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CCAC Appeals - Non-compliance

Sometimes, you may complain or appeal, and an agreement is reached, either in a hearing or through a settlement between the parties, but the agreement is not followed by the Community Care Access Centre (CCAC).  What should you do?



The best way to respond to this type of situation is to be prepared ahead of time, in case it ever happens.  Non-compliance (the CCAC not following through with something you agreed to) might apply to a plan of care, the amount of service you are supposed to receive, when it is supposed to be delivered or by whom. It is important to keep good records of all meetings with your CCAC and get all agreements in writing.

Ask for:

  • minutes of meetings or any case conferences about your care
  • letters to confirm decisions made at meetings
  • a plan of care that outlines hours of service, type of service, and who will provide the service
  • a description of how the workers providing your service are to be trained (one of the most common complaints families make is that they have to take time to train all the workers) 
  • confirmation that your services won't be changed (or cut) without your knowledge or an opportunity for you to be involved in the decision 
     

If your CCAC will not provide you with written confirmation about these matters, consider making your own notes and providing them to the CCAC for their records. It might also be a good idea to keep your own notes about worker visits. For example, it would be useful to note how many different workers come to your home to provide service, whether they arrive at the scheduled time and whether they are trained or if you have to provide training.

It might also be a good idea to make a brief note about worker visits if anything unusual takes place, particularly about any injuries to workers or any worker complaints. It might take a few minutes to prepare your notes, but the time is well spent as they create a picture of how your service is provided on a daily basis, and that picture can be very useful if there is ever a disagreement.

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CCAC Appeals - More Info

Links

CLEO - Community Legal Education Ontario

CLEO -Home Care Complaints and Appeals

CLEO - Home Care Bill of Rights

Ontario College of Social Workers and Social Service Workers
Toronto Line: 416-972-9882   
Toll-free: 1-877-828-9380

 

Contact information for the colleges that regulated health care professions in Ontario may be found on the Federation of Health Regulatory Colleges of Ontario web site, or by calling the Ministry:

Toll-free: 1-866-532-3161
Toll-free TTY: 1-800-387-5559
Human Rights

Decisions of Interest

J.C. v. South West Community Care Access Centre, 2012

T.B. v. South East Community Care Access Centre, 2011

S.P.V.K. v. Central Community Care Access Centre, 2012

A.O. v. Central East Community Care Access Centre, 2010

M.A.M. v. Community Care Access Centre of Peel, 2008

 


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CCAC Appeals Process

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Telephone Hearings
 


What the Hearing Will Be Like

Health Services Appeal and Review Board (HSARB) hearings can be done in writing, by telephone, or in person. You will be given a choice about the kind of hearing you want during a pre-hearing conference.

Oral Hearings:  Most often, cases are heard in person, in a room that looks more like a classroom than a courtroom. This is called an oral hearing. At the front of the room there is a table where a three-person panel sits. One of the three is the chair, or manager, of the hearing. 

The chair opens the hearing by introducing everyone and describing how the hearing will take place. The Chair will ask the people who are going to testify at the hearing to swear an "affirmation" which is when they promise to tell the truth.  The Chair will also review all the documents to make sure nothing is missing.

The Appellant goes first. This is your chance to tell your story and use your evidence to show how you think that the CCAC did not follow the law when they made the decision you are appealing. If you have witnesses, you can ask them questions that help show the Panel your side. Once you have finished, the Respondent (CCAC lawyer) will ask your witness more questions, and the Panel might also have a few questions.

Then the Respondent (CCAC) has their chance to tell how they think they correctly obeyed the law when they made the decision you are appealing. They will ask questions of their witnesses, and then you will have a chance to ask questions, too. Again, the Panel might ask some questions. The Respondent (CCAC) will almost always be represented by a lawyer.

After everyone has asked all the questions they want, each side will have a chance to make a closing statement. This is a chance to remind the Panel about why you think your side is correct, and to remind them of the evidence you used to make your case.

Once everyone is satisfied that all the information has been presented to the panel, the Chair will thank everyone for coming and close the hearing. The Panel then goes off to privately discuss the evidence that they learned at the hearing, and make a decision based on the law.

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Telephone Hearings:  These are much like oral hearings except that the parties connect to the hearing by telephone.  

Written Hearings:  At a written hearing, the parties are not present.  The board panel will go over all the documents provided by both parties and make a decision based on the legislation and the information in the file.  

The Decision

The Panel must give their decision within three days. They usually give a decision along with their reasons, but sometimes they will give the decision, only, and the reasons will come later.  

