursuing the Redevelopment Option. Full details about the Redevelopment Option are provided in Section 4: Redevelopment Option Guidelines.


2. Retrofit Option (New)

The Retrofit Option is a new Development Option being offered to give “D” Operators more flexibility in meeting current design standards. The Retrofit Option provides additional flexibility via a number of changes to the standards in the 1998 Long-Term Care Facility Design Manual, as follows: • It introduces Allowable Performance Ranges (standards which include a range

between a prescribed minimum and the 1998 standards); • It permits the approval of Comparable Designs (to allow some 1998 standards to

be met through alternative designs); and • It offers an optional Preferred Accommodation definition in addition to the 1998

standard. Maximum construction funding eligibility for the Retrofit Option ranges from $7.00 to $10.35 per bed per day over 20 years, depending on the degree to which designs vary from the 1998 standards. Operators may develop designs which incorporate elements of both the Retrofit and Redevelopment Options. Transition Support is available for Operators pursuing the Retrofit Option. Full details about the Retrofit Option are provided in Section 5: Retrofit Option Guidelines.

3. Upgrade Option (New)

This Option requires Operators to either invest a minimum of $3,500 per bed focused on the resident care environment, or undertake a program of work designed to upgrade the facility to a “C” classification. Operators who complete the Upgrade Option will receive $1.00 per bed per day. All Upgrade projects must be completed by December 31, 2003. Full details about the Upgrade Option are provided in Section 6: Upgrade Option Guidelines. Transition Support is not available for Operators pursuing the Upgrade Option. The Upgrade Option cannot be combined with the Redevelopment and Retrofit Options.

Transition Support Program The Ministry has introduced a Transition Support Program for “D” bed Operators


proceeding with the Redevelopment and Retrofit Options. This program provides funding for unique and unavoidable operational costs associated with redeveloping or retrofitting a facility. The Transition Support Program assists Operators in the following ways:

• It allows for a reduction in occupancy during the development period; and • It provides revenue protection during the development period and enables

normal operational funding to be redirected to cover unique transitional costs. Additional Transition Assistance may also be granted at the Ministry’s discretion. To be eligible, Operators must indicate their intent to apply by March 7, 2002. Note that Operators who choose the Upgrade Option will not be eligible for Transition Support. Full details about Transition Support options are provided in Section 7: Transition Support Program Guidelines. Adjustment to Bed Numbers

This Submission Process also enables you to indicate whether your planned development entails an increase or decrease in the number of beds currently active in your facility. The allocation of a small number of additional beds (typically 12 or fewer) is possible. The Ministry’s decision will be based on the necessity of the additional beds to the project’s overall feasibility. Full details are provided in Section 8: Requests to Adjust Bed Numbers Guidelines.

4.0 Choosing Your Development Path The Ministry will support Operators in pursuing their preferred Development Option. You are advised to undertake a thorough analysis and investigation before making a decision. Further, you are advised to attend the Information Sessions provided by the Ministry (see Appendix 9.4). The following discussion is intended to outline some of the key considerations in making the decision. However, you will need to read Sections 4 through 6 to fully understand the requirements and implications of each Development Option.


Key Considerations in Selecting an Option The acuity levels of applicants referred to LTC facilities has been rising for a number of years and will likely continue to do so. Higher resident acuity levels require modernized facilities due to greater use of equipment and greater physical demands on staff. The Ministry has expressed a clear policy preference for Operators to improve to either the 1998 (Redevelopment) or the Retrofit design standards, as these best reflect the expected future demands on the LTC facility system. This preference is backed by the additional Construction Funding and Transition Support available to Operators implementing these standards. The province is committed to the principle of client choice in the selection of a facility. The rapid expansion of the facility system now underway will create a very different market for LTC beds; by 2006, more than 35,000 beds (out of 77,000) will meet “A” standards. Residents and their families will have more choice and will quickly learn to distinguish between different facility design standards. Operators are advised to carefully consider the programmatic and economic merits of the various alternatives. Some general considerations are suggested below: Service Needs:

• Local service demand and market conditions; • Unique features and advantages of current site and its development capacity,

availability of alternatives; • Current and future ability of existing facility to meet client care requirements; • Impact of client choice and community expectations regarding accommodation

standards; and • Availability of temporary facility space should it be required.

Economic Cost/Benefit:

• revenue considerations development of preferred accommodation potential sale proceeds or alternate revenue stream from existing building or site;

• cost benefits

operating cost improvements future maintenance and repairs avoided (or not) building operation and maintenance cost reductions;

• match of estimated capital cost to Operator debt capacity; and


• useful life and future value of existing facility if not improved. Your Options at a Glance The following table provides a quick summary of the Options available: Considerations for Choosing Development Option

Redevelopment Option

Retrofit Option Upgrade Option Remain “D”

Design Standards Long-Term Care Facility Design Manual

Long-Term Care “D” Facility Retrofit Design Manual

Investment directed to priority areas

N/A

Typical total development costs (both eligible and ineligible)

$90,000 to $120,000 per bed

$70,000 to $100,000 per bed

$3,500 per bed $0

Typical minimum Net Operating Inc. from Other Accom. required

$10 to $12 per bed per day



N/A

Minimum equity required

15% to 25% of total development costs



N/A

Construction funding/ premium eligibility

$10.35 per bed per day

$7.00 to $10.35 per bed per day

$1.00 per bed per day

$0

Typical amortization period for debt

20 to 25 years 20 to 25 years 5 to 10 years N/A

Existing building Considerations

• Value of the existing building and potential alternate uses

• Development

potential of current site

• Building condition

• Ability of

envelope and floor plate to meet minimum retrofit standards

• Priorities for improvement

• Option “C” classification criteria

• Building condition and useful life

• Building condition and useful life

Gross Floor Area per bed

550-650 sq. ft. 450-600 sq. ft. N/A N/A

Transition Support Funding available?

Yes

Yes

No N/A

New bed allocations available?

Yes

Yes

No No

Retain previously awarded beds?

Yes Yes No No


5.0 Making Your Submission Once you have reviewed the Development Options and identified the Option you believe is best suited to your facility, you will be ready to prepare your Submission to the Ministry. Submissions are preferred in electronic format. Use the diskette enclosed to complete your submission forms. Documentation required to support the Submission can be scanned and included on your diskette. The complete Submission Package is also available on the Ministry’s website in both MSWord and PDF formats. (Note: The Ministry is unable to accept Submissions electronically through the website.) If you prefer, you may use the hard copy forms contained in the appropriate Submission Package to submit your response. If you need a Macintosh format version of the Submission Package forms, contact the Call Centre. Here are some steps to follow in preparing your Submission:

1) Begin working through the Submission Package. Refer to the Submission

Guidelines for details about why you are submitting certain information and how to complete the forms. The Package includes forms that require you to fill in the blanks, as well as “templates” that act as samples of how to provide specific pieces of information. These templates are not intended to be “fill in the blank” forms. You will also be requested to provide documents (for example Audited Financial Statements) or narrative material.

2) Use the Final Checklist provided with the Submission Package to organize your

Submission and to ensure that you have included all the necessary documents and completed the appropriate forms. Make sure all pages are consecutively numbered for ease of reference.

3) Send four (4) hard copies and one diskette of your completed Submission to:


Long-Term Care Redevelopment Project 415 Yonge Street – 10th Floor

Toronto, Ontario M5B 2E7

Your completed Package must be received by March 7, 2002.


You should receive a confirmation of receipt of your Submission within 5 business days of its delivery. If you do not receive confirmation, please contact the Call Centre.

6.0 Important Dates The following table identifies the key dates involved in the 2002 “D” Bed Program. • January 9, 2002 § Development Plan Submission Process Initiated • January 17 – 30, 2002 § Information Sessions (See Appendix 9.4) • March 7, 2002 § Deadline for returning Development Plan Submission

Package (1) • April 23, 2002 § Ministry Response to “D” Operator Submissions. • June 27, 2002 § Deadline for execution of Development Agreements • December 31, 2003 § Completion date for Upgrades • March 31, 2006 § Latest Date for First Occupancy for Redeveloped and

Retrofitted facilities (1) The Submission deadline is the latest date by which you must submit your Package. You may submit any time up until the March 7, 2002 deadline.

7.0 Information and Communications You may direct your questions regarding the Submission Process, guidelines or requirements to the “D” Bed Submission Process Call Centre, as follows:

Toll Free: 1-866-411-7773 Toronto: (416) 314-5061

Fax: (416) 326-5533 Email: [email protected]

The Call Centre will be open Monday through Friday, from 9:30 a.m. to 4:30 p.m., and closed on Statutory Holidays. The Call Centre will cease operations on the March 7, 2002 Submission deadline. You may also contact your Account Manager at the Ministry any time after February 1, 2002 regarding the Submission Process. You are also advised to visit the Ministry's website periodically for information about the Submission Process, including: Frequently Asked Questions (FAQ's), Bulletins, electronic versions of the Submission Forms and other relevant information. The site is


located at www.gov.on.ca/health/english/program/ltc/redev/redev_mn.html (or from www.gov.on.ca/health, select the link entitled "Redevelopment Project" then the link "Long-Term Care "D" Bed Submissions" on the left side of the page). Any amendments or changes to the 2002 “D” Bed Program will be posted on the Ministry website. If you prefer to receive updates from the Ministry by other means, contact the Call Centre. Information Sessions A series of Information Sessions about the 2002 “D” Bed Program and the Development Plan Submission Process will be held in January, 2002. The sessions will be held in 8 locations (Ottawa, Richmond Hill/Newmarket, Cambridge, Hamilton, Toronto, London, Thunder Bay and Sudbury). Exact dates and locations, as well as a fax back registration form, are contained in Appendix 9.4. To register for an Information Session use the fax back form or contact the Call Centre.

8.0 Other Notes • An “Operator” means the person or entity that holds the licence or approval to

operate the “D” facility, that makes a Submission for a Development Path, and that will enter into the Development Agreement with the Ministry. Throughout this document, when you read the word “you” it will mean the Operator.

• The Ministry will not consider reimbursement for costs of any type borne by

Operators except as set out in the construction funding policies for Redevelopment, Retrofit and Upgrade.

• The costs of preparing and submitting your Submission are solely your

responsibility. The Ministry is not responsible for expenses incurred as part of the Submission process.

• Transition Support and Adjustments to Bed Numbers will be approved at the sole

discretion of the Ministry. Eligibility for Transition Support and additional beds is restricted to Operators intending to redevelop or retrofit, and where Submissions are received by March 7, 2002.

• All Submissions to the Ministry are subject to the access provisions of the Freedom

of Information and Protection of Privacy Act (the "Act"). The Act provides people with a right to access information in the control of the Ministry, subject to a limited set of exemptions. One such exemption concerns information that reveals a trade secret or scientific, technical, commercial, financial or labour relations information supplied, in


confidence, by a third party, where disclosure of the information could reasonably be expected to result in certain harms.

If you believe that any of the information you submit in connection with your Application reveals any trade secret or scientific, technical, commercial, financial or labour relations information belonging to you, and you wish to protect the confidentiality of such information, you should clearly mark this information “confidential”. Doing so only indicates your desire to have the documents kept confidential. If the Ministry receives a request for information in connection with the Application, the Ministry will contact you so that you may, if you choose to, make representations concerning its release. You will be required, in the Applicant’s Declaration, to consent to the disclosure of information to the public of the following information:

o your name o the number and location of proposed beds requested o the number of beds awarded to you in the 1998 and 1999 RFP processes, if

any o the type of building you propose o key facility design features of your proposed facility

In addition, the Ministry may disclose the names of the successful Applicants and the number of LTC facility beds allocated.

• Operators who do not respond by the submission deadline of March 7, 2002 will be

deemed to have signed the ‘Election to Remain “D” Form’ and will thereby give up eligibility for construction funding and other incentives and supports.

• Operators intending to redevelop, retrofit or upgrade will be required to enter into a

Development Agreement by not later than June 27, 2002.


Section 2

Submission Guidelines


January 2002

Table of Contents 1.0 Submission Guidelines...................................................................... 1

2.0 What to Submit.................................................................................... 1

3.0 Instructions for Completing Your Submission Package............... 2 Part I – Submission Package Cover Sheet..........................................................................2 Part II – General Information Form........................................................................................2 Part III – Development Path Being Considered..................................................................3 Part IV – Finance ........................................................................................................................4 Part V – Operator Declaration.................................................................................................6 Part VI – Upgrade Self Assessment Form ...........................................................................6 Part VII – Final Checklist ..........................................................................................................7


1.0 Submission Guidelines In this section, more detail is provided about the information being requested by the Ministry and about how to respond through the Submission Process. Refer to this section at the same time as you work through your Submission Package (Section 3 of this binder).

2.0 What to Submit In responding to this Submission Process, you are asked to submit one of the following by March 7, 2002: • A complete Submission Package; or • An Election to Remain “D” form. Submission Package As you go through the Submission Package, you will find the following: • Forms requiring you to fill in the blanks (for example, the General Information Form); • Instructions on additional documentation you will need to provide with your

Submission (for example a letter from the municipality in which your project is located, or resumes).

Be careful to ensure you include all necessary documents. It is important for all parties to have the most accurate and complete information upon which to make decisions. A Final Checklist is provided for you at the end of the Submission Package and should be completed to help you review your Submission for completeness. You may make your Submission any time before March 7, 2002, and you may contact your Account Manager to request submission requirements and application packages specific to more advanced stages of individual program streams at any time. (Please note that some packages may not be available until February 1, 2002). Operators Electing to Remain “D” Operators that elect to have their facility remain in the “D” class are required to submit only the ‘Election to Remain “D”’ form at the front of Section 3. This form will notify the


Ministry that you do not intend to redevelop, retrofit or upgrade your facility. Please be advised that if you elect to remain in the “D” facility class, you will thereby give up your eligibility for construction funding and other incentives and supports available to Operators proceeding with facility improvements under the 2002 “D” Bed Program.

3.0 Instructions for Completing Your Submission Package

In this section we provide more information about how to complete the Submission Package. The Submission Package forms and requirements are organized as follows: Part I: Submission Package Cover Sheet Part II: General Information Form Part III: Development Path Being Considered Part IV: Finance Part V: Operator Declaration Part VI: Upgrade Self Assessment Form Part VII: Final Checklist

Part I – Submission Package Cover Sheet Complete the Cover Sheet and attach it to the front of your Submission. It includes information about your Submission in a summary form, and allows the Ministry a first-glance overview of your facility. Each Submission Package must have a Cover Sheet attached. Part II – General Information Form The General Information Form provides the Ministry with information about you, your existing facility, and the Project Team Members who are part of your Submission. 1) You will be asked for basic information about yourself and your facility, such as

your facility name, your legal business name (if different), and how to contact you or your designated representative for this Submission.

2) Project Team Members, if known, should provide information about themselves

and their role in your proposed Development Path. If you need more space than that allocated in the form provided, you may expand your response to this question. Attach Resumes for each known Team Member. If Project Team


Members have not been selected at the time you submit this Package, disregard Part B of the General Information Form.

3) You should indicate whether you and/or any of your Team Members have

declared bankruptcy in the past five years. Part III – Development Path Being Considered A. Existing Facility Part A of this form asks you to describe the beds in your existing facility. Fill in the table to indicate what type or types of beds are in your current facility. B. Development Path Part B of this form asks you to describe the Development Option or combination of Options you are considering for improving your facility. Remember, in choosing a Development Option, you are being asked to express your intent. You will be confirming or modifying your Development Path when you enter into a Development Agreement with the Ministry. Complete the tables in Part B by checking the cells that best describe the Development Path you are considering. C. Time Frame Part C of this form asks you to estimate the date your proposed development will be completed; in other words, when your facility will be ready for occupancy. Complete the table to indicate what quarter and year you anticipate completing your Development Path. D. Transition Support Part D of this form asks you to indicate whether or not you plan to apply for Transition Support and/or transitional space during your development process. Transition Support can only be formally approved at the Preliminary Sketch Plans stage (refer to Retrofit or Redevelopment Options Guidelines). If you are not yet at this stage, but do intend to apply for Transition Support, you are required to express that intent in your Submission Package. Do so by checking YES where indicated. When you are ready to apply for Transition Support you will be required to submit a more detailed application package. If you require transition space you should also indicate this on the form where indicated. This will enable the Ministry to facilitate the identification of appropriate space. Note: Transition Support is available for the Redevelopment and Retrofit Options only.


If you selected the Upgrade Option, you do not need to complete this section. E. Requests to Adjust Bed Numbers If you plan to increase or decrease the number of beds in your facility, please indicate it in Part E of the form. Prior to signing a Development Agreement, you will be required to provide more detailed information if you still plan to request an increase or decrease in the number of beds in your facility. Enter the following data to complete the form (the numbered steps below correspond to the rows in Part E of the form): 1) Enter the number of beds in your proposed concept 2) Enter the number of beds you have in your current facility (including new awards,

purchases and transfers) 3) Subtract the bed numbers in 2) from 1) 4) This is the total number of beds you are requesting as an increase (a positive

number) or returning (a negative number) to the Ministry. Note: Increases to bed numbers are available for the Redevelopment and Retrofit Options only. If you selected the Upgrade Option, you may not request an increase in your facility’s number of beds. Part IV – Finance This part of your Submission Package provides information about your existing facility’s finances, as well as financial information about your Key Stakeholders. The information requested in this part is intended to inform the Ministry of the following:

• The completeness of your financial information. • The financial capacity of your Key Stakeholders to successfully fund the

development of your project and obtain any required financing. • Specific support and facilitation needs you may have in order to successfully

complete your project. Notes on Completing the Financial Schedules Attachment 2A (at the end of this Section) contains a “Finance Schedule Completion Guide” which provides instructions cross-referenced to each numbered cell appearing on each Finance Schedule. The Ministry strongly recommends that you use the guide, as well as the following resources, to complete the financial requirements of your Submission Package: • Refer to Section 1: Program Overview under Information and Communications for

information on Ministry supports, including the Call Centre and website.


• Attend the Ministry’s Information Sessions in January and February, 2002, to review

financial and other Submission Requirements. Information and Registration Forms for the sessions are contained in Appendix 9.4 of this binder.

• Refer to Appendix 9.1: Glossary for definitions of terms related to the Financial Schedules and other Submission requirements.

• Retain financial advisers with experience in the long-term care industry to assist you

with your financial analysis. Submission Requirements 1. Copies of audited financial statements for the past 3 years for the existing

facility and for all Key Stakeholders

i) If audited financial statements have not been prepared, submit copies of the past 3 years financial statements together with a letter from the financial officer of the entity providing the financial statements confirming that audited financial statements are not prepared and that the financial statements present fairly the financial position of the entity at the balance sheet date and the operations for the year then ended in accordance with Generally Accepted Accounting Principles (GAAP).

ii) If Key Stakeholders do not have sufficient financial capacity, your project

may still meet the Ministry’s financial capacity requirements if it receives a guarantee from an Affiliate of the Operator who has sufficient financial capacity. In this instance, the audited financial statements for the Affiliate must be provided together with a non-conditional guarantee from the Affiliate.

If financial statements are not available, then equivalent evidence is required to satisfy the Ministry that you and your Key Stakeholders have the financial capacity to meet the requirements of this project. Submit what you consider to be equivalent. The Ministry will evaluate this information and request additional information if needed.

2. Copies of un-audited interim statements for the current year for the

existing facility and for all Key Stakeholders 3. Summary Financial Position: Schedule F1

The primary purpose of Schedule F1 is to provide an accurate summary of finances for the existing facility and to the extent available, to identify capacity to finance a development project. This information is NOT dependent on complete plans for any proposed facility.


For example, the Schedule should identify the amount of any existing financing and project debt. Please provide the best information currently known. This Schedule should also identify the present status of financing discussions, as well as each known issue anticipated to affect completion of both equity and project financing, and the summary financial position of each Key Stakeholder.

Exceptions: (a) Municipally operated facilities that are not constituted as non-profits for

LTC purposes, must submit the Annual Repayment Limit letter prepared by the Ministry of Municipal Affairs and Housing for the year in lieu of Schedule F1.

4. Cash Flow Statement: Schedule F2

The information provided in Schedule F2 should provide the net cash flow from operations for your existing facility. The information should reflect the most recent year actual audited or pre-audit statements of operation for your existing facility. (For example, Key Stakeholders with December year-ends should enter data from pre-audit year-end statements, followed by submitting audited statements as they become available)

5. Detailed Expenses: Schedule F3 Schedule F3 should include all expenses necessary to operate your current facility.

Copies of supporting documentation, as identified on each Schedule.

Part V – Operator Declaration This Declaration provides a formal indication of your intent to enter into an agreement appropriate to your preferred Development Option. Sample agreements are contained in Appendix 9.5. Part VI – Upgrade Self Assessment Form This form is for the Upgrade Option only. Operators choosing the Redevelopment or Retrofit Options are not required to submit this form. This questionnaire is meant as a preliminary guide to identifying investment priorities for Operators considering the Upgrade Option. You should place a checkmark in either the “Yes” or “No” column in response to each question. For commentary on how your


answer might impact on your selection of the Upgrade Option, please refer to Section 6: Upgrade Option Guidelines Part VII – Final Checklist This checklist is designed as an aid to ensure you have completed all the required forms and documents. It is also to be used to organize the order of your Submission to the Ministry. Complete the checklist and attach it to your completed Submission Package.


Attachment 2A

Finance Schedule Completion Guide


January 2002

Table of Contents General Instructions.................................................................................................................. 1 Purpose of Schedule F1........................................................................................................... 2

F1-1 .......................................................................................................................................... 2 F1-2 .......................................................................................................................................... 2 F1-3 .......................................................................................................................................... 2 F1-4 .......................................................................................................................................... 2 F1-5 .......................................................................................................................................... 3 F1-6 .......................................................................................................................................... 3

Purpose of Schedule F2........................................................................................................... 3 F2-1 .......................................................................................................................................... 4 F2-3 .......................................................................................................................................... 4 F2-4 .......................................................................................................................................... 4 F3-5 .......................................................................................................................................... 4 F2-6 .......................................................................................................................................... 5 F2-7 .......................................................................................................................................... 6 F2-8 .......................................................................................................................................... 6

Purpose of Schedule F3........................................................................................................... 6 F3-1 .......................................................................................................................................... 6 F3-2 .......................................................................................................................................... 6 F3-3 .......................................................................................................................................... 6 F3-4 .......................................................................................................................................... 6

Ministry of Health and Long-Term Care, Long-Term Care Redevelopment Project 2002 “D” Bed Development Plan Submission Process 2A-1

Note Reference #

Note

General Instructions

Please review the following notes before completing the Finance Schedules for your Submission Package. The notes briefly explain the purpose for each Finance Schedule. Each section of each Finance Schedule is also numbered and the notes for completing each section are set out below. For example, Item “F2–1” refers to Schedule F2, Note 1. The Schedules can generally be completed in any order you prefer since each schedule contains different information. Notes should accompany each Schedule to identify assumptions, other issues and to provide further explanation where appropriate. Financial statement data in the schedules should reflect the most recently available audited or unaudited annual and interim financial statements for each Key Stakeholder as applicable (for example Key Stakeholders with December year ends should submit pre-audit year-end statements, followed by audited statements as they become available). For answers to any questions you may have that require a more formal response, please contact the Call Centre. The phone, fax and email contact information for the Call Centre is provided in Section 1: Program Overview, under the subheading Information and Communications, of this binder.


Note Reference #

Note

Purpose of Schedule F1

The primary purpose of Schedule F1 is to identify existing project finances and the summary financial position of each Key Stakeholder. Relevant documentation should be attached for financing arranged as requested on the Schedule.

F1–1 This Section should identify the present status of financing discussions. Where applicable attach supporting documentation.

F1–2 The purpose of this section is to identify all project liabilities or commitments, affecting the ability of the Project to secure financing commitments.

F1–3 The purpose of this section is to identify any other known financing issues not otherwise identified elsewhere on Schedule F1. Such issues include any known dependencies on the ability to secure financing or equity, including but not limited to security impediments, site and environmental issues.

F1–4 Please identify contact information as requested. Submitted information is for the sole use of the Province, and LTCRP staff WILL NOT EXTERNALLY contact or share project identifiable information except as authorized by the Finance Team Lead for the Project. Contact with identified advisers and Key Stakeholders is deemed NOT to represent EXTERNAL information sharing for the purpose of this section.


Note Reference #

Note

F1–5 Amounts shown on the Schedule of Payments on Long-term

Liabilities should reflect information as of the most recent annual financial statement. ”Other Capital Commitments” represent capital projects which are committed but not completed, such that the projected costs at completion of the commitments are not fully recorded on the most recent financial statement.

F1–6 The purpose of this section is to identify the summary financial position of each Key Stakeholder. Amounts entered should be based on the most recent audited or pre audit financial statements for each Key Stakeholder. (For example, “YR 3” represents the most recent year, “YR 2” the next most recent year and so on. Key Stakeholders with December year ends should submit pre-audit year-end statements, followed by audited statements as they become available.) o See Appendix 9.1: Glossary for definitions[RT1] of the

following terms: Schedule of Payments for Long-term Liabilities EBITDA (Earnings Before Interest, Taxes, Depreciation and Amortization) Working Capital Tangible Net Assets Change in Long-term Liabilities Change in Owner’s Equity or Surplus


The information in this Schedule should provide the net cash flow from operations for your existing facility. The information should reflect the most recent year actual[RT2] audited or pre-audit statements of operation for your existing facility (For example, Key Stakeholders with December year ends should enter data from pre-audit year-end statements, followed by submitting audited statements as they become available).


Note Reference #

Note

F2–1 o Enter the most recent actual case mix index for levels of care funding and date of review.

o Enter present occupancy (number of residents). o Enter the average length of stay.

F2-2 o Enter the number of LTC beds eligible for private, semi private and basic accommodation for the existing facility.

o Enter the number of non-LTC beds and units for the existing facility.

o Enter the actual number of resident days for the most recent fiscal year

F2–3 Expense Projections are derived from Schedule F3: Detailed Expenses. Please ensure the amounts entered on Schedule F2 are the same as the applicable subtotals on Schedule F3.

F3–4 Resident Revenue Enter the actual revenue for the most recent fiscal year for private, semi private and basic accommodation for the existing facility. Enter the present per diem rates charged for private, semi private and basic accommodation for the existing facility.

F3–5 For the purpose of this section, Other Ministry Funding includes:

o pay equity, o debt service allowance, o nursing enhancement, o high wage transition funds, and o red circling

Note that the calculation of Total Ministry Funding excludes “Other Ministry Funding Included above” but includes “Other Ministry Funding NOT Included above”.


Note Reference #

Note

F2–6 Ministry Funding

Nursing and personal care funding is equal to the lesser of: a) Ministry’s co-payment currently set at $52.38 per diem

multiplied by the resident days; and b) the anticipated amount spent by the Operator on nursing

and personal care. Program and support services funding is equal to the lesser of: c) the Ministry’s co-payment currently set at $5.24 per diem

times resident days; and d) the anticipated amount spent by the Operator for these

services. Other accommodation funding is equal to: the number of resident days times the Ministry’s funding level of $40.21 ($44.70 accommodation funding level – $4.49 for raw food). If occupancy meets or exceeds 97%, then the number of resident days is calculated based on the total number of beds (not just those occupied) multiplied by 365 times $40.21. For example if the occupancy level was 98%, then the resident days would be calculated based on 100% occupancy. Raw food funding is equal to the lesser of: e) the Ministry’s co-payment currently set at $4.49 per diem

times the resident days; and f) the anticipated amount spent by the Operator for raw food. Miscellaneous revenue should include: any other revenue that the Operator anticipates receiving for accommodation and other revenue that the Operator anticipates receiving during the operation of the project. (Each type of miscellaneous revenue should be separately disclosed in the narrative to the schedule). This could include such items as telephone, hair styling etc. The nature and description of this income should be included in the narrative to the schedule.


Note Reference #

Note

F2–7 Total Revenue is: the sum of Resident Revenue, Ministry of

Health Revenue and Other Revenue. Net Cash Flow from Long-Term Care Operations is calculated by deducting Total Expenses from Total Revenue.

F2–8 Net Cash Flow from Non Long-Term Care Operations includes: revenues minus expenses from non long-term care components of the Project. For example, retirement home beds or seniors apartments.


This Schedule should include: all expenses necessary to operate the project. Each Subtotal on this Schedule F3 should match the appropriate reference on Schedule F2.

F3–1 Please ensure the same amount is entered on Schedule F2-3.





Section 3

Submission Package


January 2002

Table of Contents

Part I – Submission Package Cover Sheet.......................................... 3

Part II – General Information Form........................................................ 5

Part III – Development Path Being Considered .................................... 9

Part IV – Finance...................................................................................... 11

Part V – Operator Declaration............................................................... 23

Part VI – Upgrade Self Assessment Form............................................ 27

Part VII – Final Checklist.......................................................................... 29


This section contains the forms and other requirements for your Submission Package. In order to complete it correctly you will need to use the instructions contained in Section 2: Submission Guidelines. If you are unclear about terms that are used, refer to the Glossary in Appendix 9.1. Submission forms and requirements are organized as follows:

Part I: Submission Package Cover Sheet Part II: General Information Form Part III: Development Path Being Considered Part IV: Finance Part V: Operator Declaration Part VI: Upgrade Self Assessment Form Part VII: Final Checklist

If you have any questions about the Development Plan Submission Process, please contact us at: Toll Free: 1-866-411-7773 Toronto: (416) 314-5061 Fax: (416) 326-5533 Email: [email protected]


Part I – Submission Package Cover Sheet

1. Name of Operator: 2. Facility Operating Name: 3. LTC ID Number:

4. Facility Service Area:

5. Type of Organization

√√ One box For-Profit Municipal Charitable / Not-for-Profit

6. Total number of pages in Submission:

The photocopies I am submitting are the same as the original and electronic version provided. Office Use Only:

Submission Process Number:

Current Development Phase:

Signature of Operator: Date:


Part II – General Information Form

A. Facility and Contact Information Please provide the following information about your facility, and answer the questions that follow as completely as possible. FACILITY INFORMATION

Operating Name of Facility

Legal Business Name of Operator

Address of Facility

MOH Service Area (if known)

Telephone Number

Fax Number

E-mail Address

OPERATOR INFORMATION Operator (Corporation licensed or approved to operate Facility)

Address

Telephone Number

Fax Number

E-mail Address


Primary Contact (Individual for Ministry to contact if different from License Holder)

Address

Telephone Number

Fax Number

E-mail Address

Position

Alternate Contact Person (individual for Ministry to contact)

Address

Telephone Number

Fax Number

E-mail Address

Position


B. Project Team For all proposed Team Members, identify the following: (use/create as many copies of this page as required).

Name of Team Member

Legal Business Name

Address

Telephone Number

Fax Number

E-mail Address

Role in Project (e.g. architect; accountant; legal counsel)

NOTE: If project Team Members have not been selected at the time you submit your Submission Package, disregard this section of Part II - General Information Form.

• Attach resumes for each Team Member.


• Has the Operator, and/or any Team Member declared bankruptcy or made a voluntary assignment in bankruptcy in the last five years?

(Please answer "Yes" or "No" in the box below):

If the answer is “YES”, please provide details for each occurrence.

Operator

Details of bankruptcy occurrence

Team Member (use/create as many boxes as required)

Details of bankruptcy occurrence

(use/create as copies of this page as required)


Part III – Development Path Being Considered

A. Description of Beds in Existing Facility Complete the following table to describe the beds within your existing facility.

Type of Beds Yes / No

Number of Beds

I have already received a new bed award

I have existing licensed beds with the structural classification “A” I have existing licensed beds with the structural classification “B” I have existing licensed beds with the structural classification “C” I have existing licensed beds with the structural classification “D”

B. Development Path Information The path I am currently considering is: pick only one Redevelopment Retrofit Redevelopment and Retrofit Upgrade

Mark all cells that apply to your considered option:

SITE CHOICES FACILITY CHOICES

On

Existing Site

On New Site

Partial or Full Demolition

(Existing Site)

New Construction or Addition to

existing facility

Redevelopment Retrofit N/A Redevelopment & Retrofit* N/A* Upgrade N/A

* may apply in the case where an adjacent site is involved


C. Anticipated Completion Of Development I plan to have my facility ready for occupancy by: Quarter (Spring, Summer, Fall, Winter) Year

D. Transition Support I plan to apply for Transition Support:

Yes � No � I will require transitional space during redevelopment:

Yes � No �

E. Requests To Adjust Bed Numbers I plan an increase or decrease in the number of beds in my facility:

Yes � No � If Yes, I am proposing the following:

# Item # of Beds 1 Number of beds in proposed project

2 Number of Existing Beds (including inactive/unbuilt awards, purchases & transfers)

3 Subtotal

4 Total Adjustment Requested (+ / -)


Part IV – Finance

Finance Schedule F1 Summary Financial Position Schedule F2 Cash Flow Statement Schedule F3 Detailed Expenses


Schedule F1 – Summary Financial Position

Project Financing Arranged (Refer to Finance Schedule Completion Guide Note F1- 1) Notes Enter amount of Project costs incurred and paid to date. $

Enter amount of unencumbered Funds now on hand committed to Project.

$

Enter amount of any approved Provincial or other government Grant (attach documentation).

$

Enter net proceeds from assets to be sold before starting construction if applicable.

$

Enter advance on fundraising committed before starting construction if applicable.

$

Enter amount of signed financing commitments, if applicable (attach documentation).

$

Subtotal Project Financing Arranged $

Enter the amount of other unused available operating and interim credit facilities.

$


Identify Details of Existing Project Liabilities and Operating Agreements (Refer to Finance Schedule Completion Guide Note F1-2)

Enter unpaid balance on existing mortgage(s) and other long term Project liabilities

Mortgage holder Insu

red?

(Y/N

)

Rat

e

Unp

aid

Bala

nce

Mat

urity

dat

e (d

d/m

m/y

y)

Cap

Res

erve

R

equi

rem

ent

(if a

pplic

able

)

Annu

al P

&I

1: 2: 3: 4: Other Project Liabilities (specify) Total Existing Project Long-Term Liabilities Other Estimated Refinancing Costs (specify) Please provide information below regarding funding under a non-profit housing program. Attach a copy of any relevant Operating Agreements and Commitment Letters as well as a copy of any associated mortgage documents and rent-geared-to-income (RGI) assistance agreements. Is your LTC facility, or a building on the same site as your LTC facility, funded under any non-profit housing program? If yes, which one? (e.g. Federal, Federal/Provincial, Provincial, OCHAP, CSHP) Please provide details including what ongoing assistance is being received.

Does your LTC project have any outstanding mortgage debt borrowed under a non-profit housing program? If yes, who is the lender and what is the outstanding mortgage principal?


Identify Other Project Financing Issues (Explain in notes) (Refer to Finance Schedule Completion Guide Note F1- 3)

Notes 1

Ownership Structure of Borrower / Guarantors(s)

2

Borrowing Incapacity

3

Security impediments or dependencies

4

Other impediments or dependencies

5

Other (identify)

6

Other (identify)

7

Other (identify)


Identify Financing Contact Information (Refer to Finance Schedule Completion Guide Note F1- 4) Notes

Date Finance Schedules Completed

Have you retained a financial adviser for the Project? If so, include contact information below.

Y / N

Have you retained a management company for the Project? If so, include contact information below.

Y / N

Name Telephone e-mail

Finance Schedules Completed by:

Financial Adviser

Management Company Contact


Other Commitments of Key Stakeholders (including Proposed Project) (Refer to Finance Schedule Completion Guide Note F1- 5) Please submit an organizational chart showing all parent and related companies of Key Stakeholders, and principal shareholders of each.

Y / N

Key Stakeholder 1 (name): Other Capital Commitments ($ 000's)

Total Required Equity Required Borrowing Year

Schedule of Payments on

Long Term Liabilities ($ 000's)

# Pr

ojec

ts

$

Inve

sted

to

Dat

e

Addi

tiona

l To

Be

Inve

sted

Arra

nged

to

Dat

e

Addi

tiona

l To

Be

Arra

nged

2001 2002 2003 2004 2005

Thereafter Total

Key Stakeholder 2 (name):

Other Capital Commitments ($ 000's)

Total Required Equity Required Borrowing Year

Schedule of Payments on Long Term Liabilities ($ 000's)

# Pr

ojec

ts

$

Inve

sted

to

Dat

e

Addi

tiona

l To

Be

Inve

sted

Arra

nged

to

Dat

e

Addi

tiona

l To

Be

Arra

nged

2001 2002 2003 2004 2005

Thereafter Total

Note: In Case of more than 2 Key Stakeholders, attach additional sheets


Financial Position For Key Stakeholders (Refer to Finance Schedule Completion Guide Note F1- 6) Key Stakeholder 1 (name):

($ 000's) YR 1 YR 2 YR 3

EBITDA

Working Capital

Income Producing Assets

Change in Long Term Liabilities

Change in Owners Equity / Surplus Key Stakeholder 2 (name):

($ 000's) YR 1 YR 2 YR 3

EBITDA

Working Capital

Income Producing Assets

Change in Long Term Liabilities

Change in Owners Equity / Surplus Note: In Case of more than 2 Key Stakeholders, attach additional sheets


Schedule F2 – Cash Flow Statement N

OTE

S

CMI Date Enter most recent Actual Case Mix Index and date of review (dd/mm/yy). Enter present occupancy (number of residents) Enter average length of stay

1

Present Actual (Annual)

Beds: 2 Basic Accommodations

Semi-Private Private

Total Long-Term Care Beds

Annual Resident Days

Non Long-Term Care Beds

Expenses: Nursing & Personal Care (from Schedule F3)

Program & Support Services (from Schedule F3)

Other Accommodations (from Schedule F3)

Uninsured/Optional Services (from Schedule F3)

Other Expenses (from Schedule F3)

Total Expenses 3

Resident Revenues: 4

Basic Accommodation Revenue

Semi-Private Accommodation Revenue

Private Accommodation Revenue


N

OTE

S

Ministry Funding: 1. Nursing & Personal Care

2. Program & Support Services

3. Other Accommodation Funding

4. Supplementary Accommodation Funding

5. Less Basic Accommodation Revenue

6. Structural Premium

7. Accreditation

8. Other MOHLTC funding included above 5

9. Other MOHLTC funding NOT included above Total Ministry funding (Add lines 1 + 2 + 3 + 4 - 5 + 6 + 7 + 9 from above) 6

Other Revenue: Uninsured/Optional Services Municipal operating grant or subsidy

Fundraising including Income from Auxiliary Miscellaneous

Total Revenue (Basic, Semi-Private, Private, Total MOH funding and Other Revenue) 7

Net Cash Flow from Long-Term Care Operations

Net Cash Flow from Non Long-Term Care Operations 8


Schedule F3 – Detailed Expenses

Present Actual Expense Category

NOTE

S

Annual

Nursing and Personal Care: Salary, wages and benefits Other (please specify): Other (please specify): Total Nursing Expenses 1 Program & Support Services: Salary, wages and benefits Purchased services (please specify) Resident Outings Other (please specify) Other (please specify) Other (please specify) Total Programming Expenses 2 Other Accommodation: Salary, wages and benefits Raw Food Dietary Laundry Supplies Housekeeping Supplies Maintenance Supplies Repairs and Maintenance Administrative Expenses Environmental Expenses Property Taxes Utilities Other (please specify): Other (please specify): Total Accommodation Expenses: 3 Other Expenses: (Please specify) Management Fees Rent Other (please specify): Other (please specify): Total Other Expenses 4 TOTAL EXPENSES


Part V – Operator Declaration

This part contains a Declaration that must be completed by the Operator. Complete the Operator Declaration form and submit it with your Package.


Operator Declaration (Page 1of 2)

On behalf of and with the authority of the Operator I/we:

1. intend to develop, design, construct and operate long-term care facility beds in accordance with the my/our Submission, and in accordance with applicable legislation, regulations and standards as amended and issued from time to time, including the Residents’ Bill of Rights, and the standards and guidelines for my/our preferred Development Option;

2. certify that the information I/we have supplied in support of this Submission is true, correct and complete in every respect;

3. acknowledge that the Submission is based on the terms and conditions of the sample Agreement for Development of Long-Term Care Facility Beds contained in Appendix 9.5: Sample Development Agreements;

4. acknowledge that the Operator will be required to finalize and execute a Development or Upgrade Agreement in substantially the same form as the one contained in Appendix 9.5: Sample Development Agreements;

5. consent, pursuant to section 17(3) of the Freedom of Information and Protection of

Privacy Act, to the disclosure on a confidential basis of my/our Submission by the Ministry to such individuals or other parties as may be required for the purpose of reviewing the Submission to administer the submission process;

6. consent to the public disclosure of all information listed in the Submission Guidelines as information which may be disclosed to the public.

Signature of Authorized Signing Officer

Signed, Sealed and Delivered in the presence of

Print Name

Title Witness Date Date


Operator Declaration (Page 2 of 2)

If second signature required:



Print Name

Title Witness Date Date


Part VI – Upgrade Self Assessment Form Note: You are only required to submit this form if you are considering taking the Upgrade Option for your Development Path. For each question, place a checkmark in either the “Yes” or “No” box.

# Question Yes No

1. Are there any outstanding compliance orders issued by MOHLTC or any provincial agency?

2. Are there any outstanding work orders issued by municipal building inspectors or an officer of the Fire Marshall

3. Does the facility have a 2nd storey or higher floors that are not serviced by an elevator?

4. Are there more than sixty beds per nursing station (including substations)?

5. Is there a separate clothes closet available to each resident within their bedroom? If so, is each closet a minimum of 5 square feet (or 4 square feet with a minimum depth of 2 feet)?

6. Does each bedroom have an entrance door that is at least 36 inches wide?

7. Does each resident washroom have an entrance door that is at least 32 inches wide?

8. In bedrooms of more than 2 beds, are all beds no more than 2 deep from the window?

9. Is the floor to window sill height in each bedroom a maximum of 38 inches?

10. Is there at least 2 feet 6 inches of clearance around three sides of each bed?

11. Is there at least one outdoor area on the facility property; and is there is at least one outdoor area that is enclosed to prevent wandering/egress of residents?

12. Does each bedroom, which contains one bed, have a minimum of 100 square feet excluding closet, vestibule and washroom space?

13. Does each bedroom, which contains two beds, have a minimum of 169 square feet excluding closet, vestibule and washroom space?

14. Does each bedroom, which contains three beds, have a minimum of 255 square feet excluding closet, vestibule and washroom space?


# Question Yes No

15. Does each bedroom, which contains four beds, have a minimum of 305 square feet excluding closet, vestibule and washroom space?

16. Does each washroom have sufficient space to allow a wheelchair to access the washroom and then to fully close the washroom door with the wheelchair in the washroom?

17. Is there a minimum of 1 washroom with 1 toilet and 1 hand basin for every four residents?

18. Is there a minimum ratio of 1 tub and/or shower for every 12 residents (unless a Ministry exception has previously been granted to allow for 1 to every 16 residents)?

19. Is there a minimum of 15 square feet per resident for lounge area; and is there at least one lounge with a minimum size of 120 square feet provided on every floor?

20. Is there a minimum of 6 square feet per resident of floor space for the activity area?

21. Is there a minimum of 8 square feet of floor space per resident for the dining area (excluding the servery)?


Part VII – Final Checklist Final Checklist: Lists all required submissions, schedules, and forms for Operators. Note: There may be other pieces of information required of you as identified in the Submission Forms and Guidelines which are unique to your circumstances and are not listed here but which you are still required to submit. Please be sure you have included all necessary information and submit 4 copies of all documentation being provided.

Part What to Submit (4 Copies of each) √√ Part I – Submission Cover Sheet Submission Package Cover Sheet Part II – General Information General Information Form Team Members’ Resumes (if applicable) Part III – Development Path Being Considered Development Path Form Part IV – Finance

Copies of audited financial statements for the past 3 years for the existing facility and for all Key [RT1]Stakeholders

Copies of un-audited interim statements for the current year for the existing facility and for all Key Stakeholders

Summary Financial Position: Schedule F1 OR Annual Repayment Limit Letter (Municipal Operators only)

Cash Flow Statement: Schedule F2 Detailed Expenses: Schedule F3 Copies of supporting documentation Part V – Operator Declaration

Completed Operator Declaration

Part VI – Upgrade Self Assessment Form

Completed Upgrade Self Assessment Form (Operators choosing the Upgrade Option only)

Part VII – Final Checklist Attach completed Checklist to your Package

Ministry of Health and Long-Term Care, Long-Term Care Redevelopment Project “D” Bed Development Plan Submission Process

Election to Remain “D”

This form should be completed only in those cases where an Operator does not intend to Redevelop, Retrofit or Upgrade a facility.

This is to advise the Ministry of Health and Long-Term Care (the “Ministry”)

that_______________________________________________________, the owner of

_______________________________________________________, consisting of

______________ beds, located at __________________________________, in the

city / town of _______________________________________, will not be redeveloped,

retrofitted or upgraded under the 2002 “D” Bed Program.

I understand that _____________________________________________ will not be

eligible for current construction funding or other incentives and supports available to “D”

Operators who are proceeding with or have completed a Development Path under the

2002 “D” Bed Progam.



Print Name Witness

Title Date Date

<insert facility bed total> <insert facility address>

<insert facility city/township>

<insert facility name>

<name of facility owner>

<facility name>


Section 4

Redevelopment Option Guidelines


January 2002

LONG-TERM CARE FACILITY

DESIGN MANUAL


MAY, 1999

LONG-TERM CARE FACILITY DESIGN MANUAL

i

TABLE OF CONTENTS

INTRODUCTION...............................................................................................1I. BACKGROUND ............................................................................................................1II. NEW DESIGN STANDARDS......................................................................................2

HOW TO USE THIS MANUAL .........................................................................3I. MANDATORY PROVISIONS.......................................................................................3II. PURPOSE.....................................................................................................................3III. OVERVIEW OF THE MANUAL...................................................................................4IV. DESIGN OBJECTIVES, DESIGN STANDARDS AND FUNCTIONAL

CONSIDERATIONS/RECOMMENDATIONS............................................................6V. PLANS REVIEW AND APPROVAL PROCESS......................................................9

PART A: DESIGN OBJECTIVES, DESIGN STANDARDS ANDFUNCTIONAL CONSIDERATIONS/ RECOMMENDATIONS........................11

SECTION ONE: RESIDENT HOME AREA(S) ...............................................12

SECTION TWO: RESIDENT PERSONAL SPACE IN THE RESIDENTHOME AREA(S) .............................................................................................15

1. RESIDENT BEDROOMS...........................................................................................152. RESIDENT WASHROOMS .......................................................................................183. RESIDENT BATH ROOMS AND SHOWER ROOMS............................................21

SECTION THREE: FACILITY AND STAFF SUPPORT SPACE IN THERESIDENT HOME AREA(S) ..........................................................................25

1. WORK SPACE FOR NURSING AND PROGRAM/THERAPY STAFF IN EACHRESIDENT HOME AREA..........................................................................................25

2. STORAGE SPACE FOR RESIDENT CARE SUPPLIES AND EQUIPMENT INRESIDENT HOME AREAS .......................................................................................26

SECTION FOUR: RESIDENT LOUNGE AND PROGRAM/ACTIVITY SPACE........................................................................................................................28


ii

1. RESIDENT LOUNGE AND PROGRAM/ACTIVITY SPACE..................................28

SECTION FIVE: DINING AREA(S) AND DIETARY SERVICE SPACE.......311. RESIDENT DINING AREA(S)....................................................................................312. DIETARY SERVICE SPACE.....................................................................................33

SECTION SIX: RESIDENT COMMUNITY SPACE........................................371. OUTDOOR SPACE....................................................................................................372. BEAUTY PARLOUR/BARBER SHOP .....................................................................383. PLACE OF WORSHIP ...............................................................................................394. ENHANCED RESIDENT SPACE ............................................................................39

SECTION SEVEN: ENVIRONMENTAL SERVICES ....................................411. LAUNDRY SPACE.....................................................................................................412. HOUSEKEEPING SERVICE SUPPORT SPACE..................................................423. UTILITY SPACE ..........................................................................................................434. MAINTENANCE SERVICE SUPPORT SPACE.....................................................44

SECTION EIGHT: SAFETY FEATURES......................................................461. RESIDENT/STAFF COMMUNICATION AND RESPONSE SYSTEM.................462. DOOR ACCESS CONTROL SYSTEM....................................................................463. FIRE ALARM SYSTEM..............................................................................................474. WATER TEMPERATURE CONTROL SYSTEM.....................................................48

SECTION NINE: BUILDING SYSTEMS .......................................................491. LIGHTING SYSTEMS .................................................................................................492. HEATING, VENTILATION AND AIR-CONDITIONING (HVAC) SYSTEM.............50

SECTION TEN: OTHER FEATURES............................................................521. RESIDENT DEDICATED STORAGE SPACE .......................................................522. FACILITY STAFF SPACE .........................................................................................523. RECEIVING/SERVICE SPACE................................................................................544. RECEPTION/ENTRANCE SPACE..........................................................................555. ELEVATORS...............................................................................................................566. PUBLIC WASHROOMS.............................................................................................57


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7. SITE DEVELOPMENT...............................................................................................578. CORRIDORS...............................................................................................................58

SECTION ELEVEN: ARCHITECTURAL CONSIDERATIONSANDRECOMMENDATIONS...................................................................................59

PART B: LONG-TERM CARE FACILITY PLANS REVIEW PROCESS......64

DEFINITIONS OF TERMS..............................................................................67

APPENDIX A: PROJECT SUMMARY ..........................................................75

APPENDIX B: OPERATIONAL PLAN FOR THE RENOVATION,ALTERATION OR CONVERSION OF A LONG-TERM CARE FACILITY(“OPERATIONAL PLAN”) .............................................................................78


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INTRODUCTION

I. BACKGROUND

Provincially regulated and funded long-term care facilities fall into three historicalcategories of nursing homes, municipal homes for the aged and charitable homes for theaged.

In the past, two different provincial ministries were separately responsible for the nursinghome and the home for the aged (municipal and charitable) programs, with differentadministrative practices and different legislation in place, even though these facilitiesaccommodated people with similar care requirements. Up until 1991, nursing homes werethe responsibility of the Ministry of Health, and homes for the aged were the responsibilityof the Ministry of Community and Social Services.

Because of the different administrative systems under the two provincial ministries, theapproaches taken for development and implementation of design standards for long-termcare facilities also differed. Structural standards for nursing homes were regulated underthe Nursing Homes Act, while structural standards for homes for the aged were containedin design manuals and policy guidelines. This resulted in variations in the types of designand accommodations for a similar long-term care facility resident population.

Recognizing the need to bring together similar long-term care services, as the first step inmoving toward a common long-term care facility system, the provincial Governmentpassed the Long-Term Care Statute Law Amendment Act, 1993 (Bill 101) effectiveJuly 1, 1993, which amended the different legislation governing long-term care facilities. As part of this reform activity, the Government also brought all long-term care facilitiesunder one administrative structure within the Ministry of Health.

Bill 101 introduced consistent operational standards, consistent resident admission criteriaand a single funding scheme for all long-term care facilities. However, Bill 101 did notaddress the building design features, and as a result, different structural standardscontinued to be in place for nursing homes and homes for the aged.

Bill 101 also introduced a new province-wide mandatory admission policy that givespriority to people who are in greatest need of long-term care facility placement. Facilitiesare now having to admit and care for residents with more complex care requirements thanin the past. The design standards that continued to be in place after Bill 101 pre-datethese changes in service levels.


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II. NEW DESIGN STANDARDS

In the fall of 1996, the Long-Term Care Division established a working committee, chairedby the Division, to examine past Government practices with respect to design standards,and to look at the issue of design requirements for the residents who are now beingadmitted to long-term care facilities. This working committee, which includedrepresentatives from the long-term care facility provider associations and consumerorganizations, was given the mandate to develop one set of design objectives that wouldapply in the same manner to all long-term care facilities.

The joint working committee completed its mandate over the winter and spring of 1997,and presented its recommendations on new long-term care facility design standards to theMinister of Health in August of 1997.

This Long-Term Care Facility Design Manual is new and has been developed takinginto consideration the work done by the joint Long-Term Care Division/provider/ consumerproject. The design standards contained in this Manual are based on the advice andrecommendations on design objectives presented by the joint working committee to theMinister of Health. The Long-Term Care Facility Design Manual is intended to supportexperienced long-term care facility operators and those new to the long-term care facilitysector in developing facilities best suited to meet the diverse needs of residents.

It is recognized that as resident care, program and service requirements change, thedevelopment of new and revised design standards will be necessary to respond to thesechanges in resident needs. The Long-Term Care Facility Design Manual will be revisedas necessary to incorporate new ideas that will support a facility design that best meets thecare, program and service needs of residents. This review will involve the participation ofall long-term care stakeholders and will occur at regular intervals.

The evaluation of the design standards will be supported by the implementation of a post-occupancy review process to evaluate how well certain features support quality residentcare and to determine which features should be adjusted because they fail to meet thedesired outcome. This process will also be discussed and developed in conjunction withall long-term care stakeholders.


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HOW TO USE THIS MANUAL

I. MANDATORY PROVISIONS

Effective April 1, 1998, the Long-Term Care Facility Design Manual shall apply in thesame manner to the construction and/or renovation of all long-term care facilities (nursinghomes and homes for the aged) governed by the Nursing Homes Act, the CharitableInstitutions Act, and the Homes for the Aged and Rest Homes Act.

The Long-Term Care Facility Design Manual supercedes any prior provincialGovernment guidelines on long-term care facility design used in the past by either theMinistry of Health or the Ministry of Community and Social Services for long-term carefacility construction/renovation projects (includes both the nursing home and home for theaged design guidelines).

II. PURPOSE

The Long-Term Care Facility Design Manual presents a means of promoting innovativedesign in the construction of new long-term care facilities and in the renovation of existinglong-term care facilities in Ontario. This Manual includes minimum mandatory designfeatures that must be achieved for all long-term care facility projects, and also providesguidelines on “best practices” in the design of a long-term care facility to promote qualityresident care outcomes.

The overall goal of the Long-Term Care Facility Design Manual is to integrate designconcepts that will facilitate the provision of quality resident care in an environment that iscomfortable, aesthetically pleasing and as “home-like” as possible. The design of a long-term care facility must also support well-coordinated, interdisciplinary care for residentswho have diverse care requirements.

These new design standards allow service providers greater flexibility to configureenvironments that make it possible to respond positively and appropriately to the diversephysical, psychological, social and cultural needs of all long-term care facility residents.


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III. OVERVIEW OF THE MANUAL

The Long-Term Care Facility Design Manual has been developed based on anapproach that involves moving from the most private space of a resident, (residentpersonal space in a Resident Home Area) to the more public areas (which includes theoverall support system space) within a facility.

The Long-Term Care Facility Design Manual groups all of the different resident care,program and service areas of the long-term care facility under the following sections:

1. Resident Home Area(s)

Each Resident Home Area must be a self-contained, clearly defined unit, whichaccommodates a group of no more than thirty-two (32) residents. Every ResidentHome Area must include bedrooms, washrooms, bath and shower rooms, diningarea, lounge area, program/activity space, staff work space and storage space forthat area.

2. Resident Personal Space in The Resident Home Area(s)

This section sets out the mandatory and optional design expectations for the residentpersonal space, which includes bedrooms, washrooms, bath rooms and showerrooms.

3. Facility and Staff Support Space in The Resident Home Area(s)

Facility and staff support space includes the required staff work areas and the serviceareas located in the Resident Home Area(s) which are used by the different staff ofthe facility. This space must include working areas for nursing care andprogram/therapy staff, as well as storage space for nursing care supplies/equipment.

4. Resident Lounge and Program/Activity Space

This section describes the mandatory and optional Resident Lounge Space andProgram/Activity Space design expectations for the long-term care facility.

5. Dining Area(s) and Dietary Services Space

This section addresses the mandatory and optional Resident Dining Arearequirements for the long-term care facility and the related Dietary Services Space. It also includes the mandatory and optional space expectations related to cleaning


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activities for the Dietary Services Space and space for equipment used for thedietary program.

6. Resident Community Space

Resident Community Space includes the areas that are used by all residents of thelong-term care facility and that is located outside of the Resident Home Area(s). As a minimum, there must be Outdoor Space, a Beauty Parlour/Barber Shop anda Place of Worship. With the exception of the space dedicated for a Place ofWorship, the Resident Community Space is additional space which must beprovided and shall not be considered as part of the required space for ResidentLounge Space and Program \ Activity Space.

In addition, for a long-term care facility where all of the mandatory Resident LoungeSpace and Program/Activity Space is located within the Resident Home Area(s),at least one additional area for use by all residents must be provided within the facilityoutside the Resident Home Area(s). The decision on the use, purpose and size ofthis “common” area is at the discretion of the operator and should be determinedbased on the needs of the residents to be accommodated in the long-term carefacility.

7. Environmental Services

This section describes the mandatory and optional design requirements of the spaceused for the housekeeping, laundry and maintenance programs.

8. Safety Features

Safety features are the internal building features which must protect and promote thehealth, welfare and safety of residents. This section describes the mandatory andoptional design expectations for the Resident/Staff Communication andResponse System, the Door Access Control System, the Fire Alarm System(also subject to compliance with the Ontario Fire Code) and the Water TemperatureControl System.

9. Building Systems

This section describes the mandatory and optional building systems designexpectations for lighting, heating, ventilation and air conditioning (approval of thesesystems is also subject to meeting compliance with the relevant sections of the


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Ontario Building Code and any related regulatory or generally accepted standards forlighting, heating, ventilation and air conditioning systems).

10. Other Features

Other features address the remaining mandatory and optional design expectations forthe staff and “public” areas of the building, including the mandatory and optionaldesign features for resident dedicated storage space, staff room(s), receiving/servicespace, the reception and entrance ways, elevators and public washrooms.

11. Architectural Considerations

This section provides guidance and direction on design and building features thatbest support and respond to the nursing and personal care needs of residents in long-term care facilities. Architectural considerations are not mandatory requirements, butrather are suggestions on features which assist residents who may have specialneeds which result, as example, from cognitive impairments, varying degrees ofdementia, vision impairments, hearing impairments and/or physical disabilities. Although these features are recommendations for enhancement of the buildingdesign, it is strongly suggested that these recommendations be considered andincorporated accordingly.

