Public Guardians and Trustees: The Unseen Decision-Makers in Long-Term Care

October 13, 2025 | Varsha Chaugai

In Ontario's long-term care system, residents without capable family members or appointed powers of attorney often fall under the oversight of the Office of the Public Guardian and Trustee (PGT). While the PGT plays a vital legal role in protecting vulnerable individuals, the reality on the ground is that their involvement can be inconsistent, distant, and frustrating for care teams. Many LTC staff find themselves chasing signatures, waiting on decisions, and navigating unclear lines of accountability—delays that can hinder care and strain staff time.

This article unpacks the role of PGTs in long-term care, their legal responsibilities, the barriers they introduce to effective care planning, and, most importantly, what homes can do to keep them engaged. We also compare how other Canadian provinces handle public guardianship and list key differentiators.

In Ontario, the PGT operates under the Substitute Decisions Act and Health Care Consent Act, assuming decision-making authority for individuals who are mentally incapable and have no family or friends to act on their behalf. The PGT becomes involved in two main areas:

• Property Management: Overseeing finances, payments, and legal affairs
• Personal Care Decisions: Making or approving decisions related to medical care, housing, safety, and hygiene

While the PGT is legally obligated to act in the best interest of the individual, their high caseloads and bureaucratic structure often lead to delayed responses, missed communications, and minimal proactive engagement with care homes.

PGTs are often viewed as absent stakeholders. In many cases, staff must send multiple faxes or emails to secure a consent form or health directive. This delays care, frustrates team members, and creates unnecessary compliance risk. Consider:

• Delayed Medical Procedures: Residents may wait days for approval on tests or treatments.
• Bottlenecks in Consent: Seasonal vaccinations or care conferences can stall due to unreturned calls.
• Zero Family Engagement: Unlike typical POAs or family members, the PGT is not emotionally invested in the resident, which can lead to lower-quality decisions or missed nuance in care preferences.

Understanding their obligations helps LTC homes hold them accountable. Under Ontario law, the PGT must:

• Provide informed consent on behalf of the resident when required
• Be consulted for major changes in care or housing
• Respond in a timely manner to requests, though "timely" is not well defined

While LTC homes are often left frustrated, the onus is on them to document outreach efforts and escalate when necessary to comply with provincial standards like the Fixing Long-Term Care Act, 2021.

To ensure smoother workflows and protect resident well-being, homes can implement the following strategies:

• Centralize All Communication:
  Use a digital platform like Engage⁺  to log, track, and time-stamp all communication with PGTs. This not only provides a full audit trail for compliance but also allows for proactive follow-ups when timelines are missed.
• Automate Routine Requests:
  Platforms integrated with PointClickCare can automate outbound messages for vaccine consents, care conference scheduling, and billing approvals. This reduces the manual load and keeps records consistent.
• Flag High-Risk Residents:
  Use internal protocols to flag residents with PGTs and create escalation workflows. Assign a team lead or social worker to monitor all interactions and ensure no request slips through the cracks.
• Schedule Annual Check-ins:
  While PGTs are unlikely to initiate contact, homes can proactively request quarterly or annual reviews via secure digital communication to preempt delays during critical care windows.
• Build Relationships with Regional PGT Officers:
  Establishing rapport with assigned officers can lead to faster turnaround times and greater trust. Even minimal engagement helps distinguish your LTC home as organized and proactive.

British Columbia – Public Guardian and Trustee of BC

• Differences: Generally regarded as more accessible, with clearer regional contacts
• Strengths: Website offers direct forms for health care decision-making and financial management
• Challenges: Still reliant on paper processes; no mandated integration with LTC systems

Alberta – Office of the Public Guardian and Trustee

• Differences: Operates with greater transparency in care decisions, including participation in care conferences when possible
• Strengths: Alberta's Advance Care Planning (ACP) encourages early designation of POAs to minimize PGT involvement
• Challenges: Regional disparities in response times

Manitoba – Manitoba Public Guardian and Trustee

• Differences: Primarily reactive; does not participate proactively in resident care
• Strengths: Financial management processes are streamlined
• Challenges: No standardized consent forms for LTC-specific events like vaccination or outing approvals

Doing nothing about poor PGT communication has tangible costs:

• Compliance Risks: Lack of documentation for consents and updates can trigger Ministry audits or family complaints
• Staff Burnout: Chasing responses and re-explaining basic care needs eats into valuable care time
• Resident Risk: Delays in decision-making can lead to poorer health outcomes and reduced quality of life

Engage⁺ offers long-term care homes the infrastructure to manage all substitute decision-maker communication in one centralized system. With:

• Automated messaging for routine approvals
• Time-stamped message logs to support compliance
• Consent form distribution and tracking
• Audit-ready documentation

...your staff spends less time chasing signatures and more time on care.

While the PGT plays a necessary legal role, their communication model is out of step with the fast-paced, high-stakes environment of today’s LTC homes. By adopting proactive strategies and modern communication platforms, homes can reduce frustration, safeguard resident care, and ensure legal compliance.

Don't let outdated systems delay the care your residents deserve. Consider how Engage⁺ can bridge the gap, ensuring that even when families aren’t present, their rights and well-being are still protected.