Ontario does not regulate infection prevention in congregate care under a single instrument, and it never has. A long-term care home answers to the Fixing Long-Term Care Act, 2021 and its general regulation O. Reg. 246/22; a licensed retirement home answers to the Retirement Homes Act, 2010 and O. Reg. 166/11; and supported housing that holds neither licence is governed mainly through public health law. In the United States, "assisted living" is a state-licensed category that sits outside the federal nursing-home conditions of participation, so the infection-control duty an operator can actually point to depends on which licence the building holds — not on what the building is called.
This matters because the two most common errors in cross-border care-home content are attribution errors: citing O. Reg. 79/10 as though it were still the long-term care rule — that regulation was repealed with the Long-Term Care Homes Act, 2007 and its content now sits in O. Reg. 246/22 — or describing the Retirement Homes Act and the Fixing Long-Term Care Act as if they governed the same setting. Both errors are avoidable with five minutes at the source.
Quick facts
- Three Ontario care settings, three separate legal instruments — the infection prevention and control duty does not sit in the same place in any two of them.
- Long-term care: the Fixing Long-Term Care Act, 2021, s. 23 requires the program and an infection prevention and control lead; O. Reg. 246/22, s. 102 sets the substance.
- Retirement homes: the Retirement Homes Act, 2010, s. 60 (4), paragraph 2 requires a program; O. Reg. 166/11, s. 27 sets the substance.
- O. Reg. 79/10 belongs to the Long-Term Care Homes Act, 2007, which is no longer current law. It is not a citation for a 2026 care home.
- In the United States, 42 CFR part 483, subpart B binds Medicare- and Medicaid-certified nursing facilities. Assisted living is licensed by states.
- The practical test is not the word "home" in the building's name. It is which licence the operator holds.
Which Ontario law governs which care setting?
Ontario's care-home statutes are drafted around licensing categories, and the infection prevention duty is attached to the licence. The table below maps the four parameters a compliance officer needs: the statute, the general regulation, the body that inspects, and the clause that carries the infection prevention obligation.
| Care setting | Governing statute | General regulation | Inspector / regulator | Where the infection prevention duty sits | Instrument status |
|---|---|---|---|---|---|
| Long-term care home | Fixing Long-Term Care Act, 2021 | O. Reg. 246/22 | Ministry inspectors appointed under the Act | FLTCA s. 23 (1)–(5); elaborated in O. Reg. 246/22 s. 102 | Current |
| Licensed retirement home | Retirement Homes Act, 2010 | O. Reg. 166/11 | Registrar and inspectors of the Retirement Homes Regulatory Authority | RHA s. 60 (4) para. 2; elaborated in O. Reg. 166/11 s. 27 | Current |
| Supported or congregate housing without either licence | Health Protection and Promotion Act (public health) and the Housing Services Act, 2011 (service delivery) | Public health standards rather than a care-home general regulation | Local board of health and its medical officer of health; service manager under the housing statute | No operator-level program clause equivalent to FLTCA s. 23 or RHA s. 60 (4) | Current |
| Long-term care home before 2022 | Long-Term Care Homes Act, 2007 | O. Reg. 79/10 | Superseded | Content carried into O. Reg. 246/22 | No longer current |
The third row is the one operators misread. Supported housing that is neither a licensed retirement home nor a long-term care home is not a "gap" in the law so much as a different regime: the Health Protection and Promotion Act places the duty to superintend the control of infectious diseases on the local board of health, and gives the medical officer of health a written order power.
Which clause imposes the infection prevention and control program?
Long-term care homes
The Fixing Long-Term Care Act, 2021, s. 23 (1) requires every licensee of a long-term care home to ensure that there is an infection prevention and control program for the home. Section 23 (2) then lists the minimum content: evidence-based policies and procedures; an educational component for staff, residents, volunteers and caregivers; daily monitoring to detect the presence of infection in residents; measures to prevent transmission; a hand hygiene program; and any additional matters provided for in the regulations. Section 23 (4) requires the home to have an infection prevention and control lead whose primary responsibility is that program, and s. 23 (5) sends the qualifications to the regulations.