IV. DESIGN OBJECTIVES, DESIGN STANDARDS AND FUNCTIONALCONSIDERATIONS/RECOMMENDATIONS

Each of the sections of the Long-Term Care Facility Design Manual which are listedabove, with the exception of the section on “Architectural Considerations,” has the followingformat:

1. Design Objective:

The Design Objective describes the purpose and design expectations for each areaaddressed, including how the space is to be used and what the resident focus shouldbe to achieve the optimal care outcomes.

2. Design Standards:

These are the minimum design requirements that must be attained. DesignStandards are the mandatory requirements that must be incorporated into the designof each long-term care facility.


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3. Functional Considerations/Recommendations:

Functional considerations and recommendations are optional design features whichhave been developed from the work completed by the joint Long-Term CareDivision/provider/consumer project. Although functional considerations andrecommendations are not mandatory, they are considered to be features that furtherpromote quality facility design and quality care outcomes. These features have beenincluded to provide helpful guidance for operators during the design process wherethey might not otherwise have been considered.

It is acknowledged that a number of the Design Standards and FunctionalConsiderations/Recommendations would be considered as “obvious” features thatmust be or may be provided. These “obvious” mandatory and optional designfeatures are included because they are considered important to the design andfunctioning of the long-term care facility. Not all users of this Manual will be familiarwith or experienced in the design and operation of a long-term care facility. It isexpected that this Manual will be used by both experienced and non-experiencedorganizations in the long-term care sector.


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IMPORTANT - PLEASE NOTELONG-TERM CARE FACILITY PROGRAM MANUAL

It is essential that the architectural plans for any long-term care facility be developed inconsideration of the operational standards outlined in theLong-Term Care Facility Program Manual. The Long-Term Care FacilityProgram Manual describes the operational requirements for all long-term carefacilities. The operational needs of the long-term care facility and the plannedprograms to be provided are key in guiding and determining the long-term carefacility design. The long-term care facility must be designed to facilitate thebest possible care for the residents who will be accommodated.

V. PLANS REVIEW AND APPROVAL PROCESS

The Ministry of Health is responsible for the review and approval of all construction plansfor long-term care facilities. The legislation which governs long-term care facilities includesmandatory plan submission and approval protocols for all long-term care constructionand/or building renovation projects. The Ministry of Health’s plans review process for long-term care facilities are described in detail further on in a separate section of this Manual.

In addition, for any long-term care facility construction or renovation project, compliancewith the Ontario Building Code, the Ontario Fire Code and any relevant municipal buildingrequirements (includes meeting zoning and other relevant municipal by-laws) remains theresponsibility of the long-term care facility operator.

The Design Standards and Functional Considerations/Recommendations set out in thisLong-Term Care Facility Design Manual are specific to the design and construction of long-term care facilities. This does not preclude the application of these standards and guidelines toother types of facilities. However, the Ministry of Health plans review will only address theproposed design of the long-term care facility.


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IMPORTANT - PLEASE NOTEDESIGN STANDARDS FOR INTEGRATED MULTI-USE COMPLEXES

The resident care areas of a long-term care facility must be completely separateand distinct from space which is used for other purposes. If the long-term care facility isto be part of a larger integrated complex, for example, a combinedcomplex that includes a rest/retirement home and a long-term care facility, the spaceallocated for the long-term care facility resident accommodations must be distinct andseparate from the rest/retirement home.In an integrated multi-use complex, it is acceptable to share building service areas, suchas the kitchen, parking area, outdoor space, staff rooms, laundry, cafeteria, auditorium,place of worship and beauty parlour/barber shop. In addition, it is acceptable to share theinternal building systems for water, hydro, sewage, waste disposal, lighting, heating andventilation. Resident care areas and resident space, which includes bedrooms, washrooms,tub and shower rooms, dining areas, lounges and program/activity space shallnot be integrated. If an integrated multi-use complex is to be constructed, the separation of the different areasand the sharing of any building services must be clearly indicatedon the plan submission. The Ministry of Health plans review staff will evaluate the plans toensure that compliance is met with the design expectations and space separationrequirements. If it is intended that there be “common” space forsharing by residents of the long-term care facility and other people served by the integratedcomplex (including the community-at-large), such must be shown onthe plans.

The Ministry of Health will accept the sharing of “common” space when theoperator is able to demonstrate that this space will enhance and promote quality residentcare outcomes. Such requests will be evaluated as part of the constructionplans review process.


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PART A: DESIGN OBJECTIVES, DESIGN

STANDARDS AND FUNCTIONAL

CONSIDERATIONS/ RECOMMENDATIONS


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SECTION ONE: RESIDENT HOME AREA(S)

Design Objective:

The Resident Home Area(s) is a new and innovative mandatory concept that isbeing introduced to the design requirements of long-term care facilities. EachResident Home Area must accommodate a maximum of thirty-two (32) residentsand must be a self-contained unit for use by the residents in that area. The intent isto create smaller home-like units, rather than large congregate/institutional livingenvironments.

The Resident Home Area(s) must include:

• resident bedrooms and washrooms;

• resident bath and shower rooms;

• lounge areas, program/activity space, dining area(s) and residentstorage space dedicated for use by the residents living in the ResidentHome Area(s); and

• staff work space and support services areas.

Design Standards:

1. Each Resident Home Area must be a clearly defined distinct unit thatprovides accommodation for a maximum of thirty-two (32) residents.

Note: Although a Resident Home Area must not to exceed a maximum of 32 residents,this mandatory requirement does not preclude designing aResident Home Area that provides accommodation for less than 32 residents. The size and number of residents in each Resident Home Area should bedetermined in consideration of the resident care and/or program requirements. Inaddition, the number of residents in each Resident Home Area does notnecessarily have to be the same throughout the facility.


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2. All resident bedrooms must contain either one or two beds.

3. Every bedroom must have an ensuite “barrier-free” washroom that contains, ata minimum, a sink and a toilet. The entrance to the washroom must be fromwithin the bedroom itself (which includes the vestibule).

Note: The ratio of standard and preferred accommodation, as set out in the regulationsgoverning all long-term care facilities, requires that 40% of the residents must becharged at the basic accommodation rate. This permits charging up to 60% of theresidents at the preferred accommodation rate(this is the rate for semi-private and private rooms). This charging policy must be adhered to regardless of the design of the building. For example, a long-term care facility may have all one bed private rooms, but 40% of the residentsmust still be charged the basic accommodation rate.

4. In each Resident Home Area, the bath and shower rooms, dining area(s),lounge area(s) and program/activity space must be located in close proximityto the resident bedrooms.

5. Resident bedrooms in each Resident Home Area may be all basic(standard) rooms, semi-private rooms and private rooms, or a mix of eachtype of room (see definition of bedrooms in Section Two: ResidentPersonal Space in the Resident Home Area).

6. The Resident Home Area must be a self-contained “living system” and mustnot allow for transitory passage through the Resident Home Area(s) whentravelling from one part of the facility to another.

7. At least 70% of the total minimum required Resident Lounge Space andProgram/Activity Space for the long-term care facility must be located withinthe Resident Home Area(s). The remaining 30% of this required spacemay be located outside the Resident Home Area(s) either for sharing by allresidents of the long-term care facility or for use to increase lounge/programactivity space in one or more Resident Home Area(s).

8. At least 80% of the mandatory minimum Dining Area must be located withinthe Resident Home Area(s). The remaining 20% of this mandatory DiningArea may be located outside of the Resident Home Area(s) for sharing by


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all residents of the long-term care facility for use to enhance the Dining Areain one or more of the Resident Home Area(s).

Functional Considerations/Recommendations:

1. The 60/40 charging policy for preferred and basic accommodation should notdefine or guide the design of the long-term care facility. It is up to theoperator, in consultation with the architect, to decide the lay-out anddesignation of resident bedrooms depending on the care, service andprogram requirements of the residents to be accommodated.


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SECTION TWO: RESIDENT PERSONAL SPACE IN THERESIDENT HOME AREA(S)

1. RESIDENT BEDROOMS

Design Objective:

The resident bedroom is the centre of the resident’s personal space where themost private activities take place - sleeping, grooming and dressing. It must meeteach resident’s need for comfort and safety, promote resident independence anddignity, and provide for resident privacy. Each bedroom must be designed in amanner that maximizes a sense of familiarity for residents and supports direct carestaff in the safe delivery of quality resident care.

Types of Accommodation

A private bedroom must accommodate one resident and must have a separate “barrier- free” ensuite washroom.

A semi-private bedroom must accommodate one resident in one bedroom,another resident in a separate bedroom, with both bedrooms joined by a “barrier-free” ensuite washroom, (i.e., two bedrooms, with one resident in each bedroom,share one ensuite washroom).

A basic (standard) bedroom must accommodate two residents and must have aseparate “barrier-free” ensuite washroom.

Design Standards:

1. A private bedroom must have at least 130 square feet (12.1 square metres)of floor space excluding the space for the vestibule, the washroom and theclothes closet.

2. A semi-private bedroom must have at least 130 square feet (12.1 squaremetres) of floor space per resident in each one-bed room, excluding vestibulespace, the washroom and the two clothes closets.


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3. A basic (standard) bedroom must have at least 115 square feet (10.7square metres) of floor space per resident, excluding the space for thevestibule, the shared washroom and the two clothes closets.

4. Each bedroom must have a clothes closet for each resident. Each clothescloset must have at least six (6) square feet (0.6 square metres) of floorspace. The clothes closet must be of sufficient height and depth to store andhang clothes.

5. Each bedroom door must be a minimum width of 44 inches (1120 mm).

6. If a lock is installed on a bedroom door, the lock must be readily releasableand easily openable for residents and staff.

7. In each bedroom, there must be sufficient space to provide access bycaregivers to three sides of the bed, that is, to both sides of the bed and thefoot of the bed (cross-reference to item # 2 - FunctionalConsideration/Recommendations for Resident Bedrooms).

8. Specialized program equipment must be able to get around the two sides ofthe bed and the foot of the bed.

9. Each bedroom must be designed to allow a 180 degrees change of directionof any care equipment within the room.

10. There must be a device for each resident in each bedroom that will activatethe Resident/Staff Communication and Response System of the long-term care facility. The device to activate the Resident/Staff Communicationand Response System must be located within easy reach of the resident,including when the resident is lying or sitting up in bed.

11. Each bedroom must have at least one window that provides a direct view tothe outdoors or to other naturally lit space from both a sitting and lying in- bedposition. (cross-reference to criteria #6 - FunctionalConsiderations/Recommendations for Resident Bedrooms)

12. Windows that open to the outdoors must have screens in the spring, summerand fall seasons.

13 There must be no direct view of the toilet in the ensuite washroom from theoutside corridor when the washroom door is open.


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14. Each bedroom must have “cueing” features, (for example, a room number, theresident(s) name(s), and/or pictures), outside each bedroom door to assistresidents in finding their way to and easily identifying their bedrooms.

15. Each basic (standard) bedroom must provide privacy for each resident of theroom.

16. All bedroom flooring must be non-slip.

17. Wiring for a phone jack and wiring for television service must be provided foreach resident in each bedroom.


1. Larger bedrooms may be appropriate for certain types of programs orspecialized resident care needs where additional space for equipment andseating for friends/family members is required, for example, for provision ofpalliative care. The size of bedrooms should be determined during the facilityconstruction planning stage based on the anticipated care needs of residentsto be accommodated in each Resident Home Area and the operationalrequirements that support quality care to those residents.

2. The bedroom design and space must allow access by caregivers to the threesides of the bed that is, to both sides of the bed and at the foot of the bed (seeDesign Standard # 8 above). The intent of this standard is not to restrictresident preference for bed placement within the room, but rather to ensurethat adequate space is provided in each bedroom to effectively care for aresident while in bed. If a resident wishes to relocate his or her bed, forexample, against a wall, this wish should be respected to the best extentpossible (depending on the resident’s care requirements). If the resident is ina basic (standard) room, the wishes of the resident in the other bed also needto be taken into consideration.

3. In order to create variety in the appearance of the bedrooms, a variety ofinterior design features, such as carpeting, wallpaper and different wallcolours, should be considered.

4. The bedroom design should include space for items such as dressers,shelving, bookcases and tackboards to allow residents to display and store


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personal items. Residents should be given every reasonable opportunity topersonalize their bedrooms.

5. Some space should be provided at the vestibule entrance for the display offamiliar objects such as photographs and mementos.

6. The lowest edge of window glass should be no more than two feet (600 mm)from the floor to ensure an unobstructed view to the outside. The windowshould be equal to or greater than 10% of the floor area of the bedroom toensure that sufficient natural lighting is available for the bedroom.

7. When the bedroom door is closed, there should be a minimum width of twofeet (600 mm) between the door handle and the bedroom wall which isadjacent to the door.

8. Where a bedroom has a vestibule, the vestibule must be large enough topermit the unobstructed passage of a wheelchair, a walker or any specializedprogram equipment.

2. RESIDENT WASHROOMS

Design Objective:

Each washroom must be “barrier- free” and designed to promote resident privacy,dignity and independence. In addition, the washroom space must also allow for theeffective and safe delivery of care by caregivers. The entrance to the washroommust be from within the bedroom.

Design Standards:

1. Each resident washroom must have at least one toilet and one handwash sink.

2. Each washroom must have sufficient space to enable independent and/orassisted transfer from the front and at least one side of the toilet. (cross-reference to criteria # 11 - Functional Considerations/Recommendations forResident Washrooms)


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3. In order to allow for sufficient space for a wheelchair or a walker, and for staffto assist a resident, there must be a five (5) foot turning circle in each residentwashroom.

4. A securely fastened grab bar must be located beside the toilet within easyreach of the resident. Each grab bar must be of sufficient size and design tosupport the full weight of a resident and must be placed on a reinforced wallcapable of sustaining the weight load.

5. There must be a device within easy reach of the resident that will activate theResident/Staff Communication and Response System.

6. Each resident washroom must have an entrance width of at least thirty-six (36)inches (914 mm).

7. When open, a washroom door must not block the bedroom entrance-way andmust not swing into another door in the bedroom, such as the bedroom dooritself or a clothes closet door.

8. Each washroom must have counter space.

9. There must be space in each washroom for individual storage of eachresident’s personal items. When two residents share a washroom, separatestorage space must be available for each resident.

10. If a lock is to be installed on a washroom door, the lock must be readilyreleasable and easily openable.

11. The sink in each washroom must be positioned so that it meets the needs ofthe resident or the residents using the washroom, (for example, thoseresidents in wheelchairs).

12. Taps must be easy to use by residents with visual impairments and byresidents with physical disabilities that affect hand movement.

13. All washroom surfaces must be easily cleaned. In addition, all floor coveringsmust be slip-resistant.

14. Walls where grab bars are mounted must be appropriately reinforced toensure that they are capable of sustaining loads imposed on them.


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1. Each washroom should have a mirror which is preferably located over the sinkand is adjustable to accommodate residents of differing heights. Whendetermining the need and location of mirrors in washrooms, considerationshould be given to the disorientation that mirrors may cause for residents withsevere dementia. For some residents, depending on their care requirements,mirrors may be inappropriate.

2. A night-light outlet should be provided in the bedroom near the doorway to thewashroom in a location where, if a night-light is used, the light is visible fromeach bed.

3. There should be an illuminated light-switch for the washroom located in thebedroom on the wall by the washroom entrance.

4. In order to assist a resident to easily identify and locate the washroom,consideration should be given to painting the washroom door and the doorframe a colour that contrasts with the colour of the bedroom wall.

5. From a resident preference and aesthetic standpoint, consideration should begiven to installing raised toilet seats as needed, rather than providing raisedtoilets in all washrooms.

6. The exhaust and air exchange rates in washrooms should exceed therequirements of the Ontario Building Code regulations to ensure appropriateventilation in washrooms and to keep odours to a minimum.

7. An exterior light or other sign which can be activated when the washroom isoccupied should be provided outside of each washroom door.

8. Lever handled taps that clearly distinguish between hot and cold water shouldbe used in all resident washrooms. This type of fixture is the preferred modelfor residents with visual impairments and for residents with physicaldisabilities that affect hand movement.

9. Sharp edges on counters, cabinets and corners in washrooms should beavoided.

10. If the washroom door is to be a sliding door, two factors to consider are:• the weight of the door (to make sure that it is easy to move); and


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• the location of the hardware (to avoid injuring caregivers’ backs andgetting hands caught when the door slides).

11. Although the minimum design standard for the location of the toilet is accessfrom the front and at least one side of the toilet, this does not precludeproviding access to the toilet from the front and both sides of the toilet. Forsome residents, access to three sides of the toilet may be necessary to meetcare requirements.

3. RESIDENT BATH ROOMS AND SHOWER ROOMS

Design Objective:

Resident Bath Rooms and Shower Rooms must be safe, private andcomfortable for residents. They must also be designed so that caregivers caneasily and safely assist residents to bathe or shower in a manner that protectsresident dignity and promotes resident independence as much as possible.

Design Standards:

1. Each Resident Home Area must have as a minimum:

• one separate room with a raised bathtub equipped with a hydraulic,electric or mechanical lift (Note: A side-entrance bathtub may beprovided as an alternative to a raised bathtub with a hydraulic lift);

• one separate room with a shower ( the showering area must havesufficient space to accommodate a shower chair so that a resident canbe showered in the sitting position); and

• a “barrier-free” washroom (including a toilet and a sink) located either ineach bath room and shower room, or in a separate and enclosedcommon area which is between the bath and the shower rooms.

2. Where the Resident Bath Rooms and Shower Rooms are connected, thelayout of each Resident Bath Room and Shower Room must allow forvisual and acoustic privacy between the shower, the toilet and the bathtubarea. If the Resident Bath Rooms and Shower Rooms are in twocompletely separate rooms, there must be visual and acoustic privacybetween the toilet and bathtub or shower.


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3. There must be no direct view of the bathtub, the shower or the toilet from thecorridor outside of each Resident Bath Room and Shower Room.

4. There must be a device located at each bathtub, shower and toilet in eachResident Bath Room and Shower Room which will activate theResident/Staff Communication and Response System.

5. The toilet in or adjoining each Resident Bath Room and each ShowerRoom must be positioned so that independent and/or assisted transfer fromat least the front and one side of the toilet can occur.

6. There must be a securely fastened grab bar for use by residents at each toiletand on at least one wall in each shower stall.

7. The bathtub in each Resident Bath Room must be located so that there isaccess to three (3) sides of the bathtub.

8. All Resident Bath Rooms and Shower Rooms must be equipped with devices(s)/system(s) to maintain the room temperature at a comfortable levelfor residents while bathing.

9. All surfaces in the Resident Bath Rooms and Shower Rooms must beeasily cleanable.

10. To ensure resident and staff safety, all floor surfaces in the Resident BathRooms and Shower Rooms must be slip-resistant.


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1. To assist residents with visual impairments and cognitive difficulties to identifythe fixtures and features in the shower stall, the floor of each shower stallshould be visually distinct from the walls, for example, by using contrastingfloor tiles.

2. In the interest of resident comfort, privacy and dignity, there should beseparate areas in the Resident Bath Rooms and Shower Rooms whereresidents can be dressed and groomed after their bath or shower.

3. Resident Bath Rooms and Shower Rooms should have sufficient space tostore towels, washcloths, soap, shampoo and other bathing accessories.

4. Resident Bath Rooms and Shower Rooms should have secure areas tostore cleaning supplies for the cleaning and sanitizing of bathtubs, showers,toilets and handwash basins.

5. Resident Bath Rooms and Shower Rooms should have space to storewheelchairs, the shower chair and any other devices that are used to assistcaregivers to manoeuvre residents on and off toilets, and into and out ofshowers and bathtubs.

6. The exhaust and air exchange rates in Resident Bath Rooms and ShowerRooms should be over and above the Ontario Building Code regulations toensure appropriate ventilation, and to keep odours and humidity levels to aminimum.

7. To promote resident comfort and safety, all surfaces in Resident Bath andShower Rooms should be non-glare.

8. If a side-entrance bathtub is installed, it should be a “quick-filling” model toensure resident comfort.

9. In the interest of resident safety and sense of security, bathtubs with grab barsbuilt into the design should be considered.

10. Resident Bath Rooms and Shower Rooms should have moisture-resistantlight fixtures.


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11. Whenever possible, natural lighting should be provided in Resident BathRooms and Shower Rooms to provide for a more pleasant and comfortablebathing experience. Residents’ privacy can be assured through the use ofwindow curtains, window blinds, frosted windows and skylights.

12. Consideration should be given to providing a hair washing sink in at least oneResident Bath Room or Shower Room in each Resident Home Area.


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SECTION THREE: FACILITY AND STAFF SUPPORT SPACE INTHE RESIDENT HOME AREA(S)

1. WORK SPACE FOR NURSING AND PROGRAM/THERAPY STAFF INEACH RESIDENT HOME AREA

Design Objective:

The provision of resident care involves planning, assessing, communication,evaluation and implementation of care. The work space for staff in each ResidentHome Area must be designed to support a well-coordinated, multi-disciplinary caresystem that will allow staff to meet residents’ care and treatment needs in anefficient and effective manner.

It must also be designed so that it can readily be identified by residents, staff,visitors and others as an “information centre” or an area where “staff contact” can bemade.

Design Standards:

1. Each Resident Home Area must have Work Space for Nursing andProgram/Therapy Staff to allow staff to carry out their administrative duties. The space must accommodate:

• secure storage of resident care records (includes nursing care plans andmedical histories);

• multidisciplinary team activities; and

• a work area to complete documentation.

2. The Work Space for Nursing and Program/Therapy Staff must be easilyrecognized by residents, other staff, visitors and others as, for example, an“information centre” or “staff contact” area.

3. There must be space in each Resident Home Area, or in a centrallyaccessible area to each Resident Home Area, to support the delivery oftherapeutic programs such as podiatry, dental, ophthalmology, social andpsychiatric services, as well as required medical services that cannot beprovided at the bedside.


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4. In areas where therapeutic programs are delivered, there must be convenientaccess for residents to a “barrier-free” two (2) piece washroom (toilet andsink) that is separate from resident bedroom washrooms.


1. The use of sound-absorptive materials for walls, floors, and ceilings should beconsidered for all administrative and meeting areas where privacy is required.

2. Providing a room where resident family members and others could stayovernight in the long-term care facility should be considered. This can be aroom used for other functions which can be easily converted to a sleepingarea.

3. A hand washing area should be conveniently located in proximity to the WorkSpace for Nursing and Program/Therapy Staff.

2. STORAGE SPACE FOR RESIDENT CARE SUPPLIES ANDEQUIPMENT IN RESIDENT HOME AREAS

Design Objective:

Space is required for the storage of medications, and for the supplies andequipment required to provide care and treatment for residents in each ResidentHome Area. Medications and nursing care supplies/equipment must be stored in aplace where they are readily accessible to caregivers, but must not intrude on theresident’s personal space.

Design Standards:

1. The Storage Space for resident care supplies and equipment must beconvenient and accessible to the staff working in each Resident Home Area.

2. Resident medications must be stored in a secured space either within oneResident Home Area or shared between Resident Home Areas.

3. Secure space with lockable cupboards must be provided for the storage of allsupplies and equipment related to care delivery, as well as for stock


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medications related to the pharmacy services. This space must be convenientand accessible to the staff working in each Resident Home Area.

4. If oxygen therapy is offered as part of the facility’s program delivery, dedicatedspace for storage of oxygen must be provided in a location that is convenientand accessible to staff working in the Resident Home Area(s). The storageof oxygen must comply with the fire safety requirements set out in the OntarioFire Code and related provincial regulations.


1. The shelving in storage rooms should be adjustable, rust proof and easilymaintained/cleaned.

2. Consideration should be given to providing a well ventilated and separatearea for the recharging of batteries on wheelchairs. Wheelchair batteriesshould not be recharged in resident bedrooms because of potential explosivedangers and release of noxious fumes.


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SECTION FOUR: RESIDENT LOUNGE ANDPROGRAM/ACTIVITY SPACE

1. RESIDENT LOUNGE AND PROGRAM/ACTIVITY SPACE

Design Objective:

Residents’ lounges should be comfortable and designed so that residents caninteract in a relaxed atmosphere with other residents, family members and visitors. The lounges must be designed for conversation, reading, and other social activities.

Program and activity areas should accommodate a variety of resident focusedactivities, and should support social functions which promote resident quality of life.

Design Standards:

1. The minimum total required space for Resident Lounge andProgram/Activity Space is 27 square feet (2.5 square metres) per resident.

2. There must be at least one Resident Lounge provided in each ResidentHome Area that has a minimum of 120 square feet (11.15 square metres) oftotal floor area.

3. There must be at least one Resident Program/Activity Area provided ineach Resident Home Area that has a minimum of 120 square feet (11.15square metres) of total floor area.

3. At least 70% of the total required space per resident for Resident Lounge and Program/Activity Space must be located within each Resident HomeArea. Up to 30% of the total required space may be used to support otherdefined programs and may be located either within or outside of the ResidentHome Areas.

4. Each Resident Lounge must have a device which will activate the Resident/Staff Communication and Response System and eachResident Program/Activity area must have a device which will activate the Resident/Staff Communication and Response System. Where thelounge and the program activity space are integrated, it is required to haveonly one device which will activate the Resident/Staff Communication andResponse System located in that area.


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6. At least one Resident Lounge in each Resident Home Area must have awindow with a direct view to the outside or to a naturally lit area.

7. Resident Program/Activity Areas must have convenient access to a“barrier-free” washroom (toilet and sink) that is separate from and not locatedin a resident bedroom.

IMPORTANT - PLEASE NOTEALLOCATION OF RESIDENT LOUNGE

AND PROGRAM/ACTIVITY SPACE

At least 70% of the required Resident Lounge and Program/Activity Spacefor each Resident Home Area must be located in that Resident Home Area. Up to 30% of the remaining required space for the Resident Lounge andProgram/Activity Space may be located either within or outside of the ResidentHome Area(s). As an option to using the 30% remaining space for Resident Lounge andProgram/Activity Space, it is acceptable to use the 30% remaining space forother defined programs. Examples of acceptable re-allocation of this spaceinclude:• providing larger resident bedrooms to support provision of a palliative

care program;• enlarging a dining room to support a program/activity such as a domestic

kitchen; or• enlarging a bathing “spa” to address resident needs or requests.Re-allocation of the 30% required space must be determined during theconstruction plans development stage. Decisions in this regard must bemade based on the care, program and service requirements of the residents to beaccommodated. The Ministry of Health shall review all requests for re-allocationResident Lounge and Program/Activity Space. Approval shall be given to any concept which enhances the living environment for residents andsupports quality care outcomes.



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1. When decorating Resident Lounges and Resident Program/ActivitySpace, consideration should be given to using decorating products thatminimize sound and glare, and that create a “home-like” environment, forexample, carpets, blinds, curtains and wallpaper.

2. Task lighting for activities such as reading should be provided in all ResidentLounge and Resident Program/Activity Space.

3. Different sizes and designs of Resident Lounge areas - from private nooksfor intimate conversation to larger common areas for groups - should beprovided.

4. Resident Lounges areas should be designed for clustered rather than linearseating to allow resident conversations and activities to take place.

5. Resident Lounges areas should include display space to support thecreation of a “home-like” environment.

6. Resident Program/Activity Area(s) may be located adjacent to ResidentLounge areas or Dining Area(s) to provide:

• a resident kitchen combined with a lounge where residents may entertainvisitors or ;

• an overall common area subdivided into dining, kitchen, activity, andlounge to encourage a domestic ambience.

7. Where resident-accessible electrical appliances are provided, deactivationswitches should be on the appliances to ensure resident and staff safety.


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SECTION FIVE: DINING AREA(S) AND DIETARY SERVICESPACE

1. RESIDENT DINING AREA(S)

Design Objective:

All Dining Area(s) for use by residents should incorporate design features thatpromote a “home-like” ambience and that reinforce “familiar” eating patternsassociated with smaller social gatherings. Efforts shall be made to minimize noisein Dining Area(s) through the provision of finishes that reduce reflected noise andincrease sound absorption. The design of the Dining Area(s) must also reflect andrespond to the changing physical needs of residents.

Design Standards:

1. Each Resident Home Area must have dedicated space for dining, separatefrom any other type of space.

2. The minimum required space for Dining Area(s) for the long-term care facility is calculated based on 30 square feet (2.8 square metres) of floor area perresident, excluding servery space.

3. At least 80% of the total required space for Dining Area must be locatedwithin the Resident Home Areas and allocated based on the number ofresidents in each Resident Home Area. For example, for a Resident HomeArea with 20 residents, the total required Dining Area is 600 square feet; 80% of the 600 square feet, or 480 square feet, must be located in thatResident Home Area.

4. Up to 20% of the total required space for Dining Area(s) may be locatedoutside of the Resident Home Area(s) to support alternative diningprograms.

5. Each Dining Area must have a device that will activate the Resident/StaffCommunication and Response System.


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6. Each Dining Area must have convenient access to a separate “barrier-free”two-piece washroom (toilet and sink), that is not located in a residentbedroom and that does not open directly into food preparation or dining areas.

7. Each Dining Area must incorporate storage space for equipment/supplies asnecessary.

8. Each Dining Area must have a handwash sink either in the Dining Area orimmediately adjacent to the Dining Area for use by staff involved in thepreparation, delivery and service of food to the residents.

9. Each Dining Area must provide a direct view to the outdoors or other naturallylit space.

10. Each Dining Area must provide a servery area for assembling and servingmeals. If the Dining Area is located immediately next to the kitchen, thekitchen can be used for the servery function.

11. A separate housekeeping/janitor’s closet (with a sink) to store the suppliesand equipment used to clean each Dining Area must be provided near eachDining Area.


1. Adequate space for temporary storage of wheelchairs and walkers should belocated near the Dining Area(s).

2. When decorating the Dining Area(s), wall decorations, window treatments(that is, blinds and curtains) and room finishes (for example, wallpaper, trim,wainscoting) that create a “home-like” environment should be used.

3. Consideration should be given to providing additional space for visitors to stayand have a meal with a resident or a group of residents.

4. Dining Area tables should accommodate no more than four (4) persons toencourage socialization and interaction between residents at meal times.

5. To provide resident comfort and security while eating, Dining Area chairsshould have arms.


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6. Consideration should be given to locating at least one Dining Area on groundlevel, adjacent to an easily accessible Outdoor Area.

7. Dining Area(s) should have finishes and features which reduce reflectednoise and increase sound absorption, for example, window curtains, woodfinishes, wall, ceiling and floor finishes.

8. Dining Area(s) should include architectural, electrical and equipment featureswhich permit the area to be subdivided for special occasions.

9. All surfaces in Dining Areas must be smooth, easily cleanable and moistureresistant.

2. DIETARY SERVICE SPACE

Design Objectives:

The design of the Dietary Service Space must facilitate the delivery of a qualityfood service program that responds to residents’ physical, social and nutritionalcare needs. The design of the Dietary Service Space must also be flexibleenough to respond to changing dietary service models, to different cultural andtherapeutic dietary requirements and to different food preparation methods.

Decisions regarding the type of meal service program and the equipmentnecessary to support that program must be determined prior to designing theDietary Service Space.

In addition to serving residents of the long-term care facility, the Dietary ServiceSpace may also be used to provide dietary services to other types of facilities (forexample, residential facilities such as retirement homes/rest homes and supportivehousing units), or other community support service programs (for example, meals-on-wheels or non-resident community dining programs).

Dietary Service Space must accommodate the receiving and storage, as well asthe preparation of food products and goods for the dietary program and delivery ofmeals/snacks to the residents of the facility.

Design Standards:

1. Dietary Service Space must be provided to accommodate the equipmentrequired to support the facility meal service program. The equipment to be


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provided must be appropriate in size and design to prepare and serve avariety of food products and beverages that meet the nutritional care needs ofresidents, retain the texture, colour and palatability of food items and allow thefacility to meet the cultural requirements, therapeutic needs and foodpreferences of all of the residents of the long-term care facility.

2. The design of the Dietary Service Space must provide for a layout that:allows for an efficient work flow; prevents cross-contamination between cleanand soiled areas; and, supports production and delivery of food in a safemanner.

3. The design of the Dietary Service Space must allow for the preparation of arange of food products prepared in a variety of methods.

4. The design of the Dietary Service Space must support the delivery of a bulkfood service system to the Dining Areas so that meals can be served byindividual course.

5. The design of the Dietary Service Space must include serving areas adjacentto the Dining Area(s) so that residents have the opportunity to see and smellfood, snacks can be prepared, and residents can make food choices at thepoint of meal service.

6. There must be storage space for non-refrigerated (dry) goods and suppliesthat meets usual and peak capacity volume storage requirements. Thisstorage space must be well ventilated, have a temperature control system thatcan keep the temperature between 10 and 20 degrees Celsius, and bedesigned to prevent goods from being exposed to pipes, motors, condensersand direct sunlight.

7. There must be storage space for refrigerated and frozen food supplies. Thisstorage space must meet usual and peak capacity volume storagerequirements.

8. The Dietary Service Space must be designed so that the storage areas forsmall equipment and utensils and for non-refrigerated and frozen food, areconveniently located for easy access and use by dietary staff. Storage areasmust be in close proximity to dietary work areas.

9. The Dietary Service Space must provide secure storage space forchemicals, cleaning supplies and equipment used to clean the Dietary


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Service Space (for example, kitchen mops and pails) and equipment used todelivery meals and snacks to residents, (for example, food carts).

10. The Dietary Service Space must include a separate housekeeping/janitor’scloset that is equipped with a “curbed sink”.

11. The Dietary Service Space must include convenient access to electricalservices and to hot and cold water supply services.

12. The Dietary Service Space must include hand washing area(s).

13. The Dietary Service Space must provide, depending upon the food serviceprogram, space for scraping, soaking, pre-rinsing, washing, rinsing, sanitizing,air drying and sorting of dishes, pots/pans, utensils, large equipment andcarts.

14. The Dietary Service Space must provide separate and sufficient space forgarbage cans/recycling bins.

15. The Dietary Service Space must be designed in a manner that minimizesexcessive noise, steam, and heat.

16. The Dietary Service Space must include adequate floor drainage.

17. The Dietary Service Space must include a work area for dietary staff that:• is secure for records and references;• accommodates appropriate furnishings and equipment; and• is accessible without passing through the food production area.


1. Consideration should be given to involving a food design consultant in theplanning of the food service program and in the designing of the DietaryService Space.

2. Where other services/programs share Dietary Service Space, (for example,meals-on-wheels), additional Dietary Service Space should be provided asappropriate to accommodate the needs of these services/programs withoutcompromising the level of service required for the residents of the long-termcare facility.


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3. When designing the Dietary Service Space, the extent to which meals will beprepared centrally and the extent to which meals will be prepared in adecentralized location should be considered. Dietary Service Space will beallocated differently if all foods are prepared in a central kitchen versus akitchenette or servery located in a Resident Home Area. While centralizedproduction provides for the greatest control of quality food preparation,decentralized production maximizes individual service to the residents andpromotes a “home-like” atmosphere.

4. Food preparation is a familiar activity of daily living and can be part of a“home-like” environment. If possible, the Dietary Service Space should bedesigned to allow residents to view and visit the cook to discuss foodpreferences and other dietary issues.

5. Flooring in all Dietary Service Space areas should be non-slip and wallsshould be moisture resistant.

6. The design of the Dietary Service Space should incorporate some flexibilityso that the food service program can be adjusted/changed as residents’needs change.

7. Consideration should be given to the cost benefits of providing for centralizedwarewashing versus de-centralized warewashing.

IMPORTANT - PLEASE NOTEONTARIO FOOD PREMISES REGULATION

The Kitchen of a long-term care facility must comply with the design standards setout in the Ontario Food Premises Regulation under the Health Promotion andProtection Act. This Regulation is administered by municipal authorities; anyquestions related to the regulatory requirements under this legislation should bedirected to the applicable local Public Health Unit/Department.


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SECTION SIX: RESIDENT COMMUNITY SPACE

1. OUTDOOR SPACE

Design Objective:

The Outdoor Space must be designed to provide a safe environment for residentsin which they can enjoy the outdoors. Outdoor Space for use by residents must belandscaped and provide walkways, shaded areas and seating areas.

Design Standards:

1. The distance measured from the entrance of the Outdoor Space to thefarthest resident bedroom must be no more than 200 feet (61 metres).

2. In a multi-storey facility, Outdoor Space on floors above ground level can bea balcony or a roof terrace.

3. For all long-term care facilities, there must be some Outdoor Spaceaccessible at grade level. It is up to the operator, in conjunction with thearchitect, to determine the size and location of this Outdoor Space.

4. At least one Outdoor Area must be enclosed to prevent wandering/egress ofresidents. For multi-storey buildings, the requirements of the Ontario BuildingCode will define the design and safety features of Outdoor Space on thefloors above ground level.

5. There must be at least one Outdoor Area that is directly accessible from aDining Area, a Lounge or Program/Activity Area.

6. The landscaping and design of Outdoor Space must consider the safetyneeds of residents.

7. Each Outdoor Area must have a separate area that provides shade and isprotected from wind and other harsh weather elements.


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1. Brick pavers in any circulation areas should be avoided because they cancause tripping.

2. Inclines and steps in any circulation areas should be avoided.

3. Consideration should be given to incorporating a Resident/StaffCommunication/Response System in at least one Outdoor Area.

4. When decorating and landscaping Outdoor Space, consideration should begiven to such residential features as fencing, outdoor furniture and raisedflower beds.

2. BEAUTY PARLOUR/BARBER SHOP

Design Objective:

The long-term care facility must have a Beauty Parlour/Barber Shop that isavailable to all residents.

Design Standards:

1. The Beauty Parlour/Barber Shop must have a device which will activate theResident/Staff Communications and Response System.

2. There must be sufficient space to include hairdressing chairs, work andstorage counters, secured storage space for chemicals and a hair dryingarea.


1. A shampoo chair should be provided that allows residents to have their hairwashed either leaning forward over the basin, or leaning back.

2. A drying chair (chair equipped with a hooded dryer) should be provided.


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3. An adequate number of conveniently located electrical outlets should beprovided.

4. There should be additional exhaust ventilation to control odours from thehairdressing process.

3. PLACE OF WORSHIP

Design Objective:

Each long-term care facility needs to support and assist residents in maintainingtheir spiritual beliefs, religious observances, practices and affiliations. Space for aPlace of Worship gives residents space for individual private thought and spiritualcomfort.

Design Standards:

1. Each facility must provide space for the purposes of worship. It is up to theoperator, in consultation with the architect, to determine the size, location anddesign of this space. The sponsoring agency/architect has the option of usingup to 30% of the required space for Resident Lounge and Program/ActivitySpace to support the provision of space for a Place of Worship.

Functional Considerations/Recommendations

1. The Place of Worship should be designed to respond to the multi-denominational aspects of a facility’s resident population.

4. ENHANCED RESIDENT SPACE

Design Objective:

If all of the required Resident Lounge and Program/Activity Space is located in theResident Home Areas, there must be at least one additional area located outside of theResident Home Areas for use by all residents of the facility. The additional area willprovide residents with opportunities to leave the Resident Home Areas and meet andinteract for social purposes. (See Section Four: Resident Lounge and Program/Activity Space for the minimum space requirements).


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Design Standards:

1. One additional area must be located outside the Resident Home Area(s) ifall of the required Lounge Space and Program/ Activity Space is located inthe Resident Home Area(s). It is up to the operator in consultation with thearchitect, to determine the size, location and design of Enhanced ResidentSpace.

2. A device must be provided in this area which will activate the Resident/StaffCommunication and Response System for the long-term care facility.


1. Where Enhanced Resident Space is provided outside the Resident HomeAreas, a “barrier-free” washroom (toilet and sink), complete with an activationdevice connected to the Resident/Staff Communication and ResponseSystem for the long-term care facility, should be provided in that area.

2. Examples of Enhanced Resident Space include, but are not limited to, anexercise room, a library, family dining room, or a cafe.


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SECTION SEVEN: ENVIRONMENTAL SERVICES

1. LAUNDRY SPACE

Design Objective:

The Laundry Space must be designed to meet the daily laundry requirements of allresidents of the long-term care facility. These requirements include laundryservices for linens, towels and personal clothing.

Design Standards:

1. The Laundry Space must be able to accommodate industrial washers anddryers of appropriate size and capacity to meet the laundry service needs ofthe long-term care facility. If laundry services are shared with other programs,(for example, an adjoining rest/retirement home) the size of the laundry mustbe able to accommodate maximum service volumes.

2. The Laundry Space must be designed so that there is access to all sides ofthe equipment (including washers, dryers and chemical dispensers) to ensureeasy cleaning and repair work as necessary.

3. The Laundry Space must be designed so that there is separation of and aone way work flow between clean and soiled areas.

4. The Laundry Space must be equipped hand wash facilities which are conveniently located for staff use.

5. The Laundry Space must include space for the collection, storage and sortingof soiled laundry until it can be processed.

6. The Laundry Space must have space for all aspects of the launderingprocess including storing, folding, hanging of clean linen/personal clothing andlabelling of personal clothing.

7. If an off-site laundry service is used, there must be separate space in the long-term care facility for soiled linen storage, and for receiving and delivering linen.

8. The Laundry Space must have access to a separate area for the cleaningand sanitizing of laundry equipment such as baskets, carts and bags.


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9. The Laundry Space must include storage space for supplies and equipmentused for the laundry services.

10. There must be administrative space for supervisory staff to completeadministrative functions (may be combined with other administrative space inthe long-term care facility).

11. There must be floor drainage in the Laundry Space.

12. All surfaces in the Laundry Space must be easily cleanable and impermeableto moisture.

13. Floors in the Laundry Space must be non-slip to ensure staff safety.


1. Where an off-site laundry service is used, consideration should be given toproviding a refrigerated storage area for soiled laundry. This area should bedesigned so that it can be routinely washed down.

2. Consideration should be given to providing space for domestic laundry equipment to do personal laundry within the Resident Home Area(s). Thisequipment would be for use by residents, family and/or staff.

2. HOUSEKEEPING SERVICE SUPPORT SPACE

Design Objective:

Space dedicated to the housekeeping services for the long-term care facility mustbe designed to promote efficient and well-organized cleaning programs in order toensure a clean and safe environment for all residents, staff, family, and visitors.

Design Standards:

1. Housekeeping/janitor’s closets must be located both in and outside the Resident Home Areas to support the housekeeping requirements, as well asthe cleaning equipment and cleaning supply storage requirements, for thelong-term care facility.


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2. Each housekeeping/janitor’s closet must have sufficient space and provide forthe secure storage of chemicals and other cleaning supplies and havesufficient space for chemical dispensing units, storing carts and otherhousekeeping equipment, such as mops and pails.

3. Each housekeeping/janitor’s closet must be equipped with a hot and coldrunning water supply, a “curbed service sink” with a floor drain, a handwashsink and floor drain(s), and have sufficient space for the collection, sorting andpick-up of garbage.

4. All surfaces (including floors, walls, ceilings and shelves) in eachhousekeeping/janitor’s closet must be smooth, easily cleanable andimpermeable to moisture.

5. There must be administrative space for supervisory staff to completeadministrative functions (may be combined with other administrative space inthe long-term care facility).


1. Housekeeping/janitor’s closets should be located so that the transporting ofwaste and garbage through resident care and resident common areas isavoided.

2. Housekeeping/janitor’s closets should be located close to areas of highestuse, for example, close to Resident Bath Rooms and Shower Rooms andcommon “public” washrooms.

3. It is recommended that there be a recycling program for waste and garbage inaccordance with local municipal requirements.

3. UTILITY SPACE

Design Objective:

Clean and soiled Utility Space must be designed to facilitate a clean, safe andefficient working environment that prevents the risk of cross-contamination betweenclean and soiled items/areas.

Design Standards:


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1. Clean and soiled Utility Space must be conveniently located in eachResident Home Area to support the requirements for storage, cleaning andsanitizing of nursing care/therapy equipment.

2. Clean and soiled Utility Space must be large enough to contain all fixturesthat are used for cleaning, sanitizing and storing nursing care equipment. Fixtures include, for example, a hopper sink, a bedpan flusher and/or sterilizer,rinse sinks, storage racks, counters and cupboards.

3. All clean Utility Space must have a secured space for the storage of cleaning supplies and equipment, as well as counter space.

4. All soiled Utility Space must have sufficient space for the storage of theequipment used for collecting soiled supplies (for example, soiled linen andtowels), and for garbage cans/recycling bins.

5. All clean and soiled Utility Space must have at least one conveniently locatedhandwash sink for staff use.

6. All soiled Utility Space must have floor drains.

7. The surfaces in clean and soiled Utility Space must be smooth, easy to cleanand impermeable to moisture.

8. All floors in clean and soiled Utility Space must be non-slip to ensure staffsafety.


1. Ventilation standards in Utility Space should exceed the Ontario BuildingCode requirements in order to support an odour-free environment and to keepnoxious odours to a minimum.

2. Space should be provided for the temporary storage of soiled linen carts in thesoiled Utility Space(s).

3. Where laundry chutes are provided, they should be in areas only accessible tostaff, for example, in locked areas.

4. MAINTENANCE SERVICE SUPPORT SPACE

Design Objective:


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The design of the facility must incorporate Maintenance Service Support Spaceto support ongoing maintenance activities for the up-keep of equipment, furnishingsand other building contents.

Design Standards:

1. There must be dedicated Maintenance Service Support Space provided inthe long-term care facility, separate from resident personal space and diningspace, to conduct repairs on equipment, furnishings and other buildingcontents.

2. There must be an area within the Maintenance Service Support Space forthe storage of small and large maintenance equipment, machinery and tools.

3. There must be a secured area within the Maintenance Service SupportSpace to store hazardous materials and equipment.

4. There must be a secured area, inaccessible to residents, for locatingenvironmental controls and other building system controls.

5. An emergency-generator power supply must be available to support essentialbuilding systems.

Functional Recommendations/Considerations:

1. Space should be provided for maintenance staff to conduct administrativefunctions, (this space may be combined with or located near otheradministrative space).


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SECTION EIGHT: SAFETY FEATURES

1. RESIDENT/STAFF COMMUNICATION AND RESPONSE SYSTEM

Design Objective:

The Resident/Staff Communication and Response System must be provided inthe long-term care facility to give staff and residents the ability to alert other staffmembers when assistance is required. This system must be designed to facilitateprompt response to a resident or staff request. The system must not be intrusive.

Design Standards:

1. The Resident/Staff Communication and Response System must be anelectronically-designed system which is equipped with activation devices thatare easily accessible, simple and easy to use by all residents and staff.

2. The Resident/Staff Communication and Response System must be “ON”at all times and be connected to the back-up generator.

3. When any activation device for the Resident/Staff Communication andResponse System is activated, it must clearly indicate where the signal iscoming from so that staff can promptly respond.


1. If the Resident/Staff Communication and Response System uses soundto alert staff, the level of sound should be controlled so that it is not excessiveand disruptive, and is equally distributed in the areas that it covers.

2. Before installing the Resident/Staff Communication and ResponseSystem, all areas where the activation devices will be located should bechecked to ensure that the activation devices are located at the point of need.

3. A Resident/Staff Communication and Response System that requires avoice response when activated is not recommended for residents who have cognitive and sensory impairments.

2. DOOR ACCESS CONTROL SYSTEM

Design Objective:


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A safe and secure environment must be provided for all residents and staff of thelong-term care facility. Controls must be provided at all doors which exit from theresident areas of the long-term care facility so that access into the building can becontrolled when necessary.

Design Standards:

1. The Door Access Control System must conform to all relevant provincialand municipal codes and regulations, including but not limited to the OntarioBuilding Code and the Ontario Fire Code.

2. The Door Access Control System must be “ON” at all times.

3. The Door Access Control System for all exits from resident areas mustprevent unauthorized entering or exiting from the long-term care facility.

4. Electro-magnetic locking devices (or alternative means of achieving the sameresult) must be on all doors leading to stairways, secured areas and to theoutdoors, subject to compliance with the Ontario Fire Code and the OntarioBuilding Code.

5. Electro-magnetic “hold-open” devices must be on doors that are requiredunder the Ontario Fire Code to be equipped with self-closing hardware. (Consultation with the local fire department may be required).


1. Doors in non-resident areas, for example the kitchen and laundry, should beequipped with electro-magnetic “hold-open” devices to facilitate the provisionof services to resident care areas.

3. FIRE ALARM SYSTEM

Design Objective:


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A safe and secure environment must be provided for all residents and staff of thelong-term care facility. The environment must include a Fire Alarm System thatenables prompt response to emergency situations.

Design Standards:

1. The Fire Alarm System must conform to all relevant provincial and municipalcodes and regulations, including but not limited to the Ontario Building Codeand the Ontario Fire Code.


1. During the initial planning stages of the project, the Office of the Ontario FireMarshal and with local authorities should be consulted regarding fire safetyprecautions/requirements and development of fire safety policies andprocedures.

4. WATER TEMPERATURE CONTROL SYSTEM

Design Objective:

Water temperatures in areas used by residents must be maintained at levels thatsupport resident safety and comfort.

Design Standards:

1. The Water Temperature Control System must be designed to ensure hotwater provided to resident care areas is at a safe and comfortabletemperature for residents. (cross-reference the “Long-Term Care FacilityProgram Manual”, Environmental Services, Section “0": Criteria O1.16)


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SECTION NINE: BUILDING SYSTEMS

1. LIGHTING SYSTEMS

Design Objective:

Adequate lighting must be provided for residents, staff and visitors so that they cancarry out their activities in comfort and safety. Lighting design must address age-related vision loss and diminished visual acuity (sharpness). Lighting must bedesigned and located in a manner that meets residents’ needs as sensoryorientation diminishes.

Design Standards:

1. There must be a minimum of 215.28 lux of continuous lighting levels in allcorridors.

2. There must be continuous lighting levels of at least 322.92 lux in enclosedstairways.

3. There must be general lighting levels of at least 215.28 lux in all other areas ofthe facility including resident bedrooms and washrooms.

4. General illumination must be provided at all entrance doors to residentaccessible rooms, e.g., bedroom entrance doors.

5. Task lighting which is adjustable in intensity, location and direction must beprovided in bedrooms and common areas.

6. The back-up emergency generator must support essential lightingrequirements.


1. The types of lighting fixtures and their location should be determined based onthe activities/tasks of specific areas.

2. All lighting fixtures that are capable of producing a direct glare should beshaded.


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3. Skylights and windows that could create large patches of distracting light onthe floor should be shaded.

4. Window coverings, such as blinds, curtains and canopies, which reduce theglare from the outdoors without eliminating views should be provided.

5. A light should be installed inside each clothes closet which is activated by theopening of the clothes closet door.

6. Wall-mounted light switches should not exceed 41 inches (1040mm) abovethe level of the floor so that the switches are at a height that can be easilyreached by residents.

2. HEATING, VENTILATION AND AIR-CONDITIONING (HVAC)SYSTEM

Design Objective:

Air temperatures must be maintained within a range that optimizes resident comfortthroughout the year.

Design Standards:

1. The HVAC System must comply with all relevant regulations and standardsset by governing authorities, including but not limited to the Ontario BuildingCode, Canadian Standards Association, National Fire ProtectionAssociation and the American Society of Heating and Refrigeration and Air-Conditioning Engineers (ASHRAE).

2. A mechanical system to cool air temperatures must be provided in allLounges Areas, all Dining Areas, all Program/Activity Areas, the kitchenand the Laundry Space. The remaining areas of the long-term care facility,including the Resident Bedrooms, the Resident Bath Rooms and ShowerRooms and Resident Washrooms, must have a system for tempering theair to maintain air temperatures at a level that considers residents’ needs andcomfort.

3. Negative air pressurization of the washrooms, soiled Utility Space, kitchenand Laundry Areas must be provided to ensure odours are contained. All of


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these rooms must be equipped with mechanical ventilation that exhausts airfrom these areas in keeping with Ontario Building Code requirements.

4. The HVAC System must have enhanced exhaust capabilities to maintain acomfortable environment for residents with respect to humidity levels in thebath and shower areas.


1. Recirculation of bedroom air should be avoided.

2. Air-cooled condensers should be used for the mechanical air cooling systemin order to avoid contamination of the water storage unit for the mechanical airsystem.

3. Mechanical noise levels should be maintained at or below NC-30 (noisecurve) in bedrooms and NC-40 in common areas.


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SECTION TEN: OTHER FEATURES

1. RESIDENT DEDICATED STORAGE SPACE

Design Objective:

Residents must be provided with additional and conveniently located storage spacefor frequently used personal equipment, clothing in season and personal and/orcherished items.

Design Standards:

1. Resident Dedicated Storage Space, in addition to clothes closets inbedrooms, must be provided in the long-term care facility so that residentscan store their belongings. Other than the space requirements for residents’clothes closets, there are no minimum space requirements for the storagespace for resident personal belongings. It is up to the operator, inconsultation with the architect to determine the size, design and location ofResident Dedicated Storage Space.

2. The Resident Dedicated Storage Space must provide security for residentbelongings.


1. The amount of space allocated for the storage of resident belongings shouldbe reasonable and based on the needs of residents. It is not expected thatthe long-term care facility provide space for belongings that will not be usedby residents during their stay at the facility. For example, long-term carefacilities do not have to store furnishings from the former residence of aresident.

2. FACILITY STAFF SPACE

Design Objective:

The design of a long-term care facility must include “non-resident” space for use byall staff. This space, exclusive to the use of staff, is for the purpose of administrativefunctions and staff rest periods, as well as storing personal belongings, changingclothes and staff-specific activities.


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Design Standards:

1. A secured storage area(s) must be provided for staff to store personalbelongings.

2. Administrative space, for example, offices for the key staff such as theAdministrator, Director of Care and supervisory staff, must be provided. It isup to the operator, in consultation with the architect to determine the number,size, design and location of administrative space.

3. Administrative space for functions such as banking, sorting mail andclerical/secretarial activities must be provided.

4. An area, separate from resident care and common areas, must be providedfor staff “break” periods.

5. Separate change areas equipped with lockers must be provided for bothmale and female staff.


1. Staff storage space for the personal belongings of staff should be located inclose proximity to the Resident Home Area(s).

2. Sufficient toilets and handwash basins should be provided for all male andfemale staff. The following table is a suggested ratio for provision of stafftoilets and handwash basins.

Number of Male or Female Employees On Each Shift

1 to 9 1 toilet and 1 handwash basin10 to 24 2 toilets and 2 handwash basins25 to 49 3 toilets and 3 handwash basins50 to 74 4 toilets and 4 handwash basins75 to 100 5 toilets and 5 handwash basins

For every additional 30 employees over 100 of each sex, 1 additional toilet and 1additional handwash basin should be provided.


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3. RECEIVING/SERVICE SPACE

Design Objective:

A long-term care facility must have well-organized space to effectively handledelivery of goods, food supplies, dry goods and equipment.

The Receiving/Service Space may be designed to also serve as a staff entrance,ambulance entrance and, where applicable, a Meals-on-Wheels pick-up point.

Design Standards:

1. The Receiving/Service Space must provide year round access for deliveryservices. This entrance must be separate from the main entrance of thelong-term care facility. The Receiving/Service Space may have commonaccess to the property.

2. The Receiving/Service Space must be located away from resident andpublic areas so as not to expose residents and the public to noise, noxiousfumes and safety hazards.

3. Storage space for the temporary accumulation of received goods must beprovided.

4. The Receiving/Service Space must be located where there is convenientaccess to the Dietary Service Space. Direct receipt of goods into the foodpreparation areas must not occur.

5. A separate area for garbage storage and pick-up must be provided in theReceiving/Service Space.

6. The areas used for the cleaning and sanitizing of equipment such asgarbage containers, carts and racks, must have floor drains.


1. The driveway to the Receiving/Service Space should link directly to thepublic road where possible.


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2. The Receiving/Service Space should be conveniently located to generalstorage areas, the Laundry Space and the Dietary Service Space.

3. The exterior of the Receiving/Service Space should have an overhang thatwill provide staff and goods with protection from inclement weather.

4. The Receiving/Service Space should have exterior doors that can belocked to ensure safe storage of goods.

5. The Receiving/Service Space should be equipped with an exterior intercomsystem that will allow delivery persons to alert facility staff when goods havearrived.

6. Consideration should be given to providing refrigerated space for garbagestorage.

4. RECEPTION/ENTRANCE SPACE

Design Objective:

The entrance to the long-term care facility should be designed to be a welcomingintroduction to the long-term care facility, and must be at the front of the long-termcare facility. A seating area for residents should be part of the entrance toencourage residents to view outside activities.

Design Standard:

1. The Reception/Entrance Space must be designed to allow facility staff tomonitor all entering and exiting from the facility.

2. The Reception/Entrance Space must be in proximity to an outside vehicledrop-off area for residents.

3. The Reception/Entrance Space must be designed to support its function asthe “welcoming” area to the facility for residents and the public.


1. The monitoring of the Reception/Entrance Space can be accomplished through the use of electronic or mechanical devices, or by strategicallylocating the office or reception desk by the Reception/Entrance.


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2. The outside doors to the Reception/Entrance Space should be designedso that they do not create drafts, for example, by providing double doors withan enclosed vestibule.

3. The Reception/Entrance Space should include a lounge for residents to sitand rest and observe “comings and goings” of the facility.

5. ELEVATORS

Design Objective:

Elevators located in multi-story long-term care facilities must be designed so thatthey are safe and easy for residents to use. They must be located in areas that areaccessible to residents, staff and the public.

Design Standards:

1. At least one of the Elevators in the long-term care facility must be largeenough to accommodate a stretcher. This Elevator must be located inproximity to the Resident Home Areas.

2. The Elevators must have unobtrusive but effective barriers in areas whereresident access is discouraged (such as building service areas).

4. Elevators must have the capacity for visible and/or audible signals.

5. To accommodate the range of visual and tactile needs of residents, theelevator control panel must contrast with the Elevator walls and must beeasy to read, for example, have large, clear numbers.


1. “Through-lifts”, that is, Elevators with door openings at the front and back,are confusing to many residents.

2. “Visual cues”, such as large floor numbers painted in a colour that contrastswith the wall, and which can be seen from the Elevator door opening, shouldbe provided on each floor.


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6. PUBLIC WASHROOMS

Design Objective:

All Public Washrooms for common use by residents and visitors must be “barrier-free” and must be located in an area which is convenient to the Resident HomeAreas. Residents and visitors must have washrooms in easy access to commonlyused areas to avoid unnecessary travel back to bedrooms when away frombedrooms. Each Public Washroom must have at least one wheelchair accessibletoilet and one wheelchair accessible handwash sink.

