Further Clarifications on Ontario Changes to Physiotherapy and Exercise/Fall Prevention Programs

Editor’s Note: CARP members have continued to express concerns and questions about the changes to physiotherapy that the Ontario Government announced in April, despite the Ministry’s clarifications and Minister Deb Matthew’s letter to CARP. Many members are hearing conflicting information from others, causing many to worry about their coverage. CARP asked the Ministry of Health for further answers and clarification regarding the upcoming changes, and this is the answer CARP received:

Here is some clarification for you and your members on the changes to physiotherapy that address the specific questions you had.

Under the former OHIP model, we know that many of the Designated Physiotherapy Clinic providers were charging OHIP for up to 150 physiotherapy treatments per patient annually. We also know that many of these treatments actually took the form of group exercise classes which were rarely led or supervised by a physiotherapist. Physiotherapy is a goal-oriented, one-on-one personal therapy to help patients recover from illness, injury or surgery delivered by a physiotherapist who is registered with College of Physiotherapists of Ontario, and must be distinguished from exercise classes.

Under the new model, physiotherapy providers will be funded for an episode of care for each patient under their care. An episode of care commences when a patient is referred by their physician or CCAC to receive physiotherapy services. Upon receiving a patient with a  referral the provider will then commence the episode of care which includes an assessment to determine the number and type of treatments required to help the patient recover from the injury, surgery, or illness. The plan of care that is determined during the assessment will set out the number of treatments the patient will receive in order to achieve their goals. If additional treatments are required to achieve the goals in the plan of care that decision can be made by the physiotherapist in consultation with the patient. At the end of an episode of care, the patient will be discharged from the care of the physiotherapist who may recommend the patient participate in some form of exercise class so the patient can maintain their mobility.

As you note, the eligibility for publicly-funded physiotherapy is not changing. Seniors 65+, youth 19 and under, and adults 20-64 who are clients of the Ministry of Community and Social Services, remain eligible to receive high-quality publicly-funded physiotherapy services.

In order to understand why it appears some seniors will no longer receive physiotherapy we must acknowledge the difference in goals of both physiotherapy and exercise and falls prevention classes. High-quality physiotherapy helps seniors recover better from illness, surgery or injury, while falls prevention and regular exercise helps seniors stay active, healthy, and independent.  Our government acknowledges that many seniors benefit from exercise and falls prevention programs in keeping mobile, active and healthy. That’s why under the new model we’re investing an additional $10 million to provide these services in communities and retirement homes across the province at a manageable rate with appropriate providers such as fitness instructors. This is in addition to the $10 million that is being invested in these services in long-term care homes. All seniors will be eligible to participate in an unlimited number of exercise and falls prevention classes.

Under the new model, local CCACs will assess patients who were receiving OHIP-funded physiotherapy services to determine whether care needs will be continued or if the patient can be discharged. The medical assessment process is not changing. Those who need physiotherapy will continue to receive it. Doctors will still have the freedom to refer patients for physiotherapy if they will benefit from it. We are confident that many of the patients who received care under the OHIP-funded model may not actually require on-going physiotherapy services up to three times per week. All of these patients will have the opportunity to join the new seniors exercise programs that will be offered in their community.

There are many options for seniors to maintain a healthy and active lifestyle across the province. Our focus will initially be to ensure that classes that were established under the former OHIP-model are maintained. Over the coming months we will be rolling out additional classes in more communities to ensure access is consistent across the province. In addition to publicly-funded exercise and falls prevention classes for seniors, many communities offer programming for seniors to increase their activity level and keep mobile.

If your members have any questions or need information on where services are being provided we encourage them to visit our website www.ontario.ca/physiotherapy or call the Seniors’ INFOline: 1-888-910-1999