O. Reg. 246/22, s. 102 is where the operational content lives. The regulation requires the licensee to implement surveillance protocols and infection prevention standards issued by the Director (s. 102 (2)); to maintain an interdisciplinary infection prevention and control team that includes the lead, the Medical Director, the Director of Nursing and Personal Care and the Administrator, meeting at least quarterly and more often during an outbreak (s. 102 (4)); to designate a staff member as the infection prevention and control lead with education and experience across infectious diseases, cleaning and disinfection, data collection and trend analysis, reporting protocols, outbreak management, asepsis, microbiology, adult education, epidemiology and program management (s. 102 (5)); and to hold a current infection control certification from the Certification Board of Infection Control and Epidemiology at designation or obtain it within three years (s. 102 (6)).
The staffing floor is fixed in hours. O. Reg. 246/22, s. 102 (15) requires the lead to work on site at the home for at least 17.5 hours per week in a home licensed for 69 beds or fewer, 26.25 hours in a home licensed for 69 to 199 beds, and 35 hours in a home licensed for 200 beds or more — with s. 102 (16) allowing the licensee to require more hours or designate additional leads. Section 102 (9) requires symptom monitoring on every shift.
Licensed retirement homes
The retirement home duty is narrower on its face and broader in its consultation requirement. The Retirement Homes Act, 2010, s. 60 (4), paragraph 2 requires, as a condition of the licence, an infection prevention and control program that meets the prescribed requirements. O. Reg. 166/11, s. 27 (1) ties the program to that paragraph.
The prescribed content turns on the local medical officer of health. Under O. Reg. 166/11, s. 27 (2) the licensee must consult on an ongoing basis — and not less than once a year — with the local medical officer of health or designate about identifying and addressing health care issues in the home in order to reduce the incidence of infectious disease outbreaks. Section 27 (3) requires a written record of that consultation, including when it took place, what was discussed and any recommendations made. Section 27 (4) requires a written surveillance protocol, established in consultation with the medical officer of health, to identify, document and monitor residents who report symptoms of respiratory or gastrointestinal illness.
There is also a data-reporting channel that care-home operators rarely know about. The Retirement Homes Act, 2010, s. 108 (1) (d) lets the Registrar request prescribed information at any time, and O. Reg. 166/11, s. 62.1 prescribes infection prevention and control measures — including the number of active infections and the number of residents and staff who have received a vaccination or immunization against a particular infectious disease. That information must be de-identified before it is given to the Registrar.
Supported and congregate housing
For housing that holds neither licence, the operative provisions sit in public health law rather than in a care-home regulation. The Health Protection and Promotion Act, s. 5 requires every board of health to provide programmes and services in listed areas, and the second of those areas is the control of infectious diseases and diseases of public health significance. Section 22 (1) gives the medical officer of health a written order power: where the statutory conditions are met, the medical officer of health may by written order require a person to take, or refrain from taking, any action specified in the order in respect of a communicable disease.
The Housing Services Act, 2011 structures who delivers housing and homelessness services through service managers; it does not impose an operator-level infection prevention programme requirement comparable to FLTCA s. 23 or RHA s. 60 (4).
What changed when the Long-Term Care Homes Act was repealed?