Design Standards:

1. There must be clear and easily understood signage identifying all PublicWashrooms.

2. Each Public Washroom must have a lock that is readily releasable andeasily openable to ensure that a person is not accidentally locked into thewashroom.

3. Each Public Washroom must have a device which will activate theelectronic Staff/Resident Communication and Response System.

7. SITE DEVELOPMENT

Design Objective:

The development of a building site involves the physical integration of the long- termcare facility with the neighbouring community. Site configuration must permitdevelopment of access roads, walkways and ”barrier-free” outdoor recreationalareas.

Design Standards:

1. The Site must be developed to include landscaped areas.

2. The design of the Site must include level walkways without curbs or steps tothe Reception/Entrance Area of the facility.

3. Wheelchair accessible parking must be provided in close proximity to theReception/Entrance Area of the facility.


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4. Where the parking lot(s) can be seen from any resident bedroom window(s)on the ground floor, landscaping that will block the view of the parking lot(s)from the windows must be provided.

5. Trees and/or other structures that provide shade must be provided in allresident-accessible areas of the Site.

6. The design of the Site must include unobstructed access to the Site for allemergency vehicles including ambulances and fire trucks.


1. The Site should be in close proximity to medical services, shopping, andrecreational activities in the neighboring community.

2. Access to public transportation is an asset.

3. The use of adjacent lands should be compatible with a long-term care facilityin regard to noise, use of the property, scale of the surrounding buildings onthe lands and zoning.

8. CORRIDORS

Design Objective:

Corridors provide the means for travel throughout the facility for residents, staff andvisitors. The length of corridors should be minimized to provide a more “home-like” environment and reduce travel distance within the facility for residents and staff.

Design Standards:

1. All Corridors in resident areas must be a minimum width of six (6) feet (1.82 metres).


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SECTION ELEVEN: ARCHITECTURAL CONSIDERATIONSANDRECOMMENDATIONS

The choice of architectural features, fixtures and interior decorations can facilitatethe provision of a safe and secure environment for the residents of a long-term carefacility.

Note: This section contains a list of guidelines, considerations andrecommendations about architectural features that could be incorporatedinto the design of a facility to enhance quality of life and promote qualitycare outcomes.

1. As a minimum, the “barrier-free” design specifications set out in the Ontario

Building Code should be incorporated throughout the facility.

2. Doors in all resident areas, such as bedrooms, washrooms, lounge areas,program/active rooms and bath/shower rooms, should have levers or handles thatare easily used by residents.

3. Handrails should be securely mounted on both sides of all corridor walls in allresident areas, and should be located at least 31 inches (860 mm) above the floorso that the handrails are at a height that is within easy reach of the residents.

4. Handrail brackets should be located away from where the resident would grip ahandrail so that the residents’ hands can move freely along the surface of thehandrail. It is suggested that the handrail brackets be mounted at least 2.75 inches(70 mm) below the top of the handrails.

5. Visual, and/or textural “cueing” should be included on signs to assist residents inidentifying different rooms and finding their way in the facility. For example; a “knifeand fork” sign indicating a dining room, or a picture of a tub outside of a bathingarea.

6. When selecting floor finishes, consideration should be given to their effect onwheelchair and walker manoeuvrability, as well as resident gait, to ensure thatresidents can move about the facility safely. For example, carpets can presentdifficulties for residents with gait/walking problems, and can create undueresistance for resident confined to wheelchairs.


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7. Service areas should be painted a different colour from areas used by residents sothat residents can easily distinguish between resident areas and non-residentareas.

8. Features, fixtures and interior decorations should enhance and promote a “home-like” environment. For example, furnishings should resemble, as much as possible,furniture normally found in residential settings; there should be a variety in the typesof pictures on the walls; and lighting fixtures should be of a non-institutional style.

9. Fixtures, for example, wall-mounted lights, light switches and washroom sinks,should contrast with the colour of the walls so that residents can clearly and easilydistinguish the difference.

10. High-gloss paint should not be used in any resident areas because it will create anundue glare which in turn, may distort vision.

11. All stairs should be enclosed by either rails or walls on both sides of the stairs toensure safety of residents and staff.

12. Winding stairways should be avoided in areas that are accessible to residents toensure resident safety.

13. If free-standing wardrobes are used instead of built-in closets in bedrooms, theseclosets must be securely fastened to the wall and the floor to ensure resident andstaff safety.

14. Public address systems in areas used by residents should be avoided as means ofminimizing the amount of noise and sound intrusion in resident areas.

15. When considering the colour and design of signs, remember that light images orwords on a dark background are more visually effective than dark images on a lightbackground.

16. Mirrors should be avoided in Dining Areas, Resident Lounge andProgram/Activity areas that are used by residents with severe dementias becausethey can increase the level of confusion and anxiety.


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17. The doors and frames in non-resident areas should be painted the same colour asthe walls in these areas to prevent residents from accidently entering areas whichmay be unsafe for residents.

18. Walls and wall corners that will be subject to continual scrapping by wheelchairs andportable equipment should have treatment or coverings that protect the wall surface,for example, corner guards and bumper rails.

19. Finishes that reduce reflected noise on walls and ceilings, and that increase soundabsorbency, should be used in “high” use areas of the building to keep noise to aminimum.

20. Some characteristics to consider when using colour are:

• dark colour schemes near bright windows can make it difficult forresidents to distinguish objects near the window;

• colour contrast between floors and walls can help to distinguish the edgesof a room for residents with visual impairments;

• colour contrast can help to distinguish different objects and surfaceswithin a room, for example, contrasting colours will distinguish thedifferences between doors and walls, or between baseboards and walls;and

• because most resident bedroom doors are left open, it is best to providecolour contrast between the frame and wall, rather than the door andframe, so that residents can clearly determine the location of the openingto the bedroom.

21. Some wall-finishing characteristics to consider for the decoration of the long- term care facility (includes resident and non-resident areas) are:

• a flat wall finish appears less institutional, diffuses a glare, and hidesminor flaws better than a glossy surface;

• some textured wall coverings and acoustic panels are “home-like” inappearance, meet all relevant codes, and absorb excessive sounds; and

• textured surfaces can assist in a resident with visual impairments infinding his or her way about the long-term care facility.


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22. Kickplates on the “push” side of all doors, particularly hollow-core doors, should be provided to prevent damage to the doors.

23. Where door closers are used, the force required to open the door should not beexcessive in relation to the ability of residents to open the door. In addition, alldoors that are used by residents should be equipped with devices which delayclosing to ensure resident safety.

24. Signs that identify room functions should be clear, understandable and located at aheight where they can be easily read or touched by residents.


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PART B: LONG-TERM CARE

FACILITY PLANS REVIEW PROCESS


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PART B: LONG-TERM CARE FACILITY PLANS REVIEWPROCESS

INTRODUCTION

In keeping with the provincial legislation governing long-term care facilities, all constructionplans for any long-term care facility project must be reviewed and approved by the Ministryof Health prior to the start of construction. No renovation, alteration or conversion of anexisting long-term care facility, and no construction of a new long-term care facility shallcommence prior to plans approval by the Ministry of Health. The operator will beexpected to enter into an agreement with the Ministry of Health to renovate, convert orconstruct in accordance with the Ministry of Health approved plans.

Projects may involve:

• a proposed new long-term care facility to replace existing beds or to accommodatea bed award; or

• renovation(s), alternation(s), conversion(s) or addition(s) to an existing long-termcare facility.

Prior to granting final plans approval, the Executive Director of the Long-Term CareDivision must be satisfied that:

a) the design standards as outlined in the Long-Term Care Facility Design Manual have been met; and

b) the Office of the Ontario Fire Marshal has given final approval.

The Ministry of Health shall also approve the long-term care facility, or any part thereof, foroccupancy by residents upon completion of construction.

Note: The words “shall”, “must”, “mandatory” and “requirement” indicate an obligatoryprovision that must, in the view of the Ministry of Health, be complied with for aProject Summary, Operational Plan and working drawings to be approved by theMinistry of Health.


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ROLE OF THE MINISTRY OF HEALTH

I. Administrative Responsibilities

The responsibility for the overall administration of the plans review process for long-termcare facilities shall rest with the Ministry of Health’s Long-Term Care Division.

The Long-Term Care Division shall utilize a team approach in the review of constructionplans, with involvement from both the Division’s corporate and regional offices. Theco-ordination of this process within the Division shall be the responsibility of the Division’scentrally located Operations Support Branch, Specialty Services Unit.

In the long-term care facility plans review and construction process, the Ministry of Health isrequired to:

• provide information and clarification to sponsoring agencies and other interestedparties on the standards and guidelines on long-term care facility design which arecontained in the Long-Term Care Facility Design Manual;

• track and maintain an inventory of plan submissions;

• provide comments, advice and guidance to sponsoring agencies/architects on theirrespective plan submissions in order to assist sponsoring agencies/architects in thedevelopment of facilities that will best meet the needs of the residents to beaccommodated;

• review and approve plans for consistency and compliance with the design standards ofthe Long-Term Care Facility Design Manual (final approval is given in writing by theExecutive Director of the Long-Term Care Division based on the recommendationscollated from across the Long-Term Care Division); and

• monitor the development of the long-term care facility after plans are approved andconstruction starts (for existing facilities that are being renovated, this also includes theresponsibility to monitor compliance with a Ministry of Health approved operationalplan for assuring resident health, welfare and safety over the construction time-frameand to ensure compliance with the conditions set out in the construction projectagreement).


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II. Pre-Occupancy Review

On notice from the sponsoring agency that the construction of the building is finished, theLong-Term Care Division shall conduct a “pre-occupancy” review to determine whether thelong-term care facility is ready to accommodate residents. If the facility is ready and the facility has been constructed in keeping with the approvedplans and any other related agreements, the Long-Term Care Division will give approvalfor the long-term care facility to open and admit residents (the Ministry of Health’soperational funding will commence on completion of the project, approval for occupancy ofthe building by the Ministry of Health and the signing of a Service Agreement with theMinistry of Health). If the facility is not ready for occupancy following the “pre-occupancy” review, the Long-Term Care Division review team will provide direction to the sponsoring agency/architecton what still needs to be done and will schedule another “pre-occupancy” review inconsultation with the sponsoring agency/architect.


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DEFINITIONS OF TERMS

Preliminary Sketch Plans

Preliminary sketch plans are the developed planning documents identifying the site, living,working and service spaces as well as the entrances/exits of the building.

Preliminary sketch plan submission must include the following:• major entrances to and exits from the site• road access(es) and proposed routes to and from the site• parking• elevations• a floor plan for each level indicating all departments/services as outlined in the Long-

Term Care Facility Design Manual (for example, Dietary Service Space, LaundrySpace and Housekeeping Support Space)

• a floor plan for each level indicating living space (both private and communal) withineach Resident Home Area and beyond the Resident Home Areas as outlined in theLong-Term Care Facility Design Manual (for example, Resident Bedroom Space,Resident Bathroom and Shower Room Space)

Working Drawings

Working drawings contain the necessary information to construct a building and are thedrawings intended for use by the contractor and subcontractors.

Working drawings must include the following:• architectural seal• major entrances to and exits from the site• road access(es) and proposed routes to and from the site• parking• architectural specifications• mechanical specifications• electrical specifications• a floor plan for each level indicating all departments/services as outlined in the Long-

Term Care facility Design Manual (for example, Dietary Service Space, LaundrySpace and Work Space for Nursing/Program and Therapy Staff)

• a floor plan for each level of the building indicating living space (both private andcommunal) within each Resident Home Area and outside of the Resident HomeArea(s) as outlined in the Long-Term Care Facility Design Manual (for example,


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Resident Bedroom Space for private, semi-private and basic/standardaccommodation, Bath Room Space and Lounge Space and Program/ActivitySpace)

• a detailed floor plan layout of the following:- Resident Bedrooms (including a private, a semi-private and a basic/standard

bedroom as applicable- the Resident Washroom layout(s)- Dining Space layouts including the placement of tables and chairs- Dietary Service Space layouts including Servery Space(s)

STEPS IN THE PROCESS

I. REVIEW OF PROGRAM AND STRUCTURAL REQUIREMENTS

Before beginning the development of any construction project, the sponsoring agency, inconsultation with the project architect, must review:

• the Long-Term Care Facility Program Manual which describes the requiredoperational standards for all long-term care facilities; and

• the design standards and functional considerations/recommendations containedin this Long-Term Care Facility Design Manual.

The design of the long-term care facility must meet the resident care, program and serviceneeds of the long-term care facility to ensure the best possible outcomes of care for theresidents of that facility. Once the sponsoring agency determines the resident care,services and program requirements for the long-term care facility, preliminary plans mustbe developed by the architect in consideration of those identified operational needs.

II. FIRST SUBMISSION OF PLANS

1. Plan Submission

All plan submissions must comply with the design standards set out in the Long-Term Care Facility Design Manual. The functional considerations/ recommendations in theLong-Term Care Facility Design Manual are commonly accepted “best practices” andare optional guidelines that may be incorporated into the facility design.

For any proposed construction project, the sponsoring agency/architect has the option ofsubmitting either preliminary sketch plans or working drawings and specifications to theMinistry of Health as the first submission.


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As a note of caution, preliminary sketch plans are suggested as the first submission in the event that revisions may be required to the proposed design of the long-termcare facility prior to approval by the Ministry of Health. Working drawings andspecifications are more detailed and therefore more complicated to revise thanpreliminary sketch plans.

2. Project Summary

The sponsoring agency/architect must also provide as part of the first submission of plansto the Ministry of Health, a written description outlining the overall care, program andservice objectives envisioned for the long-term care facility. This written summary reportmust respond, as a minimum, to the items contained in the attached Appendix “A” -Project Summary. The sponsoring agency/architect must provide information on eachrequested item.

The purpose of completing the Project Summary is to provide the Ministry of Health’splans review team with basic information about the project and a description of how thedesign will support program and service delivery. At a minimum, the written plan mustclearly reflect how the sponsoring agency intends to comply with the requirements relatingto provision of care, program and services as outlined in the Long-Term Care FacilityProgram Manual.

The sponsoring agency/architect must submit five (5) copies of the preliminary sketchplans (or five copies of working drawings and two (2) copies of the specifications if thesponsoring agency so chooses) and five (5) copies of the Project Summary. TheMinistry of Health shall return to the sponsoring agency and shall not review any submissionwhich does not include five copies of both the preliminary sketch plans (or workingdrawings and specifications) and the Project Summary.

3. Operational Plan for the Renovation, Alteration or Conversion of a Long-TermCare Facility (“Operational Plan”)

In the case of renovations to an existing long-term care facility, the Planning Coordinatorwill upon receipt of the first submission of plans, request that the sponsoring agency submittwo (2) copies of an Operational Plan which outlines how resident health, welfare, andsafety will be assured over the schedule of the construction project.

The Operational Plan;must comply with the format set out in Appendix “B”. TheOperational Plan must cover the time frame of the project and must address alloperational aspects affected by the construction.


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One copy of the Operational Plan must be sent by Planning Coordinator to the Long-TermCare Regional Office where the facility is located. The Regional Office is responsible forgetting comments back to the Planning Coordinator within two weeks (10 working days)of receipt.

The second copy must be retained by the Planning Coordinator. Depending on the scopeof the project, the Operational Plan may be shared with the Dietary Advisor and/orEnvironmental Health Advisor assigned to the long-term care facility.

If there are concerns identified by the Ministry of Health with the Operational Plan, thePlanning Coordinator will request revisions. The Ministry of Health will not provide finalplan approval to proceed with the project in the absence of a Ministry of Health approved Operational Plan where required.

III. MINISTRY REVIEW OF FIRST PLAN SUBMISSION

Each project shall be assigned to a Planning Coordinator in the Specialty Services Unitwho shall take the lead responsibility in overseeing and coordinating the plans reviewprocess.

The Planning Co-ordinator shall distribute copies of the preliminary sketch plans (orworking drawings and specifications as applicable) and the Project Summary for reviewand comments by the following Ministry of Health staff:• Compliance Advisor (registered nurse) in the respective Long-Term Care Regional

Office where the long-term care facility is to be located• Environmental Health Advisor - Specialty Services Unit• Dietary Advisor - Specialty Services Unit• Architect - Capital and Technical Services Branch

Ministry of Health staff shall review the plans and the Project Summary, and forward theircomments and recommendations to the Planning Coordinator within 2 weeks (10working days) of the receipt of the plans, Project Summary and as applicable,Operational Plan. The Planning Coordinator shall be responsible for collating thesecomments and recommendations, and in turn, drafting a response back to the sponsoringagency/architect.

Note: In some cases, if necessary to expedite the plans review process, a meeting maybe requested by the Planning Coordinator, on behalf of the Ministry of Health‘s


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plans review team, with the sponsoring agency to discuss the project and clarifyissues.

The Ministry of Health shall review and send back comments on the first plans submission(preliminary sketch plans/working drawings and specifications and the written overview)within four weeks (20 working days) of receipt of the submission to the SpecialtyServices Unit.

Note: If working drawings are submitted as part of the first plans submission and aredetermined as acceptable by the Ministry of Health, the plans shall be approved. The notice of approval will be sent back within four weeks (20 working days)from receipt of the first plans submission from the sponsoring agency/architect. Once plans are approved, no further submissions are needed.

IV. SECOND SUBMISSION OF PLANS

Based on the comments and recommendations received from the Long-Term CareDivision on the first submission (i.e., the preliminary sketch plans or working drawings andspecifications, the Project Summary and where applicable, the Operational Plan), thesponsoring agency/architect will develop a second submission of plans. The secondsubmission may include a revised sketch plan, revised working drawings andspecifications or detailed working drawings and specifications based on approved sketchplans. It is the decision of the sponsoring agency whether to submit detailed workingdrawings and specifications or re-submit sketch plans.

In some cases, there may also be need to submit a revised Project Summary if thesponsoring agency decides to make significant program changes after the first submissionof plans. If sketch plans were the first submission and were accepted or require minor revisions, thesecond submission must include working drawings and specifications.

Working drawings and specifications must be submitted before final plans approval by theMinistry of Health.

Note: If there are any questions or concerns about the Long-Term Care Division’scomments or recommendations, the sponsoring agency and/or the architect are


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encouraged to contact the Planning Coordinator to seek clarification and todiscuss any issues related to the working drawings and specificationsdevelopment process.

Five (5) copies of the second submission (revised sketch plan or working drawings andspecifications and Project Summary, if applicable) must be submitted by the sponsoringagency/architect to the Planning Coordinator.

Where plans are substantially altered by the sponsoring agency/architect as a result of thecomments and recommendations received from Ministry of Health staff on the firstsubmission of plans, the Planning Coordinator must conduct a second distribution of theplans in accordance with the same process as set out under “First Submission of Plans”above.

Where the second submission is revised sketch plans and revisions accurately reflects theMinistry of Health comments and recommendations from the first submission, the PlanningCoordinator will verbally advise the sponsoring agency/architect within two weeks (10working days) that the second submission of plans is acceptable. Confirmation of thisapproval will be provided in writing only at the request of the sponsoring agency/architect. Following verbal notice, the sponsoring agency/architect shall then proceed with thedevelopment of detailed working drawings and specifications.

If working drawings and specifications are the second submission, and are determined asacceptable by the Ministry of Health, then the plans shall be approved. The notice ofapproval shall be sent back within four weeks (20 working days) from receipt of thesecond plans submission from the sponsoring agency/architect.

If working drawings and specifications are the second submission and are not acceptable,then the sponsoring agency/architect must re-submit revisions in keeping with Ministry ofHealth comments and recommendations until such time as working drawings andspecifications are approved.

VI. CONSTRUCTION

The Planning Coordinator shall monitor the progress of the construction project.

In the case of an existing facility under renovation, the Compliance Advisor assigned to thelong-term care facility is responsible for monitoring adherence to the Operational Plan. Ifbecause of unforeseen circumstances the Operational Plan must be revised, the


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sponsoring agency must notify the Compliance Advisor for approval of any changes. Changes can be approved verbally over the telephone; any approved changes shall beconfirmed in writing by the Ministry of Health.

VII. PRE-OCCUPANCY REVIEW

The purpose of the pre-occupancy review is to determine the acceptability of the facility foroccupancy by residents. All construction, alteration and renovation projects shall besubject to a pre-occupancy inspection by the Ministry of Health.

The pre-occupancy review shall be conducted by a multi-disciplinary team from the Long-Term Care Division which includes the Planning Coordinator, Compliance Advisor,Environmental Health Advisor and Dietary Advisor. Depending on the scope and size ofthe project, certain team members may be excluded from the pre-occupancy review. Thisdecision shall be the responsibility of the Planning Coordinator.

The pre-occupancy review team shall assess both structural design and operationalstandards to confirm that:

• the construction, alteration or renovation project conforms with the approved plans; and

• the new building or the renovated area of an existing long-term care facility is ready foroccupancy by residents.

The sponsoring agency/architect shall inform the Planning Coordinator when the project isready for pre-occupancy review. The Planning Coordinator shall arrange a time for the pre-occupancy review and verbally confirm the date with the sponsoring agency/architect. ThePlanning Coordinator shall advise the sponsoring agency/architect to request that a firesafety inspection be conducted by local authorities and subsequent approval obtained fromthe respective fire safety agency.

The Planning Coordinator shall be responsible for advising the sponsoringagency/architect that the following documents will be required at the time of the pre-occupancy review:

• Building Permit• Occupancy Permit• Fire Department/Ontario Fire Marshal formal approval documents• Hydro Permit• Fire and Call System Alarm Verification Certificate• Fire Retardancy Certificate


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The Ministry of Health shall not give approval for occupancy in the absence of the aboveapprovals from the respective governing authorities.

VII. NOTICE OF APPROVAL FOR OCCUPANCY

Following completion of the pre-occupancy review, the recommendation to approve or notapprove the building for occupancy as a long-term care facility shall be made by the pre-occupancy review team. The Executive Director shall be advised of the outcome of thepre-occupancy review and shall make the decision on approval for acceptability ofoccupancy.

Where approval is not given, the Planning Coordinator shall arrange a second pre-occupancy review in accordance with the procedure and protocols set out above.


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APPENDIX A: PROJECT SUMMARY

OVERVIEW AND PURPOSE

The Project Summary shall provide written information outlining how the design of thebuilding will support the effective delivery of care, programs and services to residentsresiding in the long-term care facility. This information shall support the timely completionof the plans review process by providing Ministry of Health staff with basic informationabout the proposed long-term care facility.

The Project Summary shall be submitted by the sponsoring agency/architect to thePlanning Coordinator for review with the first plans submission.

Five (5) copies of the Project Summary must be submitted with five (5) copies of thesketch plans or working drawings and two (2) copies of the specifications.

CONTENT OF THE “PROJECT SUMMARY”

The Project Summary must include the following information under the following generalheadings:

1. Description of Project

The description of the project should be brief and must outline the general philosophy ofcare, programs and services proposed to be provided in the long-term facility.

2. Overview of the Project

The section should be brief and must provide the following information:

• the size of the building including the total number of beds and the number offloors;

• whether the long-term care facility shall be part of an integrated multi-usecomplex (for example, attached to a rest/retirement home or a supportivehousing apartment building, or part of other services/programs to be offered inthe complex, for example as Meals-on-Wheels or a seniors day program); and

• the location and description of Outdoor Space.


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3. Resident Home Areas

This section must include a brief description of each Resident Home Area, including:

• the number of beds in each Resident Home Area;

• number and dimensions of private, semi-private and standard (basic) residentbedrooms;

• the size, dimensions and design of resident washrooms;

• the size, dimensions and design of the resident bathrooms and shower rooms;and

• a summary of the common area space including the sizes of the diningarea(s), lounge(s) and program/activity area(s).

Note: If each Resident Home Area is the same in size and design, only onedescription shall be required and the submission shall indicate that this is thecase.

4. Care and Services Programs in Resident Home Areas

This section must provide a brief description of the care and service programsproposed to be delivered in each Resident Home Area and a brief overview of howthe design of each Resident Home Area will support the delivery of the proposed careand service program(s) (for example, how will the design of a specific Resident HomeArea support the provision of a palliative care program).

5. Space for Resident Care Services

This section must briefly describe how and where space will be allocated to support theprovision of the following resident care services:

- nursing services- medical services- therapy/activity services- pastoral care services

6. Facility Support Space


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This section must briefly describe how and where space will be allocated to support theprovision of the following facility support services:

- meal services and food services- personal laundry and facility linen services- administration services- building services- housekeeping services

7. Additional Information (Optional)

Completion of this section is optional. It is up to the sponsoring agency/architect todecide any additional relevant information which can be provided to assist the Ministryof Health staff in the plans review process.


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APPENDIX B: OPERATIONAL PLAN FOR THE RENOVATION,ALTERATION OR CONVERSION OF A LONG-TERM CARE

FACILITY (“OPERATIONAL PLAN”)

OVERVIEW AND PURPOSE

The purpose of the Operational Plan is to provide a detailed account of how residenthealth, welfare, safety and general well being shall be assured over the construction period. The order in which phases of construction will occur and the time frames that each phasewill take place, must be included in the plan. The Operational Plan shall be prepared bythe sponsoring agency and two (2) copies shall be submitted to the Planning Coordinator.

An Operational Plan shall be submitted for review and approval with the submission ofworking drawings and specifications for any addition, renovation or alteration of a long-term care facility. Final plans approval to proceed with a project shall not be given by theMinistry of Health until the Operational Plan has been accepted by the Ministry of Health.

FORMAT AND CONTENT OF THE OPERATIONAL PLAN

The Operational Plan must include the following information under the following generalheadings:


This section shall provide a brief description of the project including:

• what is being built, for example, a new facility or an addition;

• the anticipated dates when construction is expected to begin and whenconstruction is expected to be completed; and

• if the project is to be done in phases or stages, the anticipated time frames forthe different phases/stages of construction.

2. Administration

This section must briefly describe how the project administration issues will be addressedincluding:


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• the name and position title of the on-site supervisor of the construction project

• communication protocols between the foreman and Administrator of the long-term care facility, for example, daily meetings to be conducted.

3. Communications

This section must briefly describe the process for notification and communication to allaffected parties about the project, safety protocols and other matters related to theconstruction project including:

• All staff - staff must be familiar with and been given the opportunity toparticipate in the development of the operational plan.

• Families - families must be notified of overall plans and be notified of changesthat will directly affect their family member.

• Fire Marshal’s Office/Local Fire Department - the Fire Marshal’s Office/LocalFire Department must be notified of overall plans.

• Public Health Unit - the Public Health Unit must be notified if there is to be anychange/disruption in the kitchen design and/or food service

4. General Safety Measures

This section must indicate how general safety measures will be addressed including butnot limited to:

• the name and position title of the person assigned to monitor safety.

• the separation(s) or types of barriers to be provided between all constructionsites from resident care and living areas.

• safety measures which will be implemented to protect confused/wanderingresidents.

• staff in-service regarding safety measures including temporary barriers,temporary alarms (doors, call pulls, fire panels) - staff and construction crewmust be aware of the need to keep construction areas and equipmentinaccessible to residents

• openings (doors, windows and walls) into the construction site must be secure;


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- Are openings used for entering and exiting alarmed?- Are all alarms (permanently and temporarily placed) checked frequently?

- Will any door alarms be temporarily disconnected?

• Measures to be implemented in the event of temporary disconnection ofelectricity for the following:

- residents care (i.e., oxygen concentrators)- monitoring of doors on alarm- fire safety issues- emergency call bells- additional staffing resources- transportation of residents, for example, when elevators not available- food preparation contingency plans- dishwashing- housekeeping- maintenance- laundry

• Measures to be implemented in the event of a temporary shut off of water forthe following:

- residents’ personal care- fire safety issues- food preparation- dishwashing and general kitchen sanitation- housekeeping- maintenance- laundry

• Protocols to be implemented to minimize dust and dirt for the construction area. -What additional housekeeping hours will be provided when necessary?

- What protection will be provided for residents who may be more affectedby increased dust levels (i.e., allergies)?

• Protocols for advising the construction crew of the safety needs specific to theresident population.

5. Resident Areas

This section must briefly describe how resident areas affected by construction will besecured.


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Questions which must be addressed:

- If during construction, there are approved temporary bedrooms, or over bedding ofexisting rooms, have all safety and comfort features been provided such as the callsystem, over bed lighting, privacy curtains?

- If during construction, there are approved temporary washrooms or tubrooms, or

renovations are occurring in parts of these areas, have all safety and comfortfeatures been provided, such as the call system, grab bars, lighting, privacy curtains,ventilation?

- If during construction, there are approved temporary common areas - lounge, dining,activity, have all safety and comfort features been provided such as lighting, natural lighting as a preference, call system?

- If during construction, resident outside areas are affected, has a temporary enclosedarea been established?

6. Food Service

This section shall briefly describe how changes to the food/meal service will be managed.


- What is the impact on the food service?

- How long will the kitchen be closed?

- When will construction work be scheduled (i.e., nights only)?

- What measures are to be taken to provide safe meals to the residents, e.g., foodhandling, food transporting and food temperature requirements are met)

- Are nutritious meals, that include sufficient menu variety, special diets and snack requirements met?

- Has the local Public Health Unit been informed and given approval to implementtemporary measures?

7. Noise Factors


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This section must briefly describe how noise factors will be managed.


- What will the time periods be when construction noises shall cease, i.e., meal times,early mornings and nights?

- Will residents have to be relocated to another section of the facility, or be out on aday trip during times when construction noise is a serious concern?

8. Laundry Services

This section must briefly describe how, if applicable, laundry services will be affected andmanaged.


- What is the contingency plan if laundry service is to be interrupted for period of time,(for example, temporary location for laundry processing)?

MINISTRY OF HEALTH

POLICY FOR FUNDING CONSTRUCTION COSTS

OF LONG-TERM CARE FACILITIES

April 1999

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PART ONE: INTRODUCTION Effective April 1, 1998, the Ministry of Health implemented a new funding policy entitled the “Policy For Funding Construction Costs of Long-Term Care Facilities” (the “Construction Funding Policy”) to support the costs of the construction of new long-term care facilities (nursing homes and homes for the aged) and the renovation of existing long-term care facilities. The Construction Funding Policy supersedes all prior construction funding policies of the Ministry of Health for long-term care facilities. Implementation of the Construction Funding Policy coincided with the release and implementation of new mandatory design standards for long-term facilities as set out in the “Long-Term Care Facility Design Manual” dated May 1998 (the “Design Manual”). Effective April 1, 1998, these new mandatory design standards supersede all prior structural standards and guidelines for long-term care facility design. Historically, the Province has provided capital grants for construction, on a cost-shared basis, to non-profit sponsors of long-term care facilities (includes both homes for the aged and nursing homes). In contrast, private sector operators have had to arrange their own financing and manage costs through operating funds when undertaking construction projects. The Ministry of Health has now introduced one consistent funding approach for managing construction costs (as set out in the Construction Funding Policy) and one set of mandatory design standards (as set out in the Design Manual) for all long-term care facility operators which shall apply in the same manner, regardless of sponsorship. Funding of projects through the capital funding method may still apply in exceptional circumstances as determined by the Ministry of Health for charitable non-profit sponsors of long-term care facilities. PART TWO: THE CONSTRUCTION FUNDING POLICY Under the Construction Funding Policy, the Ministry of Health shall provide to a long-term care facility operator the following funding if, and only if; the Ministry of Health determines that the operator meets all eligibility criteria and requirements as set out in this Construction Funding Policy: 1. a per diem of up to $10.35 in additional operating funds for a) each long-term care

bed awarded by the Ministry of Health; and, b) each long-term care bed in an existing out-dated long-term care facility identified by the Ministry of Health as in need for replacement and classified by the Ministry of Health as a Category “D” facility (collectively referred to as “Long-Term Care Facility Beds”).

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This additional operating fund shall be used to support the payment of loans secured by operators to pay for the construction of Long-Term Care Facility Beds (the “Up to $10.35 Per Diem”). The Up to $10.35 Per Diem shall be paid by the Ministry of Health to the operator on a monthly basis for a period of 20 consecutive years based on a maximum construction cost of $75,000/Long-Term Care Facility Bed. The Up to $10.35 Per Diem shall only be used by the operator for the payment of actual construction costs relating to the development of facilities for Long-Term Care Facility Beds; 2. in exceptional circumstances as determined by the Ministry of Health, a capital grant

to those non-profit charitable organizations that have demonstrated to the Ministry of Health'’ satisfaction that they have been unsuccessful in securing financing from at least three lending institutions. The amount of the capital grant shall be no more than the amount of operating funds provided through the Up to $10.35 Per Diem by the Ministry of Health under this Construction Funding Policy.

3. effective April 1, 1998, a new structural premium for those facilities which have been

determined by the Ministry of Health as substantially meeting compliance with the new design standards as set out in the Design Manual. These facilities have been classified by the Ministry of Health as Category “A” facilities. The structural premiums for Category “A” facilities shall be as follows:

i) a per diem of $5.00 per resident shall be provided to those operators who

have fully financed the construction costs of their long-term care facilities; or

ii) a per diem of up to $3.00 per resident shall be provided to those operators who have received any government grant(s) to build their long-term care facilities. The amount of the structural premium shall be adjusted depending on the amount of the grant or combined grants. For example, if the operator received a 50% capital grant from the Province, the per diem shall be $1.50 per resident;

4. effective April 1, 1998, a per diem of up to $2.50 per resident as a structural

premium to those long-term care facilities that have been determined by the Ministry of Health as substantially exceeding the 1972 regulated nursing home structural standards, but not meeting the new mandatory design standards as set out in the Design Manual. These facilities have been classified by the Ministry of Health as Category “B” facilities. If an operator received any government grant(s) to build the long-term care facility, then the amount of the premium shall be adjusted depending on the amount of the grant or combined grants. For example, if the operator received a 50% capital grant from the Province, the per diem premium shall be $1.25 per resident; and

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5. effective April 1, 1998, a per diem of up to $1.00 per resident as a structural premium to those long-term care facilities which have been determined by the Ministry of Health as meeting compliance with 1972 nursing home structural standards. These standards include the regulated nursing home standards in addition to any waivers set out under the “Compliance Plan Review Board Guidelines” (the “Standards”). These facilities have been classified by the Ministry of Health as Category “C facilities. If an operator received any government grant(s) to build the long-term care facility, the amount of the premium shall be adjusted depending on the amount of the grant or combined grants. For example, if the operator received a 50% grant from the Province, the per diem premium shall be $.50 per resident.

There shall be no structural premiums paid to long-term care facilities that are not in compliance with the Standards. These facilities have been classified by the Ministry of Health as Category “D” facilities and shall be replaced by the operators with new facilities that conform to the new mandatory design standards as set out in the Design Manual. As noted above, operators of Category “D” facilities are eligible for the Up to $10.35 Per Diem. In addition, the Ministry of Health shall phase out the debt service fund for nursing homes over five fiscal years starting in fiscal 1998/99. Each year, the amount of the debt service allowance paid to each nursing home operator now receiving the allowance shall be reduced by one-fifty (1/5) of the amount paid in calendar 1997. The first reduction took place in fiscal year 1998/99. By fiscal 2002/03, the debt service fund shall be reduced to $0 shall cease to exist. PART THREE: THE UP TO $10.35 PER DIEM (i) Eligibility for the Up to $10.35 Per Diem The following are eligible for the Up to $10.35 Per Diem: 1. Organizations that have been awarded new long-term beds by the Ministry of

Health; and 2. Operators of Category “D” facilities. (“Eligible Operators”)

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(ii) Determination of the Amount of the Up to $10.35 Per Diem The Ministry of Health’s role is to support the repayment of the Eligible Operators actual construction costs which have been approved by the Ministry of Health through regular monthly payments within specific parameters (e.g. payment of the Up to $10.35 Per Diem over a period of 20 consecutive years). The actual amount of funding support shall be verified through a Ministry of Health review process of the terms of the financing and the actual construction costs. Each Eligible Operator must demonstrate that an actual construction cost of $75,000 per Long-Term Care Facility Bed has been expended by the Eligible Operator in order to receive the maximum available through the Up to $10.35 Per Diem. For the purposes of demonstrating that $75,000 per Long-Term Care Facility Bed has been expended, actual construction costs can include the actual cost of construction, furniture, equipment, building permit, development fees, and consulting/professional fees. If the actual construction cost is less than $75,000 per Long-Term Care Facility Bed, the Up to $10.35 Per diem shall be pro-rated against the actual construction costs. The operator shall be fully responsible for all project costs including, but not limited to: 1. all actual construction costs (including the actual cost of construction, furniture,

equipment, building permit, development fees, and consulting/professional fees) above $75,000 per Long-Term Care Facility Bed; and

2. all costs relating to the land, building, demolition of the building, re-zoning

application, audit fees and site survey. (iii)Commencement of the Funding of the Up to $10.35 Per Diem The Ministry of Health shall not be obligated to provide the Up to $10.35 Per Diem to Eligible Operators unless the Ministry of Health determines that the following terms and conditions have been met: 1. the long-term care facility to be developed for the Long-Term Care Facility Beds has

been built in accordance with the mandatory design standards as set out in the Design Manual and in accordance with the plans approved by the Ministry of Health;

2. all terms and conditions set out in the agreement(s) entered into between the

Ministry of Health and the Eligible Operator relating to the development of the Long-Term Care Facility Beds have been complied with; and

3. all requirements set out in this Construction Funding Policy have been complied

with.

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The Ministry of Health may stop the funding of the Up to $10.35 Per Diem to an Eligible Operator and recover any monies provided by the Ministry of Health to an Eligible Operator relating to the Up to $10.35 Per Diem in the event that the Ministry of Health becomes aware that the Eligible Operator has not met the terms and conditions set out above in this section. The Up to $10.35 Per Diem shall be included in the Subsidy Calculation Worksheet of the Eligible Operator which is attached to and forms part of the Service Agreement between the Ministry of Health and the Eligible Operator. PART FOUR: LEVELS OF CARE FUNDING The Up to $10.35 Per Diem is in addition to the regular operating funding which a facility operator receives through the Province’s “Levels of Care” funding system. The Up to $10.35 Per Diem shall be added to the “Levels of Care” per diem operating funds for each Eligible Operator. The “Levels of Care” funding entitlement for a new long-term care facility, or an addition to an existing long-term care facility, that is opening as a result of a bed award shall start at the provincial average because the “Level of Care” of residents is not yet known. The provincial average is reflected as a Case Mix (CMI) value of “100”. In this case, the Ministry of Health contribution shall include: 1. the regulated base amount for the Nursing and Personal Care Envelope; 2. the regulated fixed per diem for the Program and Support Services Envelope; and 3. the difference between the residents’ contribution for basic accommodation and the

provincially guaranteed level of accommodation funding. For a replacement long-term care facility (i.e., replacement of the Category “D” beds in an existing older facility or part thereof), the Provincial compensation shall be calculated in the same manner described above, with the exception that the actual Case Mix Index (CMI) value for the residents already living in the long-term care facility shall be used to determine the regulated Nursing and Personal Care per diem. New long-term care facilities (includes facilities which are developed from awarded beds and replacement Category “D” beds) being gradually filled with new residents shall be funded on the basis of full occupancy for a two-month start-up period. Following this two-month start-up period, the 97% occupancy rule shall apply as it does to other long-term facilities.

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It is important to note that the Up to $10.35 Per Diem shall be paid based on the total number of Approved or Licensed Beds, and not on the actual occupancy of the long-term care facility. In this context, although the 97% occupancy rule shall not apply to the Up to $10.35 Per Diem calculation, the 97% occupancy rule shall continue to apply to the other operating funds provided by the Ministry of Health. PART FIVE: ACCOUNTABILITY STRUCTURE (i) Review of Construction Plans and Costs All construction plans for the development of a long-term care facility (this includes plans for a new long-term care facility as well as renovations, additions and/or alterations to an existing long-term care facility) shall be reviewed for acceptability by the Ministry of Health prior to the start of construction. The purpose of the Ministry of Health’s plans review process is to ensure that each Eligible Operator’s plans conform to the mandatory design standards as set out in the Design Manual. Construction plans that do not meet these mandatory design standards shall not be approved. In addition, Eligible Operators who have been awarded long-term care beds must construct their new facilities or additions/renovations to existing facilities, as the case may be, in accordance with the “Agreement For Development of Long-Term Care Facility Beds” made between the Minister of Health and the Eligible Operator (“Awardee”) Eligible Operators must clearly demonstrate their construction costs as part of the Ministry of Health’s plans review and approval process. If the Ministry of Health requires additional information about the financing of the project, Eligible Operators must submit all such additional information to the Ministry of Health in a timely manner. Approval for the Up to $10.35 Per diem funding shall not be given by the Ministry of health prior to completion of the Ministry of Health’s review and confirmation of construction costs. (ii) Site Approval In the case of an award of beds, the Ministry of Health must approve the selected site for the new long-term care facility. The Ministry of Health shall provide the Eligible Operator with a response on the acceptability of the site within 20 working days of the notice from the Eligible Operator identifying the proposed site. (iii)Tendering of Project Once the construction plans have been approved by the Ministry of Health, the project must be approved by the Ministry of Health for tender.

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Working drawings and specifications suitable for public tendering must be prepared by the Eligible Operator. These working drawings and specifications must form the basis of the contract between the Eligible Operator and the general contractor approved by the Ministry of Health. All construction projects must be publicly advertised in the Daily Commercial News and local newspapers. Eligible Operators may “invite” contractors to submit a construction bid as well. The Ministry of Health’s policies and guidelines for tendering are based on a stipulated price contract as per the Canadian Construction Documents Committee (CCDC 2) standard forms and documents. Use of the CCDC2 standard forms is recommended for all aspects of the Eligible Operators tendering process. After the close of the tender, at least three bids must be reviewed by the Eligible Operator in consultation with the Ministry of Health. The Ministry of Health shall review the bids selected by the Eligible Operator and approve the selection of the general contractor. The decision on the acceptability of the bid selected by the operator shall be based on the following qualitative criteria: 1. the comparative costs between the selected bid and the other submitted bids for all

of the various aspects of the construction project to ensure that an appropriate value is charged for each aspects of the long-term care facility construction project;

2. the comparative costs of the project relative to the typical costs for development of a

similar type of project to ensure the best value and quality for the price; and 3. if applicable, the track record and work history of the general contractor for the

selected bid. A Final Estimate of Cost (“FEC”) form (Ministry of Health document) must be prepared by the Eligible Operator and submitted to the Ministry of Health. In addition, the Eligible Operator must submit a spreadsheet identifying bidders, a written recommendation from the Eligible Operator relating to the general contractor selected by the Eligible Operator, and a letter of confirmation from the Eligible Operators lender concerning the terms of financing. (iv)Project Management Under exceptional circumstances, the Ministry of Health may approve alternative and innovative concepts for the development of a project to construct long-term care facility beds using a “project management” approach. An Eligible Operator who wishes to use a “project management” approach must submit a written request for approval to the Ministry of Health. The Ministry of Health will review the request and provide the Eligible Operator with a decision within a reasonable time frame.

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The Ministry will review any written request based on the following evaluation criteria (the “Evaluation Criteria”): 1. the extent to which the Eligible Applicant is able to demonstrate that this approach

serves the best interests of the Province of Ontario; 2. the extend to which the Eligible Applicant is able to demonstrate that this approach

is consistent with provincial criteria for the management of public funds and does not compromise the requirement for accountability for public funds;

3. extent to which the Eligible Applicant is able to demonstrate that this approach is

the better alternative method for completion of the construction project as opposed to the hiring of a general contractor.

4. whether the written request adheres to the public tendering process as set out in the

above (iii) Tendering of Project section for each aspect of the construction project (including the hiring of a “project manager”), including,

i) the advertisement of the public tenders in Daily Commercial News and local

newspapers,

ii) a competition open to all interested bidders; and

iii) selection of the highest quality, best price bids for each aspect of the construction project;

5. the “level of risk” to the Eligible Operator, including,

i) the nature and extent of the liability to be assumed by the Eligible Operator,

ii) the financial risk to the Eligible Operator and how this will impact on the financing of the construction project; and

iii) the ability of the Eligible Operator to meet the time commitments for

development of the long-term care facility beds as set out in “Schedule E” to the Agreement to develop the beds; and

6. any other factor(s) that the Ministry of Health, in its sole discretion, deems relevant. The Eligible Operator’s written request must adhere to the public tendering process as set out in the above (iii) Tendering of Project section and must address all the issues set out in the above Evaluation Criteria. As part of the process to review the request from the Eligible Operator, the Ministry of Health may ask for any additional information from the Eligible Operator which the Ministry, in its sole discretion, deems necessary.

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The Eligible Operator shall provide any such additional information to the Ministry of Health in a timely manner. Each written request from an Eligible Operator will be reviewed by the Ministry of Health on an individual basis based on the above Evaluation Criteria, with decisions made in consideration of the merits of the individual circumstances and the appropriateness of proceeding with this approach. The Ministry of Health shall have the sole and absolute discretion to approve or reject any written request for the use of the “project management” approach for a particular construction project to develop long-term care beds. The Ministry of Health shall have the sole and absolute discretion to impose any conditions on any approval granted for the use of the “project management” approach for a construction project, including conditions relating to the process and criteria for the selection of the “project manager”. The Ministry of Health shall have the sole and absolute discretion to impose different and unique conditions on similar construction projects to develop long-term care facility beds using the “project management” approach. (v) Persons Responding to Ministry of Health Requests for Proposal Persona responding to any Ministry of Health Requests for Proposals to develop long-term care facility beds shall assume that they will be required to retain a general contractor to construct any awarded long-term care beds and shall estimate their construction costs based on the retention of a general contractor. (vi)Commencement of Construction Construction shall begin as soon as the tendering process is complete and a contract is awarded and signed. Construction of the project is the responsibility of the general contractor/project manager and must be carried out in accordance with the terms of the contract between the Eligible Operator and the general contractor/project manager. (vii) Project Completion and Determination of Construction Funding The Ministry of Health shall carry out a “pre-occupancy” review to confirm that the long-term care facility or the addition thereto has been constructed in accordance with the construction plans approved by the Ministry of Health. The Eligible Operator shall address any outstanding issues relating to the “pre-occupancy review” to the satisfaction of the Ministry of Health before approval by the Ministry of Health to admit residents shall be given. Once the new facility or addition thereto has passed the “pre-occupancy review”, the Eligible Operator shall be approved by the Ministry of Health to begin admitting long-term facility residents to the new long-term care facility beds. The Up to $10.35 Per Diem funding shall begin on the day the first resident or residents is/are admitted to the long-term care facility or the addition thereto. The payment shall

11

be for the full-approved capacity of the long-term care facility, not the actual occupancy level. For example, if the long-term care facility has an approved capacity of 100 long-term care beds, the Eligible Operator shall be compensated at a rate of up to $10.35/day times 100 beds from the day the first resident moves into the facility or addition thereto for a period of 20 consecutive years. The Eligible Operator must submit an audited “Statement of Disbursements and Source of Funds” (this is a Ministry of Health form) to the Ministry of Health. Once the “Statement of Disbursements and Source of Funds” is approved by the Ministry of Health, the Up to $10.35 Per Diem shall be set or adjusted, if necessary, in the event that the Ministry of Health has been providing the Up to $10.35 Per Diem based on the Eligible Operators FEC form. The Eligible Operator must also sign a Service Agreement with the Ministry of Health in order to receive operating funds. The Up to $10.35 Per Diem for construction financing shall form part of the Service Agreement. PART SIX: WHAT HAPPENS TO THE UP TO $10.35 PER DIEM IN THE EVENT OF RECEIVERSHIP AFTER THE COMMENCEMENT OF OPERATIONS A long-term care facility may be placed under receivership where an operator is unable to meet its financial obligations. The receivership may take place after the Up to $10.35 Per Diem financing commences (for example, three or four years after opening). It is the policy of the Ministry of Health to work closely with a receiver to ensure that the needs of the residents are met and the facility is properly maintained. Ministry of Health funding support to the home continues during the receivership period to ensure continuity in the delivery of resident care programs and services. In most circumstances, the receiver, usually in conjunction with a management firm experienced in operating a long-term facility, continues to operate the facility until such time that a new operator (approved by the Ministry) assumes ownership. The new operator shall assume all obligations of the former operator relating to the operation of the long-term care facility. If the new operator does assume all obligations, the new operator shall be entitled to the same Up to $10.35 Per Diem from the Ministry of Health as previously provided to the prior operator. If a new operator cannot be found and the receiver seeks to dispose of the long-term care facility, residents shall be relocated to alternative care settings in accordance with their needs and the long-term care facility shall be closed. In this event, all Ministry of Health funding to the home shall cease (including all funding for construction or capital investment), and the receiver shall be responsible to deal with any creditors in the usual course.


Section 5.1

Retrofit Option Overview


January 2002


2.0 Retrofit Option Overview.................................................................... 1

3.0 Retrofit Option Program Details........................................................ 2

4.0 Submission Requirements ................................................................ 4

5.0 Retrofit Option Considerations......................................................... 4 5.1 The Service Area and Building Operations.................................................5 5.2 Building Condition.............................................................................................6 5.3 The Site’s Condition ..........................................................................................8

6.0 Retrofit Option Questions & Answers.............................................. 9

Ministry of Health and Long-Term Care, Long-Term Care Redevelopment Project 2002 “D” Bed Development Plan Submission Process 5.1-1

1.0 Introduction Effective January 2002, the Ministry of Health and Long-Term Care introduced two new development programs for “D” class facilities, each with new design standards and associated funding. The Retrofit Option is one of these new programs. It is designed to provide “D” Operators with increased flexibility in bringing their facilities up to current design standards.

2.0 Retrofit Option Overview Retrofit is a Development Option for facilities that can be renewed to accommodate a number of key design standards, including, but not limited to: • Resident Home Areas (RHA) with no more than 32 to 40 residents per RHA; • One bed bedrooms with a minimum size of 120 square-feet (with some exceptions),

excluding the space for the vestibule, the washroom and the clothes closet; • Two bed bedrooms with a minimum size of 210 square-feet (with some exceptions),

excluding the space for the vestibule, the washroom and the clothes closet; and • Ensuite washrooms with no more than two residents sharing one washroom. In deciding which Development Option (Redevelopment, Retrofit or Upgrade) is best suited for a facility, a thorough analysis and investigation of the opportunities and risks associated with each option is required. There are a number of factors to consider when choosing a Development Option. Some of these factors are discussed in Section 1.4: Choosing Your Development Path. In addition, there are considerations to analyze which are unique to each option. Important information is found within each of the Development Option Guidelines contained in this binder. Below is a section entitled Retrofit Option Considerations that discusses some of the key considerations in choosing the Retrofit Development Path. There are two main documents governing the Retrofit Option – the Long-Term Care “D” Facility Retrofit Design Manual (the “”D” Retrofit Design Manual”) and the Policy for Funding Construction Costs of Retrofitting “D” Long-Term Care Facilities (the “Retrofit Construction Funding Policy”). These documents have been organized to create a single point of reference for Retrofit deign and funding information.


The “D” Retrofit Design Manual sets out the design standards that a retrofitted facility must meet. This manual is based on the standards set out in the 1998 Long-Term Care Facility Design Manual (the “1998 Design Manual”). These design standards were reorganized into three categories, along with the addition of a choice in the definition of Preferred Accommodation (semi-private and private beds): • Mandatory Design Standards (no change to the 1998 design standards); • Allowable Performance Ranges (standards that include a performance range

between a minimum and the 1998 standard); and • Comparable Designs (standards that allow some of the 1998 standards to be met

through comparable designs provided that the Design Objectives and Design Considerations are adequately addressed).

The Retrofit Construction Funding Policy sets out the funding that will be provided to “D” Operators to support the construction costs of retrofitting existing “D” facilities in accordance with the standards in the “D” Retrofit Design Manual. This Policy sets out a range for the Retrofit Construction Funding Per Diem (the “Retrofit Per Diem”). The range is $7.00 to $10.35 per bed per day. The amount of the Retrofit Per Diem is determined by a methodology that reflects the use of the Performance Ranges, Comparable Designs, and the choice of Preferred Accommodation definition.

3.0 Retrofit Option Program Details Retrofit Design Standards The design standards for the Retrofit Option are set out in the “D” Retrofit Design Manual. Read through this manual thoroughly to understand how the three types of standards (Mandatory, Performance Ranges, and Comparable Designs) are treated. Also carefully read the two options for defining private and semi-private bedrooms. The “D” Retrofit Design Manual should be read in conjunction with the Retrofit Construction Funding Policy. Design standards and construction funding are linked for retrofitted facilities. The “D” Retrofit Design Manual sets out the design standards and the Retrofit Construction Funding Policy sets out the construction funding policies and process for calculating the Retrofit Per Diem.


Applications for Comparable Designs The “D” Retrofit Design Manual includes certain standards for which comparable designs may be proposed. Rather than meeting the 1998 design standards as they are written, an Operator can apply for Ministry approval for alternate designs that are considered to meet the relevant Design Objectives and Design Considerations. This application and approval process is set out in Part B of the “D” Retrofit Design Manual. The effect that use of Comparable Designs has on the Retrofit Per Diem is explained in the Retrofit Construction Funding Policy. The Retrofit Per Diem Retrofit Per Diem Eligibility Based on Design The Retrofit Per Diem eligible for retrofitted LTC facilities ranges between $7.00 and $10.35 per bed per day (for 20 years). The $10.35 per diem is available when none of the flexible standards (Performance Ranges, Comparable Designs, and optional preferred accommodation definitions) are used. In practice, however, it is expected that most Retrofit projects will be using many of the flexible standards. The Ministry will determine the amount of Per Diem potentially payable on the basis of its review of design submissions. The Retrofit Per Diem is based on the amount of funding for which the design is eligible and the amount of eligible costs Operators actually incur in order to complete the project. Maximum Eligible Cost The Maximum Eligible Cost is equal to the Retrofit Per Diem available based on the design divided by the maximum available Per Diem, which is $10.35. This factor is multiplied by 75,000, which is the Maximum Eligible construction cost, to calculate the Maximum Eligible Cost for a project. Maximum Eligible Cost will range from $50,725 to $75,000. Determination of The Retrofit Per Diem Retrofit Per Diem Calculation Forms (Ministry Forms) are used in determining the Retrofit Construction Funding Per Diem (the “Retrofit Per Diem”) for which the facility will be eligible. These forms are available in Appendix 9.5 of the “D” Bed Program binder. A Retrofit Construction Funding Calculator computer spreadsheet in various software versions will be available on the Ministry website at www.gov.on.ca/health/english/program/ltc/redev/redev_mn.html. This spreadsheet will


enable Operators to estimate the Retrofit Per Diem by applying the funding criteria to all of the relevant project data. Retrofit Per Diem Calculation Forms must be submitted at design approval stages, or whenever an Operator needs an estimate of the per diem payable based on a given design proposal. The Ministry will determine the Retrofit Per Diem payable and inform the Operator of the result. An Architect’s Certificate must be included with the Retrofit Per Diem Calculation Forms that are submitted with the Working Drawings submissions, and when revised drawings are submitted. This Certificate is available in Appendix 9.5 of the 2002 “D” Bed Program binder. The Architect’s Certificate is filled out by the Architect who prepared the drawings. By signing the Certificate, the Architect is certifying that the information provided in the Calculation Forms accurately reflects the drawings. Each time the certified Retrofit Per Diem Calculation Forms are submitted, the Ministry will reply to the Operator in writing confirming the Retrofit Per Diem approved by the Ministry. The completed facility will also be checked against the information in the Calculation Forms last submitted to the Ministry.

4.0 Submission Requirements Operators considering the Retrofit Option should complete the Submission Package as outlined in Section 2: Submission Guidelines. Once Development Planning is sufficiently advanced, Operators will be asked to submit additional submission requirements specific to the Retrofit Option (these requirements are available from your Account Manager). Two additional submission requirements that are unique to the Retrofit Option are:

• Retrofit Per Diem Calculation Forms; and • Comparable Design Application (if applicable).

5.0 Retrofit Option Considerations The discussion below deals primarily with physical and planning approval factors to consider when choosing the Retrofit Option. There are other considerations discussed


in Section 1.6: Choosing Your Development Path, including marketability, borrowing capacity, equity requirements, Ministry funding, operational impacts, care delivery, relocation costs and disruption to residents. Physical and planning approval factors that should be considered include:

• The Service Area and building operations of your facility; • The physical building condition of your facility; • The condition of your property or site; and • Other available Development Options.

5.1 The Service Area and Building Operations

Should the facility continue in its current location? Whether to move to a new site is one of the most important decisions to make when choosing a Development Option. Choosing to retrofit means staying in your current location. Issues to consider include:

• Marketability in either the current or a new location; • Obtaining Ministry approval if you choose to move to a new Service Area. • Cost of relocation to a new site; • The needs of your current community; and • The value of the existing facility for resale or in an alternate use.

Does the facility require additional space in order to be Retrofitted? The issue of whether to add new space is also a factor when choosing to retrofit. Most “D” facilities currently have less space per bed than will be required in a retrofitted facility. This will require either downsizing the number of beds from your existing facility or adding new space. Can the Retrofit Option solve current operational difficulties and other building deficiencies? The existing building may have design limitations which hinder efficient operation. It is important to evaluate these deficiencies and decide whether retrofitting the facility will solve these problems. Efficient building design can lower operational costs in the long run. Lower operating costs may help off-set the capital costs of a well designed Retrofit.


5.2 Building Condition In some circumstances a great deal of capital cost can be saved by retrofitting an existing facility. The condition of your existing facility is a key factor here. In considering the physical condition of your existing building you must ask:

• Is the building worth keeping? • How will the building’s condition affect retrofit?

Is the building worth keeping? Evaluating the state of the building is referred to as a Condition Survey. This can be carried out by a Building Inspector, Architect, Engineer or an alternate Building specialist. This will help determine whether a Retrofit will result in substantial savings compared to a new build. Special attention should be given to the structure of the building, the building envelope, and the building’s mechanical/electrical and plumbing systems. The following questions need to be considered: The structure of the building: • Is the building structurally sound? • Will the structure be viable for an additional 20 years? • Do all major building systems need to be replaced, or can a phased capital

replacement strategy be put in place? The building envelope (the skin of the building) and roof: • In what condition is your building envelope – brick or cladding, windows, insulation

within the wall cavity? • Will the building envelope last an additional 20 years without substantial

maintenance or renewal costs? • In what condition is the roof of the building? The mechanical/electrical and plumbing system of the building: • Are the services to your building adequate; is there sufficient hydro, water and waste

capacity? • Can any of the existing mechanical/electrical/plumbing system be used? • Which systems need replacement and/or upgrade? Hazardous materials: • Are there hazardous materials such as asbestos, PCBs, lead etc. in the existing

building that need to be removed or contained during Retrofit?


