Regulation Matters 2022 - Issue 1, May

Changes to Legislation for Dietitians Working in Long-Term Care

On April 11, 2022, the Fixing Long-Term Care Act, 2021 came into force in Ontario. This Act is the new legal framework governing the long-term care sector and will repeal the Long-Term Care Homes Act, 2007. Dietitians should be aware of these recent legislative changes in LTC and are encouraged to discuss changes as needed with their employers. Operational changes will be clarified through regulations which are to be developed. Dietitians may wish to be kept up to date with legislative developments and consultation.

What was the impetus for new legislation?

Ontario’s Long-Term Care (LTC) COVID-19 Commission investigated how and why COVID-19 spread in LTC homes, what prevented the spread, and the key elements in the LTC system impacting the spread of COVID-19. The Commission produced their final report on April 30, 2021 and the Commission’s recommendations led to the creation of legislation; Fixing Long-Term Care Act, 2021.

What are the changes of which dietitians should be aware?

While many similarities in the new Act exist with the Long-Term Care Homes Act, 2007, the new changes related to staffing, care, accountability and transparency, and enforcement tools. In addition, LTC Homes will be required to deliver changes related to nutritional choices and variety.
Brief highlights are provided below.

Nutritional Choices and Variety

Related to nutritional choices and variety, new regulations under the Act will come into effect on July 11, 2022. Long-Term Care homes will be required to deliver (as per O. Reg. 246/22, c. 39, Sched. 1, s.77):
  • Menu planning flexibility that better reflects the needs of the residents such as specialty diets and menu substitutions that have consistent nutritional value;
  • Menus that are approved by a registered dietitian in addition to residents’ preferences;
  • Menus that provide a variety of foods every day, including fresh produce and local foods in season;
  • More flexibility for each home to increase menu choices for residents and reduce food waste; and
  • Meals and snacks at times that are chosen with support from the home’s Residents’ Council and its administrator.
To read more, please refer to the Regulation above and see the Ontario Government News Release.

Staffing and Care

Under the Act, a system average of four hours of direct care per resident per day by 2025 will be required by long-term care homes. The direct hours of care target to be provided to residents by nurses, personal support workers and allied health care professionals is established (See s.8 (1) - s.9 (7)). For allied health care professionals, the average is calculated by taking the total number of hours of direct care actually worked by allied health care professionals in all Ontario LTC homes and dividing that number by the total number of resident days in all Ontario LTC homes for the applicable calculation period provided for in the regulations.

Measuring Progress re: Staffing and Care

The Minister of Long-Term Care will be required to assess and publicly report progress on targets and to identify and assess barriers or risks and consider mitigations to the barriers and risks (See s. 10 (1) - s.10 (6)).

Accountability and Transparency

The Residents’ Bill of Rights is expanded to align with the Ontario Human Rights Code. An example of an amendment includes allowing families and friends to visit residents who are very ill or dying, 24 hours per day.

To measure and improve quality of care, LTC homes will be required:
  • To provided care or services to residents that integrate a palliative care philosophy (concept to be defined) (See s.12 (1-2)).
  • To implement a program for infection prevention and control, led by an infection prevention and control lead (qualifications to follow in the regulations) (See s.23 (1)-(5)).
  • To implement a continuous quality improvement initiative (to be provided for in the regulations) (See s.42).
  • A yearly survey of residents, their families, and caregivers to measure their experience with the home and the care, services, programs, and goods provided at the home, including responses from caregivers in the results (See s.43).
  • To have screening measures before hiring staff and accepting volunteers (See s.81 (1-6)).
  • To maintain and monitor an email address so that the home can receive communications from a resident or their substitute decision maker of the resident (See s.84 (2 h).
  • To have an emergency plan and provide training for staff, volunteers, and students. These plans must be developed and updated with input from Residents’ and Family Councils and made available to the public (See s.90 (1-4)).
To measure and improve quality of care, some changes apply to the Ministry of Long-Term Care. The Act gives the minister the power to create a Long-Term Care Quality Centre, which will “support mission-driven organizations to advance and share research on innovative and evidence-informed person-centred models of care and other functions or purposes which will be provided in the regulations” (See s. 44 (1-2)).
Borden Ladner Gervais (2022). What you need to know about Ontario’s Fixing Long-Term Care Act. Retrieved from:
Ontario Association of Residents’ Councils (2022). Bulletin - Fixing Long-Term Care Act, 2021 coming into force on April 11, 2022. Retrieved from