This is the single largest source of misattribution in English-language care-home content. The Long-Term Care Homes Act, 2007 was replaced by the Fixing Long-Term Care Act, 2021, and its general regulation O. Reg. 79/10 moved with it. O. Reg. 79/10 is therefore not a citation for a current long-term care obligation, and it was never a retirement home instrument.
| Instrument | Belongs to | Status | Correct use in 2026 |
|---|---|---|---|
| O. Reg. 79/10 | Long-Term Care Homes Act, 2007 | No longer current | Historical comparison only |
| O. Reg. 246/22 | Fixing Long-Term Care Act, 2021 | Current | The operative general regulation for long-term care |
| O. Reg. 166/11 | Retirement Homes Act, 2010 | Current | Retirement homes only — never long-term care |
| O. Reg. 211/22 | Retirement Homes Act, 2010 | Current amending regulation | Support amendments to O. Reg. 166/11 |
| O. Reg. 178/24 and O. Reg. 62/25 | Fixing Long-Term Care Act, 2021 | Current amending regulations | Support amendments to O. Reg. 246/22 |
Two traps follow from this table. First, an operator who cites O. Reg. 79/10 in a compliance binder is citing an instrument that no longer applies. Second, an operator who cites the Retirement Homes Act for a long-term care home has swapped the statute of the wrong regulator entirely — the Retirement Homes Regulatory Authority licenses retirement homes, while long-term care homes are licensed and inspected under the Fixing Long-Term Care Act, 2021.
How does the United States side differ for assisted living?
The United States comparison is not "Ontario versus the CDC." It is two different layers, and only one of them is federal.
The federal layer is 42 CFR part 483, subpart B, which sets requirements for long-term care facilities that participate in Medicare or Medicaid. Section 483.80 requires the facility to establish and maintain an infection prevention and control program, and its structure is instructive when read beside FLTCA s. 23. Subsection (a) lists the minimum elements: a system for preventing, identifying, reporting, investigating and controlling infections for residents, staff, volunteers, visitors and contractors; written standards, policies and procedures including a surveillance system, reporting lines, standard and transmission-based precautions, isolation criteria and hand hygiene procedures; an antibiotic stewardship program; and a system for recording incidents and the corrective actions taken. Subsection (b) requires one or more designated infection preventionists with primary professional training in nursing, medical technology, microbiology, epidemiology or a related field, who work at least part-time at the facility. Subsection (f) requires an annual review of the programme. Subsection (g) requires electronic reporting of acute respiratory illness data.
The state layer is where assisted living lives. Assisted living is licensed by states rather than by the federal government, and the licensing instrument differs by state. In California, community care licensing for adult and senior care sits with the Department of Social Services. In New York, adult care facilities are licensed through the Department of Health. In Ohio, residential care and assisted living oversight sits with the Department of Aging. The practical consequence is that a single "United States assisted living infection control requirement" does not exist: there is a federal nursing-facility requirement, and there are fifty state licensure regimes.
| United States setting | Who sets the rule | Instrument to cite | Infection prevention duty |
|---|---|---|---|
| Skilled nursing facility certified for Medicare or Medicaid | Centers for Medicare & Medicaid Services (federal) | 42 CFR 483.80 | Programme required, with named infection preventionist |
| Assisted living, California | California Department of Social Services | Community care licensing, adult and senior care | State licensure conditions and regulations |
| Adult care facility, New York | New York State Department of Health | Adult care facilities | State licensure conditions and regulations |
| Residential care and assisted living, Ohio | Ohio Department of Aging | Ohio Department of Aging | State licensure conditions and regulations |
What does this comparison change on the floor?
The comparison is not academic. It changes four things an operator or a purchaser does.
- Name the instrument on the programme document. A long-term care home's infection prevention programme should cite FLTCA s. 23 and O. Reg. 246/22 s. 102. A retirement home's should cite RHA s. 60 (4) paragraph 2 and O. Reg. 166/11 s. 27. A document that cites the wrong one invites a finding on the first inspection.
- Keep the consultation record, not just the programme. O. Reg. 166/11, s. 27 (3) requires a written record of the annual consultation with the local medical officer of health. The programme itself is not the evidence; the dated record is.
- Match lead hours to licensed bed capacity. The 17.5, 26.25 and 35 hour bands in O. Reg. 246/22, s. 102 (15) are tied to licensed beds, and s. 102 (16) allows the licensee to be required to do more. Staffing plans that predate a bed increase are a common gap.