How will the building’s condition affect Retrofit? Once the building has been determined to be structurally sound, a review should be carried out by your Design Team and/or Architect to determine whether or not it could be appropriate for the building to be retrofitted. An Architect and/or a Design Team would be able to work with you to develop a spatial and functional schematic layout of the LTC facility within the parameters set out by the Ministry in the “D” Retrofit Design Manual, Ontario Building Code, Ontario Fire Code, and all other relevant provincial and Municipal codes and regulations. During this process certain questions and issues should be addressed: • Can the existing footprint or floor plate accommodate all of the mandatory design

standards in the “D” Retrofit Design Manual? o Mandatory design standards are found within the body of the “D” Retrofit Design

Manual. A summary of these can be found in Appendix 9.6: Summary of “D” Retrofit Design Standards.

• Can the facility take advantage of the flexibility given in the Performance Ranges and Comparable Designs provided in the “D” Retrofit Design Manual?

• Is an addition to the facility required? Since the spatial requirements in the “D” Retrofit Design Manual are generally larger than the existing spaces within facilities, some combination of building additions and/or bed reductions may be required. Can this be done (refer to The Site’s Condition section below)?

• Are there any special historical designations that may restrict any changes to the

design of the building?

• A decision must be made with respect to the Preferred Accommodation definition (see definition options in the “D” Retrofit Design Manual) and resident bedroom-type mix. The mix of semi-private and private bedrooms, determined by the choice in Preferred Accommodation definition, may affect space requirements of the retrofitted building. The current floor plate may place limits on the number of one-bed bedrooms you can offer.

The Architect and/or Design Team would be able to advise you on any other additional steps, requirements, and/or issues to resolve in the design process. Cost feasibility studies can be developed to determine the benefit of Retrofit versus new construction.


5.3 The Site’s Condition An evaluation of the existing site must be carried out to determine what development is permitted and which planning and building approvals are required. These requirements can be obtained by contacting your Municipal Planning and Building Departments. Generally, this information is obtained by your Architect or Design Consultant. The following questions help you to identify some Municipal requirements on the existing site: • What is the zoning for your property?

• Does the LTC facility comply with the current Official Plan and Zoning By-laws for

your property?

• What are the minimum setback requirements? o Will the setback requirements and/or other provisions contained in the Official

Plan and/or Zoning By-laws restrict an addition to the existing facility?

• Is there a height restriction on the building? o Can floors be added to the existing building?

• Once the height restriction is determined, your Design Team and/or Architect can determine whether or additional floors or additions can be added within the current zoning.

• What is the total allowable building coverage and density (allowable square footage

of the building)? o The building coverage usually refers to the percentage of the site the footprint of

the building would encompass. o Density usually refers to the ratio of the building’s gross floor area (GFA) to the

area of the property on which the building is situated. • Does your Municipal Planning Department require special provisions for full or partial

demolition, site access during construction and/or access for emergency vehicles and equipment, garbage pick up requirements etc?

• What site plan approvals will be required? Your Design Team and/or Architect will be able to advise you on the above questions. If required, minor variances, or amendments can be done through the Committee of Adjustment while larger variances will require a site specific rezoning and/or Official Plan amendment.


In addition to requirements for Municipal planning approval, site remediation issues (soil and environmental testing) should also be investigated. Site remediation issues can be identified by doing a Phase I Environmental Assessment.

6.0 Retrofit Option Questions & Answers Can a Redevelopment and/or Upgrade be combined with the Retrofit Option? How does this affect the construction funding? Facilities that use a combination of the Retrofit and Redevelopment Options are called Multi-Option facilities. An Operator can choose to develop a project which includes both retrofitted sections and newly built (redeveloped) sections. However, the Retrofit Option cannot be combined with the Upgrade Option. Where an Operator chooses to add an addition(s) to an existing facility, the “D” Retrofit Design Manual will apply to both the existing and new portions of the facility, with the exception of facilities that contain new bed awards. In cases where Operators have been awarded new beds, facilities must be built to the 1998 design standards as required by the existing Development Agreement. What if a “D” facility also contains beds classified by the Ministry as “A”, “B” or “C”? Could an Operator retrofit the “D” bed portion of the facility and maintain the other beds as they are structurally classified? When retrofitting the “D” section of your facility, the structural classification of the non-“D” sections of the facility will be maintained. However, because these facilities are integrating existing space with retrofitted space, there may be unique and complex design issues to address. Some design changes may be required to portions of the facility outside the “D” section, such as common service spaces, in order to meet the requirements in the “D” Retrofit Design Manual. Operators are advised to discuss these issues with the Ministry at an early stage in the design process. How and when will the Ministry approve Comparable Design applications? In order to support the exploration of feasible design solutions, Operators will be able to apply for Comparable Design approval at any time in the development process after February 1, 2002. This includes very early stages in the process while decisions are still being made as to which Development Option to choose. Comparable Design Applications can be modified and re-submitted at subsequent design phases. Please refer to Part B of the “D” Retrofit Design Manual for an explanation of the Comparable Design application and approval process.


What if there are building constraints that may prevent meeting all of the mandatory design criteria? The Ministry is prepared to work with Operators to implement high quality designs that are substantially compliant with the standards. Problems of this nature should be discussed with the Ministry at the earliest possible opportunity.


Section 5.2

Long-Term Care “D” Facility Retrofit Design Manual


January 2002

Table of Contents INTRODUCTION..............................................................................................1

I. BACKGROUND ......................................................................................................... 1 II. THE LONG-TERM CARE “D” FACILITY RETROFIT DESIGN MANUAL...... 1

HOW TO USE THIS MANUAL .......................................................................2

I. MANDATORY PROVISIONS................................................................................... 2 II. PURPOSE................................................................................................................... 2 III. OVERVIEW OF THE MANUAL............................................................................... 2 IV. DESIGN OBJECTIVES, MANDATORY DESIGN STANDARDS,

COMPARABLE DESIGN STANDARDS, PERFORMANCE RANGES, AND FUNCTIONAL CONSIDERATIONS/RECOMMENDATIONS............................ 5

V. PLANS REVIEW AND APPROVAL PROCESS.................................................. 7 VI. REVIEW OF ALLOWABLE PERFORMANCE RANGES................................... 7 VII. REVIEW AND APPROVAL OF COMPARABLE DESIGN APPLICATIONS.. 7 VIII. MULTI-OPTION PROJECTS................................................................................... 8 IX. MIXED CLASSIFICATION PROJECTS................................................................. 8

PART A RETROFIT DESIGN STANDARDS AND FUNCTIONAL

CONSIDERATIONS/RECOMMENDATIONS .......................... 10 1.0 RESIDENT HOME AREA(S) .......................................................................................11 1.1 RESIDENT HOME AREA.................................................................................11 2.0 RESIDENT PERSONAL SPACE IN THE RESIDENT HOME AREA(S)..............14 2.1 RESIDENT BEDROOMS..................................................................................14 2.2 RESIDENT WASHROOMS..............................................................................19 2.3 RESIDENT BATH ROOMS AND SHOWER ROOMS.................................22 3.0 FACILITY AND STAFF SUPPORT SPACE IN THE RESIDENT HOME AREA(S)..........................................................................................................................26 3.1 WORK SPACE FOR NURSING AND PROGRAM/THERAPY STAFF IN

EACH RESIDENT HOME AREA....................................................................26 3.2 STORAGE SPACE FOR RESIDENT CARE SUPPLIES AND

EQUIPMENT IN RESIDENT HOME AREAS ................................................28 4.0 RESIDENT LOUNGE AND PROGRAM/ACTIVITY SPACE..................................30 4.1 RESIDENT LOUNGE AND PROGRAM/ACTIVITY SPACE......................30 5.0 DINING AREA(S) AND DIETARY SERVICE SPACE.............................................34 5.1 RESIDENT DINING AREA(S) .........................................................................34 5.2 DIETARY SERVICE SPACE...........................................................................37

6.0 RESIDENT COMMUNITY SPACE..............................................................................42 6.1 OUTDOOR SPACE/OUTDOOR AREA(S)....................................................42 6.2 BEAUTY PARLOUR/BARBER SHOP...........................................................44 6.3 PLACE OF WORSHIP ......................................................................................45 6.4 ENHANCED RESIDENT SPACE....................................................................46

7.0 ENVIRONMENTAL SERVICES..................................................................................47 7.1 LAUNDRY SPACE............................................................................................47 7.2 HOUSEKEEPING SERVICE SUPPORT SPACE........................................49 7.3 UTILITY SPACE.................................................................................................51 7.4 MAINTENANCE SERVICE SUPPORT SPACE...........................................52 8.0 SAFETY FEATURES....................................................................................................54 8.1 RESIDENT/STAFF COMMUNICATION AND RESPONSE SYSTEM......54 8.2 DOOR ACCESS CONTROL SYSTEM..........................................................55 8.3 FIRE ALARM SYSTEM....................................................................................56 8.4 SPRINKLER SYSTEM......................................................................................57 8.5 WATER TEMPERATURE CONTROL SYSTEM..........................................57 9.0 BUILDING SYSTEMS...................................................................................................59 9.1 LIGHTING SYSTEMS .......................................................................................59 9.2 HEATING, VENTILATION AND AIR-CONDITIONING (HVAC) SYSTEM..............................................................................................................60 10.0 OTHER FEATURES......................................................................................................62 10.1 RESIDENT DEDICATED STORAGE SPACE..............................................62 10.2 FACILITY STAFF SPACE................................................................................63 10.3 RECEIVING/SERVICE SPACE.......................................................................64 10.4 RECEPTION/ENTRANCE SPACE.................................................................66 10.5 ELEVATORS......................................................................................................67 10.6 PUBLIC WASHROOMS ...................................................................................68 10.7 SITE DEVELOPMENT......................................................................................69 10.8 CORRIDORS......................................................................................................70 11.0 ARCHITECTURAL CONSIDERATIONS AND RECOMMENDATIONS..............72 PART B LONG-TERM CARE FACILITY PLANS REVIEW PROCESS

FOR RETROFIT ........................................................................ 76 INTRODUCTION............................................................................................................77 ROLE OF THE MOHLTC LONG-TERM CARE REDEVELOPMENT PROJECT............................................................................................................78 DEFINITIONS OF TERMS ...........................................................................................79 STEPS IN THE PROCESS...........................................................................................80

APPENDIX A PROJECT SUMMARY..........................................................................88 APPENDIX B OPERATIONAL PLAN FOR THE RETROFIT OF A LONG-TERM

CARE FACILITY....................................................................................91 APPENDIX C PLANS SUBMISSION CHECKLIST...................................................96

LONG-TERM CARE “D” FACILITY RETROFIT DESIGN MANUAL

Ministry of Health and Long-Term Care, Long-Term Care Redevelopment Project 5.2-1

INTRODUCTION I. BACKGROUND The provincial Government passed the Long-Term Care Statute Law Amendment Act, 1993 (Bill 101) effective July 1, 1993, which amended the different legislation governing long-term care (LTC) facilities as a first step to creating a common LTC facility system. Bill 101 introduced consistent operational standards, consistent resident admission criteria and a single funding scheme for all LTC facilities. Bill 101 also introduced a new province-wide mandatory admission policy that gives priority to people who are in greatest need of LTC facility placement. Facilities are now caring for residents with more complex care requirements than in the past. II. THE LONG-TERM CARE “D” FACILITY RETROFIT DESIGN MANUAL In the fall of 1996, the Long-Term Care Division of the MOHLTC (the “Ministry”) established a working committee to examine past Government practices with respect to design standards, and to look at the issue of design requirements for the residents who are now being admitted to LTC facilities. This working committee, which included representatives from the LTC facility provider associations and consumer organizations, was given the mandate to develop design objectives that would apply to all LTC facilities. The working committee completed its mandate over the winter and spring of 1997. The design standards contained in the 1998 Long-Term Care Facility Design Manual (the “1998 Design Manual”) are based on the advice and recommendations on design objectives presented by the working committee to the Minister of Health and Long-Term Care. When the 1998 Design Manual was introduced, it was recognized that new and revised design standards would be necessary to respond to changes in resident needs. It has also been recognized that additional support and flexibility is required by Operators who are redeveloping existing LTC facilities. The Long-Term Care “D” Facility Retrofit Design Manual (the “”D” Retrofit Design Manual”) is the first revision to the 1998 Design Manual. The “D” Retrofit Design Manual is closely modelled on the 1998 Design Manual but introduces additional flexibility in the design standards, in order to better enable Operators to adapt existing buildings to modern care requirements.



HOW TO USE THIS MANUAL I. MANDATORY PROVISIONS Effective January 9, 2002, the “D” Retrofit Design Manual shall apply in the retrofitting of all LTC facilities (nursing homes and homes for the aged) governed by the Nursing Homes Act, the Charitable Institutions Act, and the Homes for the Aged and Rest Homes Act. The “D” Retrofit Design Manual applies solely where long-term care Operators have chosen the Retrofit Option. For long-term care Operators who choose the Redevelopment Option, including new and/or renovation and alteration construction projects, the 1998 Design Manual still applies. Il. PURPOSE The “D” Retrofit Design Manual promotes innovative design in the retrofitting of existing LTC facilities. This Manual includes minimum mandatory design standards, comparable design, and design standards with allowable performance ranges. The “D” Retrofit Design Manual also provides guidelines on “best practices” to promote quality resident care outcomes in an existing LTC facility intending to undergo a retrofit. The overall goal of the “D” Retrofit Design Manual is to integrate design concepts that will facilitate the provision of quality resident care in an environment that is comfortable, aesthetically pleasing and as “home-like” as possible. The design of a LTC facility must also support well-coordinated, interdisciplinary care for residents who have diverse care requirements. These retrofit design standards allow service providers greater flexibility to configure facility environments that make it possible to respond positively and appropriately to the diverse physical, psychological, social and cultural needs of all LTC facility residents. It also allows greater flexibility when working within an existing building envelope. III. OVERVIEW OF THE MANUAL The “D” Retrofit Design Manual has been developed based on an approach that involves moving from the most private space of a resident, (resident personal space in a Resident Home Area) to the more public areas (which includes the overall support system space) within a facility. The “D” Retrofit Design Manual is closely based on the 1998 Design Manual with added design flexibility to address the constraints of an existing LTC facility building system while creating an environment that will maintain quality resident care in a “home-like” atmosphere.



The “D” Retrofit Design Manual groups all of the different resident care, program and service areas of the LTC facility under the following sections and further groups the different standards under mandatory standards, comparable design and performance ranges: 1. Resident Home Area(s)

Each Resident Home Area must be a self-contained, clearly defined unit which accommodates a group of no more than forty (40) residents. Every Resident Home Area must include bedrooms, washrooms, bath and shower rooms, dining area, lounge area, program/activity space, staff work space and storage space for that area.

2. Resident Personal Space In The Resident Home Area(s)

This section sets out the mandatory, flexible, and optional design expectations for the resident personal space, which includes bedrooms, washrooms, bath rooms and shower rooms.

3. Facility And Staff Support Space In The Resident Home Area(s)

Facility and staff support space includes the required staff work areas and the service rooms located in the Resident Home Area(s) which are used by the different staff of the facility. This space includes working areas for nursing care and program/therapy staff, as well as storage space for nursing care supplies/equipment.

4. Resident Lounge and Program/Activity Space

This section describes the mandatory, flexible, and optional Resident Lounge Space and Program/Activity Space design expectations for the LTC facility.

5. Dining Area(s) and Dietary Services Space

This section addresses the mandatory, flexible, and optional Resident Dining Area requirements for the LTC facility and the related Dietary Services Space. It also includes the mandatory, flexible, and optional space expectations related to cleaning activities for the Dietary Services Space and space for equipment used for the dietary program.

6. Resident Community Space

Resident Community Space includes the areas that are used by all residents of the LTC facility and that are located outside of the Resident Home Area(s). As a



minimum, there must be Outdoor Space, a Beauty Parlour/Barber Shop and a Place of Worship. With the exception of the space dedicated to the provision of a Place of Worship, the Resident Community Space is additional required space and is not considered as part of the required space for Resident Lounge Space and Program\Activity Space. In addition, for a LTC facility where all of the mandatory Resident Lounge Space and Program/Activity Space are located within the Resident Home Area(s), at least one additional area for use by all residents must be provided within the facility, outside the Resident Home Area(s). The decision on the use, purpose and size of this “common” area is at the discretion of the Operator and should be determined based on the needs of the residents to be accommodated in the LTC facility.

7. Environmental Services

This section describes the mandatory, flexible, and optional design requirements for the space used for the housekeeping, laundry and maintenance programs.

8. Safety Features

Safety features are the internal building features which must protect and promote the health, welfare and safety of residents. This section describes the mandatory, flexible, and optional design expectations of the Resident/Staff Communication and Response System, the Door Access Control System, the Fire Alarm System, the Sprinkler System (also subject to compliance with the Ontario Fire Code) and the Water Temperature Control System.

9. Building Systems

This section describes the mandatory, flexible, and optional building systems design expectations for lighting, heating, ventilation and air conditioning (approval of these systems is also subject to meeting compliance with the relevant sections of the Ontario Building Code and any related regulatory or generally accepted standards for lighting, heating, ventilation and air conditioning systems) .

10. Other Features

Other features address the remaining mandatory, flexible, and optional design expectations for the staff and “public” areas of the building, including the mandatory and optional design features for resident dedicated storage space, staff room(s), receiving/service space, the reception and entrance ways, elevators and public washrooms.



11. Architectural Considerations

This section provides guidance and direction on design and building features that best support and respond to the nursing and personal care needs of residents in LTC facilities. Architectural considerations are not mandatory requirements, but rather are suggestions on features which assist residents who may have special needs which result, for example, from cognitive impairments, varying degrees of dementia, vision impairments, hearing impairments and/or physical disabilities. Although these features are recommendations for enhancement of the building design, it is strongly suggested that these recommendations be considered and incorporated accordingly.

NOTE: Retrofit is not defined in this manual the same way as it is in other

provincial legislation (e.g. the Ontario Building Code, the Ontario Fire Code). Operators undertaking the Retrofit Option should consult with their Architect with respect to requirements under these statues and ordinances.

IV. DESIGN OBJECTIVES, MANDATORY DESIGN STANDARDS, COMPARABLE

DESIGN STANDARDS, PERFORMANCE RANGES, AND FUNCTIONAL CONSIDERATIONS / RECOMMENDATIONS

Each of the sections of the “D” Retrofit Design Manual which are listed above, with the exception of the section on “Architectural Considerations”, has the following format: 1. Design Objective

The Design Objective describes the purpose and design expectations for each area addressed, including how the space is to be used and what the resident focus should be to achieve the optimal care outcomes.

2. Mandatory Design Standards

These are the minimum design requirements that must be attained. Mandatory Design Standards are the compulsory requirements that must be incorporated into the design of each long-term care retrofit facility.

3. Comparable Design Standards

These standards are requirements that must be met based on the relevant design objective(s) and design consideration(s). The Ministry would prefer that the design objectives be met according to the original standard, however, due to possible



project limitations, alternatives may be proposed so long as the design objective and design consideration are addressed to the Ministry’s satisfaction.

4. Performance Range

Standards within the Performance Range category provide additional design flexibility from that of the original standard. Performance Ranges set out a minimum design standard, below which a design will not be approved, and a maximum value for funding eligibility which is based on the corresponding 1998 Design Manual standard. Operators may exceed the performance range for a given feature, but will not be eligible for additional construction funding.

5. Functional Considerations/Recommendations

Functional considerations and recommendations are optional design features which have been developed from the work completed by the joint Long-Term Care Division/provider/consumer project. Although functional considerations and recommendations are not mandatory, they are considered to be features that further promote quality facility design and quality care outcomes. These features have been included to provide helpful guidance for Operators during the design process where they might not otherwise have been considered.

It is acknowledged that a number of the Design Standards and Functional Considerations/Recommendations would be considered as “obvious” features that must be or may be provided. These “obvious” mandatory, flexible, and optional design features are included because they are considered important to the design and functioning of the LTC facility. Not all users of this Manual will be familiar with or experienced in the design and operation of a LTC facility. It is expected that this Manual will be used by both experienced and non-experienced organizations in the long-term care sector.

IMPORTANT – PLEASE NOTE

LONG-TERM CARE FACILITY PROGRAM MANUAL It is essential that the architectural plans for any long-term care facility be developed in consideration of the operational standards outlined in the Long-Term Care Facility Program Manual. The Long-Term Care Facility Program Manual describes the operational requirements for all LTC facilities. The operational needs of the long-term care facility and the planned programs to provide are key in guiding and determining the long-term care facility design. The long-term care facility must be designed to facilitate the best possible care for the residents who will be accommodated.



V. PLANS REVIEW AND APPROVAL PROCESS The Ministry of Health and Long-Term Care (MOHLTC), Long-Term Care Redevelopment Project (LTCRP) is responsible for the review and approval of all construction plans for LTC facilities. The legislation which governs LTC facilities includes mandatory plan submission and approval protocols for all long-term care construction plans. The LTCRP plans review process for LTC facilities is described in detail in Part B of this Manual. In addition, for any LTC facility construction project, compliance with the Ontario Building Code, the Ontario Fire Code, and any relevant municipal building requirements (includes meeting zoning and other relevant municipal by-laws) remains the responsibility of the LTC facility Operator. The Design Objectives, Mandatory Design Standards, Design Standards with Comparable Design, Design Standards with Allowable Performance Ranges, and Functional Considerations/Recommendations set out in this “D” Retrofit Design Manual are specific to the retrofit design and construction of LTC facilities. This does not preclude the application of these standards and guidelines to other types of facilities. However, the LTCRP plans review will only address the proposed retrofit design of the LTC facility. VI. REVIEW OF ALLOWABLE PERFORMANCE RANGES Allowable Performance Ranges chosen by the sponsoring Agency/Architect must be reflected in the Retrofit Per Diem Calculation Forms. VII. REVIEW AND APPROVAL OF COMPARABLE DESIGN

APPLICATIONS

Comparable Design Applications supplied by the sponsoring Agency/Architect must receive approval to ensure compliance with the outlined Design Objectives and Design Considerations of each Standard with Comparable Design. The Comparable Design Applications can be submitted prior to the First Submission of Plans or accompanying the first submission. It is advisable to submit the proposal for Comparable Design Applications prior to the first submission of plans to receive approval and feedback prior to continuing with the design process. Changes to the proposal can be made throughout the design process.



VIII. MULTI-OPTION PROJECTS An Operator can choose to develop a project which includes both retrofitted sections and newly built (redeveloped) sections. Where an Operator chooses to add an addition(s) or a new floor to an existing facility, the “D” Retrofit Design Manual will apply to both the existing and new sections of the facility, with the exception of facilities that contain new bed awards. In cases where Operators have been awarded new beds, these new beds must be built to the 1998 design standards as required by the existing Development Agreement. IX. MIXED CLASSIFICATION PROJECTS When retrofitting a facility, a section of which has been structurally classified as “D”, the structural classification of the non-“D” sections of the facility will be maintained. However, because these facilities are integrating existing space with retrofitted space, there may be unique and complex design issues to address. Some design changes may be required to portions of the facility outside the “D” section, such as common service spaces, in order to meet the requirements in the “D” Retrofit Design Manual. As a result, each facility must receive design approval on a case-by-case basis. Operators are advised to discuss these issues with the Ministry at an early stage in the design process.

IMPORTANT - PLEASE NOTE DESIGN STANDARDS FOR INTEGRATED MULTI-USE

COMPLEXES The resident care areas of a LTC facility must be completely separate and

distinct from space which is used for other purposes. If the LTC facility is to be part of a larger integrated complex, for example, a combined complex that includes a rest/retirement home and a LTC facility, the space allocated for the LTC facility resident accommodations must be distinct and separate from the rest/retirement home.

In an integrated multi-use complex, it is acceptable to share building service

areas, such as the kitchen, parking area, outdoor space, staff rooms, the laundry, cafeteria, auditorium, place of worship and the beauty parlour/barber shop. In addition, it is acceptable to share the internal building systems for water, hydro, sewage, waste disposal, lighting, heating and ventilation.

Resident care areas and resident space, which include bedrooms, washrooms,

tub and shower rooms, dining areas, lounges and program/activity space shall not be integrated.



If an integrated multi-use complex is to be constructed, the separation of the

different areas and the sharing of any building services must be clearly indicated on the plan submission. The LTCRP will evaluate the plans to ensure that compliance is met with the design expectations and space separation requirements. If it is intended that there be “common” space for sharing by residents of the LTC facility and other people served by the integrated complex (including the community-at-large), such must be shown on the plans.

The LTCRP will accept the sharing of “common” space when the Operator is able

to demonstrate that this space will enhance and promote quality resident care outcomes. Such requests will be evaluated as part of the construction plans review process.



PART A

RETROFIT DESIGN STANDARDS AND FUNCTIONAL

CONSIDERATIONS/RECOMMENDATIONS



1.0 RESIDENT HOME AREA(S) 1.1 RESIDENT HOME AREA Design Objective:

The Resident Home Area(s) is a new and innovative concept that is being introduced to the design requirements of LTC facilities. Each Resident Home Area accommodates a maximum of forty (40) residents and must be a self contained unit for use by the residents in that area. The intent is to create smaller home-like units, rather than large congregate/institutional living environments.

The Resident Home Area(s) includes:

• resident bedrooms and washrooms;

• resident bath and shower rooms;

• lounge areas, program/activity space, dining area(s) and resident

storage space dedicated for use by the residents living in the Resident Home Area(s); and

• staff work space and support services areas.

Design Standards with Allowable Performance Ranges: 1.1.1 Minimum Standard:

Each Resident Home Area must be a clearly defined distinct unit that provides accommodation for a maximum of forty (40) residents.

Performance Range: Bottom End: Forty (40) residents per Resident Home Area. Top End: Thirty-two (32) residents per Resident Home Area.



Note: Although a Resident Home Area must not exceed a maximum of 40 residents,

this mandatory requirement does not preclude designing a Resident Home Area that provides accommodation for less than 40 residents. The size and number of residents in each Resident Home Area should be determined in consideration of the resident care and/or program requirements. In addition, the number of residents in each Resident Home Area does not necessarily have to be the same throughout the facility.

Design Standards with Comparable Design: 1.1.2 Current 1998 Design Standard:

The Resident Home Area must be a self-contained “living system” and must not allow for transitory passage through the Resident Home Area(s) when traveling from one part of the facility to another.

Design Objective for this Standard: Ensure resident privacy and home-like environment.

Design Consideration When Developing a Comparable Design to the Current 1998 Standard: Design Features should be provided which compensate for any transitory passage by reinforcing privacy and the resident’s experience of a home-like atmosphere. Distinction between service transitory passage (e.g. transitory passage of food delivery, garbage, etc.) and passage of residents, staff, and visitors should be made. Service transitory passage must be kept at an absolute minimum and must not disrupt the experience of the home environment.

Mandatory Design Standards: 1.1.3 Each Resident Home Area must be a clearly defined distinct unit. 1.1.4 All resident bedrooms are to contain either one or two beds. 1.1.5 Every bedroom must have an ensuite “barrier-free” washroom that contains

at a minimum, a sink and a toilet. The entrance to the washroom must be from within the bedroom itself (which includes the vestibule).



Note: The ratio of standard and preferred accommodation, as set out in the

regulations governing all LTC facilities, requires that 40% of the residents must be charged at the basic accommodation rate. This permits charging up to 60% of the residents at the preferred accommodation rate (this is the rate for semi-private and private rooms). This charging policy must be adhered to regardless of the design of the building. For example, a LTC facility may have all one bed private rooms, but 40% of the residents must still be charged the basic accommodation rate.

1.1.6 In each Resident Home Area, the bath and shower rooms, dining area(s), lounge area(s) and program/activity space must be located in close proximity to the resident bedrooms.

1.1.7 Resident bedrooms in each Resident Home Area may be all basic

(standard) rooms, semi-private rooms and private rooms, or a mix of each type of room (see definition of bedrooms in 2.0 Resident Personal Space in the Resident Home Area).

1.1.8 At least 50% of the total minimum required Resident Lounge Space and

Program/Activity Space for the LTC facility must be located within the Resident Home Area(s). The remaining 50% of this required space may be located outside the Resident Home Area(s) either for sharing by all residents of the LTC facility or for use to increase lounge/program activity space in one or more Resident Home Area(s).

NOTE: Cross-reference 4.1.2 under Resident Lounge and

Program/Activity Space. 1.1.9 At least 80% of the mandatory minimum Dining Area must be located

within the Resident Home Area(s). The remaining 20% of this mandatory Dining Area may be located outside of the Resident Home Area(s) for sharing by all residents of the LTC facility or used to enhance Dining Area in one or more of the Resident Home Area(s).

NOTE: Cross-reference 5.1.2 under Dining Area(s) and Dietary Service Space.



2.0 RESIDENT PERSONAL SPACE IN THE RESIDENT HOME AREA(S)

2.1 RESIDENT BEDROOMS Design Objective:

The resident bedroom is the centre of the resident’s personal space where the most private activities take place - sleeping, grooming and dressing. It must meet each resident’s need for comfort and safety, promote resident independence and dignity, and provide for resident privacy. Each bedroom must be designed in a manner that maximizes a sense of familiarity for residents and supports direct care staff in the safe delivery of quality resident care. Types of Accommodation Operators will have additional flexibility in the types of bedrooms which may be offered as preferred accommodation. Option A is the definition as it is written in the 1998 Design Manual, while Option B offers a higher level of flexibility. Increased construction funding will be provided under the Policy for Funding Construction Costs of Retrofitting “D” Long-Term Care Facilities for Option A. Either of these definitions can be applied to any bedroom being offered as preferred accommodation. Option A: A private bedroom must accommodate one resident and must have a separate “barrier-free” ensuite washroom. A semi-private bedroom must accommodate one resident in one bedroom, another resident in a separate bedroom, with both bedrooms joined by a “barrier-free” ensuite washroom, (i.e. two bedrooms, with one resident in each bedroom, share one ensuite washroom). A basic (standard) bedroom must accommodate two residents and must have a separate “barrier-free” ensuite washroom. Option B: A private bedroom is defined as a bedroom with one bed that includes either an ensuite “barrier-free” washroom or a “barrier-free” washroom which joins two bedrooms, each with one bed. A semi-private bedroom is defined as a bedroom with two beds that includes a “barrier-free” ensuite washroom.



A basic (standard) bedroom is defined as any bedroom which is designated as such.

Design Standards with Allowable Performance Ranges: 2.1.1 Minimum Standard:

A one-bed bedroom must have at least 120 square feet (11.2 square metres) of floor space excluding the space for the vestibule, the washroom and the clothes closet.

Performance Range: Bottom End: 120 square feet (11.2 square metres) of floor space

excluding the space for the vestibule, the washroom and the clothes closet.

Top End: 130 square feet (12.1 square metres) of floor space

excluding the space for the vestibule, the washroom and the clothes closet.

NOTE: One-bed bedrooms will be permitted to meet a minimum of 115

square feet (10.7 square metres), provided that the average of the one bed-bedrooms throughout the facility is at least 120 square feet (11.2 square metres) and no more than 10% of the one-bed bedrooms throughout the facility are less than 120 square feet (11.2 square metres), excluding the space for the vestibule, the washroom and the clothes closet.

Design Consideration for One Bed-Bedroom Under 120 square feet

(11.15 square metres): Overhead lifts may be required to compensate for the lack of space within

the Resident Bedroom. 2.1.2 Minimum Standard:

A two-bed bedroom must have at least 105 square feet (9.75 square metres) of floor space per resident [210 square feet (19.5 square metres) per two-bed bedroom] excluding vestibule space, the washroom and the two clothes closets.



Performance Range: Bottom End: 105 square feet (9.75 square metres) of floor space per

resident excluding the space for the vestibule, the washroom and the two clothes closets.

Top End: 115 square feet (10.7 square metres) of floor space per

resident excluding the space for the vestibule, the washroom and the two clothes closets.

NOTE: Two-bed bedrooms will be permitted to meet a minimum of 100

square feet (9.3 square metres) per resident [200 square feet (18.6 square metres) per two -bed bedroom] provided that the average of the two-bed bedrooms throughout the facility is at least 105 square feet (9.75 square metres) per resident [210 square feet (19.5 square metres) per two -bed bedroom], and no more than 10% of the two bed-bedrooms throughout the facility are less than 105 square feet (9.75 square metres) per resident [210 square feet (19.5 square metres) per two -bed bedroom], excluding the space for the vestibule, the washroom and the clothes closet.

2.1.3 Minimum Standard:

Each bedroom must have a clothes closet for each resident. Each clothes closet must have at least five (5) square feet (0.5 square metres) of floor space. The clothes closet must be of sufficient height and depth to store and hang clothes.

Performance Range: Bottom End: Five (5) square feet (0.5 square metres) of floor space. Top End: Six (6) square feet (0.6 square metres) of floor space. Note: Bedroom spaces are usable net floor areas. The floor area is exclusive of

vestibule, resident washroom, and clothes closet space. In addition, space that is occupied by mechanical/electrical incremental units, building structure (e g. columns), and built-in furnishings cannot be included in the net floor area.

Vestibules refer to the entrance space within the bedroom. Typically it is

the space inclusive of and surrounding the door swing of the bedroom door.



Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 2.1.4 Each bedroom door must be a minimum width of 44 inches (1120 mm). 2.1.5 If a lock is installed on a bedroom door, the lock must be readily releasable

and easily openable for residents and staff. 2.1.6 In each bedroom, there must be sufficient space to provide access by

caregivers to three sides of the bed, that is, to both sides of the bed and the foot of the bed (cross-reference 2.1.18 – Functional Consideration / Recommendations for Resident Bedrooms).

2.1.7 Specialized program equipment must be able to get around the two sides of

the bed and the foot of the bed. 2.1.8 Each bedroom must be designed to allow a 180 degrees change of

direction of any care equipment within the room. 2.1.9 There must be a device for each resident in each bedroom that will activate

the Resident/Staff Communication and Response System of the LTC facility. The device to activate the Resident/Staff Communication and Response System must be located within easy reach of the resident, including when the resident is lying or sitting up in bed.

2.1.10 Each bedroom must have at least one window that provides a direct view to

the outdoors or to other naturally lit space from both a sitting and lying in-bed position. (cross-reference 2.1.22 - Functional Considerations/Recommendations for Resident Bedrooms)

2.1.11 Windows that open to the outdoors must have screens on all of these

windows in the spring, summer and fall seasons. 2.1.12 There must be no direct view of the toilet in the ensuite washroom

from the outside corridor when the washroom door is open. 2.1.13 Each bedroom must have “cueing” features, for example, a room

number, the resident(s) name(s), and/or pictures, outside each bedroom



door to assist residents in finding their way to and easily identifying their bedrooms.

2.1.14 Each basic (standard) bedroom must provide privacy for each resident of

the room. 2.1.15 All bedroom flooring must be non-slip. 2.1.16 Wiring for a phone jack and wiring for television service must be provided

for each resident in each bedroom. Functional Considerations/Recommendations: 2.1.17 Larger bedrooms may be appropriate for certain types of programs or

specialized resident care needs where additional space for equipment and seating for friends/family members is required, for example, for provision of palliative care. The size of bedrooms should be determined during the facility construction planning stage based on the anticipated care needs of residents to be accommodated in each Resident Home Area and the operational requirements that support quality care to those residents.

2.1.18 The bedroom design and space must allow access by caregivers to the

three sides of the bed that is, to both sides of the bed and at the foot of the bed (see Design Standard 2.1.6). The intent of this standard is not to restrict resident preference for bed placement within the room, but rather to ensure that adequate space is provided in each bedroom to effectively care for a resident while in bed. If a resident wishes to relocate his or her bed, for example, against a wall, this wish should be respected to the best extent possible (depending on the resident’s care requirements). If the resident is in a basic (standard) room, the wishes of the resident in the other bed also need to be taken into consideration.

2.1.19 In order to create variety in the appearance of the bedrooms, a variety of

interior design features, such as carpeting, wallpaper and different wall colours, should be considered.

2.1.20 The bedroom design should include space for items such as dressers,

shelving, bookcases and tackboards to allow residents to display and store personal items. Residents should be given every reasonable opportunity to personalize their bedrooms.

2.1.21 Some space should be provided at the vestibule entrance for the display of

familiar objects such as photographs and mementos.



2.1.22 The lowest edge of window glass should be no more than two feet (600

mm) from the floor to ensure an unobstructed view to the outside. The window should be equal to or greater than 10% of the floor area of the bedroom to ensure that sufficient natural lighting is available for the bedroom (see Design Standard 2.1.10).

2.1.23 When the bedroom door is closed, there should be a minimum width of two

feet (600 mm) between the door handle and the bedroom wall which is adjacent to the door.

2.1.24 Where a bedroom has a vestibule, the vestibule must be large enough to

permit the unobstructed passage of a wheelchair, a walker or any specialized program equipment.

2.1.25 If the bottom of the Performance Range for Closet space (5 square feet, 0.5

square metres) is chosen, it is recommended to consider compensation through added cubic space.

2.2 RESIDENT WASHROOMS Design Objective:

Each washroom must be “barrier-free” and designed to promote resident privacy, dignity and independence. In addition, the washroom space must also allow for the effective and safe delivery of care by caregivers. The entrance to the washroom must be from within the bedroom.

Design Standards with Allowable Performance Ranges; Not applicable to this section. Design Standards with Comparable Design: 2.2.1 Current 1998 Design Standards:

When open, a washroom door must not block the bedroom entrance-way and must not swing into another door in the bedroom, such as the bedroom door itself or a clothes closet door.

Design Objective for this Standard: Provide a safe and comfortable living space.



Design Consideration When Developing a Comparable Design to the Current 1998 Standard: The safety of the resident is of utmost importance. The design of door swings shall not cause a safety hazard or inconvenience to users (both resident and staff).

Mandatory Design Standards: 2.2.2 Each Resident Washroom must have at least one toilet and one hand

wash sink. 2.2.3 Each washroom must have sufficient space to enable independent and/or

assisted transfer from the front and at least one side of the toilet. (cross-reference to criteria 2.2.25 - Functional Considerations/Recommendations for Resident Washrooms)

2.2.4 In order to allow for sufficient space for a wheelchair or a walker, and for

staff to assist a resident, there must be a five (5) foot turning circle in each Resident Washroom.

2.2.5 A securely fastened grab bar must be located beside the toilet within easy

reach of the resident. Each grab bar must be of sufficient size and design to support the full weight of a resident and must be placed on a reinforced wall capable of sustaining the weight load.

2.2.6 There must be a device within easy reach of the resident that will activate

the Resident/Staff Communication and Response System. 2.2.7 Each Resident Washroom must have an entrance width of at least thirty-

six (36) inches (914 mm). 2.2.8 Each washroom must have counter space. 2.2.9 There must be space in each washroom for individual storage of each

resident’s personal items. When two residents share a washroom, separate storage space must be available for each resident.

2.2.10 If a lock is to be installed on a washroom door, the lock must be readily

releasable and easily openable. 2.2.11 The sink in each washroom must be positioned so that it meets the needs

of the resident or the residents using the washroom, (for example, those residents in wheelchairs).



2.2.12 Taps must be easy to use by residents with visual impairments and by

residents with physical disabilities that affect hand movement. 2.2.13 All washroom surfaces must be easily cleaned. In addition, all floor

coverings must be slip resistant. 2.2.14 Walls where grab bars are mounted must be appropriately reinforced to

ensure that they are capable of sustaining loads imposed on them. Functional Considerations/Recommendations: 2.2.15 Each washroom should have a mirror which is preferably located over the

sink and is adjustable to accommodate residents of differing heights. When determining the need and location of mirrors in washrooms, consideration should be given to the disorientation that mirrors may cause for residents with severe dementia. For some residents, depending on their care requirements, mirrors may be inappropriate.

2.2.16 A night-light outlet should be provided in the bedroom near the doorway to

the washroom in a location where, if a night-light is used, the light is visible from each bed.

2.2.17 There should be an illuminated light-switch for the washroom located in the

bedroom on the wall by the washroom entrance. 2.2.18 In order to assist a resident to easily identify and locate the washroom,

consideration should be given to painting the washroom door and the door frame a colour that contrasts with the colour of the bedroom wall.

2.2.19 From a resident preference and aesthetic standpoint, consideration should

be given to installing raised toilet seats as needed, rather than providing raised toilets in all washrooms.

2.2.20 The exhaust and air exchange rates in washrooms should exceed the

requirements of the Ontario Building Code regulations to ensure appropriate ventilation in washrooms and to keep odours to a minimum.

2.2.21 An exterior light or other sign which can be activated when the washroom is

occupied should be provided outside of each washroom door. 2.2.22 Lever handled taps that clearly distinguish between hot and cold water

should be used in all resident washrooms. This type of fixture is the



preferred model for residents with visual impairments and for residents with physical disabilities that affect hand movement.

2.2.23 Sharp edges on counters, cabinets and corners in washrooms should be

avoided. 2.2.24 If the washroom door is to be a sliding door, two factors to consider are:

. the weight of the door (to make sure that it is easy to move); and

. the location of the hardware (to avoid injuring caregivers’ backs and getting hands caught when the door slides).

2.2.25 Although the minimum design standard for the location of the toilet is

access from the front and at least one side of the toilet, this does not preclude providing access to the toilet from the front and both sides of the toilet. For some residents, access to three sides of the toilet may be necessary to meet care requirements (see Design Standard 2.2.3).

2.3 RESIDENT BATH ROOMS AND SHOWER ROOMS Design Objective:

Resident Bath Rooms and Shower Rooms must be safe, private and comfortable for residents. They must also be designed so that caregivers can easily and safely assist residents to bathe or shower in a manner that protects resident dignity and promotes resident independence as much as possible.

Design Standards with Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 2.3.1 Each Resident Home Area must have as a minimum:

• one separate room with a raised bathtub equipped with a hydraulic,

electric or mechanical lift (Note: A side-entrance bathtub may be provided as an alternative to a raised bathtub with a hydraulic lift);



• one separate room with a shower ( the showering area must have sufficient space to accommodate a shower chair so that a resident can be showered in the sitting position); and

• a “barrier -free” washroom (including a toilet and a sink) located either

in each bath room and shower room, or in a separate and enclosed common area which is between the bath and the shower rooms.

2.3.2 Where the Resident Bath Rooms and Shower Rooms are connected, the

layout of each Resident Bath Room and Shower Room must allow for visual and acoustic privacy between the shower, the toilet and the bathtub area. If the Resident Bath Rooms and Shower Rooms are in two completely separate rooms, there must be visual and acoustic privacy between the toilet and bathtub or shower.

2.3.3 There must be no direct view of the bathtub, the shower or the toilet from

the corridor outside of each Resident Bath Room and Shower Room. 2.3.4 There must be a device located at each bathtub, shower and toilet in each

Resident Bath Room and Shower Room which will activate the Resident/Staff Communication and Response System.

2.3.5 The toilet in or adjoining each Resident Bath Room and each Shower

Room must be positioned so that independent and/or assisted transfer from at least the front and one side of the toilet can occur.

2.3.6 There must be a securely fastened grab bar for use by residents at each

toilet and on at least one wall in each shower stall. 2.3.7 The bathtub in each Resident Bath Room must be located so that there is

access to three (3) sides of the bathtub. 2.3.8 All Resident Bath Rooms and Shower Rooms must be equipped with

devices(s)/system(s) to maintain the room temperature at a comfortable level for residents while bathing.

2.3.9 All surfaces in the Resident Bath Rooms and Shower Rooms must be

easily cleanable. 2.3.10 To ensure resident and staff safety, all floor surfaces in the Resident Bath

Rooms and Shower Rooms must be slip-resistant.



Functional Considerations/Recommendations: 2.3.11 To assist residents with visual impairments and cognitive difficulties to

identify the fixtures and features in the shower stall, the floor of each shower stall should be visually distinct from the walls, for example, by using contrasting floor tiles.

2.3.12 In the interest of resident comfort, privacy and dignity, there should be

separate areas in the Resident Bath Rooms and Shower Rooms where residents can be dressed and groomed after their bath or shower.

2.3.13 Resident Bath Rooms and Shower Rooms should have sufficient space

to store towels, washcloths, soap, shampoo and other bathing accessories. 2.3.14 Resident Bath Rooms and Shower Rooms should have secure areas to

store cleaning supplies for the cleaning and sanitizing of bathtubs, showers, toilets and hand wash basins.

2.3.15 Resident Bath Rooms and Shower Rooms should have space to store

wheelchairs, the shower chair and any other devices that are used to assist caregivers to manoeuvre residents on and off toilets, and into and out of showers and bathtubs.

2.3.16 The exhaust and air exchange rates in Resident Bath Rooms and Shower

Rooms should be over and above the Ontario Building Code regulations to ensure appropriate ventilation, and to keep odours and humidity levels to a minimum.

2.3.17 To promote resident comfort and safety, all surfaces in Resident Bath and

Shower Rooms should be non-glare. 2.3.18 If a side-entrance bathtub is installed, it should be a “quick-filling” model to

ensure resident comfort. 2.3.19 In the interest of resident safety and sense of security, bathtubs with grab

bars built into the design should be considered. 2.3.20 Resident Bath Rooms and Shower Rooms should have moisture-

resistant light fixtures. 2.3.21 Whenever possible, natural lighting should be provided in Resident Bath

Rooms and Shower Rooms to provide for a more pleasant and comfortable bathing experience. Resident privacy can be assured through the use of window curtains, window blinds, frosted windows and skylights.



2.3.22 Consideration should be given to providing a hair washing sink in at least

one Resident Bath Room or Shower Room in each Resident Home Area.



3.0 FACILITY AND STAFF SUPPORT SPACE IN THE RESIDENT HOME AREA(S) 3.1 WORK SPACE FOR NURSING AND ROGRAM/THERAPY

STAFF IN EACH RESIDENT HOME AREA Design Objective:

The provision of resident care involves the planning, assessment, communication, evaluation and implementation of care. The work space for staff in each Resident Home Area must be designed to support a well-coordinated, multi-disciplinary care system that will allow staff to meet residents’ care and treatment needs in an efficient and effective manner.

It must also be designed so that it can readily be identified by residents, staff, visitors and others as an “information centre” or an area where “staff contact” can be made.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: 3.1.1 Current 1998 Design Standard: Each Resident Home Area must have Work Space for Nursing and

Program/ Therapy Staff to allow staff to carry out their administrative duties. The space must accommodate multidisciplinary team activities.

Design Objective for this Standard:

Provide a well-coordinated, multidisciplinary care system that will allow staff to meet residents’ care and treatment in an efficient and effective manner.

Design Consideration When Developing a Comparable Design to the Current 1998 Standard: Attention should be given to the role that staff meeting space plays as a part of care delivery and sufficient space located in an accessible area must be provided.



3.1.2 Current 1998 Design Standard: There must be space in each Resident Home Area, or in a centrally

accessible area to each Resident Home Area, to support the delivery of therapeutic programs such as podiatry, dental, ophthalmology, social and psychiatric services, as well as required medical services.

Design Objective for this Standard: Maximize program delivery options and access to them. Support effective

care delivery to residents. Foster a sense of familiarity in a “home-like” setting.

Design Consideration When Developing a Comparable Design to the

Current 1998 Standard: A design alternative to this standard must provide for space to carry out

therapeutic programs (e.g. Podiatry, dental ophthalmology, social, and psychiatric services) outside of the Resident Bedroom. Bedside therapy is unacceptable because it promotes a sense of institutionalization.

Mandatory Design Standards: 3.1.3 In areas where therapeutic programs are delivered, there must be

convenient access for residents to a “barrier-free” two (2) piece washroom (toilet and sink) that is separate from resident bedroom washrooms.

3.1.4 Each Resident Home Area must have Work Space for Nursing and

Program/ Therapy Staff to allow staff to carry out their administrative duties. The space must accommodate:

• secure storage of resident care records (includes nursing care plans

and medical histories); and

• a work area to complete documentation. 3.1.5 The Work Space for Nursing and Program/Therapy Staff must be easily

recognized by residents, other staff, visitors and others as, for example, an “information centre” or “staff contact” area.



Functional Considerations/Recommendations: 3.1.6 The use of sound-absorptive materials for walls, floors, and ceilings should

be considered for all administrative and meeting areas where privacy is required.

3.1.7 Providing a room where resident family members and others could stay

overnight in the LTC facility should be considered. This can be a room used for other functions which can be easily converted to a sleeping area.

3.1.8 A hand washing area should be conveniently located in proximity to the

Work Space for Nursing and Program/Therapy Staff. 3.2 STORAGE SPACE FOR RESIDENT CARE SUPPLIES

AND EQUIPMENT IN RESIDENT HOME AREAS Design Objective:

Space is required for the storage of medications, and for the supplies and equipment required to provide care and treatment for residents in each Resident Home Area. Medications and nursing care supplies/equipment must be stored in a place where they are readily accessible to caregivers, but do not intrude on the resident’s personal space.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 3.2.1 The Storage Space for resident care supplies and equipment must be

convenient and accessible to the staff working in each Resident Home Area.

3.2.2 Resident medications must be stored in a secured space either within one

Resident Home Area or shared between Resident Home Areas.



3.2.3 Secure space with lockable cupboards must be provided for the storage of all supplies and equipment related to care delivery, as well as for stock medications related to the pharmacy services. This space must be convenient and accessible to the staff working in each Resident Home Area.

3.2.4 If oxygen therapy is offered as part of the facility’s program delivery,

dedicated space for storage of oxygen must be provided in a location that is convenient and accessible to staff working in the Resident Home Area(s). The storage of oxygen must comply with the fire safety requirements set out in the Ontario Fire Code and related provincial regulations.

Functional Considerations/Recommendations: 3.2.5 The shelving in storage rooms should be adjustable, rust proof and easily

maintained/cleaned. 3.2.6 Consideration should be given to providing a well ventilated and separate

area for the recharging of batteries on wheelchairs. Wheelchair batteries should not be recharged in resident bedrooms because of potential explosive dangers and release of noxious fumes.



4.0 RESIDENT LOUNGE AND PROGRAM/ACTIVITY SPACE 4.1 RESIDENT LOUNGE AND PROGRAM/ACTIVITY SPACE Design Objective:

Residents’ lounges should be comfortable and designed so that residents can interact in a relaxed atmosphere with other residents, family members and visitors. The lounges must be designed for conversation, reading, and other social activities.

Program and activity areas should accommodate a variety of resident focused activities, and should support social functions which promote resident quality of life.

Design Standards with Allowable Performance Ranges: 4.1.1 Minimum Standard: The minimum total required space for Resident Lounge and

Program/Activity Space is 21 square feet (1.95 square metres) per resident.

Performance Range: Bottom End: 21 square feet (1.95 square metres) per resident. Top End: 27 square feet (2.5 square metres) per resident. 4.1.2 Minimum Standard: At least 50% of the total required space per resident for Resident Lounge

and Program/Activity Space must be located within each Resident Home Area. Up to 50% of the total required space may be used to support other defined programs and may be located either within or outside of the Resident Home Areas.

Performance Range: Bottom End: At least 50% of the total required space per resident for

Resident Lounge and Program/Activity Space must be located within each Resident Home Area.

Top End: At least 70% of the total required space per resident for

Resident Lounge and Program/Activity Space must be located within each Resident Home Area.



NOTE: Under no circumstance, when applying standard 4.1.1 together with 4.1.2, shall the minimum required space for Resident Lounge and Program/Activity Space within a Resident Home Area be lower than 14 square feet (1.3 square metres) per resident.

Note: The Lounge and Program Activity Space in a Resident Home Area will be

measured as they are designated on the Plans Submission. The areas provided for each of these spaces must be indicated on the drawings.

ADL (Activities of Daily Living) Kitchenettes and built-in furnishings within a

Lounge and Program Activity Space can be considered as part of the overall floor area because it is part of Activation Programming.

Note: As an option to using the 50% remaining space (preferably 30% of the remaining

space) for Resident Lounge and Program/Activity Space, it is acceptable to use the remaining 50% of space (preferably 30% of the remaining space) for other defined programs. Examples of acceptable re-allocation of this space include:

- providing larger resident bedrooms to support provision of a palliative care program; - enlarging a dining room to support a program/activity such as a domestic kitchen; or - enlarging a bathing “spa” to address resident needs or requests. Re-allocation of the 50% required space (preferably 30%) should be determined during the construction plans development stage. Decisions in this regard should be made based on the care, program and service requirements of the residents to be accommodated. The LTCRP will review all requests for re-allocation of Resident Lounge and Program/Activity Space. Approval will be given to any concept which enhances the living environment for residents and supports quality care outcomes. Design Standards with Comparable Design: Not applicable to this section.



Mandatory Design Standards: 4.1.3 There must be at least one Resident Lounge provided in each Resident

Home Area that has a minimum of 120 square feet (11.15 square metres) of total floor area.

4.1.4 There must be at least one Resident Program/Activity Area provided in

each Resident Home Area that has a minimum of 120 square feet (11.15 square metres) of total floor area.

4.1.5 Each Resident Lounge must have a device which will activate the

Resident/Staff Communication and Response System and each Resident Program/Activity area must have a device which will activate the Resident/Staff Communication and Response System. Where the lounge and the program activity space is integrated, it is necessary to have only one device which will activate the Resident/Staff Communication and Response System located in that area.

4.1.6 At least one Resident Lounge in each Resident Home Area must have a

window with a direct view to the outside or to a naturally lit area. 4.1.7 Resident Program/Activity Areas must have convenient access to a

“barrier-free” washroom (toilet and sink) that is separate from and not located in a resident bedroom.

Functional Considerations/Recommendations: 4.1.8 When decorating Resident Lounges and Resident Program/Activity

Space, consideration should be given to using decorating products that minimize sound and glare, and that create a “home-like” environment, for example, carpets, blinds, curtains and wallpaper.

4.1.9 Task lighting for activities such as reading should be provided in all

Resident Lounge and Resident Program/Activity Space. 4.1.10 Different sizes and designs of Resident Lounge areas - from private nooks

for intimate conversation to larger common areas for groups - should be provided.

4.1.11 Resident Lounges areas should be designed for clustered rather than

linear seating to allow resident conversations and activities to take place.



4.1.12 Resident Lounges areas should include display space to support the creation of a “home-like” environment.

4.1.13 Resident Program/Activity Area(s) may be located adjacent to Resident

Lounge areas or Dining Area(s) to provide:

• a resident kitchen combined with a lounge where residents may entertain visitors; or

• an overall common area subdivided into dining, kitchen, activity, and

lounge to encourage a domestic ambience. 4.1.14 Where resident-accessible electrical appliances are provided, deactivation

switches should be on the appliances to ensure resident and staff safety.



5.0 DINING AREA(S) AND DIETARY SERVICE SPACE 5.1 RESIDENT DINING AREA(S) Design Objective:

All Dining Area(s) for use by residents should incorporate design features that promote a “home-like” ambience and that reinforce “familiar” eating patterns associated with smaller social gatherings. Efforts must be made to minimize noise in Dining Area(s) through the provision of finishes that reduce reflected noise and increase sound absorption. The design of the Dining Area(s) must also reflect and respond to the changing physical needs of residents.

Design Standards with Performance Ranges: 5.1.1 Minimum Standard: The minimum required space for Dining Area(s) for the LTC facility is 25

square feet (2.32 square metres) of floor area per resident, excluding servery space.

Performance Range: Bottom End: 25 square feet (2.32 square metres) per resident. Top End: 30 square feet (2.79 square metres) per resident. NOTE: When applying standard 5.1.1 together with 5.1.2, under no

circumstance shall the minimum required space for Resident Dining Area(s) within a Resident Home Area be lower than 24 square feet (2.2 square metres) per resident.

Note: The Dining Space in a Resident Home Area will be measured as they are

designated on the Plans Submission. The areas provided for each of these spaces must be indicated on the drawings.

Design Standards with Comparable Design: Not applicable to this section.



Mandatory Design Standards: 5.1.2 At least 80% of the total required space for Dining Area must be located

within the Resident Home Areas and allocated based on the number of residents in each Resident Home Area. For example, for a Resident Home Area with 20 residents, the total required Dining Area is 600 square feet; 80% of the 600 square feet, or 480 square feet, must be located in that Resident Home Area.

5.1.3 Up to 20% of the total required space for Dining Area(s) may be located

outside of the Resident Home Area(s) to support alternative dining programs.

5.1.4 Each Dining Area must incorporate storage space for equipment/supplies

as necessary. 5.1.5 A separate housekeeping/janitor’s closet (with a sink) to store the supplies

and equipment used to clean each Dining Area must be provided near each Dining Area.

5.1.6 Each Resident Home Area must have dedicated space for dining,

separate from any other type of space. 5.1.7 Each Dining Area must have a device that will activate the Resident/Staff

Communication and Response System. 5.1.8 Each Dining Area must have convenient access to a separate “barrier-free

two-piece washroom (toilet and sink) that is not located in a resident bedroom and that does not open directly into food preparation or dining areas.

5.1.9 Each Dining Area must have a hand wash sink either in the Dining Area or

immediately adjacent to the Dining Area for use by staff involved in the preparation, delivery and service of food to the residents.

5.1.10 Each Dining Area must provide a direct view to the outdoors or other

naturally lit space. 5.1.11 Each Dining Area must provide a servery area for assembling and serving

meals. If the Dining Area is located immediately next to the kitchen, the kitchen can be used for the servery function.



Functional Considerations/Recommendations: 5.1.12 Adequate space for temporary storage of wheelchairs and walkers should

be located near the Dining Area(s). 5.1.13 When decorating the Dining Area(s), wall decorations, window treatments

(that is, blinds and curtains) and room finishes (for example, wallpaper, trim, and wainscoting) that create a “home-like” environment should be used.

5.1.14 Consideration should be given to providing additional space for visitors to

stay and have a meal with a resident or a group of residents. 5.1.15 Dining Area tables should accommodate no more than four (4) persons to

encourage socialization and interaction between residents at meal times. 5.1.16 To provide resident comfort and security while eating, Dining Area chairs

should have arms. 5.1.17 Consideration should be given to locating at least one Dining Area on

ground level, adjacent to an easily accessible Outdoor Area. 5.1.18 Dining Area(s) should have finishes and features which reduce reflected

noise and increase sound absorption, for example, window curtains, wood finishes, wall, ceiling and floor finishes.