If you don't agree with the panel's decision you have 10 days to ask the HSARB to review it.  If you still don't agree, you can also challenge the decision in court.  You will need to get help from a lawyer if you decide this is what you should do.  

Ombudsman Ontario

The Ombudsman does not have the power to overturn decisions or change tribunal decisions, but if you believe an administrative tribunal treated you unfairly you can make a formal complaint with the Ombudsman.  If the Ombudsman agrees, he can make recommendations to the tribunal to address the problem, and he can also make recommendations about government legislation, policies or programs.  For more information on the powers of the Ombudsman over tribunals, go to:  Ombudsman Ontario

Transcript

There will be a transcript made of the hearing.  Copies are available at your own expense.

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Tribunal Number: 

CCAC Appeals Preparation

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How to Prepare for the Hearing
Get to Know the Law
 


Launching Your Appeal

The first step to appealing a decision made by a Community Care Access Centre (CCAC) is to write to the Health Services Appeal and Review Board (HSARB) to tell them you wish to do so. Once you do this, HSARB will assign an Appeal File Number to your case, and they will send you the appeal forms you need to fill in to file the appeal. 

The Pre-Hearing Conference:

For almost every appeal, the HSARB will hold a pre-hearing conference, and sometimes they will hold more than one.  

The pre-hearing conference is usually held over the phone and will give both sides a chance to:

  • Agree about what issues are being appealed.
  • Talk about the issues and perhaps agree on a settlement.
  • Agree about what facts and evidence will be used at the hearing.
  • Share information that will be used at the hearing.
  • Decide how long the hearing might take.
  • Think about anything else that might help the parties settle the issue.
  • Set a date for the hearing that works for everyone.

If you do not come to an agreement on the issues at the pre-hearing conference, nothing that is talked about during the meeting will be used against you at the hearing.  

How to Prepare for the Hearing

Thinking About the Issues:

To prepare for the hearing, get ready to explain each issue you want to appeal. Think about any facts or arguments that might help prove that something did or did not happen, or that something should have happened.

Think about the other party’s side of the story: In what ways do you disagree? What did they leave out? How do you respond?

What witnesses do you think you will need? You may be the only person with first-hand information about your side of the story, but if someone else has information that supports your side, then you should probably bring that person, or those people to the hearing as a witness. 

Prepare Your Witnesses:

  • Meet with your witness(es) to explain why you have asked the person or people to speak for you.
  • Write down questions you want to ask your witness(es). Questions should help your witness(es) talk about the things you think are important for making your case. 
  • Practice asking your questions with your witness(es) so you both feel confident and comfortable.

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Get to Know the Law:

It will be helpful for you to read the legislation that describes what the CCAC is supposed to do when they serve people in the community. 

It is important that your arguments at the hearing are based on how you think the CCAC didn’t follow the law when they made the decision to:

  • deny you a service you think you should get
  • give you less service than you think you need
  • cut back your hours of service
  • change your services
  • stop your service

It will also be helpful for you to look at other cases the review board has heard that are similar to yours. In that way you might get ideas about what evidence helps the board decide.

Documents:

  • Any documents you are planning to use to support your case should be sent to the review board and the other party at least 10 days before the hearing.
  • You can use any document about the specific issues you have raised. Examples might be emails, assessments, doctors' reports, or notes you may have made about your services.


Interpreters:

If you, or any of your witnesses, need an Interpreter, tell the board as early as possible.  They will get an Interpreter and pay for this service.

If You Can't Make it:

You might find out that you can't make the hearing at the time or date that was set. If something comes up that prevents you from attending the hearing, you can ask the review board for a different time or date. It's important to attend - if you just don't show up and don't give a good reason for it, your file may be closed and there will be no hearing.  

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CCAC Bill of Rights

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Follow the Complaint Process for Your CCAC
 


The Home Care Bill of Rights

The Home Care Bill of Rights describes how people must be treated when they apply for home care or get home care through a Community Care Access Centre (CCAC).

The Home Care Bill of Rights says you have the right to:

  • be treated with respect and to be free from abuse
  • have your privacy and dignity honoured
  • have your needs and preferences respected
  • receive information about the services you get
  • take part in decisions about your services
  • consent to or refuse services
  • comment or criticize, without anyone taking action against you
  • receive information about home care laws and policies and
  • know how to make a complaint, and have your home care records kept confidential

CLEO (Community Legal Education Ontario) and ARCH Disability Law have developed a detailed explanation of the Home Care Bill of Rights.  Click HERE to learn more.

What if Your Rights Are Violated?

If you think your rights under the Home Care Bill of Rights have been violated, you have the right to make a complaint. There is no time limit on complaints, but it is better if they are made as soon as possible.