- Do not import a United States baseline into an Ontario document. A programme built to 42 CFR 483.80 is a reasonable reference point, but it is not the Ontario requirement and cannot be cited as satisfying an Ontario instrument.
- Treat reprocessing separately from the programme. Shared-equipment reprocessing in retirement communities is governed by the reprocessing standards and, for regulated health professions, by the profession's college standard — not by the long-term care instrument. Keeping those in separate sections of the binder is what makes the binder auditable.
For the day-to-day evidence an inspector asks to see, the companion checklist at IPAC inspection evidence for retirement and assisted living residences walks through the records themselves, and the FLTCA and O. Reg. 246/22 infection prevention duties explained article covers the long-term care clause set in depth.
Programme documents are only half of the picture: the other half is the consumable supply that supports them. Isolation gowns, examination gloves and the record-keeping supplies that sit behind a daily monitoring routine are the items that get consumed at a rate the programme predicts. CliniEco Medical stocks Level 2 SMMS isolation gowns for care settings and powder-free nitrile examination gloves for institutional accounts, with case-level supply through the wholesale and institutional account page and consumables grouped by setting in the sterilization and monitoring collection. Compliance reference material for reprocessing sits in the sterilization compliance hub. Teams that need to evidence a monitoring routine can start from a five-pack biological indicator trial pack.
Related Reading
- Ontario long-term care infection prevention duties under the Fixing Long-Term Care Act
- Inspection evidence checklist for retirement and assisted living residences
- Shared-equipment reprocessing in retirement communities under CSA Z314
Related Reading
- Shared-equipment reprocessing in retirement communities
- IPAC inspection evidence for retirement and assisted living residences
- FLTCA and O. Reg. 246/22 infection prevention duties explained
- Wholesale and institutional account page
Frequently Asked Questions
Does a licensed retirement home in Ontario need an infection prevention and control program?
Yes. The Retirement Homes Act, 2010, s. 60 (4), paragraph 2 makes an infection prevention and control program a licensing requirement, and O. Reg. 166/11, s. 27 (1) requires the program to comply with that section. The prescribed content includes an annual consultation with the local medical officer of health and a written surveillance protocol for residents reporting respiratory or gastrointestinal symptoms.
Is the Retirement Homes Act the same as the Fixing Long-Term Care Act?
No. They are separate statutes with separate regulators. The Retirement Homes Act, 2010 governs licensed retirement homes and is enforced by the Retirement Homes Regulatory Authority. The Fixing Long-Term Care Act, 2021 governs long-term care homes and their requirements are set out in O. Reg. 246/22. A building is governed by one or the other according to the licence it holds, not according to the services it happens to offer.
Can I cite O. Reg. 79/10 in a current compliance document?
No. O. Reg. 79/10 was the general regulation under the Long-Term Care Homes Act, 2007, which is no longer current law. The operative general regulation for long-term care is now O. Reg. 246/22 under the Fixing Long-Term Care Act, 2021. O. Reg. 79/10 is useful for historical comparison and is not a live obligation.
How many hours must a long-term care home's infection prevention and control lead work?
O. Reg. 246/22, s. 102 (15) sets minimums of at least 17.5 hours per week in a home licensed for 69 beds or fewer, 26.25 hours per week in a home licensed for 69 to 199 beds, and 35 hours per week in a home licensed for 200 beds or more. Section 102 (16) allows the licensee to require more hours or to designate additional leads, without reducing the original obligation.
Does Ontario require a retirement home to report infection counts to the regulator?
The Registrar may request prescribed information at any time under the Retirement Homes Act, 2010, s. 108 (1) (d), and O. Reg. 166/11, s. 62.1 prescribes infection prevention and control measures including the number of active infections and the number of residents and staff who have received a vaccination or immunization against a particular infectious disease. That information must be de-identified before it is given to the Registrar.