5.1.19 Dining Area(s) should include architectural, electrical and equipment

features which permit the area to be subdivided for special occasions. 5.1.20 All surfaces in Dining Areas must be smooth, easily cleanable and

moisture resistant. 5.1.21 When designing the Resident Dining Area(s), it is recommended to

segment the total Dining Area within the Resident Home Area into smaller and more intimate groupings. This can be achieved by incorporating low partitioning walls, planters, and through the arrangement of chairs and tables. This is especially important for Resident Home Areas housing more than 32 residents.



5.2 DIETARY SERVICE SPACE Design Objectives:

The design of the Dietary Service Space must facilitate the delivery of a quality food service program that responds to residents’ physical, social and nutritional care needs. The design of the Dietary Service Space must also be flexible enough to respond to changing dietary service models, to different cultural and therapeutic dietary requirements and to different food preparation methods.

Decisions regarding the type of meal service program and the equipment necessary to support that program must be determined prior to designing the Dietary Service Space.

In addition to serving residents of the LTC facility, the Dietary Service Space may also be used to provide dietary services to other types of facilities (for example, residential facilities such as retirement homes/rest homes and supportive housing units), or other community support service programs (for example, meals-on-wheels or non-resident community dining programs).

Dietary Service Space must accommodate the receiving and storage, as well as the preparation of food products and goods for the dietary program and delivery of meals/snacks to the residents of the facility.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: 5.2.1 Current 1998 Design Standard: The Dietary Service Space must be designed so that the storage areas for

small equipment and utensils and for non-refrigerated and frozen food are conveniently located for easy access and use by dietary staff. Storage areas must be in close proximity to dietary work areas.

Design Objectives for this Standard:

Promote efficient provision of safe food and supplies.



Design Consideration When Developing a Comparable Design to the Current 1998 Standard: The design alternative must include storage spaces that can be easily accessed safely and would not interrupt or hinder the function of another space.

5.2.2 Current 1998 Design Standard: The Dietary Service Space must include a work area for dietary staff that:

• is secure for records and references; and • is accessible without passing through the food production area.

Design Objectives for this Standard: Support an efficient, convenient staff working environment. Provide a clean and safe working environment. Facilitate documentation and evaluation of individual resident’s progress. Design Consideration When Developing a Comparable Design to the Current 1998 Standard: The design alternative to this standard must ensure that proper hygiene is maintained at all times within the Dietary Service Space. The dietary staff work area must ensure secure record and reference keeping and may be located outside of the Dietary Service Space, but must be accessible without passing through the food production area.

Mandatory Design Standards: 5.2.3 The design of the Dietary Service Space must support the delivery of a

bulk food service system to the Dining Areas so that meals can be served by individual course.

5.2.4 Dietary Service Space must be provided to accommodate the equipment

required to support the facility meal service program. The equipment to be provided must be appropriate in size and design to prepare and serve a variety of food products and beverages that meet the nutritional care needs of residents, retain the texture, colour and palatability of food items and allow the facility to meet the cultural requirements, therapeutic needs and food preferences of all of the residents of the LTC facility.

5.2.5 The Dietary Service Space must include a work area for dietary staff that

accommodates appropriate furnishings and equipment.



5.2.6 The design of the Dietary Service Space must include serving areas

adjacent to the Dining Area(s) so that residents have the opportunity to see and smell food, snacks can be prepared and residents can make food choices at the point of meal service.

5.2.7 The design of the Dietary Service Space must provide for a layout that:

allows for an efficient work flow; prevents cross-contamination between clean and soiled areas; and supports production and delivery of food in a safe manner.

5.2.8 The design of the Dietary Service Space must allow for the preparation of

a range of food products prepared in a variety of methods. 5.2.9 There must be storage space for non-refrigerated (dry) goods and supplies

that meets usual and peak capacity volume storage requirements. This storage space must be well ventilated, have a temperature control system that can keep the temperature between 10 and 20 degrees Celsius, and be designed to prevent goods from being exposed to pipes, motors, condensers and direct sunlight.

5.2.10 There must be storage space for refrigerated and frozen food supplies. This

storage space must meet usual and peak capacity volume storage requirements.

5.2.11 The Dietary Service Space must provide secure storage space for

chemicals, cleaning supplies and equipment used to clean the Dietary Service Space (for example, kitchen mops and pails) and equipment used to delivery meals and snacks to residents, (for example, food carts).

5.2.12 The Dietary Service Space must include a separate housekeeping /

janitor’s closet that is equipped with a “curbed sink”. 5.2.13 The Dietary Service Space must include convenient access to electrical

services and to hot and cold water supply services. 5.2.14 The Dietary Service Space must include hand washing area(s). 5.2.15 The Dietary Service Space must provide, depending upon the food service

program, space for scraping, soaking, pre-rinsing, washing, rinsing, sanitizing, air drying and sorting of dishes, pots/pans, utensils, large equipment and carts.



5.2.16 The Dietary Service Space must provide separate and sufficient space for

garbage cans/recycling bins. 5.2.17 The Dietary Service Space must be designed in a manner that minimizes

excessive noise, steam and heat. 5.2.18 The Dietary Service Space must include adequate floor drainage. Functional Considerations/Recommendations: 5.2.19 Consideration should be given to involving a food design consultant in the

planning of the food service program and in the designing of the Dietary Service Space.

5.2.20 Where other services/programs share Dietary Service Space, (for

example, meals-on-wheels), additional Dietary Service Space should be provided as appropriate to accommodate the needs of these services/programs without compromising the level of service required for the residents of the LTC facility.

5.2.21 When designing the Dietary Service Space, the extent to which meals will

be prepared centrally and the extent to which meals will be prepared in a decentralized location should be considered. Dietary Service Space will be allocated differently if all foods are prepared in a central kitchen versus a kitchenette or servery located in a Resident Home Area. While centralized production provides for the greatest control of quality food preparation, decentralized production maximizes individual service to the residents and promotes a “home-like” atmosphere.

5.2.22 Food preparation is a familiar activity of daily living and can be part of a

“home-like” environment. If possible, the Dietary Service Space should be designed to allow residents to view and visit the cook to discuss food preferences and other dietary issues.

5.2.23 Flooring in all Dietary Service Space areas should be non-slip and walls

should be moisture resistant. 5.2.24 The design of the Dietary Service Space should incorporate some

flexibility so that the food service program can be adjusted/changed as residents’ needs change.



5.2.25 Consideration should be given to the cost benefits of providing for centralized warewashing versus de-centralized warewashing.

IMPORTANT - PLEASE NOTE

ONTARIO FOOD PREMISES REGULATION

The Kitchen of a LTC facility must comply with the design standards set out in the Ontario Food Premises Regulation under the Health Promotion and Protection Act. This Regulation is administered by municipal authorities; any questions related to the regulatory requirements under this legislation should be directed to the applicable local Public Health Unit/Department.



6.0 RESIDENT COMMUNITY SPACE 6.1 OUTDOOR SPACE/OUTDOOR AREA(S) Design Objective:

The Outdoor Space should be designed to provide a safe environment for residents in which they can enjoy the outdoors. Each Outdoor Area for use by residents should be landscaped and provide walkways, shaded areas and seating areas.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: 6.1.1 Current 1998 Design Standard:

The distance measured from the entrance of the Outdoor Space to the farthest resident bedroom must be no more than 200 feet (61 metres). Design Objectives for this Standard: Provide for a safe, readily accessible environment for residents to enjoy the outdoors. Design Consideration When Developing a Comparable Design to the Current 1998 Standard: Attention should be given to the need to make outdoor space reasonably accessible to residents who may have ambulatory constraints.

6.1.2 Current 1998 Design Standard:

There must be at least one Outdoor Area that is directly accessible from a Dining Area, a Lounge or Program/Activity Area.

Design Objectives for this Standard: Support choice in relation to use of available space. Support opportunities for socialization. Foster a sense of familiarity in the home-like setting. Maximize a sense of awareness/orientation.

Design Consideration When Developing a Comparable Design to the Current 1998 Standard: When developing an alternative design, accessibility to an Outdoor Area must be provided. Secure Resident Home Area(s), for residents with



dementia, for example, require security to the Outdoor Area, while maintaining a level of accessibility.

Mandatory Design Standards: 6.1.3 In a multi-storey facility, Outdoor Space on floors above ground level can

be a balcony or a roof terrace. 6.1.4 For all LTC facilities, there must be some Outdoor Space accessible at

grade level. It is up to the Operator, in conjunction with the Architect, to determine the size and location of this Outdoor Area.

6.1.5 At least one Outdoor Area must be enclosed to prevent wandering/egress

of residents. For multi-storey buildings, the requirements of the Ontario Building Code will define the design and safety features of Outdoor Space on the floors above ground level.

6.1.6 The landscaping and design of Outdoor Space must consider the safety

needs of residents. 6.1.7 Each Outdoor Area must have a separate area that provides shade and is

protected from wind and other harsh weather elements. Functional Considerations/Recommendations: 6.1.8 Brick pavers in any circulation areas should be avoided because they can

cause tripping. 6.1.9 Inclines and steps in any circulation areas should be avoided. 6.1.10 Consideration should be given to incorporating a Resident/Staff

Communication/Response System in at least one Outdoor Area. 6.1.11 When decorating and landscaping Outdoor Space, consideration should

be given to such residential features as fencing, outdoor furniture and raised flower beds.



6.2 BEAUTY PARLOUR/BARBER SHOP Design Objective:

The Beauty Parlour/Barber Shop within a LTC facility enables residents to participate in an enhanced level of grooming that is a familiar activity of daily living.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 6.2.1 The LTC facility must have a Beauty Parlour/Barber Shop that is available

to all residents. 6.2.2 The Beauty Parlour/Barber Shop must have a device which will activate

the Resident/Staff Communications and Response System. 6.2.3 There must be sufficient space to include hairdressing chairs, work and

storage counters, secured storage space for chemicals and a hair drying area.

Functional Considerations/Recommendations: 6.2.4 A shampoo chair should be provided that allows residents to have their hair

washed either leaning forward over the basin, or leaning back. 6.2.5 A drying chair (chair equipped with a hooded dryer) should be provided. 6.2.6 An adequate number of conveniently located electrical outlets should be

provided. 6.2.7 There should be additional exhaust ventilation to control odours from the

hairdressing process.



6.3 PLACE OF WORSHIP Design Objective:

Each LTC facility needs to support and assist residents in maintaining their spiritual beliefs, religious observances, practices and affiliations. Space for a Place of Worship gives residents space for individual private thought and spiritual comfort.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 6.3.1 Each facility must provide space dedicated for the purposes of worship. It

is up to the Operator, in consultation with the Architect, to determine the size, location and design of this space. The sponsoring Agency/Architect has the option of using up to the remainder of the Lounge and Program/Activity Space, specified under 4.1.2 (cross-reference Design Standards with Allowable Performance Ranges 4.1.2), to support the provision of space for a Place of Worship.

Functional Considerations/Recommendations 6.3.2 The Place of Worship should be designed to respond to the multi-

denominational aspects of a facility’s resident population.



6.4 ENHANCED RESIDENT SPACE Design Objective:

If all of the required Resident Lounge and Program/Activity Space is located in the Resident Home Area(s), there must be at least one additional area located outside of the Resident Home Area(s) for use by all residents of the facility. The additional area will provide residents with opportunities to leave the Resident Home Areas and meet and interact for social purposes. (See 4.0 Resident Lounge and Program/Activity Space for space requirements).

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 6.4.1 One additional area must be located outside the Resident Home Area(s)

only if all of the required Lounge Space and Program/ Activity Space is located in the Resident Home Area(s). It is up to the Operator in consultation with the Architect, to determine the size, location and design of Enhanced Resident Space.

6.4.2 A device must be provided in this area which will activate the Resident/Staff

Communication and Response System for the LTC facility. Functional Considerations/Recommendations: 6.4.3 Where Enhanced Resident Space is provided outside the Resident Home

Areas, a “barrier-free” washroom (toilet and sink), complete with an activation device connected to the Resident/Staff Communication and Response System for the LTC facility, should be provided in that area.

6.4.4 Examples of Enhanced Resident Space include, but are not limited to, an

exercise room, a library, family dining room or a cafe.



7.0 ENVIRONMENTAL SERVICES 7.1 LAUNDRY SPACE Design Objective:

The Laundry Space must be designed to meet the daily laundry requirements of all residents of the LTC facility. This includes laundry services for linens, towels and personal clothing.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: 7.1.1 Current 1998 Design Standard: The Laundry Space must be designed so that there is access to all sides

of the equipment (including washers, dryers and chemical dispensers) to ensure easy cleaning and repair work as necessary.

Design Objectives for this Standard:

Promote a clean, safe and efficient working environment. To facilitate timely and safe storage, transporting, sorting, processing, and delivery. Safe and easy access for cleaning and repair.

Design Consideration When Developing a Comparable Design to the Current 1998 Standard: An alternate design option must include sufficient space for easy access to laundry equipment and necessary repair work.

7.1.2 Current 1998 Design Standard: The Laundry Space must include storage space for supplies and

equipment used for the laundry services. Design Objectives for this Standard: Support an efficient, convenient staff working environment.

Design Consideration When Developing a Comparable Design to the Current 1998 Standard: Storage space for supplies and laundry equipment may be outside the Laundry Space, but must be reasonably accessible.



Mandatory Design Standards: 7.1.3 The Laundry Space must be able to accommodate industrial washers and

dryers of appropriate size and capacity to meet the laundry service needs of the LTC facility. If laundry services are shared with other programs, such as an adjoining rest/retirement home, the size of the laundry must be able to accommodate maximum service volumes.

7.1.4 The Laundry Space must be designed so that there is separation of and a

one way work flow between clean and soiled areas. 7.1.5 There must be administrative space for supervisory staff to complete

administrative functions (may be combined with other administrative space in the LTC facility).

7.1.6 The Laundry Space must be equipped with hand wash facilities that are

conveniently located for staff use. 7.1.7 The Laundry Space must include space for the collection, storage and

sorting of soiled laundry until it can be processed. 7.1.8 The Laundry Space must have space for all aspects of the laundering

process including storing, folding, hanging of clean linen/personal clothing and labeling of personal clothing.

7.1.9 If an off-site laundry service is used, there must be separate space in the

LTC facility for soiled linen storage, and for receiving and delivering linen. 7.1.10 The Laundry Space must have access to a separate area for the cleaning

and sanitizing of laundry equipment such as baskets, carts and bags. 7.1.11 There must be floor drainage in the Laundry Space. 7.1.12 All surfaces in the Laundry Space must be easily cleanable and

impermeable to moisture. 7.1.13 Floors in the Laundry Space must be non-slip to ensure staff safety.



Functional Considerations/Recommendations: 7.1.14 Where an off-site laundry service is used, consideration should be given to

providing a refrigerated storage area for soiled laundry. This area should be designed so that it can be routinely washed down.

7.1.15 Consideration should be given to providing space for domestic laundry

equipment to do personal laundry within the Resident Home Area(s). This equipment would be for use by residents, family and/or staff.

7.2 HOUSEKEEPING SERVICE SUPPORT SPACE Design Objective:

Space dedicated to the housekeeping services for the LTC facility must be designed to promote efficient and well-organized cleaning programs in order to ensure a clean and safe environment for all residents, staff, family, and visitors.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: 7.2.1 Current 1998 Design Standard: Housekeeping/janitor’s closets must be located both in and outside the

Resident Home Areas to support the housekeeping requirements, as well as the cleaning equipment and cleaning supply storage requirements for the LTC facility.


Facilitate a safe and clean environment for residents. Maximize efficiency of service delivery.

Design Consideration When Developing a Comparable Design to the Current 1998 Standard: When developing an alternative design option, the convenience of maintenance staff in accessing the janitor/housekeeping closet and the proximity the janitor/housekeeping closet services must be considered and addressed.



7.2.2 Current 1998 Design Standard: Each housekeeping/janitor’s closet must be equipped with a hot and cold

running water supply, a “curbed service sink” with a floor drain, a hand wash sink and floor drain(s), and have sufficient space for the collection, sorting and pick-up of garbage. Design Objective for this Standard: Maximize efficiently and convenience in service delivery. To prevent build up of odours. To prevent unsanitary conditions. Design Consideration When Developing a Comparable Design to the Current 1998 Standard: An alternate design option must include fixtures and elements which will prevent odour build-up, unsanitary conditions, and allow for cleanliness within the housekeeping/janitor closet.

Mandatory Design Standards: 7.2.3 There must be administrative space for supervisory staff to complete

administrative functions (may be combined with other administrative space in the LTC facility).

7.2.4 Each housekeeping/janitor’s closet must have sufficient space and provide

for the secure storage of chemicals and other cleaning supplies, have sufficient space for chemical dispensing units, and have sufficient space for storing carts and other housekeeping equipment, such as mops and pails.

7.2.5 All surfaces (including floors, walls, ceilings and shelves) in each

housekeeping/janitor’s closet must be smooth, easily cleanable and impermeable to moisture.

Functional Considerations/Recommendations: 7.2.6 Housekeeping/janitor’s closets should be located so that the transporting of

waste and garbage through resident care and resident common areas is avoided.

7.2.7 Housekeeping/janitor’s closets should be located close to areas of highest

use, for example, close to Resident Bath Rooms and Shower Rooms and common “public” washrooms.



7.2.8 It is recommended that there be a recycling program for waste and garbage in accordance with local municipal requirements.

7.3 UTILITY SPACE Design Objective:

Clean and soiled Utility Space must be designed to facilitate a clean, safe and efficient working environment that prevents the risk of cross-contamination between clean and soiled items/areas.

Design Standards with Allowable Performance Standards: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 7.3.1 Clean and soiled Utility Space must be conveniently located in each

Resident Home Area to support the requirements for storage, cleaning and sanitizing of nursing care/therapy equipment.

7.3.2 Clean and soiled Utility Space must be large enough to contain all fixtures

that are used for cleaning, sanitizing and storing nursing care equipment. Fixtures include, for example, a hopper sink, a bedpan flusher and/or sterilizer, rinse sinks, storage racks, counters and cupboards

7.3.3 All clean Utility Space must have a secured space for the storage of

cleaning supplies and equipment, as well as counter space. 7.3.4 All soiled Utility Space must have sufficient space for the storage of the

equipment used for collecting soiled supplies (for example soiled linen and towels), and for garbage cans/recycling bins.

7.3.5 All clean and soiled Utility Space must have at least one conveniently

located hand wash sink for staff use. 7.3.6 All soiled Utility Space must have floor drains.



7.3.7 The surfaces in clean and soiled Utility Space must be smooth, easy to clean and impermeable to moisture.

7.3.8 All floors in clean and soiled Utility Space must be non-slip to ensure staff

safety. Functional Considerations/Recommendations: 7.3.9 Ventilation standards in Utility Space should exceed the Ontario Building

Code requirements in order to support an odour-free environment and to keep noxious odours to a minimum.

7.3.10 Space should be provided for the temporary storage of soiled linen carts in

the soiled Utility Space(s). 7.3.11 Where laundry chutes are provided, they should be in areas only accessible

to staff, for example, in locked areas. 7.4 MAINTENANCE SERVICE SUPPORT SPACE Design Objective:

The design of the facility must incorporate Maintenance Service Support Space to support ongoing maintenance activities for the up-keep of equipment, furnishings and other building contents.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: 7.4.1 Current 1998 Design Standard: There must be an area within the Maintenance Service Support Space for

the storage of small and large maintenance equipment, machinery and tools.

Design Objective for this Standard: Provide safety and security.



Design Consideration When Developing a Comparable Design to the Current 1998 Standard: Space must be provided, either inside or outside of the Maintenance Service Support Space, for small and large maintenance equipment, machinery, and tools. Storage must also be sufficient and must be safe and secure from other parts of the LTC facility.

7.4.2 Current 1998 Design Standard: There must be a secured area within the Maintenance Service Support

Space to store hazardous materials and equipment. Design Objective for this Standard: Promote a safe working environment.

Design Consideration When Developing a Comparable Design to the Current 1998 Standard: Space must be provided, either inside or outside of the Maintenance Service Support Space, for storage of hazardous materials and equipment. Storage must also be sufficient and must be safe and secure from other parts of the LTC facility.

Mandatory Design Standards: 7.4.3 There must be dedicated Maintenance Service Support Space provided

in the LTC facility, separate from resident personal space and dining space, to conduct repairs on equipment, furnishings and other building contents.

7.4.4 There must be a secured area, inaccessible to residents, for locating

environmental controls and other building system controls. 7.4.5 An emergency-generator power supply must be available to support

essential building systems. Functional Recommendations/Considerations: 7.4.6 Space should be provided for maintenance staff to conduct administrative

functions (this space may be combined with or located near other administrative space).



8.0 SAFETY FEATURES

8.1 RESIDENT/STAFF COMMUNICATION AND RESPONSE SYSTEM

Design Objective:

The Resident/Staff Communication and Response System is provided in the LTC facility to give staff and residents the ability to alert other staff members when assistance is required. This system must be designed to facilitate prompt response to a resident or staff request, but at the same time not be intrusive.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 8.1.1 The Resident/Staff Communication and Response System must be an

electronically-designed system which is equipped with activation devices that are easily accessible, simple and easy to use by all residents and staff.

8.1.2 The Resident/Staff Communication and Response System must be

“ON” at all times and be connected to the back-up generator. 8.1.3 When any activation device for the Resident/Staff Communication and

Response System is activated, it must clearly indicate where the signal is coming from so that staff can promptly respond.

Functional Considerations/Recommendations: 8.1.4 If the Resident/Staff Communication and Response System uses sound

to alert staff, the level of sound should be controlled so that it is not excessive and disruptive, and also so that the sound is equally distributed in the areas that it covers.



8.1.5 Before installing the Resident/Staff Communication and Response System, all areas where the activation devices will be located should be checked to ensure that the activation devices are located at the point of need.

8.1.6 A Resident/Staff Communication and Response System that requires a

voice response when activated is not recommended for residents who have cognitive and sensory impairments.

8.2 DOOR ACCESS CONTROL SYSTEM Design Objective:

A safe and secure environment must be provided for all residents and staff of the LTC facility. This includes providing controls at all doors which exit from the resident areas of the LTC facility so that access into the building can be controlled when necessary.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 8.2.1 The Door Access Control System must conform to all relevant provincial

and municipal codes and regulations, including but not limited to the Ontario Building Code and the Ontario Fire Code.

8.2.2 The Door Access Control System must be “ON” at all times. 8.2.3 The Door Access Control System for all exits from resident areas must

prevent unauthorized entering or exiting from the LTC facility. 8.2.4 Electro-magnetic locking devices (or alternative means of achieving the

same result) must be on all doors leading to stairways, secured areas and to the outdoors, subject to compliance with the Ontario Fire Code and the Ontario Building Code.



8.2.5 Electro-magnetic “hold-open” devices must be on doors that are required under the Ontario Fire Code to be equipped with self-closing hardware. (Consultation with the local fire department may be required).

Functional Considerations/Recommendations: 8.2.6 Doors in non-resident areas, for example the kitchen and laundry, should

be equipped with electro-magnetic “hold-open” devices to facilitate the provision of services to resident care areas.

8.3 FIRE ALARM SYSTEM Design Objective:

A safe and secure environment must be provided for all residents and staff of the LTC facility. The environment must include a Fire Alarm System that enables prompt response to emergency situations.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 8.3.1 The Fire Alarm System must conform to all relevant provincial and

municipal codes and regulations, including but not limited to the Ontario Building Code and the Ontario Fire Code.

Functional Considerations/Recommendations: 8.3.2 During the initial planning stages of the project, the Office of the Ontario

Fire Marshal and with local authorities should be consulted regarding fire safety precautions/requirements and development of fire safety policies and procedures.



8.4 SPRINKLER SYSTEM Design Objective:

A safe and secure environment must be provided for all residents and staff of the LTC facility. In addition to a fire alarm system, fire suppression mechanisms should be in place to control the spread of fire throughout the facility. Residents of LTC facilities are typically physically restricted, which makes fire control mechanisms all the more important.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 8.4.1 A Sprinkler System must be provided and conform to all relevant

provincial and municipal codes and regulations, including but not limited to the Ontario Building Code and the Ontario Fire Code (attention should be given to Parts 3 and 11 of the 1997 Ontario Building Code. Parts may vary with updated versions of the Ontario Building Code).

8.5 WATER TEMPERATURE CONTROL SYSTEM Design Objective:

Water temperatures in areas used by residents must be maintained at levels that support resident safety and comfort.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section.



Mandatory Design Standards: 8.5.1 The Water Temperature Control System must be designed to ensure hot

water provided to resident care areas is at a safe and comfortable temperature for residents. (cross-reference the “Long-Term Care Facility Program Manual”, Environmental Services, Section “0": Criteria O1.16)



9.0 BUILDING SYSTEMS 9.1 LIGHTING SYSTEMS Design Objective:

Adequate lighting must be provided for residents, staff and visitors so that they can carry out their activities in comfort and safety. Lighting design must address age-related vision loss and diminished visual acuity (sharpness). Lighting must be designed and located in a manner that meets residents’ needs as sensory orientation diminishes.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 9.1.1 There must be a minimum of 215.28 lux of continuous lighting levels in all

corridors. 9.1.2 There must be continuous lighting levels of at least 322.92 lux in enclosed

stairways. 9.1.3 There must be general lighting levels of at least 215.28 lux in all other areas

of the facility including Resident Bedrooms and Washrooms. 9.1.4 General illumination must be provided at all entrance doors to resident

accessible rooms, e.g., bedroom entrance doors. 9.1.5 Task lighting which is adjustable in intensity, location and direction must be

provided in bedrooms and common areas. 9.1.6 The back-up emergency generator must support essential lighting

requirements.



Functional Considerations/Recommendations: 9.1.7 The types of lighting fixtures and their locations should be determined

based on the activities/tasks of specific areas. 9.1.8 All lighting fixtures that are capable of producing direct glare should be

shaded. 9.1.9 Sky-lights and windows that could create large patches of distracting light

on the floor should be shaded. 9.1.10 Window coverings, such as blinds, curtains and canopies, which reduce

glare from the outdoors without eliminating views should be provided. 9.1.11 A light should be installed inside each clothes closet which is activated by

the opening of the clothes closet door. 9.1.12 Wall-mounted light switches should not exceed 41 inches (1040mm) above

the level of the floor so that the switches are at a height that can be easily reached by residents.

9.2 HEATING, VENTILATION AND AIR-CONDITIONING

(HVAC) SYSTEM Design Objective:

Air temperatures should be maintained within a range that optimizes resident comfort throughout the year.




Mandatory Design Standards: 9.2.1 The HVAC System must comply with all relevant regulations and standards

set by governing authorities, including but not limited to the Ontario Building Code, Canadian Standards Association, National Fire Protection Association and the American Society of Heating and Refrigeration and Air-Conditioning Engineers (ASHRAE).

9.2.2 A mechanical system to cool air temperatures must be provided in all

Lounge Areas, all Dining Areas, all Program/Activity Areas, the Kitchen and the Laundry Space. The remaining areas of the LTC facility, including the Resident Bedrooms, the Resident Bath Rooms and Shower Rooms and Resident Washrooms, must have a system for tempering the air to maintain air temperatures at a level that considers residents’ needs and comfort.

9.2.3 Negative air pressurization of washrooms, soiled Utility Space, Kitchen

and Laundry Areas must be provided to ensure odours are contained. All of these rooms must be equipped with mechanical ventilation that exhausts air from these areas in keeping with Ontario Building Code requirements.

9.2.4 The HVAC System must have enhanced exhaust capabilities to maintain a

comfortable environment for residents with respect to humidity levels in the bath and shower areas.

Functional Considerations/Recommendations: 9.2.5 Recirculation of bedroom air should be avoided. 9.2.6 Air-cooled condensers should be used for the mechanical air cooling

system in order to avoid contamination of the water storage unit for the mechanical air system.

9.2.7 Mechanical noise levels should be maintained at or below NC-30 (noise

curve) in bedrooms and NC-40 in common areas.



10.0 OTHER FEATURES 10.1 RESIDENT DEDICATED STORAGE SPACE Design Objective: Residents require additional and conveniently located storage space for

frequently used personal equipment, clothing in season and personal and/or cherished items.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 10.1.1 Resident Dedicated Storage Space, in addition to clothes closets in

bedrooms, must be provided in the LTC facility so that residents can store their belongings. Other than the space requirements for residents’ clothes closets, there are no minimum space requirements for the storage space for resident personal belongings. It is up to the Operator, in consultation with the Architect to determine the size, design and location of Resident Dedicated Storage Space.

10.1.2 The Resident Dedicated Storage Space must provide security for

resident belongings. Functional Considerations/Recommendations: 10.1.3 The amount of space allocated for the storage of resident belongings

should be reasonable and based on the needs of residents. It is not expected that the LTC facility provide space for belongings that will not be used by residents during their stay at the facility. For example, LTC facilities are not required to store furnishings from the former residence of a resident.



10.2 FACILITY STAFF SPACE Design Objective:

The design of a LTC facility must include “non-resident” space for use by all staff. This space, exclusive to the use of staff, is for the purpose of administrative functions and staff rest periods, as well as storing personal belongings, changing clothes and staff-specific activities.

Design Standards with Allowable Performance Ranges Not applicable to this section. Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 10.2.1 Administrative space, for example, offices for key staff such as the

Administrator, Director of Care and supervisory staff, must be provided. It is up to the Operator, in consultation with the Architect to determine the number, size, design and location of administrative space.

10.2.2 Administrative space for functions such as banking, sorting mail and clerical / secretarial activities must be provided. 10.2.3 A secured storage area(s) must be provided for staff to store personal

belongings. 10.2.4 An area, separate from resident care and common areas must be

provided for staff “break” periods. 10.2.5 Separate change areas equipped with lockers must be provided for both

male and female staff. Functional Considerations/Recommendations: 10.2.6 Staff storage space for the personal belongings of staff should be located

in close proximity to the Resident Home Area(s).



10.2.7 Sufficient toilets and hand wash basins should be provided for all male and female staff. The following table is a suggested ratio for provision of staff toilets and handwash basins.

Number of Male or Female Employees On Each Shift

1 to 9 1 toilet and 1 hand wash basin 10 to 24 2 toilets and 2 hand wash basins 25 to 49 3 toilets and 3 hand wash basins 50 to 74 4 toilets and 4 hand wash basins 75 to 100 5 toilets and 5 hand wash basins

For every additional 30 employees over 100 of each sex, 1 additional toilet and 1 additional hand wash basin should be provided.

10.3 RECEIVING/SERVICE SPACE Design Objective:

A LTC facility must have well organized space to effectively handle delivery of goods, food supplies, dry goods and equipment.

The Receiving/Service Space may be designed to also serve as a staff entrance, ambulance entrance and, where applicable, a Meals-on-Wheels pick-up point.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: 10.3.1 Current 1998 Design Standard: The Receiving/Service Space must be located away from resident and

public areas so as not to expose residents and the public to noise, noxious fumes and safety hazards.

Design Objective for this Standard: Ensure resident and public safety.



Design Consideration When Developing a Comparable Design to the Current 1998 Standard: A design alternative must include consideration of the safety of residents and the public near the receiving/shipping spaces. The containment of fumes and safety hazards must be addressed.

10.3.2 Current 1998 Design Standard: A separate area for garbage storage and pick-up should be provided in

the Receiving/Service Space.

Design Objective for this Standard: Provide a safe and clean environment. Design Consideration When Developing a Comparable Design to the Current 1998 Standard:

A design alternative to this standard should take into consideration the convenience and direct exit of garbage through the receiving/shipping space while containing and preventing the travel of fumes.

10.3.3 Current 1998 Design Standard: The Receiving/Service Space must be located where there is convenient

access to the Dietary Service Space. Design Objective for this Standard:

Promote accessibility to staff and maximize efficient use of staff resources. Design Consideration When Developing a Comparable Design to the Current 1998 Standard: The Owner/Operator in consultation with their Architect may choose where to locate the Receiving/Shipping Space with relation to its convenience to the Dietary Service Space. However, there must not be direct receiving of goods into food preparation areas.

Mandatory Design Standards: 10.3.4 Direct receipt of goods into the food preparation areas must not occur. 10.3.5 Storage space for the temporary accumulation of received goods should

be provided. 10.3.6 The Receiving/Service Space must provide year round access for

delivery services. This entrance must be separate from the main entrance of the LTC facility and can have same access to the property.



10.3.7 The areas used for the cleaning and sanitizing of equipment such as

garbage containers, carts and racks, must have floor drains. Functional Considerations/Recommendations: 10.3.8 The driveway to the Receiving/Service Space should link directly to the

public road where possible. 10.3.9 The Receiving/Service Space should be conveniently located to general

storage areas, the Laundry Space and the Dietary Service Space. 10.3.10 The exterior of the Receiving/Service Space should have an overhang

that will provide staff and goods with protection from inclement weather. 10.3.11 The Receiving/Service Space should have exterior doors that can be

locked to ensure safe storage of goods. 10.3.12 Receiving/Service Space should be equipped with an exterior intercom

system that will allow delivery persons to alert facility staff when goods have arrived.

10.3.13 Consideration should be given to providing refrigerated space for garbage

storage. 10.4 RECEPTION/ENTRANCE SPACE Design Objective:

The entrance to the LTC facility should be designed to be a welcoming introduction to the LTC facility, and must be at the front of the LTC facility. A seating area for residents should be part of the entrance to encourage residents to view outside activities.




Mandatory Design Standards: 10.4.1 The Reception/Entrance Space must be designed to allow facility staff to

monitor all entering and exiting from the facility. 10.4.2 The Reception/Entrance Space must be in proximity to an outside

vehicle drop-off area for residents. 10.4.3 The Reception/Entrance Space must be designed to support its function

as the “welcoming” area to the facility for residents and the public. Functional Considerations/Recommendations: 10.4.4 The monitoring of the Reception/Entrance Space can be accomplished

through the use of electronic or mechanical devices or by strategically locating the office or reception desk by the Reception/Entrance.

10.4.5 The outside doors to the Reception/Entrance Space should be designed

so that they do not create drafts, for example, by providing double doors with an enclosed vestibule.

10.4.6 The Reception/Entrance Space should include a lounge for residents to

sit and rest and observe “comings and goings” at the facility. 10.5 ELEVATORS Design Objective:

Elevators located in multi-story LTC facilities must be designed so that they are safe and easy for residents to use. They must be located in areas that are accessible to residents, staff and the public.




Mandatory Design Standards: 10.5.1 At least one of the Elevators in the LTC facility must be large enough to

accommodate a stretcher and be located in proximity to the Resident Home Areas.

10.5.2 The Elevators must have unobtrusive but effective barriers in areas

where resident access is discouraged (such as building service areas). 10.5.3 Elevators must have the capacity for visible and/or audible signals.

10.5.4 To accommodate the range of visual and tactile needs of residents, the

Elevator control panel must contrast with the Elevator walls and must be easy to read, for example, have large, clear numbers.

Functional Considerations/Recommendations: 10.5.5 “Through-lifts”, that is, Elevators with door openings at the front and back,

are confusing to many residents. 10.5.6 “Visual cues”, such as large floor numbers painted in a colour that

contrasts with the wall, which can be seen from the Elevator door opening should be provided on each floor.

10.6 PUBLIC WASHROOMS Design Objective:

All Public Washrooms for common use by residents and visitors must be “barrier-free” and must be located in an area which is convenient to the Resident Home Areas. Residents and visitors should have washrooms in easy access to commonly used areas to avoid unnecessary travel back to bedrooms when away from bedrooms. Each Public Washroom must have at least one wheelchair accessible toilet and one wheelchair accessible hand wash sink.

Design Standards with Allowable Performance Ranges: Not applicable to this section.



Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards: 10.6.1 There must be clear and easily understood signage identifying all Public

Washrooms. 10.6.2 Each Public Washroom must have a lock that is readily releasable and

easily openable to ensure that a person is not accidentally locked into the washroom.

10.6.3 Each Public Washroom must have a device which will activate the

electronic Staff/Resident Communication and Response System. 10.7 SITE DEVELOPMENT Design Objective:

The development of a building site involves the physical integration of the long- term care facility with the neighbouring community. Site configuration should permit development of access roads, walkways and barrier free outdoor recreational areas.

Design Standards with Allowable Performance Ranges: Not applicable to this section. Design Standards with Comparable Design: 10.7.1 Current 1998 Design Standard: Where the parking lot(s) can be seen from any resident bedroom

window(s) on the ground floor, landscaping that will block the view of the parking lot(s) from the windows must be provided.


Facilitate visual transition between parking area and resident space.



Design Consideration When Developing a Comparable Design to the Current 1998 Standard: The Owner/Operator, in consultation with their Architect and/or Landscape Architect, may choose how to create visual interest, for views from any Resident Bedroom window into parking lots.

Mandatory Design Standards: 10.7.2 The Site must be developed to include landscaped areas. 10.7.3 The design of the Site must include level walkways without curbs or steps

to the Reception/Entrance Area of the facility. 10.7.4 Wheelchair accessible parking must be provided in close proximity to the

Reception/Entrance Area of the facility. 10.7.5 Trees and/or other structures that provide shade must be provided in all

resident-accessible areas of the Site. 10.7.6 The design of the Site must include unobstructed access to the Site for all

emergency vehicles including ambulances and fire trucks. Functional Considerations/Recommendations: 10.7.7 The Site should be in close proximity to medical services, shopping, and

recreational activities in the neighbouring community. 10.7.8 Access to public transportation is an asset. 10.7.9 The use of adjacent lands should be compatible with a LTC facility in

regard to noise, use of the property, scale of the surrounding buildings on the lands and zoning.

10.8 CORRIDORS Design Objective:

Corridors provide the means for travel throughout the facility for residents, staff and visitors. The length of corridors should be minimized to provide a more “home-like” environment and reduce travel distance within the facility for residents and staff.



Design Standards with Allowable Performance Ranges 10.8.1 Minimum Standard:

All Corridors in resident areas must be a minimum width of sixty-eight (68) inches (1727 mm).

Performance Range: Bottom End: Sixty-eight (68) inches (1727 mm) corridor width. Top End: Seventy-two (72) inches (1820 mm) corridor width.

Note: A sixty-eight (68) inch (1727 mm) corridor width is the minimum necessary to allow two wheelchairs to pass.

Note: Corridors are measured from “wall-to-wall”.

Design Standards with Comparable Design: Not applicable to this section. Mandatory Design Standards:

Not applicable to this section. Functional Considerations/Recommendations: 10.8.2 For the safety of the staff and residents, it is recommended that corridor

space not be used for storage purposes (e.g. storage of medical carts, wheelchairs, etc.)

10.8.3 Alcoves and/or lay-bys are recommended along the corridor space to allow

for passage of wheelchairs and other care equipment.



11.0 ARCHITECTURAL CONSIDERATIONS AND RECOMMENDATIONS

The choice of architectural features, fixtures and interior decorations can facilitate the provision of a safe and secure environment for the residents of a LTC facility.

Note: This section contains a list of guidelines, considerations and

recommendations about architectural features that could be incorporated into the design of a facility to enhance quality of life and promote quality care outcomes.

11.1 As a minimum, the “barrier-free” design specifications set out in the Ontario

Building Code should be incorporated throughout the facility. 11.2 Doors in all resident areas, such as bedrooms, washrooms, lounge areas,

program/active rooms and bath/shower rooms, should have levers or handles that are easily used by residents.

11.3 Handrails should be securely mounted on both sides of all corridor walls in all

resident areas, and should be located at least 31 inches (860 mm) above the floor so that the handrails are at a height that is within easy reach of the residents.

11.4 Handrail brackets should be located away from where the resident would grip a

handrail so that the residents’ hands can move freely along the surface of the handrail. It is suggested that the handrail brackets be mounted at least 2.75 inches (70 mm) below the top of the handrails.

11.5 Visual, and/or textural “cueing” should be included on signs to assist residents in

identifying different rooms and finding their way in the facility. For example; a “knife and fork” sign indicating a dining room, or a picture of a tub outside of a bathing area.

11.6 When selecting floor finishes, consideration should be given to their effect on

wheelchair and walker maneuverability, as well as resident gait, to ensure that residents can move about the facility safely. For example, carpets can present difficulties for residents with gait/walking problems, and can create undue resistance for residents confined to wheelchairs.



11.7 Service areas should be painted a different colour from areas used by residents so that residents can easily distinguish between resident areas and non-resident areas.

11.8 Features, fixtures and interior decorations should enhance and promote a “home-

like” environment. For example, furnishings should resemble, as much as possible, furniture normally found in residential settings. There should be a variety in the types of pictures on the walls and lighting fixtures should be of a non-institutional style.

11.9 Fixtures, for example, wall-mounted lights, light switches and washroom sinks,

should contrast with the colour of the walls so that residents can clearly and easily distinguish the difference.

11.10 High-gloss paint should not be used in any resident areas because it will create

undue glare which in turn, may distort vision.

11.11 All stairs should be enclosed by either rails or walls on both sides of the stairs to ensure safety of residents and staff.

11.12 Winding stairways should be avoided in areas that are accessible to residents to

ensure resident safety. 11.13 If free-standing wardrobes are used instead of built-in closets in bedrooms, these

closets must be securely fastened to the wall and the floor to ensure resident and staff safety.

11.14 Public address systems in areas used by residents should be avoided as a

means of minimizing the amount of noise and sound intrusion in resident areas. 11.15 When considering the colour and design of signs, remember that light images or

wording on a dark background are more visually effective than dark images on a light background.

11.16 Mirrors should be avoided in Dining Areas, Resident Lounge and

Program/Activity areas that are used by residents with severe dementias because they can increase the level of confusion and anxiety.

11.17 The doors and frames in non-resident areas should be painted the same colour

as the walls in these areas to prevent residents from accidentally entering areas which may be unsafe for residents.



11.18 Walls and wall corners that will be subject to continual scraping by wheelchairs and portable equipment should have treatment or coverings that protect the wall surface, for example, corner guards and bumper rails.

11.19 Finishes that reduce reflected noise on walls and ceilings, and that increase

sound absorbency, should be used in “high” use areas of the building to keep noise to a minimum.

11.20 Some characteristics to consider when using colour are:

• dark colour schemes near bright windows can make it difficult for residents to distinguish objects near the window;

• colour contrast between floors and walls can help to distinguish the

edges of a room for residents with visual impairments;

• colour contrast can help to distinguish different objects and surfaces within a room, for example, contrasting colours will distinguish the differences between doors and walls, or between baseboards and walls; and

• because most resident bedroom doors are left open, it is best to

provide colour contrast between the frame and wall, rather than the door and frame, so that residents can clearly determine the location of the opening to the bedroom.

11.21 Some wall-finishing characteristics to consider for the decoration of the LTC

facility (includes resident and non-resident areas) are:

• a flat wall finish appears less institutional, diffuses glare, and hides minor flaws better than a glossy surface;

• some textured wall coverings and acoustic panels are “home-like” in

appearance, meet all relevant codes, and absorb excessive sounds; and

• textured surfaces can assist in a resident with visual impairments in

finding his/her way about the LTC facility. 11.22 Kick plates on the “push” side of all doors, particularly hollow-core doors,

should be provided to prevent damage to the doors.



11.23 Where door closers are used, the force required to open the door should not be excessive in relation to the ability of residents to open the door. In addition, all doors that are used by residents should be equipped with devices which delay closing to ensure resident safety.

11.24 Signs that identify room functions should be clear, understandable and located at

a height where they can be easily read or touched by residents.



PART B

LONG-TERM CARE FACILITY PLANS REVIEW PROCESS FOR RETROFIT



INTRODUCTION In keeping with the provincial legislation governing LTC facilities, all construction plans for any LTC facility project must be reviewed and approved by the Ministry of Health and Long-Term Care (MOHLTC), Long-Term Care Redevelopment Project (LTCRP) prior to the start of construction. No retrofit construction or construction of an addition to a LTC facility may commence prior to plans approval by the LTCRP. The Operator will be expected to enter into an agreement with the MOHLTC to retrofit or construct in accordance with the LTCRP approved plans. Prior to granting final approval of working drawings and specifications so that construction can start, the Assistant Deputy Minister of the LTCRP must be satisfied that:

a) the design standards as outlined in the Long-Term Care “D” Facility Retrofit Design Manual (the “D” Retrofit Design Manual) have been met; and

b) the Office of the Ontario Fire Marshal has given final approval.

The LTCRP shall also approve the LTC facility, or any part thereof, for occupancy by residents upon completion of construction. Note: The words “shall”, “must”, “mandatory” and “requirement” indicate an obligatory

provision that must, in the view of the LTCRP, be complied with for a Project Summary, Operational Plan and working drawings to be approved by the LTCRP.



ROLE OF THE MOHLTC LONG-TERM CARE REDEVELOPMENT PROJECT 1. Administrative Responsibilities The responsibility for the overall administration of the plans review process for LTC facilities rests with the LTCRP. In the LTC facility plans review and construction process, the LTCRP is responsible for: • providing information and clarification to sponsoring agencies and other interested

parties on the standards and guidelines on LTC facility design which are contained in the “D” Retrofit Design Manual ;

• tracking and maintaining an inventory of plan submissions; • providing comments, advice and guidance to sponsoring Agencies/Architects on

their respective plan submissions in order to assist sponsoring Agencies/Architects in the development of facilities that will best meet the needs of the residents to be accommodated;

• reviewing and approving plans for consistency and compliance with the design

standards of the “D” Retrofit Design Manual (Final approval is given in writing by the Assistant Deputy Minister of the LTCRP);

• monitoring the development of the LTC facility after plans are approved and

construction starts; and • monitoring compliance with an approved operational plan for assuring resident

health, welfare, safety and general well-being over the construction period. 2. Pre-Occupancy Review Upon notice from the sponsoring Agency that the construction of the building is finished through notification from the Architect that the facility has achieved Total Completion, as defined by the Development Agreement, the LTCRP will conduct a “Pre-Occupancy Review” to determine whether the LTC facility is ready to admit and care for residents. If the facility is prepared from an operational standpoint and has been constructed in accordance with approved plans and any other related agreements, the LTCRP will give approval for the LTC facility to begin staff orientation and then begin admitting residents (the MOHLTC construction funding subsidy will commence on completion of the project,



the granting of approval of the retrofitted facility by the Ministry and the signing of a Service Agreement with the Ministry). Where deficiencies are identified in the facility during the “Pre-Occupancy Review” that prevent the Ministry granting approval to operate, the LTCRP will provide direction to the sponsoring Agency/Architect regarding another “Pre-Occupancy Review”. DEFINITIONS OF TERMS 1. Preliminary Sketch Plans Preliminary sketch plans are the developed planning documents identifying the site, living, working and service spaces as well as the entrances/exits of the building. Preliminary sketch plan submission must include the following: • major entrances to and exits from the site; • road access(es) and proposed routes to and from the site; • parking; • elevations; and • a floor plan, scaled no smaller than 1:200 (1:1/16), for each level indicating: a) All departments/services as outlined in the “D” Retrofit Design Manual

(e.g. dietary service space, laundry space and housekeeping support space); and

b) Living space (both private and communal) within each Resident Home

Area and beyond the Resident Home Areas as outlined in the “D” Retrofit Design Manual (e.g. resident bedroom space, resident bathroom and shower room space).

2. Working Drawings Working drawings contain the necessary information to construct a building and are the drawings intended for use by the contractor and subcontractors. Working drawings must include the following: • architectural seal; • major entrances to and exits from the site; • road access(es) and proposed routes to and from the site; • parking;



• architectural specifications; • mechanical specifications; • electrical specifications; and • a floor plan, scaled no smaller than 1:100 (1:1/8) for each level indicating: a) All departments/services as outlined in the “D” Retrofit Design Manual

(e.g. dietary service space, laundry space and work space for nursing/program and therapy staff); and

b) Living space (both private and communal) within each Resident Home

Area and outside of the Resident Home Area(s) as outlined in the “D” Retrofit Design Manual (e.g. resident bedroom space for private, semi-private and basic/standard accommodation, bath room space, and lounge and program/activity space).

• a detailed floor plan layout, scaled no smaller than 1:50 (1:1/4) of the following:

- Resident Bedrooms (including a private, a semi-private and a basic/standard bedroom as applicable);

- The Resident Washroom layout(s); - Dining Space layouts including the placement of tables and chairs; and - Dietary Service Space layouts including Servery Space(s).

STEPS IN THE PROCESS 1. Review of Program and Structural Requirements Before beginning the development of any construction project, the sponsoring Agency, in consultation with the project Architect, must review:

• the Long-Term Care Facility Program Manual which describes the required operational standards for all LTC facilities; and

• the design standards and functional considerations/recommendations

contained in this “D” Retrofit Design Manual. The design of the LTC facility must meet the care, program and service needs of the LTC facility residents to ensure the best possible outcomes of care for the residents of that facility. Once the sponsoring Agency determines the resident care, services and program requirements for the LTC facility, preliminary plans must be developed by the Architect in consideration of those identified operational needs.



2. First Submission of Plans The first submission of plans includes: • Plan Submission (preliminary sketch plans or working drawings and specifications); • Project Summary; • Operational Plan; • Comparable Design Application(s) (if applicable); and • Retrofit Per Diem Calculation Forms

a) Plan Submission

All plan submissions must meet compliance with the Mandatory Design Standards, the Allowable Performance Ranges, and Design Objectives and Considerations of the Standards with Comparable Design set out in the “D” Retrofit Design Manual. The functional considerations/ recommendations in the “D” Retrofit Design Manual are commonly accepted “best practices” and are optional guidelines that should be incorporated into the facility design.

For any proposed construction project, the sponsoring Agency/Architect has the option of submitting either preliminary sketch plans or working drawings and specifications to the Ministry as the first submission.

o Preliminary Sketch Plans:

§ If the sponsoring Agency/Architect submits Preliminary Sketch Plans as part of the First Submission of Plans, four (4) copies must be submitted according to the above definition.

o Working Drawings:

§ Refer to requirements of the Second Submission of Plans. As a note of caution, preliminary sketch plans are strongly suggested as the first submission in the event that revisions may be required to the proposed design of the LTC facility prior to approval by the LTCRP. Working drawings and specifications are more detailed and therefore more complicated to revise than preliminary sketch plans.



b) Project Summary

The sponsoring Agency/Architect must also provide as part of the first submission of plans to the LTCRP, a written description outlining the overall care, program and service objectives envisioned for the LTC facility. This written summary report must respond, as a minimum, to the items contained in the attached Appendix “A” - Project Summary. The sponsoring Agency/Architect must provide information on each requested item.

The purpose of completing the Project Summary is to provide the LTCRP Plans Review Team with basic information about the project and a description of how the design will support program and service delivery. At a minimum, the written plan must clearly reflect how the sponsoring Agency intends to meet the requirements relating to provision of care, programs and services as outlined in the Long-Term Care Facility Program Manual.

The sponsoring Agency/Architect must submit four (4) copies of the Project Summary. The LTCRP will not review any first submission of plans which does not include four (4) copies of the Project Summary.

c) Operational Plan for the Retrofit of a Long-Term Care Facility

It is required that the sponsoring Agency/Architect submit two (2) copies of an Operational Plan to the Planning Coordinator at the LTCRP as part of the first submission of plans. An Operational Plan is a written plan which outlines how resident health, welfare, and safety will be assured over the schedule of the construction project.

This plan is referred to as the Operational Plan for the Retrofit of a Long-Term Care Facility; see Appendix “B” for the format. The plan is to cover the time frame of the project and must address all operational aspects affected by the construction.

If the LTCRP identifies concerns with the Operational Plan, the Planning Coordinator will request revisions. The Ministry of Health and Long-Term Care will not provide final plan approval to proceed with the project in the absence of an LTCRP approved Operational Plan where required.

d) Comparable Design Application(s)

Comparable Design Applications must be submitted to the LTCRP to obtain approval of any of the Comparable Designs as defined in the “D” Retrofit Design Manual. The application will require Operators to indicate the design



standard for which a Comparable Design is proposed and a description of the proposed design. Note that Comparable Designs are only permitted where indicated in the “D” Retrofit Design Manual. Sketch drawings must be included with the application. Comparable Design Application forms are available on request. The Operator/Architect will be able to apply for Comparable Design approval at any time in the development process up to working drawing approval, including early stages of the process when decisions regarding development options are still being considered. Comparable Design applications can be changed subsequently as well as the design process evolves. It is advisable to submit the Comparable Design Application(s) prior to first submission of plans to ensure that the contemplated Comparable Design complies with the relevant LTCRP’s Design Considerations and Design Objectives. The LTCRP will respond to individual Comparable Design Applications within ten (10) business days of submission.

e) Retrofit Per Diem Calculation Forms

The Retrofit Per Diem Calculation Forms are used to determine the Retrofit Construction Funding Per Diem (the “Retrofit Per Diem”) for which the facility will be eligible. Retrofit Per Diem eligibility is dependent on the use of Comparable Designs, Performance Ranges and choice of preferred accommodation definition. Refer to the Policy for Funding Construction Costs of Retrofitting “D” Long-Term Care Facilities (the “Retrofit Construction Funding Policy”) for more details. The Operator/Architect is required to submit two (2) copies of the Retrofit Per Diem Calculation Forms to the LTCRP along with the submission of preliminary sketch plans. The forms are available from the Ministry.

3. Ministry Review of First Plan Submission Each project shall be assigned to a Planning Coordinator in the LTCRP, who shall take the lead responsibility in overseeing and coordinating the plans review process. The Planning Coordinator shall distribute copies of the preliminary sketch plans (or working drawings and specifications as applicable) and the Project Summary for review and comments by the following LTCRP Plans Review Team staff:



• Planning Coordinator • Nurse Advisor, and • Dietary Advisor

The LTCRP will review the plans, the Project Summary, Comparable Design Application(s) (including copies of Ministry letters approving previous applications, if applicable), and the Retrofit Per Diem Calculation Forms, and forward their comments and recommendations to the Planning Coordinator within 2 weeks (10 working days) of the receipt of all of these documents. The Planning Coordinator is responsible for collating these comments and recommendations, and drafting a response back to the sponsoring Agency/Architect. Note: In some cases, if necessary to expedite the plans review process, the Planning

Coordinator, on behalf of the LTCRP Plans Review Team, will meet with the sponsoring Agency to discuss the project and clarify issues.

The LTCRP will review and send back comments on the first plans submission (preliminary sketch plans/working drawings and specifications and the written overview) within four weeks (20 working days) of receipt of the complete submission to the LTCRP office. 4. Second Submission of Plans Based on the comments and recommendations received from the LTCRP on the first submission the sponsoring Agency/Architect will develop a second submission of plans. The second submission may include:

o A revised set of working drawings and specifications; or o A set of detailed working drawings and specifications based on approved sketch

plans. In addition to the drawings, the following must be included as part of the second submission of plans:

o Comparable Design Applications (if applicable); and o Updated Retrofit Per Diem Calculation Forms with Architect’s Certificate.

In some cases, there may also be a need to submit a revised Project Summary if the sponsoring Agency decides to make significant program changes after the first submission of plans.



Working drawings and specifications must be submitted before final plans approval by the LTCRP. Note: If there are any questions or concerns about the LTCRP’s comments or

recommendations, the sponsoring Agency and/or the Architect are encouraged to contact the Planning Coordinator to seek clarification and to discuss any issues related to the working drawings and specifications development process.

a) Working Drawings Working drawing submission includes the following:

• Two (2) complete set of working drawings: • Architectural • Structural • Mechanical and Electrical;

• Two (2) copies of Specifications; • Two (2) additional copies of Architectural drawings only; and • One (1) additional copy of Dietary drawings (showing the main kitchen,

serveries, elevations, and kitchen equipment list).

Where plans are substantially altered by the sponsoring Agency/Architect as a result of the comments and recommendations received from the LTCRP staff on the first submission of plans, the Planning Coordinator conducts a second distribution of the plans in accordance with the same process as set out under “First Submission of Plans” above.

If the working drawings and specifications are determined to be acceptable by the LTCRP, then the plans will be approved. The notice of approval will be sent back within four weeks (20 working days) from receipt of the second plans submission from the sponsoring Agency/Architect.

If the working drawings and specifications are the second submission and are not acceptable, then the sponsoring Agency/Architect must re-submit revisions in keeping with the LTCRP comments and recommendations until such time as working drawings and specifications are approved.

b) Comparable Design Application(s) Comparable Design Applications must be submitted to the LTCRP to obtain approval of any Comparable Design as defined in the “D” Retrofit Design Manual. The application will require Operators to indicate the Comparable



Design standard for which a Comparable Design is proposed and a description of the proposed design. Sketch drawings must be included with the application. Comparable Design Application forms are available on request. The Operator/Architect will be able to apply for Comparable Design approval at any time in the development process up to working drawing approval. Comparable Design applications can be changed subsequently as well. The LTCRP will respond to Comparable Design Applications within ten (10) business days of submission. If approval of a Comparable Design Application(s) is requested along with the submission of working drawings, the sponsoring Agency/Architect is required to submit four (4) copies of the Comparable Design Application(s) to the LTCRP.

c) Retrofit Per Diem Calculation Forms

The Operator/Architect must submit updated Retrofit Per Diem Calculation Forms along with the working drawings. These forms are used in determining the Retrofit Construction Funding Per Diem (the “Retrofit Per Diem”) for which the facility will be eligible. The Retrofit Per Diem is dependent on the number of Comparable Designs and Performance Ranges used. Refer to the Policy for Funding Construction Costs of Retrofitting “D” Long-Term Care Facilities (the “Retrofit Construction Funding Policy”) for more details. The Operator/Architect is required to submit two (2) copies of the Retrofit Per Diem Calculation Forms and the associated Architect’s Certificate (see below) to the LTCRP along with the submission of working drawings.

d) Architect’s Certificate

This certificate must be prepared by the Architect who prepared the working drawings and must accompany the submission of these plans to confirm that all the entries in the Retrofit Per Diem Calculation Forms are correct.

