What you need to know about personal care home eligibility

Hey there, time traveller!
This article was published 12/09/2022 (1436 days ago), so information in it may no longer be current.

Most of us don’t like to think about placing ourselves or a loved one into a personal care home (PCH) or long-term care facility, so it comes as no surprise that it’s a process often avoided until every feasible alternative has been exhausted.

What may surprise you, however, is that the Winnipeg Regional Health Authority (WRHA) is just as likely to view placement into long-term care (LTC) as a “last resort” as you are.

The WRHA has long held a “home is best” philosophy focused on helping people to remain independent and live in their own communities for as long as possible. Research shows this offers a better road toward the maintenance of good health and quality of life. At home you are in your own space, can sleep in your own bed, have meals at your own table and be as independent as possible.

In fact, placement in LTC is only considered when the client can no longer be supported by formal and informal community supports, and all options for community living have been reviewed.

Formal supports might include the WRHA Home Care program, private care, housing with additional services, meal delivery programs, community agencies, transportation services, primary care networks and many others. Informal supports include the invaluable efforts of family, friends, neighbours and faith communities, to name a few.

Despite these supports, there may come a time when people can no longer manage in their home and require the 24-hour nursing care available in a PCH (sometimes called a “nursing home”).

In order to be eligible for LTC, clients must meet Manitoba residency requirements, require 24-hour nursing support/care, be medically, functionally and behaviorally stable and consent to move to LTC. The majority of the costs for these services are paid by the provincial government, with the client paying a daily charge based on income as assessed by the Canada Revenue Agency. The Manitoba government reviews these charges annually.

The WRHA funds and oversees the operations of 38 LTC facilities, including 37 personal care homes and the St. Amant health care facility. In total, there are over 5,200 PCH beds in Winnipeg.

The WRHA’s Long Term Care Access Centre (LTCAC) is responsible for determining eligibility for LTC, ensuring clients have access to LTC services that are most appropriate to their needs, approving LTC applications and for maintaining waiting lists for PCHs, supportive housing and LTC.

The actual paneling process is relatively straightforward and easy to understand. Long-term care navigators from the LTCAC work together with their home care and hospital partners to assist with problem-solving. A consult can be requested by the home care case coordinator to the LTC navigator. The navigator will compile and complete the LTC application with the client and their primary care provider. A medical assessment will be requested from the client’s physician, nurse practitioner or physician assistant. Once that is complete, the LTC navigator will panel and approve the application.

The client will be placed on the wait list for their preferred long-term care facility. Clients being paneled to a facility directly from hospital will be placed in the first available bed that meets their care needs. This is an interim placement until a bed in the facility of their choice is available. We recognize this may not be ideal for some, but it is important to ensure there are hospital beds available for patients with immediate medical needs.

Clients being paneled from home can most often stay home with the appropriate supports until a bed at the care home of their choosing is available. The navigator will maintain regular contact with the client to ensure they remain stable at home. If that changes, they may need to be placed from the community into the first available bed that meets their care needs. The goal is to have as many clients as possible transitioned to a PCH from their home and community instead of from hospital.

If you have questions about the process for assessment of eligibility for PCH, don’t hesitate to reach out to your home care case coordinator or the WRHA Long Term Care Access Centre.

In addition, the Long Term & Continuing Care Association of Manitoba has complied an online reference for frequently asked questions about PCHs. It’s available at ltcam.mb.ca/pch-faq.htm.

More information is also available from the WRHA’s Long Term Care Access Centre at 204-940-8670, or by visiting wrha.mb.ca/long-term-care/.

Laurel Rose is the continuing care operations leader with the Winnipeg Regional Health Authority.