Do United States assisted living facilities follow 42 CFR 483.80?
42 CFR 483.80 applies to long-term care facilities that participate in Medicare or Medicaid. Assisted living is a state-licensed category, so an assisted living residence follows its state's licensure conditions and regulations rather than the federal nursing-facility requirement. Reading the federal clause as an assisted living rule is a category error.
What about housing that is neither a long-term care home nor a licensed retirement home?
Those settings are regulated mainly through public health law. The Health Protection and Promotion Act, s. 5 requires each board of health to provide programmes and services for the control of infectious diseases, and s. 22 (1) gives the medical officer of health a written order power in respect of a communicable disease where the statutory conditions are met. There is no operator-level program clause equivalent to FLTCA s. 23 or RHA s. 60 (4).
Does an infection prevention programme written to United States requirements satisfy Ontario obligations?
No. A programme built around 42 CFR 483.80 is a reasonable reference document, but Ontario's obligations run from Ontario instruments. A long-term care home should cite the Fixing Long-Term Care Act, 2021, s. 23 and O. Reg. 246/22, s. 102; a retirement home should cite the Retirement Homes Act, 2010, s. 60 (4) and O. Reg. 166/11, s. 27. Cross-referencing is useful; substituting is not.
Sources
- Fixing Long-Term Care Act, 2021, S.O. 2021, c. 39, Sched. 1 — s. 23 infection prevention and control program; s. 146 annual inspection; s. 147 unannounced inspections; s. 152 inspection report; s. 180 publication of reports.
- O. Reg. 246/22, General, under the Fixing Long-Term Care Act, 2021 — s. 53 required programs; s. 102 infection prevention and control program; s. 168 continuous quality improvement report; s. 271 website requirements; s. 351 protection of privacy in reports.
- Retirement Homes Act, 2010, S.O. 2010, c. 11 — s. 60 (4) licensing standards; s. 108 (1) (d) Registrar's information request; Part V inspections.
- O. Reg. 166/11, General, under the Retirement Homes Act, 2010 — s. 27 infection prevention and control program; s. 62.1 Registrar requests for information.
- O. Reg. 79/10, General, under the Long-Term Care Homes Act, 2007 — historical instrument, no longer current.
- Health Protection and Promotion Act, R.S.O. 1990, c. H.7 — s. 5 mandatory health programmes and services; s. 22 (1) order by medical officer of health.
- Housing Services Act, 2011, S.O. 2011, c. 6, Sched. 1 — service delivery structure for housing and homelessness services.
- Retirement Homes Regulatory Authority — licensing authority for retirement homes in Ontario.
- RHRA: understanding the Act — the Authority's own description of its statutory role.
- RHRA: applying for a licence — licensing conditions for operators.
- RHRA: retirement home database — public register of licensed retirement homes.
- Public Health Ontario: infection prevention and control for long-term care — provincial guidance index for long-term care settings.
- Public Health Ontario: guidance for cleaning, disinfection and sterilization in all health care settings — provincial reprocessing guidance.
- Ontario: about long-term care — provincial programme description.
- Ontario: find a long-term care home — public home search.
- 42 CFR 483.80 Infection control — federal requirements for long-term care facilities.
- 42 CFR 483.10 Resident rights — resident rights in certified facilities.
- 42 CFR 483.20 Resident assessment — assessment requirements in certified facilities.
- California Department of Social Services: community care licensing, adult and senior care — state licensure for assisted living.
- New York State Department of Health: adult care facilities — state licensure for adult care facilities.
- Ohio Department of Aging: divisions and offices — state residential care oversight.
- Public Health Ontario: infection prevention and control programme index — provincial infection prevention and control resources across care settings.
CliniEco Medical is a Canadian supplier of sterilization monitoring and infection prevention consumables, licensed under MDEL #35334. This article describes regulatory requirements and does not constitute legal or compliance advice; operators should confirm current requirements against the instruments cited above.
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