5. Construction The Planning Coordinator shall monitor the progress of the construction project. Adherence to the Operational Plan will be monitored by the Compliance Advisor assigned to the LTC facility. If, because of unforeseen circumstances, the Operational Plan must be revised, the sponsoring Agency must notify the Compliance Advisor for



approval of any changes. Changes can be approved verbally over the telephone. Any approved changes shall be confirmed in writing by the LTCRP. 6. Preparation for Occupancy Process The LTCRP has developed a process for the Preparation for Occupancy of new and redeveloped LTC facilities. It is designed to lead Operators through a set of ‘Best Practices’ that will ensure that they meet the expectations of the Ministry in being prepared for the formal Pre-Occupancy Review which takes place following total completion of the Retrofit project. Refer to the Preparation for Occupancy Guide for details of the Pre-Occupancy Review Process. 7. Notice of Approval for Occupancy Following completion of the Pre-Occupancy review, the recommendation to approve or not approve the building for occupancy as a LTC facility shall be made by the Pre-Occupancy Review team. The Assistant Deputy Minister shall be advised of the outcome of the Pre-Occupancy review and then make the decision on approval.



APPENDIX “A”: PROJECT SUMMARY OVERVIEW AND PURPOSE The Project Summary provides written information outlining how the design of the building will support the effective delivery of care, programs and services to residents residing in the LTC facility. This information supports the timely completion of the plans review process by providing the LTCRP staff with basic information about the proposed LTC facility. CONTENT OF THE “PROJECT SUMMARY” The Project Summary must include the following information under the following general headings: 1. Description of Project

The description of the project should be brief and outline the general philosophy of care, programs and services proposed to be provided in the long-term facility.


The section should be brief and provide the following information:

• the size of the building including the total number of beds and the number of floors;

• description of the building (e.g. whether or not there will be redeveloped

portions of the building, new add-ons to the building, other classifications existing in the building, and which parts will not be redeveloped or retrofitted);

• whether or not the LTC facility will be part of an integrated multi-use

complex for example, attached rest/retirement home or a supportive housing apartment building, as well as other services/programs to be offered in the complex, for example as Meals-on-Wheels or a seniors day program; and

• the location and description of Outdoor Areas.



3. Resident Home Areas

This section must include a brief description of each Resident Home Area, including:

• the number of beds in each Resident Home Area;

• the number and dimensions of private, semi-private and standard (basic)

resident bedrooms;

• the size, number, dimensions and design of resident washrooms;

• the size, number, dimensions and design of the resident bathrooms and shower rooms; and

• a summary of the common area space including the sizes of the dining

area(s), lounge(s) and program/activity area(s).

Note: If each Resident Home Area is the same in size and design, only one description will be required and the submission should indicate that this is the case.

4. Care and Service Program(s) in Resident Home Areas

This section must provide a brief description of the care and service program(s) proposed to be delivered in each Resident Home Area and an brief overview of how the design of each Resident Home Area will support the delivery of the proposed care and service program(s), for example, how the design of a specific Resident Home Area will support the provision of a palliative care program.

5. Space for Resident Care Services This section must briefly describe how and where space will be allocated to support

the provision of the following resident care services: - nursing services; - medical services; - therapy services; and - pastoral care services



6. Facility Support Space

This section must briefly describe how and where space will be allocated to support the provision of the following facility support services:

- meal services and food services; - personal laundry and facility linen services; - administration services; - building services; and - housekeeping services.

7. Additional Information (Optional)

Completion of this section is optional. It is up to the sponsoring Agency/Architect to decide any additional relevant information which can be provided to assist the LTCRP staff in the plans review process.



APPENDIX “B”: OPERATIONAL PLAN FOR THE RETROFIT OF A LONG-TERM CARE FACILITY

OVERVIEW AND PURPOSE The purpose of the Operational Plan is to provide a detailed account of how resident health, welfare, safety and general well-being will be assured over the construction period. The order in which phases of construction will occur and the time frames that each phase will take place must be included in the plan. The confirmed Operational Plan should be prepared by the sponsoring Agency and two (2) copies submitted to the LTCRP for review and approval with the submission of working drawings and specifications. Final plans approval to proceed with a project will not be given until the Operational Plan has been accepted.

FORMAT AND CONTENT OF THE OPERATIONAL PLAN The Operational Plan must include the following information under the following general headings: 1. Overview of the Project This section provides a brief description of the project including:

• what is being built, for example, a retrofit and/or an addition;

• the anticipated dates when construction is expected to begin and when construction is expected to be completed; and

• if the project is to be done in phases or stages, the anticipated time frames

for the different phases/stages of construction. 2. Administration This section must briefly describe how the project administration issues will be addressed including:

• the name and position title of the on-site supervisor of the construction project; and

• communication protocols between the foreman and Administrator of the LTC

facility, for example, daily meetings to be conducted.



3. Communications This section must briefly describe the process for notification and communication to all affected parties about the project, safety protocols and other matters related to the construction project including:

• All staff: Staff must be familiar with and have been given the opportunity to participate in the development of the operational plan;

• Families: Families must be notified of overall plan and be notified of

changes that will directly affect their family member;

• Fire Marshal’s Office/Local Fire Department: The Fire Marshal’s Office/Local Fire Department must be notified of overall plan; and

• Public Health Unit: The Public Health Unit must be notified if there is to be

any change/disruption in the kitchen design and/or food service. 4. General Safety Measures This section must indicate how general safety measures will be addressed including but not limited to:

• the name and position title of the person assigned to monitor safety;

• the separation(s) or types of barriers to be provided between all construction sites and resident care and living areas;

• safety measures which will be implemented to protect confused/wandering

residents;

• staff in-service regarding safety measures including temporary barriers, temporary alarms (doors, call pulls, fire panels) - staff and construction crew must be aware of the need to keep construction areas and equipment inaccessible to residents;

• openings (doors, windows and walls) into the construction site must be

secure;

- Are openings used for entering and exiting alarmed? - Are all alarms (permanently and temporarily placed) checked

frequently? - Will any door alarms be temporarily disconnected?

• measures to be implemented in the event of temporary disconnection of

electricity for the following;



- resident care (i.e., oxygen concentrators) - monitoring of doors on alarm - fire safety issues - emergency call bells - additional staffing resources - transportation of residents, for example, when elevators not available - food preparation contingency plans - dishwashing - housekeeping - maintenance - laundry

• measures to be implemented in the event of a temporary shut off of water for the following;

- resident personal care - fire safety issues - food preparation - dishwashing and general kitchen sanitation - housekeeping - maintenance - laundry

• protocols to be implemented to minimize dust and dirt for the construction area; - What additional housekeeping hours will be provided when necessary?

- What protection will be provided for residents who may be more affected by increased dust levels (i.e., allergies)? and

• protocols for advising the construction crew of the safety needs specific to

the resident population. 5. Resident Areas This section must briefly describe how resident areas affected by construction will be secured. Questions which must be addressed are:

- If during construction, there are approved temporary bedrooms, or over bedding of existing rooms, have all safety and comfort features been provided such as the call system, over bed lighting, privacy curtains?

- If during construction, there are approved temporary washrooms or tubrooms, or

renovations are occurring in parts of these areas, have all safety and comfort



features been provided, such as the call system, grab bars, lighting, privacy curtains, ventilation?

- If during construction, there are approved temporary common areas - lounge,

dining and/or activity, have all safety and comfort features been provided such as lighting, natural lighting as a preference, and call system?

- If during construction, resident outside areas are affected, has a temporary

enclosed area been established? 6. Food Service This section should briefly describe how changes to the food/meal service will be managed. Questions which must be addressed are:

- What is the impact on the food service?

- How long will the kitchen be closed?

- When will construction work be scheduled (i.e., nights only)?

- What measures are to be taken to provide safe meals to the residents, e.g., food handling, food transporting and food temperature requirements are met)

- How will nutritious meals that include sufficient menu variety, special diets and

snack requirements be delivered?

- Has the local Public Health Unit been informed and given approval to implement temporary measures?

7. Noise Factors This section must briefly describe how noise factors will be managed. Questions which must be addressed are: - What will the time periods be when construction noises should cease, i.e., meal

times, early mornings and nights?

- Will residents have to be re-located to another section of the facility, or out on a day trip during times when construction noise is a serious concern?



8. Laundry Service This section must briefly describe how, if applicable, laundry services will be affected and managed. Questions which must be addressed are:

- What is the contingency plan if laundry service is to be interrupted for a period of time (for example, temporary location for laundry processing)?



APPENDIX “C”: PLANS SUBMISSION CHECKLIST FIRST SUBMISSION OF PLANS Preliminary Sketch Plans:

Preliminary Sketch Plans Project Summary (4 copies) (4 copies)

Comparable Design Application(s) Retrofit Per Diem Calculation (4 copies) Forms (2 copies)

Operational Plan (2 copies)

OR

Working Drawings:

Working Drawings (2 copies) Specifications (2 copies) - Architectural - Structural - Mechanical / Electrical

Architectural Drawings Only (2 copies) Dietary Drawings Only (1 copy)

Comparable Design Application(s) Retrofit Per Diem Calculation (4 copies) Forms (2 copies)

Architect’s Certificate (1 copy)

SECOND SUBMISSION OF PLANS [Refer to above Working Drawings requirements.]


Section 5.3

Policy for Funding Construction Costs of

Retrofitting “D” Long-Term Care Facilities


January 2002


2.0 The Construction Funding Policy..................................................... 1

3.0 The Retrofit Per Diem ......................................................................... 2

4.0 Accountability Structure.................................................................... 5

5.0 What Happens to the Retrofit Per Diem in the Event of Receivership after the Commencement of Operations?............... 7

Ministry, Long-Term Care Redevelopment Project 5.3-1

1.0 Introduction Effective January, 2002, the Ministry of Health and Long Term Care (the “Ministry”) implemented a new funding policy entitled the Policy For Funding Construction Costs of Retrofitting “D” Long-Term Care Facilities (the “Retrofit Construction Funding Policy”) to support the costs of retrofitting “D” LTC facilities (nursing homes and homes for the aged). This document sets out the Ministry’s Policy for Funding Construction Costs of Retrofitting “D” Long-Term Care Facilities. Additional funding policy details may be found in the Policy for Funding Construction Costs of Long-Term Care Facilities (April 1999). Implementation of the Retrofit Construction Funding Policy coincided with the release and implementation of the retrofit design standards for long-term facilities as set out in the Long-Term Care “D” Facility Retrofit Design Manual dated January 2002 (the ““D” Retrofit Design Manual”).

2.0 The Construction Funding Policy

Under the Retrofit Construction Funding Policy, the Ministry shall provide to a Long-Term Care (LTC) “D” Facility Operator the following funding if, and only if, the Ministry determines that the Operator meets all eligibility criteria and requirements as set out in this Retrofit Construction Funding Policy:

• A maximum per diem of between $7.00 and $10.35 (referred to as the Retrofit Per Diem) in additional operating funds for each “D” long-term care bed.

• The Retrofit Per Diem shall be paid by the Ministry to the Operator on a monthly

basis for a period of 20 consecutive years.

• The Retrofit Per Diem paid by the Ministry shall be based on the Retrofit Per Diem eligibility of the approved design and demonstrated actual costs. If actual construction costs are less than the Maximum Eligible Costs, the Retrofit Per Diem shall be prorated against the actual construction costs.


3.0 The Retrofit Per Diem I. Eligibility for the Retrofit Per Diem Operators of Category “D” facilities that have entered into a Retrofit Development Agreement with the Ministry are eligible for the Retrofit Per Diem. Operators must construct their new facilities or additions/renovations to existing facilities, as the case may be, in accordance with the “Agreement for Retrofit of LTC Facility Beds” made between the Minister of Health and Long Term Care and the Operator. II. Retrofit Per Diem Eligibility As set out in the “D” Retrofit Design Manual, a number of mandatory design standards must be met in order to obtain Ministry design approval. Flexibility in design standards is provided through the inclusion of Performance Ranges and Comparable Designs for selected design standards and the choice of Preferred Accommodation Definition. The Retrofit Per Diem eligibility is determined by the Ministry based on the final approved design. Operators that enter into agreements to Retrofit “D” facilities are eligible for a Retrofit Per Diem of $7.00 to up to $10.35 (a range of $3.35). Total Retrofit Per Diem eligibility is determined by the Ministry based on the portion of the available flexibility which is actually incorporated into final, approved Retrofit designs. A design which meets only the minimum mandatory standards in each category is eligible for up to $7.00. A design which does not require any flexibility in relation to the 1998 Facility Design Standards is eligible for up to $10.35 per diem. Each flexible design feature has been allocated a portion of the $3.35 range available based on design performance as follows:

Flexible Standard Per Diem Allocation Optional Preferred Bed Definition 0.50 Performance Ranges

1 Number of Beds in RHA 0.42 2 Bedroom Size* 0.52 3 Clothes Closet Size 0.10 4 Lounge and Activity Space per Resident 0.30 5 Dining Space per Resident 0.30 6 Corridor Widths 0.20 7 % of Lounge and Activity Space in RHA 0.20

Sub-total Performance Ranges 2.04


Comparable Designs 1 Transitory passage** 0.13 2 Washroom door swing** 0.04 3 Admin space for Nursing and Program/Therapy Staff** 0.04 4 RHA space for therapeutic programs 0.04 5 Storage space for small equipment, etc. in Dietary Service

Space 0.04

6 Work area for records/reference in Dietary Service Space 0.04 7 Resident bedroom in RHA no more than 200 ft. to Outdoor

Space** 0.04

8 At least one Outdoor Area from Dining, Lounge, or Program/Activity Space

0.04

9 Access to all sides of laundry equipment 0.04 10 Storage for supplies and equipment in Laundry Space 0.04 11 Janitor’s closet both in and outside of RHA** 0.04 12 Design of janitor’s closet 0.04 13 Storage of equipment and machinery within Maintenance

Service Support Space 0.04

14 Storage for hazardous materials and equipment in Maintenance Service Support Space

0.04

15 Location of Receiving/Service Space 0.04 16 Convenient access to Dietary Service Space from

Receiving/Service Space 0.04

17 Separate area for garbage in Receiving/Service Space 0.04 18 Landscaping of parking lot 0.04

Sub-total Comparative Designs 0.81 TOTAL RETROFIT PER DIEM ALLOCATED FLEXIBLE DESIGN

* *Comprised of $0.42 for average room size, $0.10 for use of allowable exceptions ** Comparable Designs prorated based on frequency of use.

$3.35

The actual amount of the Retrofit Per Diem is determined following submission of Retrofit Per Diem Calculation Forms (Ministry Forms). III. Determination of the Amount of the Retrofit Per Diem Payable Maximum Eligible Cost is in proportion to the Retrofit Per Diem eligibility. It will have a range of $50,725 to $75,000 and will be calculated by dividing the Retrofit Per Diem eligibility by $10.35 and multiplying the result by $75,000. The actual amount of funding support shall be determined by a Ministry review of the actual construction costs. For the purposes of demonstrating that the Maximum Eligible Cost has been expended, actual construction costs can include the actual cost of construction, furniture, equipment, building permit, development fees, and consulting/professional fees.


If the actual construction cost is less than the Maximum Eligible Cost, the Retrofit Per Diem eligibility shall be pro-rated against the actual construction costs. The Operator shall be fully responsible for all project costs including, but not limited to: 1. all actual construction costs (including the actual cost of construction, furniture,

equipment, building permit, development fees, and consulting/professional fees) above the Eligible Cost Threshold; and

2. all costs relating to the land, building, re-zoning application, audit fees and site

survey. IV. Commencement of the Funding of the Retrofit Per Diem The Ministry shall not be obligated to provide the Retrofit Per Diem to Eligible Operators unless the Ministry determines that the following terms and conditions have been met: 1. the LTC facility has been retrofitted in accordance with the design standards as

set out in the “D” Retrofit Design Manual, as amended from time to time, and in accordance with the plans approved by the Ministry;

2. all terms and conditions set out in the agreement(s) entered into between the

Ministry and the Eligible Operator relating to the Retrofit of the LTC facility Beds have been complied with;

3. all requirements set out in this Retrofit Construction Funding Policy have been

complied with; and 4. a pre-occupancy review has been completed by the Ministry and the Operator

has received approval to admit residents. The Ministry may stop the funding of the Retrofit Per Diem to an Operator and recover any monies provided by the Ministry to an Operator relating to the Retrofit Per Diem in the event that the Ministry becomes aware that the Operator has not met the terms and conditions set out above in this section. The Retrofit Per Diem shall be included in the Subsidy Calculation Worksheet of the Operator which is attached to and forms part of the Service Agreement between the Ministry and the Eligible Operator.


4.0 Accountability Structure I. Review of Construction Plans and Costs Eligible Operators must clearly demonstrate their construction costs and project financing plans as part of the Ministry’s plans review and approval process. If the Ministry requires additional information about the financing of the project, Operators must submit all such additional information to the Ministry in a timely manner. All construction plans for the retrofit of a LTC facility (this includes plans for renovations, additions and/or alterations to an existing LTC facility) shall be reviewed for acceptability by the Ministry prior to the start of construction. The purpose of the Ministry’s plans review process is to ensure that each Operator’s plans conform to the design standards as set out in the “D” Retrofit Design Manual. Construction plans that do not meet these design standards will not be approved. Approval for the Retrofit Per Diem funding shall not be given by the Ministry prior to completion of the Ministry’s review and confirmation of final estimate of construction costs based on the final design approval. II. Tendering of Project Once the construction plans have been approved by the Ministry, the project must be approved by the Ministry for tender. Working drawings and specifications suitable for public tendering must be prepared by the Operator. These working drawings and specifications must form the basis of the contract between the Operator and the general contractor/project manager approved by the Ministry. All construction projects must be publicly advertised in the Daily Commercial News and local newspapers. Operators may “invite” contractors to submit a construction bid as well. The Ministry’s policies and guidelines for tendering are based on a stipulated price contract as per the Canadian Construction Documents Committee (CCDC 2) standard forms and documents. Use of the CCDC2 standard forms is recommended for all aspects of the Operators tendering process. After the close of the tender, at least three bids must be reviewed by the Operator in consultation with the Ministry. The Ministry shall review the bids selected by the Operator and approve the selection of the general contractor/project manager. A Final Estimate of Cost (“FEC”) form (Ministry document) must be prepared by the Operator and submitted to the Ministry. In addition, the Operator must submit a


spreadsheet identifying bidders, a written recommendation from the Operator relating to the general contractor selected by the Operator, and a letter of confirmation from the Operator’s lender concerning the terms of financing. III. Commencement of Construction Construction shall begin as soon as the tendering process is complete and a contract is awarded and signed. Construction of the project is the responsibility of the general contractor/project manager and must be carried out in accordance with the terms of the contract between the Operator and the general contractor/project manager. IV. Project Completion and Determination of Construction Funding The Ministry shall carry out a “pre-occupancy” review to confirm that the retrofitted LTC facility or any addition thereto has been constructed in accordance with the construction plans approved by the Ministry. The Operator shall address any outstanding issues relating to the “pre-occupancy review” to the satisfaction of the Ministry before approval by the Ministry to admit residents shall be given. Once the new facility or addition thereto has passed the “pre-occupancy review”, the Eligible Operator shall be approved by the Ministry to begin admitting LTC facility residents to the new LTC facility beds. The Retrofit Per Diem funding shall begin on the day the Operator has received permission to admit residents to the LTC facility or addition thereto. The payment shall be for the full-approved capacity of the LTC facility and shall continue for 20 years from the date of approval to admit residents. The Operator must submit an audited “Statement of Disbursements and Source of Funds” (this is a Ministry form) to the Ministry. Once the “Statement of Disbursements and Source of Funds” is approved by the Ministry, the Retrofit Per Diem shall be set or adjusted, if necessary, in the event that the Ministry has been providing the Retrofit Per Diem based on the Operator’s FEC form. The Operator must have a valid Service Agreement with the Ministry in order to receive operating funds. The Retrofit Per Diem for construction financing shall form part of the Service Agreement.


5.0 What Happens to the Retrofit Per Diem in the Event of Receivership after the Commencement of Operations?

A LTC facility may be placed under receivership where an Operator is unable to meet its financial obligations. The receivership may take place after the Retrofit Per Diem financing commences (for example, three or four years after opening). It is the policy of the Ministry to work closely with a receiver to ensure that the needs of the residents are met and the facility is properly maintained. Ministry funding support to the home continues during the receivership period to ensure continuity in the delivery of resident care programs and services. In most circumstances, the receiver, usually in conjunction with a management firm experienced in operating a long-term facility, continues to operate the facility until such time that a new Operator (approved by the Ministry) assumes ownership. The new Operator shall assume all obligations of the former Operator relating to the operation of the LTC facility. If the new Operator does assume all obligations, the new Operator shall be entitled to the same Retrofit Per Diem from the Ministry as previously provided to the prior Operator. If a new Operator cannot be found and the receiver seeks to dispose of the LTC facility, residents shall be relocated to alternative care settings in accordance with their needs and the LTC facility shall be closed. In this event, all Ministry funding to the home shall cease (including all funding for construction or capital investment), and the receiver shall be responsible to deal with any creditors in the usual course.


Section 6

Upgrade Option Guidelines


January 2002


2.0 Upgrade Option Guidelines and Requirements.............................. 2

3.0 Self Assessment Guide...................................................................... 5 APPENDIX 1: ACCOUNTABILITY STRUCTURE FOR UPGRADE PROJECTS.....7


1.0 Introduction Effective January, 2002, the Ministry of Health and Long-Term Care (the “Ministry”) introduced two new Development Options for “D” Class facilities, each with new design standards and associated funding. The Upgrade Program is one of these new programs. It is designed to provide a flexible option to “D” Operators constrained in pursuing either Redevelopment or Retrofit in upgrading their facilities. The Upgrade Option cannot be combined with either the Retrofit or Redevelopment Options in the same facility. Please note that Transition Support is not available to Operators for facilities pursuing the Upgrade Option. Operators pursuing this option will also not be eligible for any new bed awards to that facility and will be required to return any previously awarded beds related to the facility. Description The Upgrade Option allows Operators to improve their facilities within the range of structural design features used in the facility classification process. Operators can choose to: 1) invest a minimum of $3,500 per bed in facility upgrades within certain targeted

areas of direct benefit to residents, in particular: o Bath/Shower areas; o Resident Lounges; o Resident Dining Areas; o Resident Activity Areas; and/or o Facility Accessibility (elevators)

OR 2) implement a program of work designed to upgrade the facility to a “C”

classification by meeting the standards set in the 19 classification criteria outlined below.

Any work under the Upgrade Option must be approved by the Ministry prior to the start of construction. The Ministry reserves the right to verify satisfactory completion of Upgrade work prior to authorizing a Structural Premium of $1.00 per bed per diem for facilities completing the Upgrade Option.


2.0 Upgrade Option Guidelines and Requirements

Upgrade Construction Funding The Construction Funding Policy for long-term care (LTC) facilities is amended effective January 9, 2002 as follows: a structural premium of $1.00 per diem is payable to Operators on completion of the Upgrade work. This premium will not be adjusted for any government grant(s) previously received. Timeframe, Accountability Operators must indicate their intention to pursue the Upgrade Option no later than March 7, 2002. Operators electing to proceed with the Upgrade option will be required to enter into an Upgrade Agreement. Under this Agreement, Operators will submit a proposed scope of Upgrade work for Ministry approval. Operators will be responsible for arranging any required project financing. All work must be publicly tendered. Operators may use a construction management approach, provided that the manager is selected through an open tendering process. Project work being done for the Upgrade Option must be completed by December 31, 2003. The structural premium of $1.00 per diem will start on satisfactory inspection of the completed work and receipt of a statement of disbursements. Additional detail is provided in Appendix 1: Accountability Structure for Upgrade Projects, to these Guidelines. Self Assessment Facility Operators considering the Upgrade Option should review the Criteria, Policy and Requirements and then complete the “Self Assessment Guide.” The Self Assessment Guide is intended to help Operators to assess their current facility status in relation to the classification criteria used for “C” facilities. Operators can use the results of this questionnaire together with the comments following the form as part of a decision making process to determine which of the Upgrade Alternatives would be most suitable for them. A completed Upgrade Self Assessment Form must be submitted by March 7, 2002.


Eligible Expenditures Only expenditures related to an approved scope of work will be included for consideration in meeting the $3,500 investment criteria. For example, general repair, maintenance and replacement work such as a new roof or furnace will not be eligible. Compliance, Permits Any outstanding Ministry compliance orders must be completed. Outstanding work orders issued by Municipalities or other local authorities must also be completed. The final inspection will not be performed until proof of compliance has been submitted. Priority Areas for Upgrade Work In cases where an Upgrade to meet all “C” class facility requirements is not feasible, Operators will be required to invest a minimum of $3,500. The Ministry will approve work plans for Upgrade. The primary approval criteria will be the expected benefit to residents. For this reason, priority areas for Upgrade include:

• Bath/Shower areas; • Resident Lounges; • Resident Dining Areas; • Resident Activity Areas; and • Facility Accessibility (elevators).

Operators may also propose upgrades to other facility areas. Such proposals should clearly demonstrate:

• Benefit to the resident environment; • That the work is not required to fulfil an outstanding compliance or work order;

and • The work is not part of any normal building maintenance or replacement work.

Facilities able to meet all “C” criteria In cases where facilities already meet a majority of “C” Class facility structural criteria, it may be possible to achieve full compliance for less than $3,500 per bed. In this case Operators may propose a scope of work which targets specific areas of deficiency in relation to the “C” classification criteria.


The criteria used to classify “C” facilities are listed below:

Design Feature # Criteria

Nursing Stations 1. Maximum of sixty beds per nursing station (including substations)

2. One-bed bedroom: a minimum of 100 square feet excluding closet, vestibule and washroom space

3. Two-bed bedroom: a minimum of 169 square feet excluding closet, vestibule and washroom space

4. Three-bed bedroom: a minimum of 255 square feet excluding closet, vestibule and washroom space

Floor Space - Bedrooms

5. Four-bed bedroom: a minimum of 305 square feet excluding closet, vestibule and washroom space

Bedroom Clothes Closet 6.

A separate clothes closet available to each resident within their bedroom - each closet a minimum of 5 square feet (or 4 square feet with a minimum depth of 2 feet)

Bedroom Entrance Door

7. Each bedroom has an entrance door that is at least 36 inches wide

8. In bedrooms of more than 2 beds, all beds are no more than 2 deep from the window Bed Placement

9. At least 2 feet 6 inches of clearance around three sides of each bed Windows - Bedrooms 10. Floor to window sill height in each bedroom a maximum of 38 inches

11. Each resident washroom has an entrance door that is at least 32 inches wide

12. Each washroom has sufficient space to allow a wheelchair to access the washroom and then to fully close the washroom door with the wheelchair in the washroom

Washrooms

13. A minimum ratio of 1 washroom with 1 toilet and 1 hand basin for every four residents

Bath/Shower Rooms 14.

A minimum ratio of 1 tub and/or shower for every 12 residents (unless a Ministry exception has previously been granted to allow for 1 to every 16 residents)

Resident Lounges 15.

A minimum of 15 square feet per resident of floor space for lounge area; and there is at least one lounge with a minimum size of 120 square feet provided on every floor

Activity Space 16. A minimum of 6 square feet per resident of floor space for activity area Resident Dining Space 17. A minimum of 8 square feet of floor space per resident for dining area

(excluding the servery)

Outdoor Space 18. At least one outdoor area on the facility property; and there is at least one outdoor area that is enclosed to prevent wandering/egress of residents

Elevators 19. 2-storey or higher facilities serviced by at least one elevator


3.0 Self Assessment Guide The questions below are organized into general groupings followed by comments. The notes are intended to summarize some of the key considerations for Operators in assessing their answers to the questions. # Question Yes No

1. Are there any outstanding compliance orders issued by MOHLTC or any other Provincial authority?

2. Are there any outstanding work orders issued by municipal building inspectors or an officer of the fire marshal?

No

te

Facilities must clear all outstanding compliance orders or structural or life-safety work orders before being eligible for the Upgrade Program. Depending on the nature and extent of these orders, Operators may elect to handle these orders through a Retrofit or Redevelopment project. Costs for capital improvements (other than those listed in the upgrade criteria) and the cost of improvements required due to work orders are not eligible as areas for upgrade as defined by the Upgrade Program.

# Question Yes No 3. Does the facility have a 2nd storey or higher floors that are not serviced (or

not adequately serviced) by an elevator?

No

te

Installing an elevator in an existing facility is likely to consume most or all of the $3,500 per bed investment required in the Upgrade Option Alternative 1. Operators should weigh investing in an elevator against the potential benefit of other improvements.

# Question Yes No 4. Are there more than sixty beds per nursing station (including substations) 5. Is there a separate clothes closet available to each resident within their

bedroom? If so, is each closet a minimum of 5 square feet (or 4 square feet with a minimum depth of 2 feet)

6. Does each bedroom have an entrance door that is at least 36 inches wide? 7. Does each resident washroom have an entrance door that is at least 32

inches wide?

8. In bedrooms of more than 2 beds, are all beds no more than 2 deep from the window?

9. Is the floor to window sill height in each bedroom a maximum of 38 inches? 10. Is there at least 2 feet 6 inches of clearance around three sides of each

bed?

11. Is there at least one outdoor area on the facility property; and is there is at least one outdoor area that is enclosed to prevent wandering/egress of residents?

Note

Design criteria in this group are likely to present easier or less expensive renovations to meet the standards than other criteria. This, of course, is dependent on various factors such as the extent of renovation work required to meet the standards and building specific factors such as whether or not doors are located in bearing walls.

# Question Yes No 12. Does each bedroom, which contains one bed, have a minimum of 100

square feet excluding closet, vestibule and washroom space?

13. Does each bedroom, which contains two beds, have a minimum of 169 square feet excluding closet, vestibule and washroom space?


14. Does each bedroom, which contains three beds, have a minimum of 255 square feet excluding closet, vestibule and washroom space?

15. Does each bedroom, which contains four beds, have a minimum of 305 square feet excluding closet, vestibule and washroom space?

16. Does each washroom have sufficient space to allow a wheelchair to access the washroom and then to fully close the washroom door with the wheelchair in the washroom?

17. Is there a minimum of 1 washroom with 1 toilet and 1 hand basin for every four residents?

Note

Design criteria in the above group are likely to be more expensive than in the previous group and are also likely to result in reduced resident numbers. With a number of “Yes” answers in this group, the Operator might be best to either consider selecting priority areas for upgrading using the minimum $3,500 per bed investment option (Alternative 1) or consider pursuing a Retrofit or Redevelopment option.

# Question Yes No 18. Is there a minimum ratio of 1 tub and/or shower for every 12 residents

(unless a Ministry exception has previously been granted to allow for 1 to every 16 residents)

19. Is there a minimum of 15 square feet per resident of floor space for lounge area; and is there at least one lounge with a minimum size of 120 square feet provided on every floor?

20. Is there a minimum of 6 square feet per resident of floor space for activity area?

21. Is there a minimum of 8 square feet of floor space per resident for dining area (excluding the servery)?

Note

Design Criteria in this group may offer Operators a broad range of renovation options for pursuing Alternative 1. These options might include:

• Building an addition if the zoning and lot size allow • Changing current usage of some rooms within the facility (i.e. converting some bedrooms

to lounge or activity spaces)


APPENDIX 1: ACCOUNTABILITY STRUCTURE FOR

UPGRADE PROJECTS 1. Review of Facility Status and Proposed Upgrade The Ministry reserves the right to verify the status of a facility through an on-site inspection. All proposed work under the Upgrade Option must be approved by the Ministry prior to the start of construction. Eligible Operators must clearly demonstrate their construction costs as part of the Ministry’s plans review and approval process. If the Ministry requires additional information about the financing of the project, Eligible Operators must submit all such additional information to the Ministry in a timely manner. 2. Tendering of Project Once the construction plans have been approved by the Ministry, the project must be tendered and the Ministry must approve the selection of the successful bidder. Working drawings and specifications suitable for public tendering must be prepared by the Eligible Operator. These working drawings and specifications must form the basis of the contract between the Eligible Operator and the general contractor approved by the Ministry. All construction projects must be publicly advertised in the Daily Commercial News and local newspapers. Eligible Operators may “invite” contractors to submit a construction bid as well. The Ministry’s policies and guidelines for tendering are based on a stipulated price contract as per the Canadian Construction Documents Committee (CCDC 2) standard forms and documents. Use of the CCDC2 standard forms is recommended for all aspects of the Eligible Operators tendering process. After the close of the tender, at least three bids must be reviewed by the Eligible Operator in consultation with the Ministry. The Ministry shall review the bids selected by the Eligible Operator and approve the selection. A Final Estimate of Cost (“FEC”) form (Ministry document) must be prepared by the Eligible Operator and submitted to the Ministry. In addition, the Eligible Operator must submit a spreadsheet identifying bidders, a written recommendation from the Eligible Operator relating to the general contractor selected by the Eligible Operator, and a letter of confirmation from the Eligible Operator’s lender concerning the terms of financing.


3. Project Completion and Determination of Construction Funding The Ministry shall carry out an inspection to confirm that upgrades to the LTC facility or the addition thereto have been constructed in accordance with the construction plans approved by the Ministry. The Eligible Operator shall address any outstanding issues relating to the inspection to the satisfaction of the Ministry. The $1.00 per diem funding shall begin on the first business day following a satisfactory inspection. The Eligible Operator must submit an audited “Statement of Disbursements and Source of Funds” (this is a Ministry form) to the Ministry.


Section 7

Transition Support Program Guidelines


January 2002

Table of Contents 1.0 Purpose................................................................................................. 1

2.0 Eligibility and Application.................................................................. 1 2.1 Application Process ..........................................................................................1

3.0 Approval Process................................................................................ 2 3.1 Approval Criteria ................................................................................................2 3.2 Eligible Expenses...............................................................................................2 3.3 Exclusions ...........................................................................................................3

4.0 Funding Details.................................................................................... 3 4.1 Funding and Reconciliation ............................................................................4 4.2 Special Transition Assistance ........................................................................5

5.0 Transition Support Funding Business Case (Template)............... 5

6.0 Transition Support Questions & Answers....................................... 6

7.0 For Additional Information................................................................. 7


1.0 Purpose The purpose of Transition Support funding is to allow “D” Operators to provide for client services and meet fixed and/or unique operational costs through the development period. Transition Support funding is meant to sustain an otherwise feasible Development. It is not intended to subsidize project costs or otherwise reduce the Operator’s share of development capital costs. Transition Support will enable a reduction in facility occupancy while permitting Operators to retain funding which would otherwise be subject to reconciliation. The retained funding can be used to cover fixed costs which cannot be avoided, or to meet unique operating costs entailed by a Redevelopment or Retrofit project.

2.0 Eligibility and Application All “D” facilities redeveloping or retrofitting their facility may apply for Transition Support funding. To be eligible, Operators must, at a minimum, indicate intent to apply for Transition Support by March 7, 2002 and enter into a Development Agreement by not later than June 27, 2002. 2.1 Application Process Operators must indicate their intent to apply for Transition Support funding in their Submission Package by checking “Yes” in Part E of the Development Path Being Considered Form (Section 3, Part III). Final approval will be confirmed at the preliminary plan approval stage as defined in the 1998 and “D” Retrofit Design Manuals. In order to obtain final approval, Operators will be required to submit a number of additional items, subsequent to this Submission Process. These subsequent submission requirements are available upon request from their Ministry Account Managers, and may include the following:

• A detailed description of your Project Concept; • Transition Support Funding Business Case (see template attached); • Operational Plan (Appendix B of 1998 and “D” Retrofit LTC Facility Design

Manuals); • Additional Finance and development Schedules for the Proposed Facility; and • Audited Financial Statements.


• Municipal Operators only: Council Resolution, Capital Plan and Annual Repayment letter

3.0 Approval Process An initial eligibility determination will be made as soon as an Operator has indicated its intent to enter into an agreement to Redevelop or Retrofit the existing “D” facility. This determination permits the Operator to develop a detailed operating plan for the transition and enables the Ministry to begin its Transition Support planning and coordination. The Transition Support Funding Business Case and other documentation will be evaluated by the Ministry. Following this assessment the Ministry will confirm conditional approval of Transition Support as appropriate and the Operator’s Development and Service Agreements will be amended as necessary. 3.1 Approval Criteria Transition Support costs must meet all of the following criteria:

• resident focused/operational in nature; • unavoidable; • fixed or unique to transition; • non-recurring (before or after the transition period); • in support of a viable Development; • shown not to displace normal Operator contribution to redevelopment.

3.2 Eligible Expenses Eligibility of expenses will be determined on a case by case basis based on the criteria outlined above in Section 3.1. Subject to an approved Transition Support Funding Business Case, items eligible for Transition Support funding may include:

• Dual operating costs (e.g., temporary facility leasing, heating, taxes, etc. on one of two sites);

• Required lease-hold improvements to upgrade temporary facilities to minimum standards (e.g., installation of new locks on buildings, etc.);

• Temporary storage; • Temporary operational costs above usual costs (laundry delivery, temporary air

quality equipment, sound barriers to protect resident quality of life, etc.);


• Extra staff during move period; • Transportation (residents, equipment, supplies, etc.); • Resources for coordination/planning (e.g., project management, coordinating

move, etc.). Other expenses required to support a Redevelopment or Retrofit may be presented in the Business Case and will be considered based on the criteria in Section 3.1 above. Please note that staff orientation costs associated with a new facility are supported under a separate policy for newl y completed facilities, not under the Transition Support Program. 3.3 Exclusions The following items are not eligible for Transition Support:

• capital in nature (e.g., site demolition); • not identified in the Transition Support Funding Business Case; • already funded through the level of care envelopes or other Ministry sources.

4.0 Funding Details Funding terms and conditions will be negotiated on a case by case basis. Transition Support funding is implemented by setting targets for the following funding variables: Occupancy Reduction Period – the number of days required to reduce the occupancy level to the transition bed count based on the facility’s current annual resident turn-over rate, up to 365 days. Transition Period – the number of days required to complete development of the new or retrofitted facility, i.e., the construction period through to pre-occupancy review. Fill Period – the number of days to be funded as if at 100% occupancy following a pre-occupancy approval of the new/retrofitted facility. Transition Bed Count – the number of beds that are required to remain in service through the transition period. Retention Bed Count – the number beds unoccupied during the transition period for which funding will be retained. Funding will be based on the facility’s existing CMI.


The transition bed count and retention bed count will be assessed based on:

• the development schedule; • the Operational Plan; • transitional space requirements and availability; • degree of difficulty in maintaining full occupancy during the transitional period; • minimum required funding to cover fixed costs; • required funding to cover unique transitional costs.

4.1 Funding and Reconciliation Occupancy Reduction Period – facilities will continue to be funded as if at 100% occupancy through this period though they will cease (or curtail) admissions during this period. Operators are required to admit residents as required to meet 97% of the transition bed count during this period. In exceptional cases where resident turn-over does not sufficiently reduce occupancy to the Transition Bed Count, special transfers or other measures may need to be arranged. At reconciliation, 100% of all funding envelopes (Nursing & Personal Care, Program & Support Services, and Other Accommodation) will be retained by the Operator. For unoccupied bed days under 97% occupancy, 50% of the Nursing & Personal Care (NPC) and Program & Support Services (PSS) envelopes will be deemed to be redirected to cover unique transition costs as outlined in the Transition Support Funding Business Case. Transition Period – facilities will be funded for the transition bed count as well as for the retention bed count (up to 100% funding prior to transition). For example, if a 100 bed facility has reduced its occupancy to a transition bed count of 80 beds and a retention bed count of 10 beds, it will be funded as if at an occupancy of 90 beds for the transition period. At reconciliation, where occupancy is maintained at, or above, 97% of the transition bed count, the NPC and PSS envelopes will be reconciled to 100% of the transition bed count plus the retention bed count. In the case that occupancy rates drop below 97% of the transition bed count, the NPC and PSS envelopes will be reconciled to actual occupancy rates plus the retention bed count, i.e., the retention bed count is exempt from normal occupancy requirements. Retention of the Other Accommodation envelope for reduced beds in the Occupancy Reduction Period and for the Retention Bed Count in the transition period is deemed to cover an Operator’s exceptional fixed costs for those periods and is not subject to reconciliation. Retention of the NPC and PSS envelopes for reduced beds in the Occupancy Reduction Period and the Retention Bed Count for the Transition Period are deemed to


be redirected to cover unique transition costs as outlined in the Transition Support Funding Business Case and will be reconciled against actual costs. Fill-Period – facilities will fall under the Ministry’s Fill Rate policy which funds facilities as if at 100% occupancy for a specified period. 4.2 Special Transition Assistance Special Transition Assistance will be available for exceptional cases where: • local conditions are such that there is limited flexibility to adjust occupancy levels

through the transition period, and/or; • eligible expenses cannot be met through adjustments to funding variables as

outlined in sections 4.0 and 4.1 above. Special Transition Assistance will be approved at the sole discretion of the Ministry and subject to the availability of funding.

5.0 Transition Support Funding Business Case (Template)

Following are the minimum required contents for the Transition Support Funding Business Case. Operators may wish to provide additional justification in support of their applications. Background Current Redevelopment or Retrofit project status. Outline of the impact of Redevelopment or Retrofit on the facilities operations and the general management strategy to be used through transition period. Options/Risk Analysis Description of alternative development scenarios and transitional plans considered. Discussion of risk to residents and/or successful completion of redevelopment/retrofit if proposed Transition Support is not available.


Detailed Explanation of Costs Detail for each cost item being submitted for Transition Support. Cost Summary A summary table of the costs outlined above.

6.0 Transition Support Questions & Answers 1) Is Transition Support funding available retroactively?

Yes. If an Operator can provide proof of costs incurred after April 1, 1998, they will be considered for Transition Support funding upon submission of the required documentation.

2) Will the Ministry replace preferred revenue through the transition period?

No. Revenue protection will only include funding within the current level of care envelopes.

3) Are facilities that choose the Upgrade Option eligible for Transition Support?

No. Only facilities that are redeveloping or retrofitting are eligible for Transition Support.

4) How is the resident co-payment for unoccupied beds treated during the

transition period?

Full accommodation funding will be maintained for the Retention Bed Count. This will include the resident co-payment.

5) Do facilities need to re-apply for Transition Support annually?

No. The application process will be one-time, but is monitored through milestones in the Development Agreement, and is subject to reconciliation as outlined in the Transition Support Program Guidelines.


7.0 For Additional Information Please contact the “D” Bed Submission Process Call Centre, as follows:

Toll Free: 1-866-411-7773 Toronto: (416) 314-5061



Section 8

Requests to Adjust Bed Numbers Guidelines


January 2002


2.0 Additional Beds ................................................................................... 1

3.0 Reduction/Return of Beds.................................................................. 2


1.0 Introduction Operators whose Redeveloped or Retrofitted facility will have the same number of beds as in their current “D” facility should skip this section. Respondents to the Development Plan Submission Process are required to indicate the number of beds they wish to Redevelop, Retrofit or Upgrade. In some cases, Operators may require additional beds to support the viability of their Development Plans. In others, a reduction in the number of beds may be required by site or other constraints. Operators must indicate by March 7, 2002 whether they plan to request, return or transfer beds. This indication is made on the Development Path Being Considered form (see Section 3: Submission Package, Part III). Only Operators who are redeveloping or retrofitting and who enter into a Development Agreement by not later than June 27, 2002 are eligible for consideration for additional beds.

2.0 Additional Beds Criteria for Awarding Additional Beds The number of beds allocated to a facility will typically be small (less than 12). Requests for additional beds will not be formally considered until a development site has been confirmed and a project’s financial feasibility can be demonstrated. Operators may also be required to submit a number of additional items to the Ministry (requirements are available upon request from Ministry Account Managers). These additional requirements may include the following:

• Outline of Project Concept; • Additional Finance and Development Schedules for the Proposed Facility; • Evidence of Right to Land; and, • For Municipal Operators only: Council Resolution, Capital Plan, and Annual

Repayment letter. To obtain additional beds Operators will be required to explain in a Project Concept description why they need more beds, indicating how these beds will improve the viability of their Development Plans.


3.0 Reduction/Return of Beds Operators planning to return some beds should indicate the exact decrease in facility beds in Part E of the Development Path Being Considered form in Part III of Section 3: Submission Package. Operators may find that in designing a Retrofit or Redevelopment they need to reduce the total number of beds based on a new floor plan or a changed number of beds per Resident Home Area (RHA). Preliminary and working drawings may indicate a reduction in the number of beds. Depending on which legislation governs a facility, the reductions are handled differently. Nursing Homes Act: Nursing Homes (For-Profit and Non-Profit) may choose to either sell their surplus bed licenses to other Nursing Home Operators in the same Service Area for redevelopment to the standards in the 1998 Long-Term Care Facility Design Manual, or to return the bed licenses to the Ministry. All sales of licenses must be approved by the Ministry. Operators may also apply to have the beds placed in abeyance. Charitable Institutions Act: All Charitable Home beds must be returned directly to the Ministry except where a charity wishes to transfer beds from one of their facilities to another facility they own within the same Service Area. All transfers of beds between facilities must be approved by the Ministry. Homes for the Aged and Rest Homes Act: The Province recently confirmed that the requirement of Municipalities to operate at least one Home for the Aged would be continued. Municipalities may still wish to reduce the number of beds they operate in order to implement modern design standards. All inactive Municipal Home beds must be returned directly to the Ministry except where a municipality wishes to transfer beds from one facility to another within the same Service Area. All transfers of beds between facilities must be approved by the Ministry. Guidelines for Returning Beds Returned beds will be reflected in the Development Agreement and Service Agreement you sign with the Ministry. The Development and Service Agreements will show the total number of beds in the improved/planned facility as less than the number in the current facility. Transfer of Beds to Another Location


The Ministry will consider a request to transfer bed awards to another site. This request must be detailed in your Project Concept description.


Section 9

Appendices


January 2002


Appendix 9.1 Glossary 1998 Standards: refers to the design standards set out in the 1998 Long-Term Care Facility Design Manual. 1998 Design Manual: refers to the 1998 Long-Term Care Facility Design Manual. This Manual outlines the design standards for the Redevelopment Option. Allowable Performance Range: indicates a Retrofit design standard that includes an accepted range between a prescribed minimum and the 1998 Standards. Allowable Performance Range standards affect the amount of construction funding provided by the Ministry of Health and Long-Term Care (the “Ministry”) for a retrofitted facility. CD: refers to Comparable Design Change in Long Term Liabilities: implies the net increase or decrease of Long Term Liabilities from the previous fiscal period to the current fiscal period. Change in Owner’s Equity / Surplus: implies the net increase or decrease of Owner’s Equity / Surplus from the previous fiscal period to the current fiscal period. Comparable Design standard: facility design standards (for the Retrofit Option) which allow some 1998 standards to be met through alternative designs provided that relevant Design Objectives and Design Considerations are met and addressed. Comparable Designs affect the amount of construction funding provided by the Ministry for a retrofitted facility. Construction Funding: refers to the funding per diem that will be provided to Operators choosing the Redevelopment and/or Retrofit Options. The funding is provided by the Ministry to support the cost of redevelopment and/or retrofit of Long Term Care facilities. See Policy for Funding Construction Costs of Long-Term Care Facilities and Policy for Funding Construction Costs of Retrofitted “D” Long-Term Care Facilities. “D” Retrofit Design Manual: refers to the Long-Term Care “D” Facility Retrofit Design Manual. Development Agreement: An Agreement to be entered into between the Operator and the Ministry, which outlines the approved Development Path and details the steps required to complete the Development within the Program time frame. EBITDA: means Earnings Before Interest, Taxes, Depreciation, and Amortization. Taking the Net Income or Loss for the fiscal period and adding back any charges in the fiscal period for Interest, Taxes, Depreciation, and Amortization would calculate EBITDA.


Equity: (as defined in section 1000.36 of the CICA Accounting Handbook) “the residual interest in its assets after deducting its liabilities. [Equity] may include specific categories of items that may be either restricted or unrestricted as to their use.” Income Producing Assets: means Tangible Net Assets excluding land, properties under development and other non income producing assets. Interest: includes interest expensed during the fiscal period that is charged on debt, capital lease obligations, and other interest-bearing liabilities. Key Stakeholder: The definition of Key Stakeholder depends on the status of organization leading the Operator. Specifically: • Profit entities: Key Stakeholders are those who are proposed to hold an equity

interest in the project, those proposed to operate the project, and others having decision-making authority with respect to the project.

• Not-for-profit entities: Key Stakeholders are those operating the project, those responsible for major fundraising initiatives and others having decision-making authority with respect to the project.

• Municipalities: Key Stakeholders are the municipality(ies), those operating the project, and others having decision-making authority with respect to the project.

Liabilities: Liabilities are defined by section 1000.32-.33 of the CICA Accounting Handbook as: “Liabilities are obligations of an entity arising from past transactions or events, the settlement of which may result in the transfer or use of assets, provision of services or other yielding of economic benefits in the future. Liabilities have three essential characteristics:

(a) they embody a duty or responsibility to others that entails settlement by future transfer or use of assets, provision of services or other yielding of economic benefits, at a specified or determinable date, on occurrence of a specified event, or on demand;

(b) the duty or responsibility obligates the entity leaving it little or no discretion to avoid it; and

(c) the transaction or event obligating the entity has already occurred.” LTC: means Long-Term Care. Long Term Liabilities: these are Liabilities that are not considered Current Liabilities. Current Liabilities, as defined by section 1510.03 of the CICA Accounting Handbook, “include amounts payable within one year from the date of the balance sheet or within the normal operating cycle, where this is longer than a year (the normal operating cycle should correspond with that used for current assets). The current liability classification should also include the current portion of future income tax liabilities.”


MOHLTC: means Ministry of Health and Long-Term Care for the Province of Ontario Mandatory Design Standards: refers to the mandatory design standards set out in the Long-Term Care Facility Retrofit Design Manual Ministry: means Ministry of Health and Long-Term Care for the Province of Ontario Net Income: (as per section 1000.27 of the CICA Handbook) defined as “the residual amount after expenses and losses are deducted from revenues and gains. Operational Plan: A written Plan which outlines how resident health, welfare and safety will be assured over the schedule of a retrofit or renovation construction project. Operator: means the person(s), entity or firm that currently holds the licence for the “D” facility and that will enter into the Development Agreement with the Ministry. Policy for Funding Construction Costs of Long-Term Care Facilities: refers to the policy that outlines the construction funding available to Operators choosing the Redevelopment Option. This document can be found in the Redevelopment Program Manual. Policy for Funding Construction Costs of “D” Retrofitted Long-Term Care Facilities: refers to the policy that outlines the construction funding available to Operators choosing the Retrofit Option. This document can be found in the Retrofit Program Manual. Preferred Accommodation: the proportion of preferred rooms in a facility that may charge a premium for certain services or amenities above and beyond the basic (standard) level of accommodation. Preliminary Sketch Plan: describes a preliminary level of drawings and project concept submitted for approval by the Ministry. RHA: means Resident Home Area. Redevelopment Option: indicates that the facility will be replaced with one that meets the standards set out in the 1998 Long-Term Care Facility Design Manual. Resident Home Area (RHA): refers to a new and innovative concept that is being introduced into the design of long-term care facilities. Each RHA is self-contained and accommodates a maximum of 32 residents in Redeveloped facilities and 40 residents in Retrofitted facilities. The intent is to create smaller home-like units, rather than large congregate/institutional living environments. An RHA contains: • Resident bedrooms and washrooms • Resident bath and shower rooms • Resident Dining Areas


• Lounge, activity and program spaces • Staff work space and support services areas Retrofit Construction Funding Per Diem: see Retrofit Per Diem. Retrofit Construction Funding Policy: refers to the Policy for Funding Construction Costs of Retrofitting “D” Long-Term Care Facilities. Retrofit Per Diem: refers to the per diem monetary amount available to Operators selecting the Retrofit Option. Retrofit Per Diem ranges from a maximum of $7.00 to $10.35 per bed, for a period of 20 years. Retrofit Option: indicates that the existing facility will be retrofitted to meet the standards set out in the Long-Term Care “D” Facility Retrofit Design Manual. Revenue Protection: is a component of the transition support program allowing operators to negotiate interim funding independent of actual occupancy rate during the redevelopment, retrofit or upgrade of a “D” facility Schedule of Payments of Long Term Liabilities: The Schedule of Payments of Long Term Liabilities would include all payments required to discharge, partially or in full, the obligation, broken down by fiscal period of the organization. Payments would include the nominal value of repayments towards discharging the obligation. The Schedule of Payments would also include the value required to discharge the Long Term Liability upon maturity. Sector: indicates which legislation your facility is constituted under. There are four sectors named below, followed by the legislation they are constituted under: • Nursing Home (For-Profit) - Nursing Homes Act • Nursing Home (Non-Profit) – Nursing Homes Act • Charitable Home for the Aged – Charitable Institutions Act • Municipal Home for the Aged –Homes for the Aged and Rest Homes Act Service Agreement: means the Long-Term Care Facility Service Agreement referred to in s.20.13 of the Nursing Homes Act s.28 of the Homes for the Aged and Rest Homes Act and section 9 of the Charitable Institutions Act. Tangible Net Assets: Section 1000.36 of the CICA Accounting Handbook defines Net Assets as “the residual interest in its assets after deducting its liabilities. Net assets may include specific categories of items that may be either restricted or unrestricted as to their use.” Tangible Net Assets, therefore, means Net Assets excluding Intangible Assets. Intangible Assets is defined by section 3062.05 as “an asset, other than a financial asset, that lacks physical substance.” Transition Support Program: refers to the funding program available for extraordinary, non-capital transition costs incurred in redeveloping, retrofitting or


upgrading a “D” facility. See also “revenue protection” and “transitional grant” definitions Upgrade Option: indicates that the existing facility will be upgraded according to the criteria set out in the Upgrade Option Guidelines Working Capital: current assets minus current liabilities. A firm's working capital is the money it has available to meet current obligations (those due in less than a year). Working Drawings: describes a final and detailed set of construction documentation that forms the basis of a formal tender process.


Appendix 9.2 Frequently Asked Questions Submission Process - General Q. What is the 2002 “D” Bed Program? A. The “D” Bed Program represents a major commitment by the Ontario Ministry of

Health and Long-Term Care (the “Ministry”) to implement a fully-modernized long-term care (LTC) facility system. The 2002 “D” Bed Program provides additional flexibility and support to Operators, while requiring them to indicate their intention to proceed within the Program time frame.

Q. What’s new in the 2002 “D” Bed Program? A. Two new Development Options have been introduced: a Retrofit Option and an

Upgrade Option. These Options give Operators additional design flexibility. In addition, the Ministry has introduced a Transitional Support Program to assist

Operators through the transitional phase of redeveloping or retrofitting their facilities.

Finally, Operators have the opportunity to request an adjustment in the number

of beds for their improved facility. Q. What are my Development Options? A. There are three Development Options:

• Redevelopment (Transition Support and new beds possible) • Retrofit (Transition Support and new beds possible) • Upgrade

In addition, Operators may elect to have their facility remain in the “D” structural class.

Q. What is the Submission Process? A. The Submission Process requires Operators of “D” facilities to indicate their

intended Development Path, i.e. Redevelop, Retrofit, Upgrade, or remain in the structural “D” category. It also provides Operators an opportunity to apply for Transitional Support or additional beds where essential to project feasibility.

The Submission Package includes basic information about your organization,

and finances, and an indication of the Development Path you believe best suits your facility.


Q. When is the Submission Package due? A. The Submission Package is due on March 7, 2002. You may submit your

completed Package any time before that date. Q. How will I know which Development Path to pursue? A. Operators are advised to undertake a thorough review of the options based on

their individual circumstances. Some suggested considerations are provided in Section 1: Program Overview, under the subheading Choosing Your Development Options. Detailed program information is also provided for each Option and Support available (see Sections 4 through 8).

Q. What if an Operator would like to explore the Retrofit Option but there are

building constraints that may prevent meeting all of the mandatory design criteria?

A. The Ministry is prepared to work with Operators to implement high quality

designs that are substantially compliant with the standards. Problems of this nature should be discussed with the Ministry at the earliest possible opportunity.

Q. How will my Submission be assessed by the Ministry? A. The Ministry will review your Submission to ensure that you have the capacity to

meet the Program time frame for your proposed Option. The Submission and the results of the Ministry’s review will form the basis of discussion leading to a Development Agreement. The information submitted will also be used to plan and coordinate supports for Operators as the Program moves forward.

Q. When can I expect to receive a response regarding my Submission? A. You should receive a confirmation of receipt of your Submission within 5

business days of its delivery. If you do not receive confirmation, please contact the Ministry. The Ministry will advise Operators of the results of its review by April 23, 2002.

Q. What, if any, action will the Ministry take if I elect to remain in the “D”

structural category or do not respond to the Submission Process? A. The 2002 “D” Bed Program has been established to encourage “D” bed

Operators to redevelop, retrofit or upgrade their facilities to improve standards for their residents. The Program provides time-limited financial and other incentives for “D” bed Operators. Operators who elect to remain in the “D” structural category may lose their eligibility for construction funding and other supports and incentives available to “D” Operators who are proceeding under the program.


Operators who do not respond to the Submission Process by March 7, 2002 or

who do not make a timely commitment to redevelopment will be deemed to have elected to have their facilities remain in the “D” structural class.

Q. Why does the program apply only to ‘D’s and not to ‘B’s and ‘C’s? A. The government’s priority is to improve those facility beds that do not meet the

structural standards set out in the 1972 Nursing Home Act regulations. These beds are classified as ‘’’D’’ beds.

Q. How will I know how much construction funding will be available to me? A. “D” Operators who Redevelop their facilities will receive a construction funding

subsidy of up to $10.35 per bed per day for 20 years. Those who Retrofit will be eligible for a maximum of $7 to $10.35 per bed per day for 20 years. “D” Operators completing the Upgrade option will be eligible for a structural compliance premium of $1 per bed per day. Additional detail is provided in the program guidelines.

Transition Support Program Q. What is Transition Support for? A. LTC facilities undertaking Redevelopment or Retrofit face unique challenges and

costs because they are already running a facility. Transition Support will provide assistance for specific costs and will help Operators to maintain their services and organization through the redevelopment period.

Q. Who is eligible for transition support funding? A. Only those Operators who Redevelop or Retrofit are be eligible for Transition

Support. Indication of intent to apply must be received by March 7, 2002. Q. How much is Transition Support is Available? A. Transition Support will reflect the circumstances unique to each project.

Commitment to an actual type/amount of support will be given once Operators have reached the Preliminary plan approval stage and have demonstrated their capacity to complete the project.


