Consent to Care Facility Admission

Before an adult is admitted into a care facility, it is required by law that consent is obtained for their admission. This is required by Part 3 of the Health Care (Consent) and Care Facility (Admission) Act which became law in British Columbia on November 4, 2019. Consent to admission is given by the adult who is going into the care facility unless they have been assessed and determined to be incapable of giving or refusing this consent. When this is the case, consent will be sought from the person closest to them, their substitute.

When Consent is Required

Consent is required when an adult is admitted to either a publicly-subsidized or private-pay care facility, including:

• a long-term care home (including short-stay services),
• a hospice,
• a facility licensed for the treatment of mental health and substance use issues, or
• another licensed facility for adults (excluding a Community Living BC home)

How Consent is Obtained

The person responsible for arranging admission to a care facility is considered the ‘manager’ and is responsible for seeking consent. For admission to a facility that is publicly-subsidized, the manager will be someone from the health authority, such as an access coordinator or care manager. For an admission to a facility that is not subsidized, the person responsible for seeking consent will be an employee of the care facility, such as the manager or director of care.

Consent Must Be:

Informed: An adult must be given enough information to understand the decision they are making, and they must have the opportunity to ask questions and get answers to their questions.

Voluntary: An adult must have the option of refusing consent, of saying ‘no’. They must not be unduly pressured into giving consent.

Specific: Consent to admission must be for a specific facility or specific facilities.

Given by a capable adult: An adult must able to understand the decision and the information provided in order to make the decision.

Incapability to Consent to Care Facility Admission

An adult may be incapable of giving or refusing consent because they are unable to understand the information they are provided to make the decision. An adult may also be incapable of making this decision because they are unable to appreciate this information; unable to apply it to their own life and circumstances. The way an adult communicates with others may not, by itself, indicate they are incapable of giving or refusing consent to care facility admission.

Making a decision that appears to others to be a ‘bad’ decision or the wrong decision does not mean a person is incapable of making that decision. If they understand the decision they are making and appreciate its consequences, then they are still considered capable.

Incapability Assessments

An adult is presumed to be capable of making a care facility admission decision, until it has been demonstrated that they cannot make the decision. While consent is being sought and information is being provided about the care facility decision, the adult may show signs that they are unable to understand or appreciate the information. If this is the case, an incapability assessment will be conducted. An incapability assessment is not required for everyone who may be admitted to a care facility – only when there is doubt about whether the adult is capable of making this decision.

Assessors for Conducting Incapability Assessments

An incapability assessment must be conducted by a:

• physician,
• nurse practitioner,
• registered nurse,
• registered psychiatric nurse,
• psychologist,
• occupational therapist, or
• social worker.

Only these professionals can make a determination that an adult is incapable of giving or refusing consent to care facility admission.

Will I be informed if I’ve been determined to be incapable? What if I disagree?

You must be informed if you’ve been determined to be incapable of giving or refusing consent to a care facility. If you disagree with this determination, you can request a second assessment; then a second assessment will be conducted by another health professional.

Who makes the care facility decision if I’ve been determined to be incapable of giving or refusing consent to care facility admission?

If you have a committee of person, the committee will make the care facility admission decision on your behalf. Otherwise, if you have been determined to be incapable, a substitute will be chosen from the following ranked list:

1. Your representative, if they have the authority to consent to admission on your behalf;
2. Your spouse;
3. Your adult child;
4. Your parent;
5. Your sibling;
6. Your grandparent;
7. Your grandchild;
8. Another person related to you by birth or adoption;
9. Your close friend;
10. Another person related to you by marriage;

In order to be your substitute for this decision, a person needs to be capable of making this decision themself. They also need to be someone who has been in contact with you in the last year and not have any disputes with you.

If there is no one who meets these criteria, or if there is a dispute about who should be the substitute, the Public Guardian and Trustee will become involved and choose the substitute. The substitute could be an employee of the Public Guardian and Trustee, if there is no other suitable person.

Duties of a Substitute

A substitute chosen to make a care facility decision on another adult’s behalf is required to consult with that adult and others in their life who have offered to help with this decision.

A substitute is also required to make a decision in the adult’s best interests. This means they need to take into consideration the adult’s current wishes, and any wishes the adult expressed previously, as well as their values and beliefs. The substitute must also consider whether going into a care facility will be beneficial for the adult and whether there are other less restrictive options available to meet their needs.

• Duties of a Substitute Decision Maker

What if I am in a care facility and I want to leave?

If you are capable of giving consent to care facility admission, you are able to choose to leave the facility. If you have been determined to be incapable of giving or refusing consent to care facility admission, your substitute can decide whether you will remain in the facility, as long as they are making a decision in your best interests. If you’ve been determined to be incapable of making a care facility decision, and you express a desire to leave a care facility, your substitute will be asked to give consent to your continuing to remain in the care facility.

Other information

Legislation:

• Health Care (Consent) and Care Facility (Admission) Act
• Health Care Consent Regulation
• Community Care and Assisted Living Act
• Residential Care Regulation
• Patients’ Bill of Rights Regulation

Information for managers and assessors

• Practice Guidelines for Seeking Consent to Care Facility Admission
• Consent to Care Facility Admission in BC: A Quick Guide
• eLearning course - Consent to Care Facility Admission in British Columbia: A Course for Managers and Assessors