The law says that every CCAC must have a way to deal with complaints. CCACs don’t all follow the same complaints process, so you should ask your care coordinator to give you a written description of the complaints process for your CCAC.

If you are complaining about a particular decision, you should get the decision in writing from your care coordinator.

The law says you have a right to get copies of all documents the CCAC has about you. Before you complain, you should ask for a copy of all their documents. They might ask you to pay for these copies. If you think they are charging too much, or if they don’t give you the documents, you should contact a Community Legal Clinic for help.

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Follow the Complaints Process for Your CCAC

Pay attention to deadlines in the complaints process, because if you miss a deadline it might stop you from being able to complain or force you to start all over again.

The first step of the complaints process will most likely be to have your care coordinator reconsider the decision he or she made. The care coordinator should give you the decision in writing.

If you are not happy with the decision, you can ask for another review by different people in the CCAC.

If you don’t like the second review, you can complain to an ombudsman. Ombudsman Complaint Form

If you are still not satisfied, you still might be able to appeal the decision to the Health Services Appeal and Review Board (HSARB).

However, if your concern is not one of the issues that can be decided by the HSARB, there are other options. 

  1. Complain to the college: If your complaint is about a health profession that is overseen by a regulatory collage, such as nursing, physiotherapy, occupational therapy or social work, you can complain to that profession's college.
  2. Human Rights Tribunal of Ontario (HRTO): If you believe you have been discriminated against on the basis of your religion, race, age, sexual orientation, ethnicity or disability, you can make a complaint to the Human Rights Tribunal of Ontario (HRTO).
  3. Ombudsman Ontario: The Ombudsman does not have the power to overturn decisions or change tribunal decisions, but if you believe you were treated unfairly by an administrative tribunal you can make a formal complaint with the Ombudsman. If the Ombudsman agrees, he can make recommendations to the tribunal to address the problem, and he can also make recommendations about government legislation, policies or programs. For more information on the powers of the Ombudsman over tribunals, go to:
  4. Police: If a worker has stolen from you, threatened you, physically assaulted you, or committed any crime against you, you should call the police.

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CCAC Appeals Overview

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Types of Issues the Board will Hear
 


The information below explains how to complain to and how to appeal decisions made by local Community Care Access Centres (CCACs), under the Home Care and Community Services Act. If your issue is complicated or difficult to explain, you may want to see a lawyer before beginning an appeal.

If you wish to complain or make an appeal, contact The Health Services Appeal and Review Board (HSARB), The HSARB hears appeals under a number of health care laws, including the Home Care and Community Services Act, which used to be called the Long-Term Care Act. This act describes how CCACs offer a number of health services including nursing care, personal support workers, and homemaking to people who live in the community.  It also includes the Home Care Bill of Rights, which is a document that describes the quality of service you have a right to expect from your local CCAC.

The job of the CCACs in Ontario is to make sure that people who live in the community get the supports and services they need.  If your CCAC decides that you are not eligible for service, or if they cut back the service you receive, they must tell you in writing about how to ask for a review of the decision and how to make a complaint. 

After you go through the complaint process, you can appeal some decisions to the HSARB.  Each of the 14 CCACs has its own way of handling complaints, so if you'd like to make a complaint, ask your CCAC to explain the procedure to you in detail. You should also keep all letters from your CCAC about their decisions and any complaints you might have. These will be useful if you decide to appeal.

Types of Issues the Board Will Hear

The HSARB will hear your appeal if:

  • You think you have not been given the right kind of service (nursing, home care, homemaking).
  • You think you need more service than you’ve been given.
  • Your services were cut back.
  • Your services were changed.
  • Your services were stopped.

What the HSARB Can Do for You

The HSARB can do one of three things:

  • Agree with the CCAC (uphold the decision).
  • Order the CCAC to make a new decision; it can also make suggestions about what the CCAC should consider in making the decision.
  • Replace the CCAC decision with one of its own.

What HSARB Cannot Do for You

The HSARB cannot hear appeals about:

  • the quality of the service you receive
  • complaints that are covered or that may be resolved under the Home Care Bill of Rights.

How Do You Apply?

To apply to the HSARB for an appeal, call or write to the review board and ask for a hearing. They will send you the forms and a description of how the hearing will take place.

HSARB can be reached at:

Health Services Appeal and Review Board
151 Bloor Street West, 9th Floor
Toronto, Ontario
M5S 1S4

Toronto Line: 416-327-8512
Toll-free: 1-800-282-2179
TTY: 416-326-7889
TTY (toll free): 1-877-301-0889
FAX: 416-327-8524
Email: hsarb@ontario

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