New Bed Awards – Additional Beds Q. Can a “D” Operator request additional beds? A. Yes. The Ministry decision on whether to allocate beds will be based on how the

additional beds will contribute to the overall feasibility of the project. Further Information, Additional Support Q. How do I contact the Ministry of Health and Long-Term Care? A. You may contact the Call Centre during the Submission Process (i.e. up to March

7), as follows: Toll Free: 1-866-411-7773 Toronto: (416) 314-5061


The Call Centre will be open Monday through Friday, from 9:30 a.m. to 4:30 p.m.,

and closed on Statutory Holidays. The Call Centre will operate until March 7, 2002.

You can also visit the Ministry's website for information about the Submission Process, including: Frequently Asked Questions (FAQ's), Bulletins, PDF and Word versions of the Submission Forms and other relevant information. The site is located at www.gov.on.ca/health (select the link entitled "Redevelopment Project" then the link "Long-Term Care "D" Bed Submissions" on the left side of the page). If you need a Macintosh format version of the Submission Forms document, contact the Call Centre to request one.

Q. What support will be available to Operators in responding to the

Submission Process? A. Operators will have access to a range of supports in completing the Submission

Process. These supports include: • Information Sessions held in various regions; • Detailed program support manuals included with the Submission Process

binder; • A Call Centre to respond to individual questions; • A website with “help” materials; and • The assistance of Ministry Account Managers and other resources.


Q. How do I submit my response to the Ministry? A. The Ministry prefers to receive Submissions in electronic format, but you may

also submit your Package in hard copy. • To submit in electronic format, use the diskette provided with the Submission

Process binder. Documentation required to support the Submission can be scanned and included on your diskette.

• To submit in hard copy, fill out the forms contained in the appropriate Submission Package, and collect all the required documentation.

Send your diskette or and four (4) hard copies of your Submission to:


2001 Bed Allocations 415 Yonge Street – 10th Floor

Toronto, Ontario M5B 2E7

Q. Will my information be treated confidentially? A. Information submitted to the Ministry is subject to FIPPA[JG1], the Freedom of

Information and Protection of Privacy Act.


Appendix 9.3 Contacts and Resources Association of Municipalities of Ontario 393 University Ave., Ste. #1701 Toronto, Ontario Canada M5G 1E6 Phone: 416-971-9856 Voicemail: 416-971-8099 Fax: (416) 971-6191 Toll-free in Ontario: 1-877-4-AMO-LAS Email: [email protected] Website: http://www.amo.on.ca Canada Housing and Mortgage Corporation (CMHC) 100 Sheppard Avenue East, Ste. #500 Toronto, Ontario Canada M2N 6Z1 Phone: 416-221-2642 Fax: 416-218-3310 Website: http://www.cmhc.ca Centre for Studies in Aging Sunnybrook and Women’s College Health Sciences Centre 2075 Bayview Avenue, Toronto, Ontario Canada M4N 3M5 Phone: 416-480-5858 Fax: 416-480-5856 Community Care Access Centres (Ontario Association of CCACs) 1940 Eglinton Avenue East, Ste. #500 Toronto, Ontario Canada M1L 4R1 Phone: 416-750-1720 Fax: 416-750-3624 Website: http://www.oaccac.on.ca Council of Ontario Construction Associations 920 Yonge St., Suite 602, Toronto, Ontario Canada M4W 3C7 Phone: 416-968-7200 Fax: 416-968-0362 Email: [email protected] Website: http://www.coca.on.ca


Ontario Statutes and Regulations Publications Ontario 50 Grosvenor St Toronto Ontario Canada M7A 1N8 Telephone: 416-326-5300 Toll Free: 1-800-668-9938 Fax: 416-326-5317 Email: [email protected] Website: http://www.publications.gov.on.ca and Electronic versions of Ontario Laws: http://www.e-laws.gov.on.ca Ministry of Health and Long-Term Care Redevelopment Project 415 Yonge Street, 10th Floor Toronto, Ontario Canada M5B 2E7 Toll Free: 1-866-411-7773 Telephone: 416-314-5061 Fax: 416-326-5533 Email: [email protected] Website: http://www.gov.on.ca/health/english/program/ltc/redev/redev_mn.html Ministry of Municipal Affairs and Housing Ontario Building Code Commission 777 Bay Street, 2nd Floor Toronto, Ontario Canada M5G 2E5 Phone: 416-585-6503 Fax: 416-585-7531 Website: http://obc.mah.gov.on.ca Ontario Association of Architects 111 Moatfield Drive Toronto, Ontario Canada M3B 3L6 Phone: 416-449-6898 Fax: 416-449-5756 Email: [email protected] Website: http://www.oaa.on.ca Ontario Association of Landscape Architects 2842 Bloor Street West, Ste. #101 Toronto, Ontario Canada M8X 1B1 Telephone: 416-231-4181


Fax: 416-231-2679 Email: [email protected] Website: http://oala.on.ca Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS) 7050 Weston Road, Ste. #700 Woodbridge, Ontario Canada L4L 8G7 Telephone: 905-851-8821 Fax: 905-851-0744 Email: [email protected] Website: http://www.oanhss.org Ontario General Contractors Association 6299 Airport Road, Suite 703 Mississauga, Ontario Canada L4V 1N3 Phone: 905-671-3969 Fax: 905-671-8212 Email: [email protected] Website: http://www.ogca.ca Ontario Institute of Quantity Surveyors P.O. Box 124, Station R Toronto, Ontario Canada M4G 3Z3 Telephone: 905-471-0882 Fax: 905-471-7545 Email: [email protected] Website: http://oiqs.org Ontario Long-Term Care Association (OLTCA) 345 Renfrew Drive, Suite 102-202 Markham, Ontario Canada L3R 9S9 Telephone: 905-470-8995 Fax: 905-470-9595 Email: [email protected] Website: http://www.oltca.com


Appendix 9.4 Information Sessions

Information Session Registration Form

The Ministry of Health and Long-Term Care will be holding a series of Information Sessions to outline the details of the recently announced 2002 “D” Bed Program. Each facility/Operator is asked to send a delegate(s) to the most conveniently located Session. Session attendees are asked to bring their 2002 “D” Bed Program binder to the Session.

Return Completed form by FAX: (416) 326-5533 Sessions will be held at the following locations from 9:00 am until 1:00 pm:

Choose one (see details on next page)

££ Ottawa (January 30, 2002) ££ Richmond Hill (January 29, 2002) ££ Cambridge (January 30, 2002) ££ Hamilton (January 29, 2002) ££ Toronto (January 24, 2002) ££ London (January 24, 2002) ££ Thunder Bay (January 17, 2002) ££ Sudbury (January 17, 2002)

Registration will begin at 8:30 am - Refreshments will be provided

I. Attendees Attendees:

(list all persons you are sending) Telephone # Role in Organization

List additional participants and roles on separate page if insufficient space

II. Facility Information Facility Name Primary Contact Facility Address Telephone # Fax # E-mail address Owner (legal corporate name) Current Number of Beds Proposed Beds for Redevelopment Submitted by (please print) Telephone # Fax #


Venues 2002 “D” Bed Program Information Sessions, January 2002 DATE LOCATION VENUE Week 1

Thunder Bay Valhalla Inn 1 Valhalla Road Thunder Bay, ON January 17 (Thursday)

Sudbury Holiday Inn 50 Brady Street Sudbury, ON

Week 2 Toronto/Scarborough Malvern Community Centre

30 Sewells Road Scarborough, ON January 24 (Thursday)

London Four Points Hotel Sheraton 1150 Wellington Road South London, ON

Week 3 Hamilton Sheraton Hamilton Hotel

116 King Street West Hamilton, ON

January 29 (Tuesday) Richmond Hill Sheraton Parkway Toronto North Hotel and Suites 600 Highway #7 East Richmond Hill, ON

Cambridge Best Western Cambridge Hotel 730 Hesepeler Road Cambridge, ON January 30 (Wednesday)

Ottawa Marriott Residence Inn 161 Laurier Avenue West Ottawa, ON

All sessions will be from 9:00 am until 1:00 pm


Appendix 9.5 Sample Development Agreements

D-bed Dev.Agr. 2001

AGREEMENT FOR DEVELOPMENT OF

LONG-TERM CARE FACILITY BEDS IN [SERVICE AREA]

THIS AGREEMENT made this _____ day of _____________, 200_ between HER MAJESTY THE QUEEN in right of Ontario, as represented by the Minister of Health and Long-Term Care for Ontario (the “Minister”) and [Legal name of Operator] (the “Operator”).

WHEREAS:

1. the Operator maintains a facility, FACILITY, with [Beds in the Agreement] “D” Beds and [AU beds] Approved But Unopened Beds;

2. the Ministry has made funding available to the operator to assist it to rebuild the “D” beds and build the Approved But Unopened Beds;

3. the Operator wishes to avail itself of the Ministry’s offer and wishes to rebuild the “D” Beds and build the Approved But Unopened Beds;

NOW THEREFORE in consideration of the mutual covenants, promises, and agreements contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties to this Agreement agree as follows:

ARTICLE 1 INTERPRETATION

1.11.1 Definitions. In this Agreement, the following terms have the meanings set out below:

“Agreement” means this Agreement, including the Schedules to this Agreement, as it or they may be amended or supplemented from time to time, and the expressions “hereof”, “herein”, “hereto” “hereunder”, “hereby” and similar expressions refer to this Agreement and not to any particular Section or other portion of this Agreement.

“Applicable Law” means, with respect to any Person, property, transaction, event or other matter, any law, rule, statute, regulation, order, judgment, decree, treaty or other requirement having the force of law (collectively, the “Law”) relating or applicable to such Person, property, transaction, event or other matter. Applicable Law also includes, where appropriate any interpretation of the Law (or any part) by any Person having jurisdiction over it, or charged with its administration or interpretation subject to applicable appeal processes.

“Approved but Unopened Beds” has the meaning set forth in Schedule “F”;

“Beds” means the Long-Term Care Facility “D” Beds and Approved But Unopened Beds to be re-developed by the Operator pursuant to this Agreement; “Business Day” means any day except Saturday, Sunday or any day on which the Ontario Provincial Government is not open for business.

D Bed DEVELOPMENT AGREEMENT

October 17 2001

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D-bed Dev. Agr. 2001

“CLA” means the Construction Lien Act, R.S.O. 1990, c. C.30, as the same may be amended or re-enacted from time to time.

“Confidential Information” has the meaning set forth in Section 5.1(1) (Duty of Confidentiality).

“Construction” has the meaning set forth in Section 2.3 (Construction).

“Construction Plans” means preliminary sketch plans (as defined in the Design Manual), working drawings (as defined in the Design Manual) and specifications, and any revisions to the foregoing, relating to the Project.

“Controlling Shareholder” of a corporation means a shareholder who or which holds (or another Person who or which holds for the benefit of such shareholder), other than by way of security only, voting securities of such corporation carrying more than fifty percent (50%) of the votes for the election of directors, provided that the votes carried by such securities are sufficient, if exercised, to elect a majority of the board of directors of such corporation.

“D” Beds” means beds that are in a Facility, or part thereof, of the Operator and classified by the Ministry as a Facility, or part thereof, that does not comply with the 1972 nursing home structural standards.

“Design Manual” means the Long-Term Care Facility Design Manual issued by the Ministry on or about May, 1999, as amended to the date hereof.

“Environmental Laws” means Applicable Law in respect of the natural environment, public or occupational health or safety, and the manufacture, importation, handling, transportation, storage, disposal and treatment of Hazardous Substances.

“Facility” means the Long-Term Care Facility for which the Beds are being re-developed and for greater certainty, includes the Beds and the common areas and common elements which will be used, at least in part, for the Beds being re-developed by the Operator pursuant to this Agreement, but excludes any other part of the building which already exists or will be built in contemplation of further expansion or for uses other than long-term care (for example, a hospital) and which will not be used for the Beds being re-developed by the Operator pursuant to this Agreement.

“FEC Form” means a completed form, in or substantially in the form of Schedule “A”, setting out the final estimate of the cost of the Project.

“Force Majeure” has the meaning set forth in Section 8.5 (Force Majeure).

“Hazardous Substance” means any solid, liquid, gas, odour, heat, sound, vibration, radiation or combination of them that may impair the natural environment, injure or damage property, plant or animal life or harm or impair the health of any individual.

“including” means including, without limitation, and “includes” means includes, without limitation.

“Letter of Approval” has the meaning set forth in Section 3.3 (Occupancy Approval).

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“Lien” means a mortgage, charge, pledge, lien (statutory or otherwise), security interest or other encumbrance or adverse claim of any nature or kind whatsoever.

“Long-Term Care Facility” means an approved charitable home for the aged (as defined in the Charitable Institutions Act, R.S.O. 1990, c. C.9), a home (as defined in the Homes for the Aged and Rest Homes Act, R.S.O. 1990, c. H.13), or a nursing home (as defined in the Nursing Homes Act, R.S.O. 1990, c. N.7).

“Long-Term Care Facility Bed” means a bed in a Long-Term Care Facility.

“Minister” means the Minister of Health and Long-Term Care for Ontario or any agent or representative thereof or any other Person to whom the Minister of Health and Long-Term Care for Ontario has properly delegated certain responsibility(ies).

“Ministry” means the Ontario Ministry of Health and Long-Term Care.

“Occupancy” means the admission of the first person as a resident of the Facility.

“Operator’s Personnel” means the Controlling Shareholders (if any), directors, officers, employees, agents or other representatives of the Operator. For the purposes of Article 7 (Liability and Indemnification) only, “Operator’s Personnel” shall, in addition to the foregoing, include the contractors and subcontractors for the Construction and their respective shareholders, directors, officers, employees, agents or other representatives.

“Operational Plan" has the meaning set forth in the Design Manual but shall apply to all “D” Bed construction and shall not be limited to renovations.

“Person” is to be broadly interpreted and includes an individual, a corporation, a partnership, a trust, a joint venture, an unincorporated organization, an association, the government of a country or any political subdivision thereof, or any agency or department of any such government, and the executors, administrators or other legal representatives of an individual in such capacity.

“Policy” means the Policy for Funding Construction Costs of Long-Term Care Facilities attached hereto as Schedule “B”.

“Program Manual” means the Long-Term Care Facility Program Manual issued by the Ministry on or about December, 1993, as amended from time to time.

“Project” means the Construction and all other work to be performed and steps to be taken by or on behalf of the Operator to complete the Facility (including the furnishing and decoration thereof) and re-develop the Beds.

“Project Documents” has the meaning set forth in Section 2.4(1) (Approval of Project Documents).

“Project Schedule” has the meaning set forth in Section 2.4(1)(a) (Timing).

“Service Agreement” has the meaning set forth in Section 3.5 (Service Agreement).

“Site” has the meaning set forth in Section 2.2(1) (Approval of Site).

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“Term” means the term of this Agreement as set forth in Section 8.1 (Term), together with any extensions or renewals thereof.

“Total Completion” means that the Project has been completed (and for greater certainty, without limiting the generality of the foregoing, the Facility has been completed and is ready to be opened for use as a long-term care Facility).

1.21.2 Headings and Division. The division of this Agreement into Articles and Sections and the insertion of headings are for convenience of reference only, and are not intended to affect the construction or interpretation of this Agreement.

1.31.3 Calculation of Time . Unless otherwise specified, time periods within or following which any payment is to be made or any act is to be done shall be calculated by excluding the day on which the period commences and including the day on which the period ends.

ARTICLE 2 RE-DEVELOPMENT OF LONG-TERM CARE FACILITY BEDS

2.12.1 Re-Development of Beds. The Operator shall re-develop [Beds in the Agreement] Beds in [Facility Location], Ontario in accordance with the Design Manual and the terms and conditions set forth in this Agreement, including the Project Summary.

2.22.2 Site.

(1) Approval of Site. The site on which the Beds shall be re-developed in [Facility Location], Ontario (the “Site”) shall be subject to the approval of the Minister. The ownership or leasehold interest of the Operator in the Site, and any agreements, documents or instruments relating to such interest (including any lease of the Site or joint venture agreement), shall be subject to the approval of the Minister.

(2) Zoning. The zoning of the Site shall, from and at all times after commencement of the Construction, permit the Site to be used for a Long-Term Care Facility of the type that the Facility is proposed to be.

2.32.3 Construction. In order to re-develop the Beds, the Operator shall [Option 1: cause the construction of a new building on the Site][Option 2: cause the renovation, conversion or upgrading of the building currently existing on the Site][Option 3: cause an addition to be constructed on or to the building currently existing on the Site] (the “Construction”). The Operator shall not commence the Construction unless and until it has obtained any necessary permits, including building permits, required by Applicable Law and has submitted a copy of such permit(s) to the Ministry.

2.42.4 Approval by Minister.

(1) Project Documents. The Operator shall submit the following items to the Minister for the Minister’s approval:

(a) by [Date of Providing a Schedule E] a completed Project Schedule in the form attached hereto as Schedule “E” provided however that all such dates inserted by the Operator shall be satisfactory to the Minister, acting reasonably, by [14 calendar days], and are in accordance with the

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Operator’s obligation to complete the Project on or before March 31, 2006;

(b) Construction Plans, and a Project Summary (as defined in the Design Manual) [If Option 2 or 3 was chosen in Section 2.3 and there are residents living in the existing building, insert: and an Operational Plan], all in accordance with and as required by the Design Manual for the First Submission of Plans described therein;

(c) Construction Plans and, if applicable, a revised Project Summary, in accordance with and as required by the Design Manual for the Second Submission of Plans as described therein;

(d) the agreements, documents and instruments referred to in Section 2.2 (Approval of Site);

(e) a construction schedule for the Project setting forth dates to be agreed upon between the Operator and the general contractor selected in accordance with Section 2.4(3);

(f) any other documents, agreements or instruments relating to the Construction or otherwise to the Project or the Facility as the Minister may reasonably request;

(individually the "Documents" and collectively, the “Project Documents”).

The Operator shall not commence the tendering process until the Minister has approved, in writing, the Documents listed above in Section 2.4(1) (a), (b), (c) and (d); and the Operator shall not commence Construction until the Minister has approved in writing all of the Documents listed above in Section 2.4(1) (e) and (f).

The Minister’s approval of the Documents shall be conditional upon approval by the Ontario Fire Marshall of the Construction Plans.

(2) Expiry of Approval. The Construction shall commence within six (6) months after the date on which the Minister has approved, in writing, the successful tender bid pursuant to Section 2.4(3), and if the Construction is not commenced within such period, the Minister shall be entitled, in the Minister’s sole and absolute determination, to declare such approval to have expired at any time from or after the end of such period.

(3) General Contractor and FEC Form.

(a) Selection Process. The Operator shall select a general contractor for the Construction by means of a public tender in accordance with the Policy. The Operator shall not select a general contractor without the written approval of the Minister. Prior to selecting the successful tender bid, the Operator shall submit to the Minister for approval the following documents: (i) the tender bid which the Operator intends to select as the successful bid together with the two other tender bids which the Operator would otherwise select as alternative successful bids; (ii) an FEC Form based on the tender bid which the Operator intends to select as the successful bid; and (iii) a letter of confirmation of financing from the

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Operator’s lender containing the terms of the financing for the Project. If the Minister does not approve any of the three tender bids submitted to it by the Operator, the Operator shall submit up to three other tender bids which the Operator would otherwise select as successful bids, together with an FEC Form based on the tender bid which the Operator would then select as the successful bid. The Minister shall have the right to approve any of the tender bids submitted by the Operator and shall also have the right not to approve any of such tender bids, in which case the Operator shall issue a new invitation to tender for a general contractor for the Construction. Once a general contractor has been approved by the Minister, the Operator shall promptly prepare and submit to the Minister an FEC Form based on such contractor unless an FEC Form based on such contractor was previously submitted to the Minister as part of the foregoing approval process.

(b) Criteria. The Operator acknowledges and agrees that the Minister will be reviewing the tender bids on the basis of qualitative criteria which are set out in the Policy in addition to the prices quoted in such bids and that the Minister may not necessarily approve the general contractor which has submitted the tender bid with the lowest price. The Operator shall ensure that the invitation to tender and the other documents relating to the tender process clearly stipulate that “lowest price” is not the only criterion on which the tender bids will be assessed and selected, that the selection of the successful bid is subject to the approval of the Minister and that the Operator has the right not to select any of the tender bids and may issue a new invitation to tender for a general contractor.

2.52.5 Compliance.

(1) General. All aspects of the Construction shall be carried out in accordance with, and the Facility, once completed, shall comply with, all Applicable Law (including the CLA, all Environmental Laws, the Ontario Building Code and the Ontario Fire Code), the Design Manual, the Project Documents, and this Agreement (including for greater certainty, the Project Summary); provided that in the event that there are any inconsistencies, conflicts or ambiguities between (i) the terms of the Project Summary, and (ii)any Applicable Law or the Design Manual, the Applicable Law and the terms of the Design Manual shall prevail over the terms of the Project Summary.

(2) Occupational Health and Safety. Without limiting the generality of Section 2.5(l), the Operator shall be responsible for ensuring that the Construction is completed in compliance with all Applicable Law relating to health and safety (including the Occupational Health and Safety Act, R.S.O. 1990, c. O.1 (the “OHSA”)). The Operator shall ensure that the general contractor for the Construction acts as “constructor” in accordance with the OHSA.

2.62.6 Inspection During Construction. The Minister shall be entitled, without notice to the Operator, at any time and from time to time on any Business Day before the Project has been completed, to enter upon the Site and inspect the Site, the Facility and the progress of the Project; provided that the Minister shall not unduly interfere with or cause the delay of the Construction during the course of such an inspection.

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2.72.7 Timing.

(1) Project Schedule. The Operator shall carry out and complete the Project in accordance with the Project Schedule approved by the Minister in accordance with clause 2.4(1)(a), and in any event, shall ensure that Total Completion has been attained on or before [Total Completion Date] The Minister may, at any time, in the Minister’s sole and absolute determination, extend the deadline for Total Completion or any or all of the deadlines set forth in the Project Schedule.

(2) Progress Reports. The Operator shall submit to the Minister any information relating to the Project which the Minister may request during and in connection with the progress of the Project.

(3) Delays.

(a) Notification. The Operator shall notify the Minister in writing promptly if the submission of any Project Documents or work on the Project is behind the Project Schedule or upon becoming aware of any actual or threatened occurrence or condition which would reasonably be expected to cause a delay in meeting the deadlines set forth in Section 2.7(l) (Project Schedule) or in Schedule “E” for (i) submission of any of the Project Documents, or (ii) Total Completion.

(b) Responsibility. In the event of a delay, the Operator will use its best efforts to perform its obligations under this Agreement and to overcome or minimize the effects of such delay (including rearranging and rescheduling the work on the Project so as to minimize the ultimate delay in completion of the Project) in a timely manner utilizing to such end all resources reasonably required in the circumstances, including obtaining supplies or services from other sources if the same are reasonably available. The Operator shall be responsible for the care, maintenance and protection of the Project in the event of a shut-down.

(c) Project Documents. Subject to Section 8.5 (Force Majeure), if a delay in meeting the deadlines set forth in Schedule “E” for submission of any of the Project Documents is expected to be more than sixty (60) days, the Minister may, in the Minister’s sole and absolute determination, terminate this Agreement in accordance with Section 8.2 (Termination by Minister).

(d) Total Completion. Subject to Section 8.5 (Force Majeure), if the deadline set forth in Section 2.7(l) (Project Schedule) for Total Completion is not met or is not reasonably expected to be met, then the Minister may, in the Minister’s sole and absolute determination, terminate this Agreement in accordance with Section 8.2 (Termination by Minister), unless such delay was a direct result of the Minister not approving one or more of the tender bids submitted by the Operator to the Minister pursuant to Section 2.4(3) (General Contractor and FEC Form) and the Operator was, in the sole and absolute determination of the Minister, acting in good faith in the public tender process and in selecting the tender bids.

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2.82.8 Changes to Project. The Operator shall submit to the Minister a copy of any change order prior to implementing the change contemplated thereby if such change (a) affects the Construction Plans in any material respect, or (b) once implemented, would materially increase or decrease the total cost of the Project set out in the FEC Form prepared based on the general contractor for the Construction. The Operator shall not implement any such change order without the prior written approval of the Minister. In the event that the Minister does not consent to the proposed changes, the Operator shall continue with the Project in the manner contemplated in the Project Summary and the Project Documents, as approved by the Minister. Notwithstanding the foregoing, the Operator need not obtain the approval of the Minister for a change order (i) if the change contemplated by such change order will not cause any delay in meeting the deadlines set forth in Schedule “E” or Section 2.7(l) (Project Schedule), (ii) if the change contemplated by such change order will not result in any non-compliance of the Project with the Design Manual or any Applicable Law, and (iii) if the cost which would have been expended by the Operator on the Project without such change would have exceeded Seventy-Five Thousand Dollars ($75,000) per Bed unless, after implementation of such change order, the costs which will be expended by the Operator on the Project will not exceed Seventy-Five Thousand Dollars ($75,000). In addition, the Operator need not obtain the approval of the Minister for a change order if the change contemplated by such change order is required by Applicable Law, unless such change will result in non-compliance of the Project with the Design Manual.

ARTICLE 3 APPROVAL AND FUNDING

3.13.1 Pre-Occupancy Review.

(1) Timing. The Operator shall notify the Minister in writing thirty (30) Business Days prior to the date on which the Operator reasonably expects Total Completion to be attained. The Operator shall notify the Minister in writing at the time the Operator reasonably believes that Total Completion has been attained. Once the Operator has notified the Minister in writing that the Operator reasonably believes that Total Completion has been attained, the Minister shall arrange a time and date with the Operator for a pre-occupancy review by the Minister, which date for the pre-occupancy review shall be within ten (10) Business Days after the date on which the Operator reasonably believes Total Completion to have been attained. The Minister shall be entitled at the time and on the date set for the pre-occupancy review to enter upon the Site (including the Facility) to conduct the pre-occupancy review, including inspection of the Site and the Facility.

(2) Postponement. If it is readily apparent to the Minister that Total Completion has not been attained and that, in the sole and absolute determination of the Minister, a substantial amount of further work is required on the Project in order to attain Total Completion, the Minister shall be entitled, at the Minister’s option, not to conduct or to complete the pre-occupancy review at such time and the Minister need not provide or impose conditions on the Operator specifying the work necessary to be performed on the Project in order to attain Total Completion. In such event, the Minister shall notify the Operator that the Minister will not conduct or complete the pre-occupancy review at such time and will, if requested, give reasons for the decision. The Operator shall perform such further work on the Project as is necessary in order to attain Total Completion and a new time and date for the pre-occupancy review shall be arranged in accordance with Section 3.1(1) (Timing).

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(3) Other Inspections. The Minister shall advise the Operator to request that a fire safety inspection of the Facility be conducted by local authorities and to obtain the following documents prior to the pre-occupancy review: (a) occupancy permit; (b) approval of the Office of the Ontario Fire Marshall or local fire department; (c) certificate from Ontario Hydro regarding inspection of the Facility and compliance with the Electrical Safety Code; (d) fire and call system alarm verification certificate; and (e) fire retardancy certificate.

3.23.2 Conditions. The Minister shall be entitled to impose on the Operator conditions to the approval of the Facility for Occupancy requiring the Operator to repair, improve or modify any aspect of the Facility (for greater certainty, including the common areas and common elements which will be used, at least in part, for the Beds being re-developed by the Operator pursuant to this Agreement but not including any other part of the building which will not be used for the Beds being re-developed by the Operator pursuant to this Agreement) which does not comply with this Agreement, the Design Manual, the Construction Plans, the Project Summary (and revisions thereof), approved by the Minister pursuant to Section 2.4(l) (Project Documents) or any Applicable Law. The Operator shall complete all such repairs, improvements and/or modifications within the time period specified by the Minister. For greater certainty, the Minister’s approval of the Facility for Occupancy shall be conditional on completion of such repairs, improvements and/or modifications to the satisfaction of the Minister.

3.33.3 Occupancy Approval. Within seven (7) Business Days following completion of a pre-occupancy review, the Minister shall notify the Operator, in writing, whether the Minister (a) approves the Facility for Occupancy (in which case, such notice shall be referred to as the “Letter of Approval”), or (b) does not approve the Facility for Occupancy, together with the reasons for not approving the Facility. If the Minister does not approve the Facility for Occupancy (whether after the first or any subsequent pre-occupancy review), the Operator shall satisfy any conditions to approval imposed by the Minister pursuant to Section 3.2 (Conditions) and address any other issues raised by the Minister in such notice to the satisfaction of the Minister. In such case, the Minister shall arrange and conduct one or more subsequent pre-occupancy reviews in accordance with Section 3.1 (Pre-Occupancy Review).

3.43.4 Operation of Beds. From and after the time Occupancy has occurred, the Operator shall operate the Beds and the Facility in accordance with the Program Manual and the Project Summary, provided that the Operator must comply with all Applicable Law and meet the standards and criteria for the operation of a Long-Term Care Facility set out in the Program Manual notwithstanding anything to the contrary in the Project Summary, and in the event that there are any inconsistencies, conflicts or ambiguities between the terms of the (i) Project Summary and (ii) any Applicable Law or the Program Manual, the Applicable Law and the terms of the Program Manual shall prevail over the terms of the Project Summary.

3.53.5 Service Agreement. The Operator shall execute and deliver to the Minister a service agreement relating to, among other things, the operation of the Beds and the Facility (the “Service Agreement”), in or substantially in the form of the agreement to be provided by the Minister, prior to or within forty-five (45) Business Days after receipt from the Minister of a Letter of Approval pursuant to Section 3.3 (Occupancy Approval). The Service Agreement and each and every subsequent service agreement entered into between the Operator and the Minister shall contain, among other things, an express continuing obligation on the Minister to provide the Operator with funding for the costs of the Construction and re-development of the Beds in accordance with the Policy, subject to the conditions set forth in Section 3.6 (Funding) having been met. The Operator acknowledges and agrees that the Service Agreement and each and

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every such subsequent service agreement shall contain an express continuing obligation on the Operator that is the same or substantially the same as the obligation set forth in Section 3.4 (Operation of Beds).

3.63.6 Funding.

(1) Funding Conditions. The Minister shall provide the Operator with funding for the costs of the Construction and re-development of the Beds in accordance with the Policy. The Minister shall not be obligated to provide any such funding to the Operator until the following conditions have been met:

(a) the Minister has issued a Letter of Approval to the Operator pursuant to Section 3.3 (Occupancy Approval);

(b) the Operator has obtained or been granted a licence or statutory approval to operate a Long-Term Care Facility pursuant to the Nursing Homes Act, R.S.O. 1990, c. N.7, the Charitable Institutions Act, R.S.O. 1990, c. C.9 or the Homes for the Aged and Rest Homes Act, R.S.O. 1990, c. H.13;

(c) the Operator has executed and delivered the Service Agreement to the Minister in accordance with Section 3.5 (Service Agreement); and

(d) Occupancy has occurred.

The Minister shall provide the Operator funding based on the FEC Form for the general contractor approved by the Minister pursuant to Section 2.4(3) (General Contractor and FEC Form) until such time as the Operator provides the Minister with a Statement of Disbursements and Source of Funds for the Project, in or substantially in the form set out in Schedule “D”, and proof, satisfactory to the Minister, of the costs expended by the Operator on the Project up to a maximum of Seventy-Five Thousand Dollars ($75,000) per Bed; for greater certainty, the Operator may incur costs exceeding Seventy-Five Thousand Dollars ($75,000) per Bed but need not provide the Minister with proof of costs in excess of such amount given that funding will not be provided by the Minister in respect of any such excess costs in accordance with the Policy.

(2) Statement of Disbursements. The Operator shall use reasonable efforts to provide the Minister with such Statement of Disbursements and Source of Funds and such proof of costs as soon as possible after Occupancy, but in no event more than one (1) year after the date of Occupancy (or such longer period as the Minister may consent to in writing). The amount of funding provided prior to, and the amount of funding to be provided after, the provision of such Statement and proof to the Minister may be adjusted by the Minister: (a) based on such Statement and proof such that the amount of funding being provided to the Operator for the costs of the Construction and re-development of the Beds is in accordance with the Policy, or (b) in the sole and absolute determination of the Minister, if the Operator has not provided such Statement and proof within the time period set out in the previous sentence, based on the costs of the Construction and re-development of the Beds which the Minister believes were actually incurred by the Operator in order that the amount of such funding is in accordance with the Policy.

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ARTICLE 4 REPRESENTATIONS, WARRANTIES AND COVENANTS

4.14.1 Representations and Warranties. The Operator hereby represents and warrants to the Minister as follows:

(1) Status. [Option 1 – If the Awardee is a corporation (for profit or not-for-profit:] The Operator is a corporation [If the corporation does not have share capital, insert: with/without share capital] incorporated and validly subsisting under the laws of the jurisdiction of its incorporation. The Operator has the necessary corporate power and authority to own its property and assets and [to carry on its business, and is qualified to do business][or if corporation is not for profit: conduct its affairs] in the Province of Ontario. No act or proceeding has been taken by or against the Operator in connection with the dissolution, liquidation, winding-up, bankruptcy or reorganization or the Operator.

[Option 2 – If the Operator is a partnership:] The Operator is a [Insert if applicable: limited] partnership formed and validly subsisting under the laws of the jurisdiction of its formation. The [Insert if applicable: limited] partnership agreement is in full force and effect. The Operator has the power and authority to own its property and assets and to [carry on business, and is qualified to do business or if not for profit [conduct its affairs] in the Province of Ontario. No act or proceeding has been taken by or against the Operator in connection with dissolution, liquidation, winding-up, bankruptcy or reorganization of the Awardee.

[Option 3 – If the Operator is an individual or sole proprietorship] The Operator is at least 18 years of age and has the physical and mental capacity necessary to execute, deliver and perform its obligations under this Agreement.

(1) Due Authorization. The Operator has the full power and authority to enter into this Agreement and all other agreements and instruments to be executed by it as contemplated herein (including the Service Agreement) and to carry out its obligations under this Agreement and such other agreements and instruments, and [If the Operator is a general partnership, insert each of the partners of; If the Operator is a limited partnership, insert the general partner of] the Operator has taken all necessary action to authorize the execution, delivery and performance of its obligations under this Agreement and such other agreements and instruments.

(2) Enforceability The Operator holds or will hold all permits, licences, consents, intellectual property rights, registrations and authorizations required to carry on business and to perform its obligations under this Agreement and such other agreements and instruments referred to in Section 4.1(2). This Agreement constitutes a legal, valid and binding obligation of the Operator enforceable against the Operator in accordance with its terms, subject to limitations on enforcement imposed by bankruptcy, insolvency, reorganization or other laws affecting creditors’ rights generally and subject to general principles of equity.

(3) No Legal Bar. The execution, delivery and performance by the Operator of this Agreement and such other agreements and instruments referred to in Section 4.1(2): (a) do not and will not conflict with, result in a breach or violation of or constitute a default under any Applicable Law or any agreement, instrument or other document to which the Operator is a party or by which the Operator or any of its property or assets are bound, except for violations

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which do not relate to the Site, the Facility or the Project or will not, in the aggregate, have a material adverse effect on the present or future business, operations, property, prospects or condition (financial or otherwise) of the Operator; and (b) [Option 1 – If the Operator is a corporation, insert: do not and will not conflict with, result in a breach or violation of, or constitute a default under, its constituting documents or by-laws [add if corporation is for profit or any unanimous shareholders agreement between the shareholders of the Operator] [Option 2 – If the Operator is a general partnership, insert: do not and will not conflict with, result in a breach or violation of, or constitute a default under, its partnership agreement.][Option 3 – If the Operator is a limited partnership, insert: do not and will not conflict with, result in a breach or violation of, or constitute a default under, its limited partnership agreement.].

(4) Interest in Site. [Option 1 – If the Operator already owns the Site as of the date of this Agreement or it is known that the Operator will purchase the Site:] On and as of the later of (a) the date of this Agreement and (b) the date on which the Operator acquires the Site, the Operator has good and marketable title to the Site, free and clear of any and all Liens except those Liens which have been listed by the Operator, as set out in Schedule “C”.

[Option 2 – If the Operator already leases the Site as of the date of this Agreement or if it is known that the Operator will lease the Site] On and as of the later of (a) the date of this Agreement and (b) the date on which the Operator enters into a lease of the Site, the Operator has a good and valid leasehold interest in the Site under the lease between the Operator and [insert name of landlord] dated [insert date of lease], and the Operator is in good standing under such lease and such lease is in full force and effect, unamended. The Operator’s leasehold interest in the Site is free and clear of any and all Liens except those Liens which have been listed by the Operator, as set out in Schedule “C”.

[Option 3 – If the Operator does not, as of the date of this Agreement, know whether it will purchase or lease the Site:] On and as of the date on which:

(a) the Operator acquires the Site, the Operator has a good and marketable title to the Site, free and clear of any and all Liens except those Liens which have been listed by the Operator, as set out in Schedule “C”; or

(b) the Operator enters into a lease of the Site, the Operator has a good and valid leasehold interest in the Site under a lease between the Operator and the landlord, and the Operator is in good standing under such lease and such lease is in full force and effect, unamended. The Operator’s leasehold interest in the Site is free and clear of any and all Liens except those Liens which have been listed by the Operator, as set out in Schedule “C”.

(5) Environmental Matters.

On and as of the later of (a) the date of this Agreement and (b) the date on which the Operator acquires the Site or enters into a lease of the Site, the Operator warrants either that:

(i) to the best of the Operator’s knowledge upon reasonable inquiry, no hazardous material is now or was formerly (including the period prior to the Operator’s acquisition of the Site) used, stored, generated, manufactured,

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installed, disposed of or otherwise present at or about the Site or any property adjacent to the Site, other than in accordance with Environmental Laws; or

(ii) the site has been remediated in accordance with any and all Environmental laws, and that it shall submit proof of this to the Ministry; or

(iii) the Operator has a plan to remediate the Site in accordance with any and all Environmental laws, and that it shall remediate the Site in accordance with any and all Environmental laws before construction begins, and that it shall submit proof of this to the Ministry; and that

(iv) all current permits, licences, approvals and filings required with respect to the Site by Environmental Laws have been obtained,

(v) the Operator’s use, operation and the present condition of the Site does not and will not violate any Environmental Laws during the term of this Agreement;

(vi) the Operator has not violated any Environmental Laws in the conduct of its business (including business not relating to the Site or the Project), and

(vii) to the best of the Operator’s knowledge no civil, criminal or administrative action, suit, claim, hearing, investigation or proceeding has been brought, nor have any settlements been reached by or with any party or any Liens imposed, concerning Hazardous Materials or Environmental Laws in connection with the Site or any other real property owned or leased by the Operator, or otherwise on or against the Operator.

(6) Full Disclosure. All written statements made or furnished by or on behalf of the Operator to the Minister in the Project Summary or otherwise in connection with the transactions contemplated by this Agreement, were, as of the time such statements were made, true in all material respects and remain true in all material respects on the date hereof, and such statements do not contain any untrue statement of a material fact or omit a material fact necessary to make such statements not misleading, and all such statements, taken as a whole, do not contain any untrue statement of a material fact or omit a material fact necessary to make such statements or the statements contained herein not misleading. All expressions of expectation, intention, belief and opinion contained therein were honestly made on reasonable grounds after due and careful inquiry by the Operator (and any other Person who furnished such material). There is no fact which the Operator has not disclosed to the Minister in writing which adversely and materially affects, or so far as the Operator can now reasonably foresee, will adversely and materially affect its business, operations, property, prospects, liabilities or condition (financial or otherwise), or its ability to perform its obligations under this Agreement or to operate the Beds and the Facility in accordance with the Project Summary and the Program Manual.

4.24.2 Covenants. In addition to any other covenants and agreements of the Operator in this Agreement or the Project Summary, the Operator agrees and covenants with the Minister as follows:

(1) No Change in Ownership. The Operator shall not, without the prior written consent of the Minister, permit a significant change in the management or ownership [Delete or ownership if the Operator is a publicly traded corporation] of the Operator after the date of

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the Project Summary and during the Term of this Agreement, which change is, in the sole and absolute determination of the Minister, material; and

(2) Material Documents. The Operator shall not terminate the contract with the general contractor for the Construction or any agreements, documents or instruments forming part of the Project Documents, and shall not amend, supplement or replace such contract with the general contractor [If the Operator leases the Site, insert or the lease referred to in Section 2.2(1) (Approval of Site)][If it is not known whether or not the Operator will own or lease the Site, insert: or the lease, if any, referred to in Section 2.2(1)(Approval of Site)] in a manner that may adversely and materially affect the Project [If the Operator leases the Site, insert: or the operation of such lease][If it is not known if the Operator will lease the Site, insert: or the operation of such lease, if any] without the prior written consent of the Minister; and

(3) No Change in Site. The Operator shall not re-develop the Beds at any location other than the Site which has been approved by the Minister. The Operator shall not sell, assign, convey or otherwise dispose of the Operator’s [If the Operator leases the Site, insert: leasehold] interest in the Site without the prior written consent of the Minister. [If the Operator leases the Site, insert: and shall not purchase the Site, whether pursuant to a purchase option under the lease thereof or otherwise, without the prior written consent of the Minister.][If it is not known whether or not the Operator will lease the Site, insert: and if the Operator leases the Site, the Operator shall not purchase the Site, whether pursuant to a purchase option under the lease thereof or otherwise, without the prior written consent of the Minister.]

4.34.3 Insurance.

(1) General. The Operator shall protect itself, by obtaining and maintaining insurance in accordance with Section 4.3, from and against all claims that might arise from anything done or omitted to be done by the Operator or the Operator’s Personnel under this Agreement, and more specifically all claims that might arise from anything done or omitted to be done under this Agreement where bodily injury (including personal injury), death or property damage, including loss of use thereof, is or may be caused.

(2) Construction Insurance. The Operator shall, at its own expense, maintain in full force and effect during the Term of this Agreement with financially sound and reputable insurance companies, at least the following:

(a) Builder’s Risk property insurance for the full Replacement value of the complete Project, including earthquake and flood and testing and commissioning, with a reasonable deductible per loss for which the Operator shall be solely responsible and including the following endorsements: Replacement Cost Value, stated amount co-insurance and waiver of subrogation;

(b) Wrap Up Liability insurance, providing coverage with a limit of not less than Five Million Dollars ($5,000,000) for each occurrence of a claim of bodily injury (including personal injury), death or property damage, including loss of use thereof, that may arise directly or indirectly from the acts or omissions of the Operator or the Operator’s Personnel, and including at least the following policy endorsements: Her Majesty the

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Queen in right of Ontario as represented by the Minister of Health and Long-Term Care and the Minister’s officers and employees as Additional Insureds, Cross Liability, Blanket Contractual Liability, Products and Completed Operations, Contingent Employers Liability, and thirty (30) day written notice of cancellation, except that coverage of completed operations liability shall be maintained for two (2) years from the date of first Occupancy,

And take reasonable measures to ensure that professionals providing advice or services to the Project maintain in full force and effect during the Term of this Agreement with financially sound and reputable insurance companies Professional Liability insurance, providing coverage with a limit of not less than Five Million Dollars ($5,000,000) for each occurrence, insuring liability for errors and omissions in the performance or failure to perform professional services in the development of Beds.

(3) Other Insurance Requirements. To the extent that any Applicable Law, the nature of the Operator’s business or any other factor requires the Operator to maintain any particular type of insurance (in addition to the insurance expressly required by this Agreement) with respect to the Site, the Facility, or any contents thereof, the Operator shall comply with all such requirements.

(4) Proof of Insurance. The Operator shall submit to the Ministry certificates of insurance or other proof of the insurance coverage required in Section 4.3, together with copies of the relevant portion or portions of each insurance policy incorporating the terms and clauses referred to in Sections 4.3(2) and (3).

ARTICLE 5 CONFIDENTIALITY

5.15.1 General.

(1) Duty of Confidentiality. During the Term and after the termination or expiry of this Agreement, the Operator shall,

(a) treat as confidential any data, information (whether oral, written, in computer readable format or otherwise) or any other item in any form (including any data, information or other item derived from any data) relating to the Ministry, this Agreement or the Service Agreement which the Operator or the Operator’s Personnel may have acquired or learned in the course of, or incidental to, the performance of this Agreement or otherwise, which was labeled or otherwise identified by or on behalf of the Minister as confidential (the “Confidential Information”);

(b) use Confidential Information only with the prior written consent of the Minister or as required for the performance of this Agreement; and

(c) not directly or indirectly disclose to any Person any Confidential Information without the prior written consent of the Minister except where an order of the Information and Privacy Commissioner or a court under the Municipal Freedom of Information and Protection of Privacy Act,

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R.S.O. 1990, c. M.56 and the regulations thereunder require the Operator to do otherwise.

(2) Exceptions. Confidential Information does not include information that,

(a) is known to the public at the time such information is made available to the Operator other than through a breach of this Agreement,

(b) becomes known to the public after the time such information is made available to the Operator other than through a breach of this Agreement; or

(c) is required to be disclosed by the Operator by Applicable Law, but prior to such disclosure, and to the extent feasible, the Minister shall be consulted as to the proposed form and nature of the disclosure and the Operator shall cooperate with and assist the Minister if the Minister wishes to take reasonable action to challenge the requirement to disclose.

5.25.2 Freedom of Information Legislation. The Minister agrees to treat as confidential all information provided to the Minister by the Operator pursuant to this Agreement except where an order of the Information and Privacy Commissioner or a court under the Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. F.31 and the regulations thereunder require the Minister to do otherwise.

5.35.3 Operator’s Personnel.

(1) Confidentiality. The Operator shall not disclose Confidential Information to any of the Operator’s Personnel not having a need to know such information in connection with the performance of this Agreement. The Operator shall advise the Operator’s Personnel of the requirements of Sections 5.1 (General - Confidentiality) and 5.2 (Freedom of Information Legislation) and shall take appropriate action to ensure compliance by the Operator’s Personnel with the terms of Sections 5.1 and 5.2 as if such sections applied directly to them.

(2) Liability. In addition to any other liabilities the Operator may have under this Agreement, the Operator shall be liable for all damages (including incidental, indirect and consequential damages), costs, expenses, losses, claims or actions arising from any non-compliance by the Operator’s Personnel with Sections 5.1, 5.2 and 5.3(l).

5.45.4 Return of Information. Following termination or expiry of this Agreement and at the request of the Minister, the Operator shall (and shall cause each of the Operator’s Personnel to) deliver forthwith to the Minister all copies of any tangible items (other than this Agreement), if any, which are or which contain Confidential Information. No copy or duplicate of any such items shall be retained by the Operator without the prior written consent of the Minister. The Operator shall not destroy any such items without the prior written consent of the Minister.

ARTICLE 6 CONFLICT OF INTEREST

6.16.1 General. The Operator shall not, and shall cause the Operator’s Personnel not to, engage in any activity where such activity creates a conflict of interest (actually or potentially in the sole and absolute determination of the Minister) in connection with the transactions

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contemplated by this Agreement (including the re-development of Beds). The Operator acknowledges and agrees that it shall be a conflict of interest for it or any of the Operator’s Personnel to use confidential information of Her Majesty the Queen in right of Ontario (including the Confidential Information) relevant to the re-development of Beds where the Minister has not specifically authorized such use.

6.26.2 Disclosure. The Operator shall disclose to the Minister without delay any actual or potential situation that may be reasonably interpreted as being either a conflict of interest or a potential conflict of interest on the part of the Operator or any of the Operator’s Personnel.

6.36.3 Use of Information. During the Term and after the termination or expiry of this Agreement, the Operator shall not, and shall cause the Operator’s Personnel not to, directly or indirectly use for personal or any other type of gain any information obtained in connection with the transactions contemplated by this Agreement.

6.46.4 Operator’s Personnel. The Operator shall make all reasonable efforts to ensure that the Operator’s Personnel do not violate this Article 6. Such efforts shall include, but shall not be limited to, bringing the prohibitions under this Article to the attention of all such Persons.

6.56.5 Breach. A breach of this Article by the Operator or the Operator’s Personnel shall entitle the Minister to terminate this Agreement, in accordance with Section 8.2 (Termination by Minister) in addition to any other remedies that the Minister has in this Agreement, at law or in equity.

ARTICLE 7 LIABILITY AND INDEMNIFICATION

7.17.1 Limitation of Liability. The Minister and the Minister’s officers, employees, volunteers, agents and other representatives and successors and assigns shall not be liable to the Operator or the Operator’s Personnel for any losses, expenses, costs, claims, damages (including incidental, indirect and consequential damages) and liabilities arising in connection with or as a result of:

(a) anything done or omitted to be done by the Operator or the Operator’s Personnel in carrying out the Project or otherwise in the performance of this Agreement or the obligations under the Project Summary;

(b) the selection of the Site, the Construction of the Facility, the contract with the general contractor for the Construction or any of the Project Documents, notwithstanding any consent to or approval of any of the foregoing by the Minister; or

(c) termination of this Agreement pursuant to Section 8.2 (Termination by Minister) or Section 9.8 (Severability).

7.27.2 Indemnification by Operator. The Operator shall indemnify and save harmless the Minister and the Minister’s officers, employees, volunteers, agents and other representatives, successors and assigns (collectively, the “Indemnified Parties”) from any and all losses, damages (including incidental, indirect and consequential damages), liabilities, judgments, claims, demands, causes of action, suits, actions or other proceedings of any kind or nature and

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expenses (including legal fees on a solicitor and solicitor’s own client basis) which the Indemnified Parties, or any of them, may suffer or incur arising in connection with or as a result of anything done or omitted to be done by the Operator or the Operator’s Personnel in carrying out the Project or otherwise in the performance of this Agreement or the obligations under the Project Summary or otherwise in connection with this Agreement, or the Project Summary, including any breach by the Operator of its obligations under, or its representations, warranties and covenants set forth in this Agreement, or the Project Summary.

ARTICLE 8 TERM AND TERMINATION

8.18.1 Term. The term of this Agreement shall commence on the date first written above and, subject to earlier termination pursuant to Section 8.2 (Termination by Minister), continue until the Minister has issued a Letter of Approval to the Operator pursuant to Section 3.3 (Occupancy Approval), the conditions for funding set out in Section 3.6 (Funding) have been satisfied, in the sole and absolute determination of the Minister, and the Minister has received a Statement of Disbursements and Source of Funds and proof of costs from the Operator as required by Section 3.6 (Funding).

8.28.2 Termination by Minister.

(1) Termination. The Minister, without liability, cost or penalty, may, in the Minister’s sole and absolute determination and without prejudice to any other rights or remedies of the Minister under this Agreement or at law or in equity, terminate this Agreement immediately upon giving written notice to the Operator if any of the following events or conditions have occurred or exist:

(a) despite Section 8.2(1)(b), the Operator fails to complete and submit Schedule “E” in accordance with Section 2.4(1)(a),

(b) subject to Section 8.2(2) (Cure Period), the Minister is of the opinion that there has been a material breach by the Operator of any term, warranty, representation, condition, covenant or other provision of this Agreement or, subject to Section 9.2 (Inconsistencies Between Contract Documents) of the Project Summary;

(c) subject to Section 8.5 (Force Majeure) and Section 8.2(l)(d), an actual occurrence or condition is reasonably expected to cause a delay in meeting the deadlines set forth in Schedule “E” for submission of any of the Project Documents by more than sixty (60) days, as contemplated in Section 2.7(3)(c) (Project Documents);

(d) subject to Section 8.5 (Force Majeure), Section 8.2(l)(d) and the limitation expressed in Section 2.7(3)(d) (Total Completion), the deadline for Total Completion set out in Section 2.7(l) (Project Schedule) is not met or is not reasonably expected to be met, as contemplated in Section 2.7(3)(d);

(e) an event of Force Majeure prevents or delays performance by the Operator of a material obligation for more than two hundred and seventy (270) days, as contemplated in Section 8.5 (Force Majeure);

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(f) the Operator is adjudged bankrupt or is insolvent according to the provisions of the Bankruptcy and Insolvency Act, R.S.C. 1985, c. B-3 and the regulations made thereunder, or any bankruptcy, reorganization, arrangement, insolvency, liquidation or winding up proceedings or any other proceedings for the benefit of creditors generally are instituted by or against the Operator (including an assignment, proposal, compromise or arrangement for the benefit of creditors);

(g) a receiver, a receiver and manager, trustee or other official with similar powers is appointed for the Operator or all or a substantial part of the property of the Operator, or the Operator files for the appointment of any such official, prior to Occupancy, provided that at the time the Minister is to notify the Operator of approval of the Facility for Occupancy, pursuant to Section 3.3 (Occupancy Approval), such official (or a replacement thereof) is still in place and has not sold, assigned or transferred the property of the Operator (with the consent of the Minister pursuant to Section 9.11 (Assignment)) to another Person who will assume the obligations of the Operator under this Agreement;

(h) the indebtedness of the Operator under any financing arrangements for the Project has been declared due and payable by the creditor(s) thereunder, where such financing has not been replaced by comparable financing arrangements approved by the Minister, prior to the date or dates on which such indebtedness would otherwise have been due thereunder;

(i) the financing arrangements made by the Operator for the Project are cancelled or no longer available to the Operator, other than in the event contemplated in Section 8.2(l)(g), and have not been replaced by comparable financing arrangements approved by the Minister;

(j) the Operator attempts to execute a bulk sale of its property, except with the prior written consent of the Minister, which consent shall not be unreasonably withheld; or

(k) the Operator ceases, or notifies the Minister of its intention to cease, carrying on business as presently carried on by it or any steps are taken to dissolve the Operator or the Operator is not, or ceases to be, qualified under Applicable Law to operate the Facility.

(2) Cure Period. In the event that the Minister is of the opinion that there has been a material breach by the Operator of any term, warranty, representation, condition, covenant or other provision of this Agreement or, subject to Section 9.2 (Inconsistencies between Contract Documents), the Project Summary and such breach is not remedied within forty-five (45) days (the “Cure Period”) after the Operator receives from the Minister written notice of such breach setting out the particulars thereof, then, in any such event, in addition to the Minister’s other rights and remedies under this Agreement or at law or in equity, the Minister shall have the right to terminate this Agreement immediately upon giving notice of termination to the Operator to that effect at the end of the Cure Period, provided, however, that if such breach is of such a nature that it cannot be completely cured or remedied within the Cure Period, or the Operator is not proceeding in a manner satisfactory to the Minister, the Minister shall have the right to

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terminate this Agreement immediately upon giving notice of termination to the Operator prior to the end of the Cure Period.

8.38.3 Effective Date of Termination. In the event of early termination of this Agreement, the effective date of the termination shall be the last day of the notice period, if any, and if there is no notice period, immediately upon the Minister giving notice of termination to the Operator.

8.48.4 Consequences of Termination. In the event of early termination of this Agreement:

(1) Rejection of the Project Summary. The Operator shall have no further entitlement to re-develop the Beds and there shall be no obligation on the Minister to provide to the Operator any funding in accordance with the Policy.

(2) Liabilities Upon Termination. All rights and obligations of the Operator and the Minister under this Agreement shall cease upon any termination of this Agreement (including any obligation on the Minister to provide to the Operator any funding in accordance with the Policy), subject to Section 9.6 (Survival of Certain Terms).

8.58.5 Force Majeure. If, as a result of an event of Force Majeure (as defined below), the Operator fails to perform or comply with any of its obligations under this Agreement, such failure shall not constitute a default or breach of this Agreement. Dates and times by which the Operator is required to render performance under this Agreement shall be postponed automatically to the extent and for the period of time that the Operator is prevented from meeting them by causes beyond its control which are not avoidable by the exercise of reasonable foresight. Such causes (each such cause, an event of “Force Majeure”) shall include but not be limited to acts of God, acts of war, riots, epidemics, fire, strikes, labour disruptions or lock outs and delays or difficulties (other than such as are caused by the actions or omissions of the Operator) in obtaining zoning which permits the Site to be used for a Long-Term Care Facility of the type that the Facility is proposed to be. The Operator must, however, notify the Minister immediately, in writing and in detail of the commencement and nature of such event of Force Majeure and the probable consequences thereof. The Operator must use its reasonable efforts to perform its obligations under this Agreement and to overcome or minimize the effects of such event of Force Majeure (including rearranging and rescheduling the work on the Project so as to minimize the ultimate delay in completion of the Project) in a timely manner utilizing to such end all resources reasonably required in the circumstances, including obtaining supplies or services from other sources if the same are reasonably available. Notwithstanding the foregoing, if performance of a material obligation is prevented or delayed for more than two hundred and seventy (270) days by reason of an event of Force Majeure, the Minister may on notice treat the delay as a material breach of a term of this Agreement and may terminate this Agreement in accordance with Section 8.2 (Termination by Minister).

ARTICLE 9 GENERAL PROVISIONS

9.19.1 Entire Agreement. This Agreement and the Schedules listed below, together with the Project Summary, constitute the entire agreement between the parties hereto pertaining to the subject matter of this Agreement and supersede all prior agreements and understandings, collateral, oral, or otherwise. There are no conditions, warranties, representations or other agreements between the parties in connection with the subject matter of this Agreement (whether oral or written, expressed or implied, statutory or otherwise), except as specifically set

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forth or incorporated by reference in this Agreement or in the Project Summary. No modification of this Agreement shall be binding upon the parties to this Agreement unless in writing and executed by the designated representatives of the Operator and the Minister, as specified in Section 9.14 (Designated Representatives).

The Schedules to this Agreement are:

Schedule “A” - Final Estimate of Costs (FEC) Form Schedule “B” - Policy for Funding Construction Costs of Long-Term Care Facilities Schedule “C” - Liens Schedule “D” - Statement of Disbursements and Sources of Funds Schedule “E” - Project Schedule Schedule “F” - Approved but Unopened Beds 9.29.2 Inconsistencies Between Contract Documents.

(1) In the event that there are any inconsistencies, conflicts or ambiguities between the terms of this Agreement (other than the Project Summary), the Project Summary or any other document incorporated by reference herein, the terms of this Agreement shall prevail.

(2) In the event that there are any inconsistencies, conflicts or ambiguities between the terms of any Schedule to this Agreement and the terms of this Agreement (other than the Schedules), the terms of this Agreement (other than the Schedules) shall prevail over the terms of such Schedule.

(3) In the event that there are any inconsistencies, conflicts or ambiguities between the terms of the Project Summary or any other document incorporated by reference herein, and this Agreement is silent on the subject matter thereof, the terms of the Project Summary shall prevail.

9.39.3 Currency. All payments to be made by the Minister or the Operator under this Agreement shall be made in the lawful currency of Canada.

9.49.4 Further Assurances. The Operator agrees to promptly perform, make, execute, deliver, or cause to be performed, made, executed, or delivered, all such further acts and documents as the Minister may reasonably require for the purpose of giving effect to this Agreement.

9.59.5 Independent Contractor. The Operator and the Minister are independent contractors and neither of them shall be deemed to be the employee, agent, partner of, or in a joint venture with, the other. The Operator’s Personnel shall not be deemed to be the employees, agents, partners of, or in a joint venture with, the Minister.

9.69.6 Survival of Certain Terms. The representations, covenants, warranties, indemnities and limitations of liability set out in Section 4.1 (Representations and Warranties) (except Section 4.1(6) (Environmental Matters)) and Section 4.3 (Insurance) of this Agreement shall survive the termination or expiry of this Agreement, and shall bind the parties and their successors and assigns, for a period of six years. The representations, covenants, warranties, indemnities and limitations of liability set out in Section 4.1(6) (Environmental Matters), Article 5 (Confidentiality), Article 7 (Liability and Indemnification), Section 8.4 (Consequences of Termination) and Section 9.6 (Survival) of this Agreement shall survive the termination or expiry of this Agreement, and shall bind the parties and their successors and assigns, indefinitely. The

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representations, covenants, warranties, indemnities and limitations of liability set out in Section 3.4 (Operation of Beds), and the second and third sentences of Section 3.5 (Service Agreement) of this Agreement shall survive the expiry of this Agreement, and shall bind the parties and their successors and assigns, indefinitely.

9.79.7 Enurement. This Agreement shall enure to the benefit of and be binding upon the respective successors and permitted assigns of each of the parties.

9.89.8 Severability. If any provision of this Agreement is invalid, illegal or unenforceable, such provision shall be severed from the balance of this Agreement and the remaining provisions of this Agreement shall continue in full force provided that such remaining provisions express the intent of the parties. If the intent of either party cannot be preserved, this Agreement shall be either renegotiated or terminated by either party, without liability, cost or penalty to the other party, upon thirty (30) days prior written notice to the other party.

9.99.9 Waiver. No waiver of any breach of this Agreement shall operate as a waiver of any subsequent breach or of the breach of any other provision of this Agreement. No provision of this Agreement shall be deemed to be waived, and no breach excused, unless such waiver or the consent excusing the breach is in writing and signed by the party that is purported to have given such a waiver or consent. No delay or omission on the part of any party to this Agreement to avail itself of any right it may have under this Agreement shall operate as a waiver of any such right. No waiver or failure to enforce any of the provisions of this Agreement shall in any way affect the validity of this Agreement or any part hereof.

9.109.10 Rights and Remedies Cumulative. The rights and remedies of the parties to this Agreement are cumulative and are in addition to and not in substitution for any rights and remedies provided at law or in equity.

9.119.11 Assignment. The Operator shall not assign, transfer, or pledge, directly or indirectly, any of its rights or obligations under this Agreement without the prior written consent of the Minister. Such consent of the Minister may be withheld by the Minister, in the Minister’s sole and absolute determination. Such consent shall be conditional upon the assignee, transferee or pledgee, as the case may be, executing an agreement, in form and substance satisfactory to the Minister, whereby such assignee, transferee or pledgee, as the case may be, assumes all obligations and liabilities of the Operator hereunder and under the Service Agreement or the service agreement in effect at the time of such assignment, transfer or pledge, as the case may be. Such consent may also be granted subject to such other terms and conditions as the Minister may require. For greater certainty, the Operator may retain contractors and subcontractors for any and all aspects of the Construction but the Operator shall at all times be held fully responsible for the acts and omissions of all of such contractors and subcontractors and their respective shareholders, directors, officers, employees, agents or other representatives, successors and assigns.

9.129.12 Time of the Essence. Time shall be of the essence of this Agreement in all respects.

9.139.13 Publicity. The Operatorshall notify the Minister in advance of any proposed publicity or publications by or on behalf of the Operator relating to this Agreement or the re-development of the Beds (including press releases and press conferences but excluding brochures, pamphlets, books or other marketing materials intended to promote or advertise the Beds and the Facility) ,

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where feasible, and shall use reasonable efforts to make such changes thereto reasonably requested by the Minister.

9.149.14 Designated Representatives. For purposes of this Agreement, the designated representatives are as follows:

(a) the designated representative of the Minister is:

Ms. Gail Paech Assistant Deputy Minister Long-Term Care Redevelopment Project 415 Yonge Street, 10th Floor Toronto, Ontario M5B 2E7 Phone: (416) 326-6485 Fax: (416) 326-5533 E-mail: [email protected]

(b) the designated representative of the Operator, who shall be an authorized signing officer of the Operator, is:

[OPERATOR'S REP TITLE; FIRST NAME; LAST NAME] [OPERATOR'S REP POSITION] [Legal Name of the Operator] [Street Address] [City, Province Postal Code] Phone: [Phone Number] Fax: [Fax Number]

[e-mail address]

Any party may designate different representatives, addresses, telephone or facsimile numbers, or electronic addresses, by notifying the other party in accordance with Section 9.15 (Notice).

9.159.15 Notice.

(1) Form. Any notice, request, demand, consent, approval or authorization (each, a “Notice”) required, permitted or contemplated under this Agreement shall be in writing, whether or not such Notice is expressly stated herein to be provided or made in writing, (unless a provision of this Agreement expressly provides otherwise); under the signature of the respective designated representative as specified in Section 9.14 (Designated Representatives); and delivered by courier, personal delivery or sent by facsimile or e-mail or ordinary mail addressed to the designated representative of the party to whom it is intended as specified in Section 9.14 (Designated Representatives).

(2) Deemed Receipt. A Notice sent by e-mail or facsimile or delivered by courier on a Business Day is deemed to be received by the addressee on the day that it is sent. If the

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Notice is so sent or delivered after the end of the Business Day, then it is deemed to be received by the addressee on the following Business Day. If the Notice is so sent or delivered on a day other than a Business Day, then it is deemed to be received by the addressee on the following Business Day. A Notice sent by ordinary mail is deemed to be received by the addressee to which it is delivered on the fifth (5th) Business Day following the date when it is so mailed; provided however that no such Notice will be mailed during any actual or apprehended disruption of postal services.

9.169.16 Approvals. With respect to any matter which is subject to the approval or consent of the Minister pursuant to this Agreement, unless a time period for providing such approval or consent is expressly provided hereunder, the Minister shall use reasonable efforts to notify the Operator as to whether or not the Minister approves or consents of or to such matter in a prompt and timely manner.

9.179.17 Governing Law. This Agreement shall be governed by, subject to, and interpreted in accordance with the laws of the Province of Ontario and the laws of Canada applicable therein, and the parties agree to submit to the jurisdiction of the courts of the Province of Ontario.

9.189.18 Joint and Several Liability. In the event that the Operator is comprised of more than one party, each of such parties shall execute and deliver this Agreement and shall be jointly and severally liable in all respects under and in connection with this Agreement.

IN WITNESS WHEREOF the parties hereto have executed this Agreement as of the date first written above.

HER MAJESTY THE QUEEN in right of Ontario, as represented by the Minister of Health and Long-Term Care

Per:

Date Gail Paech Assistant Deputy Minister

Witness

Print Witness name [LEGAL NAME OF OPERATOR] Per: (c/s)

Date Operator's Rep's Name Position

D-bed Dev.Agr. 2001

SCHEDULE “A”

FINAL ESTIMATE OF COSTS (FEC) FORM

See attached.


SCHEDULE “B”

POLICY FOR FUNDING CONSTRUCTION COSTS OF LONG -TERM CARE FACILITIES

See attached.


SCHEDULE “C”

LIENS


SCHEDULE “D”

STATEMENT OF DISBURSEMENTS AND SOURCES OF FUNDS

See attached.


SCHEDULE “E”

PROJECT SCHEDULE

Activity/Objective Completion Date MM/DD/YY

Acquisition of Site

Zoning (if applicable)

Severance (if applicable)

Submission of agreements, documents and instruments relating to Awardee’s ownership or leasehold interest in the Site (see Section 2.2 (Site) of the Agreement)

First Submission of Plans (i.e. submission of (a) preliminary sketch plans* and/or working drawings* and specifications, and (b) project summary*)

Submission of Operational Plan*

Second Submission of Plans (i.e. submission of revised sketch plans, revised working drawings and specifications, detailed working drawings and specifications based on approved sketch plans and/or revised project summary)

Public Tender for Construction: xxxxxxxxxxxxxxxxx

Invitation to Tender

Deadline for Bids

Submission of Top Bids to Minister for Approval

Construction Start Date

Construction Schedule The dates in the Construction Schedule to be agreed upon between the Awardee and the general contractor are hereby incorporated by reference.

Notify Minister 30 Business Days prior to expected Total Completion

Total Completion Date**

* As defined in the Design Manual. ** See Article 1 of the Agreement for definitions.


SCHEDULE “F”

APPROVED BUT UNOPENED BEDS Approved but Unopened Beds includes: Awards Beds (AW beds) meaning beds that were awarded in 19…. by the Ministry to a nursing home operator Multi-cultural bed awards (AWMC beds) meaning beds awarded through an RFP in 1986 to organizations that were willing to build a nursing home to meet the needs of a specific identified multi-cultural population. Compliance Plan Review Board (CPRB beds) meaning beds awarded in 198… to a facilities with fewer than 60 beds to create facilities of at least 60 beds. These awards were made on the conditions that the beds would only be awarded upon the completion of the construction, the beds would not be transferable, the ministry had no future obligation to license any other beds. Beds in Abeyance (BIA beds) meaning previously licenced Nursing Home beds that are not currently in operation Homes for the Aged (HFA beds) meaning previously approved Homes for the Aged and Rest Homes beds that are not currently in operation.

Ministry of Health and Long-Term Care, Long-Term Care Redevelopment Project 2002 “D” Bed Development Plan Submission Process 9.6 -1

Appendix 9.6 Summary of “D” Retrofit Design Standards

GENERAL GUIDELINES 1. In retrofitting a long-term care facility, regard must be had for the Design

Objectives, Functional Considerations / Recommendations, and Architectural Considerations and Recommendations expressed in the Long-Term Care “D” Facility Retrofit Design Manual. There are also design requirements found in the Long-Term Care Facility Program Manual, the Ontario Building Code, the Ontario Fire Code, and other related documents.

2. All ”D” Retrofit Design Standards for which there are Allowable Performance Ranges

require meeting the Minimum Retrofit Standards. 3. All ”D” Retrofit Design Standards for which there are Comparable Design require

satisfying the Ministry that the relevant Design Objectives and Design Considerations have been met.

4. Retrofit Design Standards with Allowable Performance Ranges and Comparable

Design will be reviewed for the purposes of determining the amount of Construction Funding. Operators will have additional flexibility in the types of bedrooms which may be offered as preferred accommodation. Option A is the definition as it is written in the Long-Term Care Facility Design Manual, while Option B offers a higher level of flexibility. Increased construction funding will be provided under the Policy for Funding Construction Costs of Retrofitted Long-Term Care Facilities for Option A. Either of these definitions can be applied to any bedroom being offered as preferred accommodation.

PREFERRED ACCOMMODATION OPTIONS OPTION A: Long-Term Care Facility Design Manual: A private bedroom must accommodate one resident and must have a separate “barrier-free” ensuite washroom. A semi-private bedroom must accommodate one resident in one bedroom, another resident in a separate bedroom, with both bedrooms joined by a “barrier-free” ensuite washroom, (i.e. two bedrooms, with one resident in each bedroom, share one ensuite washroom). A basic (standard) bedroom must accommodate two residents and must have a separate “barrier-free” ensuite washroom.

Ministry of Health and Long-Term Care, Long-Term Care Redevelopment Project 2002 “D” Bed Development Plan Submission Process 9.6 -2

OPTION B: Long-Term Care “D” Facility Retrofit Design Manual: A private bedroom is defined as a bedroom with one bed that includes either an ensuite “barrier-free” washroom or a “barrier-free” washroom which joins two bedrooms, each with one bed. A semi-private bedroom is defined as a bedroom with two beds that includes a “barrier free” ensuite washroom. A basic (standard) bedroom is defined as any bedroom which is designated as such.


SUMMARY OF MANDATORY ”D” Retrofit Design Standards

PART A: Mandatory 1998 Design Standards which apply to Retrofit Projects

Standard Reference

No. Design Standard

1. Resident Home/Living Area 1.1.3 Each Resident Home Area must be a clearly defined distinct unit.

2. 1.1.6 In each Resident Home Area, the bath and shower rooms, dining area(s), lounge area(s) and program/activity space must be located in close proximity to the resident bedrooms.

3. 1.1.7 Resident bedrooms in each Resident Home Area may be all basic (standard) rooms, semi-private rooms and private rooms, or a mix of each type of room.

4. Bedrooms 1.1.4 All resident bedrooms must contain either one or two beds. 5.

2.1.6 In each bedroom, there must be sufficient space to provide access by caregivers to three sides of the bed, that is, to both sides of the bed and the foot of the bed (cross-reference 2.1.19 – Functional Consideration/Recommendations for Resident Bedrooms)

6. 2.1.7 Specialized program equipment must be able to get around two sides of the bed and the foot of the bed.

7. 2.1.4 Each bedroom door must be a minimum width of forty-four (44) inches (1120 mm). 8. 2.1.5 If a lock is installed on a bedroom door, the lock must be readily releasable and easily openable for

residents and staff. 9. 2.1.8 Each bedroom must be designed to allow a 180 degrees change of direction of any care equipment

within the room. 10.

2.1.9

There must be a device for each resident in each bedroom that will activate the Resident/Staff Communication and Response System of the long-term care facility. The device to activate the Resident/Staff Communication and Response System must be located within easy reach of the resident, including when the resident is lying or sitting up in bed.

11. 2.1.13

Each bedroom must have “cueing” features (for example, room number, resident(s) name(s), and/or pictures) outside the bedroom door to assist residents in finding their way and easily identifying their bedrooms.

12. 2.1.14 Each two bed bedroom must provide privacy for each resident of the room. 13. 2.1.16 Wiring for phone jack and wiring for television service must be provided for each resident in each

bedroom.



Standard Reference

No. Design Standard

14. 2.1.15 All bedroom flooring must be non-slip 15. Windows-Bedrooms

2.1.10 Each bedroom must have at least one window that provides a direct view to the outdoors or to other naturally lit space from both a sitting and lying in bed position (cross reference 2.1.22 – Functional Considerations / Recommendations for Resident Bedrooms)

16. 2.1.11 Windows that open to the outdoors must have screens in the spring, summer and fall seasons. 17. Washrooms

1.1.5 Every bedroom must have an ensuite “barrier-free” washroom that contains, at a minimum, a sink and a toilet. The entrance to the washroom must be from within the bedroom itself (which includes the vestibule).

18. 2.2.3

Each washroom must have sufficient space to enable independent and/or assisted transfer from the front and at least one side of the toilet (cross reference 2.2.25 – Functional Considerations / Recommendations for Resident Washrooms)

19. 2.2.4 In order to allow for sufficient space for a wheelchair or a walker, and for staff to assist a resident, there must be a five (5) foot turning circle in each resident washroom.

20. 2.2.7 Each resident washroom has an entrance width of at least thirty-six (36) inches (914 mm). 21. 2.1.12 There must be no direct view of toilet in ensuite washroom from the outside corridor when washroom

door is open. 22. 2.2.2 Each resident washroom must have at least one toilet and one handwash sink. 23. 2.2.10 If a lock is to be installed on a washroom door, the lock must be readily releasable and easily openable. 24.

2.2.5 A securely fastened grab bar must be located beside the toilet within easy reach of the resident. Each grab bar must be of sufficient size and design to support the full weight of a resident and must be place on a reinforced wall capable of sustaining the weight load.

25. 2.2.6 There must be a device within easy reach of the resident that will activate the Resident/Staff Communication and Response System.

26. 2.2.9 There must be space in each washroom for individual storage of each resident’s personal items. When two residents share a washroom, separate storage space must be available for each resident.

27. 2.2.8 Each washroom must have counter space. 28. 2.2.11 The sink in each washroom must be positioned so that it meets the needs of the resident or residents

using the washroom, (for example, those residents in wheelchairs). 29. 2.2.12 Taps must be easy to use by residents with visual impairments and by residents with physical

disabilities that affect hand movement. 30. 2.2.13 All washroom surfaces must be easily cleaned. In addition, all floor coverings must be slip-resistant. 31. 2.2.14 Walls where grab bars are mounted must be appropriately reinforced to ensure that they are capable of



Standard Reference

No. Design Standard

sustaining loads imposed on them. 32. Bath/Shower

Rooms

2.3.1

Each Resident Home Area must have as a minimum:

• one separate room with a raised bathtub equipped with a hydraulic, electric or mechanical lift; (Note: A side entrance bathtub may be provided as an alternative to a raised bathtub with a hydraulic lift);

• one separate room with a shower ( the showering area must have sufficient space to

accommodate a shower chair so that a resident can be showered in the sitting position); and

• A “barrier-free” washroom (including a toilet and a sink) located either in each bath room and shower room, or in a separate and enclosed common area which is between the bath and the shower rooms.

33.

2.3.2

Where the Resident Bath Rooms and Shower Rooms are connected, the layout of each Resident Bath Room and Shower Room must allow for visual and acoustical privacy between the shower, the toilet and the bathtub area. If Resident Bath Rooms and Shower Rooms are two completely separate rooms, there must be visual and acoustic privacy between the toilet and bathtub or shower.

34.

2.3.3 There must be no direct view of the bathtub, shower, or toilet from the corridor outside of each Resident Bath Room and Shower Room.

35. 2.3.4 There must be a device located at each bathtub, shower and toilet in each resident Bath Room and Shower Room which will activate the Residents Resident/Staff Communication and Response System.

36. 2.3.5 The toilet in or adjoining each Resident Bath Room and each Shower Room must be positioned so that independent and/or assisted transfer from at least the front and side of the toilet can occur.

37. 2.3.6 There must be a securely fastened grab bar for use by residents at each toilet and on at least one wall in each shower stall.

38. 2.3.7 The bathtub in each Resident Bath Room must be located so that there is access to three (3) sides of the bathtub.

39. 2.3.8 All Resident Bath Rooms and Shower Rooms must be equipped with device(s)/system to maintain the room temperature at a comfortable level for residents while bathing.

40. 2.3.9 All surfaces in the Resident Bath Rooms and Shower Rooms must be easily cleanable. 41. 2.3.10 To ensure resident and staff safety, all floor surfaces in the Resident bath Rooms and Show Rooms

must be slip-resistant. 42. Staff Work Area 3.1.4 Each Resident Home Area must have Work Space for Nursing and Program/Therapy Staff to allow staff



Standard Reference

No. Design Standard

to carry out their administrative duties. The space must accommodate: secure storage of resident care records (includes nursing care plans and medical histories); and a work area to complete documentation.

43. 3.1.5 The Work Space for Nursing and Program/Therapy staff must be easily recognized by residents, other staff, visitors and others as, for example, an “information center” or staff contact” area.

44. 3.1.3

In areas where therapeutic programs are delivered, there must be convenient access for residents to a “barrier-free” two (2) piece washroom (toilet and sink) that is separate from resident bedroom washrooms.

45. Storage Space for Supplies and Equipment

3.2.1 The Storage Space for resident care supplies and equipment must be convenient and accessible to the staff working in each Resident Home Area.

46. 3.2.2 Resident medications must be stored in a secured space either within one Resident Home Area or shared between Resident Home Areas.

47. 3.2.3

Secure space with lockable cupboards must be provided for the storage of all supplies and equipment related to care delivery, as well as for stock medications related to the pharmacy services. This space must be convenient and accessible to the staff working in each Resident Home Area.

48.

3.2.4

If oxygen therapy is offered as part of the facility’s program delivery, dedicated space for storage of oxygen must be provided in a location that is convenient and accessible to staff working in the Resident Home Area(s). The storage of oxygen must comply with the fire safety requirements set out in the Ontario Fire Code and related provincial regulations.

49.

Resident Lounge and Activity Space 4.1.3 There must be at least one Resident Lounge provided in each Resident Home Area that has a minimum

of 120 sq. ft. of total floor area. 50. 4.1.4 There must be at least one Resident Program/Activity area provided in each Resident Home Area that

has a minimum of 120 sq. ft. of total floor area. 51.

4.1.5

Each Resident Lounge must have a device which will activate the Resident/Staff Communication and Response System and each Resident Program/Activity area must have a device which will activate the Resident/Staff Communication and Response System. Where the lounge and the program activity space are integrated, it is required to have only one device which will activate the Resident/Staff Communication and Response System located in that area.

52. 4.1.6 At least one Resident Lounge in each Resident Home Area must have a window with a direct view to the outside or to a naturally lit area.

53. 4.1.7 Resident Program/Activity Areas must have convenient access to a “barrier-free” washroom (toilet and sink) that is separate from and not located in a resident bathroom.



Standard Reference

No. Design Standard

54. Resident Dining Space 5.1.6 Each Resident Home Area must have dedicated space for dining, separate from any other type of

space. 55.

5.1.2

At least 80% of the total required space for Dining Area must be located within the Resident Home Areas and allocated based on the number of residents in each Resident Home Area. For example, for a Resident Home Area with 20 residents, the total required Dining Area is 600 square feet; 80% of the 600 square feet, or 480 square feet, must be located in that Resident Home Area.

56. 5.1.3 Up to 20% may be located outside the resident home/living area to support alternative dining programs. 57. 5.1.7 Each Dining Area must have a device that will activate the Resident/Staff Communication and

Response System. 58.

5.1.8 Each Dining Area must have convenient access to a separate “barrier-free” two-piece washroom (toilet and sink) that is not located in a resident bedroom that does not open directly into food preparation or dining areas.

59. 5.1.9 Each Dining Area must have a hand wash sink either in the Dining Area or immediately adjacent to the Dining Area for use by staff involved in the preparation, delivery, and service of food to the residents.

60. 5.1.10 Each Dining Area must provide a direct view of the outdoors or other naturally lit space. 61. 5.1.11 Each Dining Area must provide a servery area for assembling and serving meals. If the Dining Area is

located immediately next to the kitchen, the kitchen can be used for the servery function. 62. 5.1.5 A separate housekeeping/janitors closet (with a sink) to store the supplies and equipment used to clean

each Dining Area must be provided near each Dining Area. 63. 5.1.4 Each Dining Area must incorporate storage space for equipment/supplies as necessary. 64. Dietary Service

Space 5.2.7 The design of the Dietary Service Space must provide for a layout that: allows for an efficient work flow; prevents cross-contamination between clean and soiled areas; and, supports production and delivery of food in a safe manner.

65. 5.2.8 The design of the Dietary Service Space must allow for the preparation of a range of food products prepared in a variety of methods.

66.

5.2.9

There must be storage space for non-refrigerated (dry) goods and supplies that meets usual and peak capacity volume storage requirements. This storage space must be well ventilated, have a temperature control system that can keep the temperature between 10 and 20 degrees Celsius, and be designed to prevent goods from being exposed to pipes, motors, condensers and direct sunlight.

67. 5.2.10 There must be storage space for refrigerated and frozen food supplies. This storage space must meet usual and peak capacity volume storage requirements.

68. 5.2.11 The Dietary Service Space must provide secure storage space for chemicals, cleaning supplies and equipment used to clean the Dietary Service Space (for example, kitchen mops and pails) and



Standard Reference

No. Design Standard

equipment used to delivery meals and snacks to residents, (for example, food carts). 69. 5.2.12 The Dietary Service Space must include a separate housekeeping/janitor’s closet that is equipped with

a “curbed sink”. 70. 5.2.3 The design of the Dietary Service Space must support the delivery of a bulk food service system to the

Dining Areas so that meals can be served by individual course. 71. 5.2.13 The Dietary Service Space must include convenient access to electrical services and to hot and cold

water supply services. 72. 5.2.14 The Dietary Service Space must include hand washing area(s). 73.

5.2.15 The Dietary Service Space must provide, depending upon the food service program, space for scraping, soaking, pre-rinsing, washing, rinsing, sanitizing, air drying and sorting of dishes, pots/pans, utensils, large equipment and carts.

74. 5.2.16 The Dietary Service Space must provide separate and sufficient space for garbage cans/recycling bins. 75. 5.2.17 The Dietary Service Space must be designed in a manner that minimizes excessive noise, steam, and

heat. 76. 5.2.18 The Dietary Service Space must include adequate floor drainage. 77.

5.2.6 The design of the Dietary Service Space must include serving areas adjacent to the Dining Area(s) so that residents have the opportunity to see and smell food, snacks can be prepared, and residents can make food choices at the point of meal service.

78. 5.2.5 The Dietary Service Space must include a work area for dietary staff that accommodates appropriate furnishings and equipment.

79.

5.2.4

Dietary Service Space must be provided to accommodate the equipment required to support the facility meal service program. The equipment to be provided must be appropriate in size and design to prepare and serve a variety of food products and beverages that meet the nutritional care needs of residents, retain the texture, colour and palatability of foods items and allow the facility to meet the cultural requirements, therapeutic needs and food preferences of all of the residents of the long-term care facility.

80. Outdoor Space 6.1.4 For all long-term care facilities, there must be some Outdoor Space accessible at grade level. It is up to the operator, in conjunction with the architect, to determine the size and location of this Outdoor Space.

81. 6.1.5

At least one Outdoor Area must be enclosed to prevent wandering/egress of residents. For multi-storey buildings, the requirements of the Ontario Building Code will define the design and safety features of Outdoor Space on the floors above ground level.

82. 6.1.6 The landscaping and design of Outdoor Space must consider the safety needs of residents. 83. 6.1.7 Each Outdoor Area must have a separate area that provides shade and is protected from wind and



Standard Reference

No. Design Standard

other harsh weather elements. 84. 6.1.3 In a multi-storey facility, Outdoor space on floors above ground level can be a balcony or a roof terrace. 85. Beauty

Parlour/Barber Shop 6.2.1 The Long Term Care Facility must have a Beauty Parlour/Barber Shop that is available to all residents.

86. 6.2.2 The Beauty Parlour/Barber Shop must have a device that will activate the Resident/Staff Communications and Response System.

87. 6.2.3 There must be sufficient space to include hairdressing chairs, work and storage counters, secured storage space for chemicals and a hair drying area.

88. Place of Worship

6.3.1

Each facility must provide space dedicated for the purposes of worship. It is up to the operator, in consultation with the architect, to determine the size, location and design of this space. The sponsoring agency/architect has the option of using up to the remainder of the Lounge and Program/Activity Space, specified under 4.1.2 (cross-reference Design Standards with Allowable Performance Ranges 4.1.2), to support the provision of space for a Place of Worship.

89. Enhanced Resident Space 6.4.2 A device must be provided in this area which will activate the Resident/Staff Communication and

Response System for the long-term care facility. 90.

6.4.1

One additional area must be located outside the Resident Home Area(s) only if all of the required Lounge Space and Program/ Activity Space is located in the Resident Home Area(s). It is up to the operator in consultation with the architect, to determine the size, location and design of Enhanced Resident Space.

91. Laundry Space 7.1.6 The Laundry Space must be equipped hand wash facilities which is conveniently located for staff use. 92.

7.1.3

The Laundry Space must be able accommodate industrial washers and dryers of appropriate size and capacity to meet the laundry service needs of the long-term care facility. If laundry services are shared with other programs (for example, an adjoining rest/retirement home), the size of the laundry must be able to accommodate maximum service volumes.

93. 7.1.4 The Laundry Space must be designed so that there is separation of and a one way work flow between clean and soiled areas.

94. 7.1.7 The Laundry Space must include space for the collection, storage and sorting of soiled laundry until it can be processed.

95. 7.1.8 The Laundry Space must have space for all aspects of the laundering process including storing, folding, hanging of clean linen/personal clothing and labelling of personal clothing.

96. 7.1.9 If an off-site laundry service is used, there must be separate space in the long-term care facility for soiled linen storage, and for receiving and delivering linen.

97. 7.1.10 The Laundry Space must have access to a separate area for the cleaning and sanitizing of laundry



Standard Reference

No. Design Standard

equipment such as baskets, carts and bags. 98. 7.1.11 There must be floor drainage in the Laundry Space. 99. 7.1.12 All surfaces in the Laundry Space must be easily cleanable and impermeable to moisture.

100. 7.1.13 Floors in the Laundry Space must be non-slip to ensure staff safety. 101. 7.1.5 There must be administrative space for supervisory staff to complete administrative functions (may be

combined with other administrative space in the long-term care facility). 102. Housekeeping

Service Support Space

7.2.4 Each housekeeping/janitor’s closet must have sufficient space and provide for the secure storage of chemicals and other cleaning supplies and have sufficient space for chemical dispensing units, storing carts and other housekeeping equipment, such as mops and pails.

103. 7.2.5 All surfaces (including floors, walls, ceilings and shelves) in each housekeeping/janitor’s closet must be smooth, easily cleanable and impermeable to moisture.

104. 7.2.3 There must be administrative space for supervisory staff to complete administrative functions (may be combined with other administrative space in the long-term care facility).

105. Utility Space 7.3.1 Clean and soiled Utility Space must be conveniently located in each Resident Home Area to support the requirements for storage, cleaning and sanitizing of nursing care/therapy equipment.

106. 7.3.2

Clean and soiled Utility Space must be large enough to contain all fixtures that are used for cleaning, sanitizing and storing nursing care equipment. Fixtures include, for example, a hopper sink, a bedpan flusher and/or sterilizer, rinse sinks, storage racks, counters and cupboards.

107. 7.3.3 All clean Utility Space must have a secured space for the storage of cleaning supplies and equipment, as well as counter space.

108. 7.3.4 All soiled Utility Space must have sufficient space for the storage of the equipment used for collecting soiled supplies (for example soiled linen and towels), and for garbage cans/recycling bins.

109. 7.3.5 All clean and soiled Utility Space must have at least one conveniently located hand wash sink for staff use.

110. 7.3.6 All soiled Utility Space must have floor drains. 111. 7.3.7 The surfaces in clean and soiled Utility Space must be smooth, easy to clean and impermeable to

moisture. 112. 7.3.8 All floors in clean and soiled Utility Space must be non-slip to ensure staff safety. 113. Maintenance


7.4.3 There must be dedicated Maintenance Service Support Space provided in the long-term care facility, separate from resident personal space and dining space, to conduct repairs on equipment, furnishings and other building contents.

114. 7.4.4 There must be a secured area, inaccessible to residents, for locating environmental controls and other



Standard Reference

No. Design Standard

building system controls. 115. 7.4.5 An emergency-generator power supply must be available to support essential building systems. 116. Resident/Staff

Communication and Response System

8.1.1 The Resident/Staff Communication and Response System must be an electronically-designed system which is equipped with activation devices that are easily accessible, simple and easy to use by all residents and staff.

117. 8.1.2 The Resident/Staff Communication and Response System must be “ON” at all times and be connected to the back-up generator.

118. 8.1.3 When any activation device for the Resident/Staff Communication and Response System is activated, it must clearly indicate where the signal is coming from so that staff can promptly respond.

119. Door Access Control System 8.2.1 The Door Access Control System must conform to all relevant provincial and municipal codes and

regulations, including but not limited to the Ontario Building Code and the Ontario Fire Code. 120. 8.2.2 The Door Access Control System must be “ON” at all times. 121. 8.2.3 The Door Access Control System for all exits from resident areas must prevent unauthorized entering or

exiting from the long-term care facility. 122.

8.2.4 Electro-magnetic locking devices (or alternative means of achieving the same result) must be on all doors leading to stairways, secured areas and to the outdoors, subject to compliance with the Ontario Fire Code and the Ontario Building Code.

123. 8.2.5

Electro-magnetic “hold-open” devices must be on doors that are required under the Ontario Fire Code to be equipped with self-closing hardware. (Consultation with the local fire department may be required).

124. Fire Alarm System 8.3.1 The Fire Alarm System must conform to all relevant provincial and municipal codes and regulations, including but not limited to the Ontario Building Code and the Ontario Fire Code.

125. Sprinkler System

8.4.1

A Sprinkler System must be provided and conform to all relevant provincial and municipal codes and regulations, including but not limited to the Ontario Building Code and the Ontario Fire Code (attention should be given to Parts 3 and 11 of the 1997 Ontario Building Code, Parts may vary with updated versions of the Ontario Building Code).

126. Water Temperature Control System 8.5.1

The Water Temperature Control System must be designed to ensure hot water provided to resident care areas is at a safe and comfortable temperature for residents. (cross-reference the “Long-Term Care Facility Program Manual”, Environmental Services, Section “0": Criteria O1.16)

127. Lighting Systems 9.1.1 There must be a minimum of 215.28 lux of continuous lighting levels in all corridors. 128. 9.1.2 There must be continuous lighting levels of at least 322.92 lux in enclosed stairways. 129. 9.1.3 There must be general lighting levels of at least 215.28 lux in all other areas of the facility including

resident bedrooms and washrooms.



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No. Design Standard

130. 9.1.4 General illumination must be provided at all entrance doors to resident accessible rooms, e.g., bedroom entrance doors.

131. 9.1.5 Task lighting which is adjustable in intensity, location and direction must be provided in bedrooms and common areas.

132. 9.1.6 The back-up emergency generator must support essential lighting requirements. 133. Heating Ventilation

and Air-Conditioning (HVAC) System 9.2.1

The HVAC System must comply with all relevant regulations and standards set by governing authorities, including but not limited to the Ontario Building Code, Canadian Standards Association, National Fire Protection Association and the American Society of Heating and Refrigeration and Air-Conditioning Engineers (ASHRAE).

134.

9.2.2

A mechanical system to cool air temperatures must be provided in all Lounge Areas, all Dining Areas, all Program/Activity Areas, the kitchen and the Laundry Space. The remaining areas of the long-term care facility, including the Resident Bedrooms, the Resident Bath Rooms and Shower Rooms and Resident Washrooms, must have a system for tempering the air to maintain air temperatures at a level that consider residents’ needs and comfort.

135. 9.2.3

Negative air pressurization of washrooms, soiled Utility Space, kitchen and Laundry Areas must be provided to ensure odours are contained. All of these rooms must be equipped with mechanical ventilation that exhausts air from these areas in keeping with Ontario Building Code requirements.

136. 9.2.4 The HVAC System must have enhanced exhaust capabilities to maintain a comfortable environment for residents with respect to humidity levels in the bath and shower areas.

137. Resident Dedicated Storage

10.1.1

Resident Dedicated Storage Space, in addition to clothes closets in bedrooms, must be provided in the long-term care facility so that residents can store their belongings. Other than the space requirements for residents’ clothes closets, there are no minimum space requirements for the storage space for resident personal belongings. It is up to the operator, in consultation with the architect to determine the size, design and location of Resident Dedicated Storage Space.

138. 10.1.2 The Resident Dedicated Storage Space must provide security for resident belongings. 139. Facility Staff Space 10.2.3 A secured storage area(s) must be provided for staff to store personal belongings. 140. 10.2.4 An area, separate from resident care and common areas must be provided for staff “break” periods. 141. 10.2.5 Separate change areas equipped with lockers must be provided for both male and female staff. 142.

10.2.1 Administrative space, for example, offices for the key staff such as the Administrator, Director of Care and supervisory staff, must be provided. It is up to the operator, in consultation with the architect to determine the number, size, design and location of administrative space.

143. 10.2.2 Administrative space for functions such as banking, sorting mail and clerical/secretarial activities must be provided.



Standard Reference

No. Design Standard

144. Receiving/Service Space 10.3.6

The Receiving/Service Space must provide year round access for delivery services. This entrance must be separate from the main entrance of the long-term care facility. The Receiving/Service Space may have common access to the property.

145. 10.3.4 Direct receipt of goods into the food preparation area must not occur. 146. 10.3.7 The areas used for the cleaning and sanitizing of equipment such as garbage containers, carts and

racks, must have floor drains. 147. 10.3.5 Storage space for the temporary accumulation of received goods should be provided. 148. Reception/Entrance

Space 10.4.1 The Reception/Entrance Space must be designed to allow facility staff to monitor all entering and exiting from the facility.

149. 10.4.2 The Reception/Entrance Space must be in proximity to an outside vehicle drop-off area for residents. 150. 10.4.3 The Reception/Entrance Space must be designed to support its function as the “welcoming” area to the

facility for residents and the public. 151. Elevators 10.5.1 At least one of the Elevators in the long-term care facility must be large enough to accommodate a

stretcher. This elevator must be located in proximity to the Resident Home Areas. 152. 10.5.2 The Elevators must have unobtrusive but effective barriers in areas where resident access is

discouraged (such as building service areas). 153. 10.5.3 Elevators must have the capacity for visible and/or audible signals. 154. 10.5.4 To accommodate the range of visual and tactile needs of residents, the elevator control panel must

contrast with the Elevator walls and must be easy to read, for example, have, large, clear numbers. 155. Public Washrooms 10.6.1 There must be clear and easily understood signage identifying all Public Washrooms. 156. 10.6.2 Each Public Washroom must have a lock that is readily releasable and easily openable to ensure that a

person is not accidentally locked into the washroom. 157. 10.6.3 Each Public Washroom must have a device that will activate the electronic Staff/Resident

Communication and Response System. 158. Site Development 10.7.3 The design of the Site must include level walkways without curbs or steps to the Reception/Entrance

Area of the facility. 159. 10.7.4 Wheelchair accessible parking must be provided in close proximity to the Reception/Entrance Area of

the facility. 160. 10.7.5 Trees and/or other structures that provide shade must be provided in all resident-accessible areas of

the Site. 161. 10.7.6 The design of the Site must include unobstructed access to the Site for all emergency vehicles including

ambulances and fire trucks.



Standard Reference

No. Design Standard

162. 10.7.2 The Site must be developed to include landscaped areas.


SUMMARY OF ”D” Retrofit Design Standards WITH ALLOWABLE PERFORMANCE RANGES

PART B:”D” Retrofit Design Standards with Allowable Performance Ranges

Area

Upper End of the Performance Range (taken from 1998 Design

Standard) Minimum End of the Performance

Range Allowable

Performance Ranges

1

Reference: Standard 1.1.1

Resident Home/Living Area

Each Resident Home Area must be a clearly defined distinct unit that provides accommodation for a maximum of thirty-two (32) residents.

Each Resident Home Area must be a clearly defined distinct unit that provides accommodation for a maximum of forty (40) residents.

40 to 32 beds

2


Bedrooms – One Bed Bedroom Size

A one-bed bedroom must have at least 130 square feet (12.1 square metres) of floor space excluding the space for the vestibule, the washroom and the clothes closet.

A one-bed bedroom must have at least 120 square feet (11.15 square metres) of floor space excluding the space for the vestibule, the washroom and the clothes closet. NOTE: One-bed bedrooms will be permitted to meet a minimum of 115 square feet (10.7 square metres), provided that the average of the one bed-bedrooms throughout the facility is at least 120 square feet (11.2 square metres) and no more than 10% of the one-bed bedrooms throughout the facility are less than 120 square feet (11.2 square metres), excluding the space for the vestibule, the washroom and the clothes closet.

120 to 130 sq. ft.

3


Bedrooms – Two Bed Bedroom Size

A two-bed bedroom must have at least 115 square feet (10.7 square metres) of floor space per resident, excluding vestibule space, the washroom and the two clothes closets.

A two-bed bedroom must have at least 105 square feet (9.75 square metres) of floor space per resident, excluding vestibule space, the washroom and the two clothes closets. NOTE: Two-bed bedrooms will be

210 to 230 sq. ft.



Area



Range Allowable

Performance Ranges

permitted to meet a minimum of 100 square feet (9.3 square metres) per resident [200 square feet (18.6 square metres) per two-bed bedroom] provided that the average of the two-bed bedrooms throughout the facility is at least 105 square feet (9.75 square metres) per resident [210 square feet (19.5 square metres) per two-bed bedroom], and no more than 10% of the two bed-bedrooms throughout the facility are less than 105 square feet (9.75 square metres) per resident [210 square feet (19.5 square metres) per two-bed bedroom], excluding the space for the vestibule, the washroom and the clothes closet.

4


Bedrooms – Clothes Closet

Each bedroom must have a clothes closet for each resident. Each clothes closet must have at least six (6) square feet (0.6 square metres) of floor space. The clothes closet must be of sufficient height and depth to store and hang clothes.

Each bedroom must have a clothes closet for each resident. Each clothes closet must have at least five (5) square feet (0.5 square metres) of floor space. The clothes closet must be of sufficient height and depth to store and hang clothes.

5 to 6 sq. ft.

5


Resident Lounge and Program Activity Space -Size

The minimum total required space for Resident Lounge and Program/Activity Space is 27 square feet (2.5 square metres) per resident.

The minimum total required space for Resident Lounge and Program/Activity Space is 21 square feet (1.95 square metres) per resident. NOTE: Cross-reference 4.1.1 and 4.1.2, under no circumstance shall the minimum required space for Resident

21 to 27 sq. ft.



Area



Range Allowable

Performance Ranges

Lounge and Program/Activity Space within a Resident Home Area be lower than 14 square feet (1.3 square metres) per resident.

6


Resident Lounge and Activity Space – Location

At least 70% of the total required space per resident for Resident Lounge and Program/Activity Space must be located within each Resident Home Area. Up to 30% of the total required space may be used to support other defined programs and may be located either within or outside of the Resident Home Areas.

At least 50% of the total required space per resident for Resident Lounge and Program/Activity Space must be located within each Resident Home Area. Up to 50% of the total required space may be used to support other defined programs and may be located either within or outside of the Resident Home Areas.

50% to 70%

7


Resident Dining Space - Size

The minimum required space for Dining Area(s) for the long-term care facility is 30 square feet (2.79 square metres) of floor area per resident, excluding servery space.

The minimum required space for Dining Area(s) for the long-term care facility is 25 square feet (2.32 square metres) of floor area per resident, excluding servery space. NOTE: Cross-reference 5.1.1 and 5.1.2, under no circumstance shall the minimum required space for Resident Dining Area(s) within a Resident Home Area be lower than 24 square feet (2.2 square metres) per resident.

25 to 30 sq. ft.

8


Corridors - Width All Corridors in resident areas must be a minimum width of seventy-two (72) inches (1820 mm).

All Corridors in resident areas must be a minimum width of sixty-eight (68) inches (1727 mm).

68 to 72 inches


SUMMARY OF”D” Retrofit Design Standards WITH COMPARABLE DESIGN, DESIGN OBJECTIVE(S) AND DESIGN CONSIDERATIONS

PART C: ”D” Retrofit Design Standards For Which Comparable Design Can Be Proposed

Design Standard Design Objectives Design Considerations 1

Reference: Standard

1.1.2

Resident Home/Living Area

The Resident Home Area must be a self-contained “living system” and must not allow transitory passage through the Resident Home Area(s) when traveling from one part of the facility to another.

Ensure resident privacy and home-like environment.

Design Features should be provided which compensate for any transitory passage by reinforcing privacy and the resident’s experience of a home-like atmosphere. Distinction between service transitory passage (e g. Transitory passage of food delivery, garbage, etc.) and passage of residents, staff, and visitors should be made. Service transitory passage must be kept at an absolute minimum and must not disrupt the experience of the home environment.

2

Reference: Standard

2.2.1

Resident Washroom

When open, a washroom door must not block the bedroom entrance-way and must not swing into another door in the bedroom, such as the bedroom door itself or a clothes closet door.

Provide a safe and comfortable living space.

The safety of the resident is of the utmost importance. The design of door swings shall not cause a safety hazard or inconvenience users (both resident and staff).

3

Reference: Standard

3.1.1

Staff Work Area Each Resident Home Area must have Work Space for Nursing and Program/Therapy Staff to allow staff to carry out their administrative duties. The space must accommodate multidisciplinary team activities.

Provide a well-coordinated, multi-disciplinary care system that will allow staff to meet residents’ care and treatment in an efficient and effective manner.

Attention should be given to the role that staff meeting space plays a part of care delivery and sufficient space located in an accessible area must be provided.

4 There must be space in each Maximize program delivery A design alternative to this



Design Standard Design Objectives Design Considerations

Reference: Standard

3.1.2

Resident Home Area, or in a centrally accessible area to each Resident Home Area, to support the delivery of therapeutic programs such as podiatry, dental, ophthalmology, social and psychiatric services, as well as required medical services.

options and access to them. Support effective care delivery to residents. Foster a sense of familiarity in a “home-like” setting.

standard must provide for space to carry out therapeutic programs (e.g. Podiatry, dental ophthalmology, social, and psychiatric services) outside of the Resident Bedroom. Bedside therapy is unacceptable because it promotes a sense of institutionalization.

5

Reference: Standard

5.2.1

Dietary Service Space

The Dietary Service Space must be designed so that the storage areas for small equipment and utensils and for non-refrigerated and frozen food are conveniently located for easy access and use by dietary staff. Storage areas must be in close proximity to dietary work areas.

Promote efficient provision of safe food and supplies.

The design alternative must include storage spaces that can be easily accessed safely and would not interrupt or hinder the function of another space.

6

Reference: Standard

5.2.2

The Dietary Service Space must include a work area for dietary staff that:

is secure for records and references; and

is accessible without passing though the food production area.

Support an efficient, convenient staff working environment. Provide a clean and safe working environment. Facilitate documentation and evaluation of individual resident’s progress.

The design alternative to this standard must ensure that proper hygiene is maintained at all times within the Dietary Service Space. The dietary staff work area must ensure secure record and reference keeping and may be located outside of the Dietary Service Space, but must be accessible without passing through the food production area.

7

Outdoor Space The distance measured from the entrance of the Outdoor Space to

Provide for a safe, readily accessible environment for

Attention should be given to the need to make outdoor space




Reference: Standard

6.1.1

the farthest resident bedroom must be no more than 200 feet (61 metres).

residents to enjoy the outdoors.

reasonably accessible to residents who may have ambulatory constraints.

8

Reference: Standard

6.1.2

There must be at least one Outdoor Area that is directly accessible from a Dining Area, a Lounge, or Program/Activity Area.

Support choice in relation to use of available space. Support opportunities for socialization. Foster a sense of familiarity in the home-like setting. Maximize a sense of awareness/orientation.

When considering a design alternative, accessibility to an Outdoor Area must be provided. When developing an alternative design, accessibility to an Outdoor Area must be provided. Secure Resident Home Area(s), for residents with dementia, for example, require security to the Outdoor Area, while maintaining a level of accessibility.

9

Reference: Standard

7.1.1

Laundry Space The Laundry Space must be designed so that there is access to all sides of the equipment (including washers, dryers and chemical dispensers) to ensure easy cleaning and repair work as necessary.

Promote a clean, safe and efficient working environment. To facilitate timely and safe storage, transporting, sorting, processing, and delivery. Safe and easy access for cleaning and repair.

An alternate design option must include sufficient space for easy access to laundry equipment and necessary repair work.

10

Reference: Standard

7.1.2

The Laundry Space must include storage space for supplies and equipment used for the laundry services.

Support an efficient, convenient staff working environment.

Storage space for supplies and laundry equipment may be outside the Laundry Space, but must be reasonably accessible.

11

Reference: Standard

7.2.1

Housekeeping Service Support Space

Housekeeping/janitor’s closets must be located both in and outside the Resident Home Areas to support the housekeeping requirements, as well as the

Facilitate a safe and clean environment for residents. Maximize efficiency of service delivery.

When developing an alternative design option, the convenience of maintenance staff in accessing the janitor/housekeeping closet and




cleaning equipment and cleaning supply storage requirements, for the long-term care facility.

the proximity the janitor/housekeeping closet services must be considered and addressed.

12

Reference: Standard

7.2.2

Each housekeeping/janitor’s closet must be equipped with a hot and cold running water supply, a “curbed service sink” with a floor drain, a hand wash sink and floor drain(s), and have sufficient space for the collection, sorting and pick-up of garbage.

Maximize efficiently and convenience in service delivery. To prevent build up of odours. To prevent unsanitary conditions.

An alternate design option must include fixtures and elements which will prevent odour build up, unsanitary conditions, and allow for cleanliness within the housekeeping/janitor closet.

13

Reference: Standard

7.4.1

Maintenance Service Support Space

There must be an area within the Maintenance Service Support Space for the storage of small and large maintenance equipment, machinery and tools.

Provide safety and security. Space must be provided, either inside or outside of the Maintenance Service Support Space, for small and large maintenance equipment, machinery, and tools. Storage must also be sufficient and must be safe and secure from other parts of the long-term care facility.

14

Reference: Standard

7.4.2

There must be a secured area within the Maintenance Service Support Space to store hazardous materials and equipment.

Promote a safe working environment.

Space must be provided, either inside or outside of the Maintenance Service Support Space, for storage of hazardous materials and equipment. Storage must also be sufficient and must be safe and secure from other parts of the long-term care facility.

15

Reference: Standard

Receiving/Service Space

The Receiving/Service Space must be located away from resident and public areas so as not to expose residents and the public to noise,

Ensure resident and public safety.

A design alternative must include the consideration of public and resident safety near receiving and shipping spaces.




10.3.1

noxious fumes and safety hazards. The containment of fumes, and safety hazards must be addressed.

16

Reference: Standard

10.3.2

A separate area for garbage storage and pick-up should be provided in the Receiving/Service Space.

Provide a safe and clean environment.

A design alternative to this standard should take into consideration the convenience and direct exit of garbage through the receiving/shipping space while containing and preventing the travel of fumes.

17

Reference: Standard

10.3.3

The Receiving/Service Space must be located where there is convenient access to the Dietary Service Space.

Promote accessibility to staff and maximize efficient use of staff resources.

The Owner/Operator in consultation with their Architect may choose where to locate the Receiving/Shipping Space with relation to it’s convenience to the Dietary Service Space. However, there must not be direct receiving of goods into food preparation areas.

18

Reference: Standard

10.7.1

Site Development Where the parking lot(s) can be seen from any resident bedroom window(s) on the ground floor, landscaping that will block the view of the parking lot(s) from the windows must be provided.

Facilitate visual transition between parking area and resident space.

The Owner/Operator, in consultation with their Architect and/or Landscape Architect, may choose how to create visual interest, for views, from any Resident Bedroom window into parking lots.

Ministry of Health and Long-Term Care, Long-Term Care Redevelopment Project “D” Bed Development Plan Submission Process 9.7-1

Appendix 9.7 Retrofit Per Diem Calculation Forms

WORKSHEET 1 – FACILITY INFORMATION & PREFERRED ACCOMODATION

DEFINITION WORKSHEET 2 – NUMBER OF BEDS PER RHA WORKSHEET 3 – BEDROOM SIZES

WORKSHEET 4 – CLOSET SIZE WORKSHEET 5 – ACTIVITY/LOUNGE SPACE SIZE PER RESIDENT

WORKSHEET 6 – DINING SPACE SIZE PER RESIDENT

WORKSHEET 7 – CORRIDOR WIDTH WORKSHEET 8 – ACTIVITY/LOUNGE SPACE WITHIN RHA

WORKSHEET 9 – COMPARABLE DESIGNS (CD'S) ARCHITECT’S CERTIFICATE FOR RETROFIT PER DIEM CALCULATION FORMS


WORKSHEET 1 - FACILITY INFORMATION & PREFERRED ACCOMODATION DEFINITION

Facility Name

Primary Contact

Facility Address

Telephone #

Fax #

e-mail address

Owner (legal corporate name)

Current Number of Beds

Proposed Beds after Retrofit

Submitted by (please print)

Telephone #

Fax #

PREFERRED ACCOMMODATION DEFINITION Definition of Preferred Accommodation

Instructions: Operators have a choice of definitions for preferred accommodation (see “D” Retrofit Design Manual for details) Please indicate below the number of bedrooms for which Option A and Option B will apply. Enter the number of bedrooms in the appropriate boxes to indicate choice.

Preferred Accommodation Definition Numbers of Bedrooms Option A (1998 definition) Option B (Revised definition)

Date Completed: COPY THIS SHEET IF MORE SPACE IS REQUIRED


WORKSHEET 2 – NUMBER OF BEDS PER RHA

Facility Name Instructions: Provide the following information for Retrofitted facility: 1) each RHA #; 2) a description of each RHA location; and 3) # of beds in each RHA. Copy additional blank sheets if required.

RHA # Description of RHA Location Actual # of Beds



WORKSHEET 3 – BEDROOM SIZES

Facility Name

One-bed Bedrooms Two-bed Bedrooms

Bedroom #Actual Room Size

(Sq. Ft.) Bedroom # Actual Room Size

(Sq. Ft.) Bedroom #Actual Room Size

(Sq. Ft.) Bedroom # Actual Room Size

(Sq. Ft.)

1. Minimum Average Room Size is 120 s.f. (Up to 10% of 1-bed rooms can be between 115 & 120) 2. Minimum Average Room Size is 210 s.f. (Up to 10% of 2-bed rooms can be between 200 and 210)



WORKSHEET 4 – CLOSET SIZE

Facility Name Instructions: Provide the following information for each closet: 1) description of closet location; and 2) actual size (Sq. Ft.) of each closet. Copy additional blank sheets if required.

Description of Closet Location

Actual Closet Size

(Sq. Ft.) Description of Closet Location Actual Closet Size (Sq. Ft.)

Minimum Closet Size = 5 Sq. Ft.



WORKSHEET 5 – ACTIVITY/LOUNGE SPACE SIZE PER RESIDENT

Facility Name Instructions: Provide the following information: 1) RHA # (if applicable for that row); 2) Location description for each activity/lounge space outside of an RHA; 3) Size (Sq. Ft.) of activity/lounge space within that RHA (if applicable); 4) Number of beds in that RHA (if applicable); 5) Size (Sq. Ft.) of activity/lounge space outside of RHA. Copy additional blank sheets if required.

RHA # (if applicable)

Description of Activity/Lounge Space Location (if outside of RHA)

Activity/Lounge Space Size (Sq. Ft.) within

RHA No. of beds in

RHA

Activity/Lounge Space Size (Sq. Ft.) outside of

RHA

COPY THIS SHEET IF MORE SPACE IS REQUIRED Date Completed:


WORKSHEET 6 – DINING SPACE SIZE PER RESIDENT

Facility Name Instructions: Provide the following information: 1) RHA # (if applicable for that row); 2) Location description for each Dining space outside of an RHA; 3) Size (Sq. Ft.) of Dining space within that RHA (if applicable); 4) Number of beds in that RHA (if applicable); 5) Size (Sq. Ft.) of Dining space outside of RHA. Copy additional blank sheets if required.

RHA # (if applicable) Description of Dining Space Location (if outside RHA)

Dining Space Size (Sq. Ft.) within RHA

No. of beds in RHA

Dining Space Size (Sq. Ft.) outside of

RHA



WORKSHEET 7 – CORRIDOR WIDTH

Facility Name

Instructions: Provide information as follows: 1) corridor location; 2) actual width (inches) of each corridor; and 3) actual length (inches) of each corridor. Copy additional blank sheets if required.

Description of Corridor Location (by definition, when a corridor width changes, this creates a new corridor with a new location) Actual Corridor

Width (inches) Actual Corridor Length (inches)



WORKSHEET 8 – ACTIVITY/LOUNGE SPACE WITHIN RHA

Facility Name

Instructions: Provide the following information: 1) RHA #; 2) total size (Sq. Ft.) of activity/lounge space provided for RHA residents, both inside and outside RHA; and 3) total size (Sq. Ft.) of activity/lounge space provided inside of RHA. Copy additional blank sheets if required.

RHA # Total Size (Sq. Ft.) of Activity/Lounge Space Provided for

RHA Residents, both inside and outside RHA

Total Sq. Ft. of Activity/Lounge Space Provided inside RHA



WORKSHEET 9 – COMPARABLE DESIGNS (CD'S)

Facility Name

Instructions: Some Comparable Designs (CD’s) are score based on how many times they are used (CD’s marked with *). Other CD’s are simply scored based on whether they are used or not (yes or no). Provide the following information: 1) how many possible times this CD could be used (for CD’s marked with *); 2) how many times the CD was actually used; 3) YES or NO as applicable (for CD’s scored based on whether you use them or not). Refer to the Retrofit Design Manual for a detailed explanation of Comparable Designs.

CD # CD Description (* indicates CD's whose scores are

prorated based on frequency of use)

Enter how many possible times this CD could

be used.

Enter how many times this CD was actually

used.

CD Used? (YES or

NO) 1 Transitory passage* 2 Washroom door swing*

3 Admin space for Nursing and Program/Therapy Staff* 4 RHA space for therapeutic programs 5 Storage space for small equipment, etc. in Dietary Service

Space

6 Work area for records/reference in Dietary Service Space 7 200 ft. to Outdoor Space* 8 At least one Outdoor Area from Dining, Lounge, or

Program/Activity Space

9 Access to all sides of laundry equipment

10 Storage for supplies and equipment in Laundry Space 11 Janitor's closet both in and outside of RHA* 12 Design of janitor's closet 13 Storage of equipment and machinery within Maintenance


14 Storage for hazardous materials and equipment in Maintenance Service Support Space

15 Location of Receiving/Service Space 16 Convenient access to Dietary Service Space from

Receiving/Service Space

17 Separate area for garbage in Receiving/Service Space

18 Landscaping of parking lot



ARCHITECT’S CERTIFICATE FOR RETROFIT PER DIEM CALCULATION FORMS

Date: ______________________________

The following Ministry (the “Ministry”) Retrofit Per Diem Calculation Forms (the “Calculation Forms”) dated ______________________ have been completed and are attached:

Worksheet Check all that apply (√√ )

1. Facility Information and Preferred Accommodation Definition

2. Number of Beds Per RHA

3. Bedroom Sizes

4. Closet Sizes

5. Activity/Lounge Space Size Per Resident

6. Dining Space Size per Resident

7. Corridor Width

8. Activity/Lounge Space Within RHA

9. Comparable Designs (CD’s)

Note: If any comparable designs are being used in Worksheet 9, a copy of the relevant Comparable Design applications, or the Ministry letters approving the use of these Comparable Designs, must be attached.


This is to certify that the information contained in the attached Calculation Forms conforms to and is consistent with the information contained in the following drawings which have been submitted to the Ministry for approval:

Insert here the relevant drawing number(s), title, date, revision date or mark:

Certified on (date):_____________________

by:

_____________________________________

Architect:

Address:

Phone: Fax:

2002 “D” Bed Program2002 “D” Bed Development Plan Submission Process 1-1 1.0 Introduction...

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