Elderly patients forced into long-term care

Here are the facts about the new legislation from the Ontario Conservative government of Doug Ford, Bill 7 – More Beds and Better Care Act of 2022, which was introduced in the Legislative Assembly of Ontario last week and is currently being debated. The government has made a series of claims, some of which have been printed in the mainstream media, which do not correspond to the facts. Here are the facts:

  1. There are 38,000 people waiting for a long-term care (LTC) home in Ontario. The reason there are Alternate Level of Care (ALC) patients in hospitals waiting for LTC is the LTC waiting list. The only long-term care homes that don’t have long waiting lists are the ones where people don’t want to go.
  2. The pandemic has exposed horrific care and living conditions in some long-term care homes. Despite numerous promises, accountability for exposed operators for providing such substandard care has not materialized. There were no fines for lack of care. No license has been revoked. Full annual inspections of all homes have not been reinstated. Many people are afraid to go to homes that have a history of poor legal compliance and poor outcomes during the COVID-19 pandemic. These are the homes that have spaces that patients could be forced into.
  3. In fact, the majority of “ANS patients” do not wait for long-term care. Many ALC patients are waiting for another type of hospital care (rehabilitation, complex continuing care, mental health beds) for which all hospital beds are full. Targeting a population of patients (the elderly and people with chronic illness/disability) and suspending their fundamental rights is discriminatory. They have an equal right to health care as a patient waiting in the emergency department or an ALC patient waiting for rehabilitation. Their lives have value and their needs are legitimate. Moreover, the claim that a significant portion of ALC patients wait for home care is false. Generally, patients are now being discharged to wait at home for home care. Proponents have raised concerns about this “wait-at-home” strategy because patients may be promised home care that does not materialize.
  4. After decades of downsizing, Ontario has the fewest hospital beds per capita from any province in Canada. In fact, Canada ranks very low among all OECD countries in terms of hospital beds per capita, and Ontario is near the bottom of the OECD scale. The Ontario government’s hospital downsizing policy is one of the most sweeping in the developed world and has had a serious impact on patients. Ontario funds its hospitals at the lowest rate in Canada. (Funding of hospitals by the provinces as a proportion of the GDP and per person.) Patients are not responsible for the lack of proper health care planning and resources. The result is that the competition for scarce resources has been devastating for the elderly and those with chronic needs.
  5. The new legislation clearly, openly:
    • Suspends the informed consent requirement;
    • Allows hospital doctors and nurses to assess the eligibility of any ALC patient (not necessarily just those waiting for long-term care) for long-term care without their consent;
    • Allows the placement coordinator to share the patient’s personal information with any long-term care home without consent;
    • Allows the completion of the patient’s request for long-term care without consent; and
    • Allows the patient to be admitted to any long-term care home without their consent.

This legislation sets a tone – a tone of discrimination and coercion – that is very dangerous. Elderly and disabled patients are often already under unacceptable levels of pressure as hospitals seek to free up beds in a competition for too few resources. This legislation gives them a new tool – express powers to revoke consent.

  1. The Current Situation: Patients have the right to choose up to five (5) long-term care homes and rank them by preference. (If the patient has been considered a “crisis”, he can make an unlimited number of choices.) When a bed becomes available in one of the homes he has chosen, he is discharged and must be admitted to this foyer.
  2. The right to consent is fundamental in clinical practice. Targeting older people and people with disabilities to violate this right is, in our view, a violation of their fundamental rights. In Ontario, the Health Care Consent Act and the Fix the long-term care law codify the requirement of informed consent in the admissions process.
  3. The Health Insurance Act authorized since 1996 the imposition of a “chronic care co-payment” on hospitalized patients awaiting placement in a long-term care home. (See p. 16 here for a summary of the Harris government’s Bill 26, an omnibus bill, passed in 1996, introducing new co-payments for inpatients in chronic care and patients waiting for long-term care.) The co- maximum payment equals the basic accommodation rate in a long-term care home. Nothing in Bill 7 changes that. Claims that the bill allows hospitals to charge for this co-payment are false. They could, and did, for decades.
  4. It is clear that hospitals cannot use physical force or restraint to transport a patient to a long-term care home. That would violate a whole host of laws. However, if a patient refuses a valid offer of admission – which will now include a long-term care home they did not choose and which may be remote, culturally inappropriate, unsanitary or in which the patient is afraid of go – the hospital may charge them an uninsured bed fee (usually $1,200 to $1,500 per day) for not leaving the hospital. If the Minister of Long Term Care is honest and serious when he says it will not happen, he needs to change his own law to ban it. Bill 7 does nothing to prevent that from happening.
  5. There is an unprecedented staff crisis in long-term care and in our public hospitals. We do not accept the validity of the claim that it is in the interest of patients to move them against their will to a home which is not of their choice, which may be remote or inaccessible to their families and supports, which is culturally inappropriate, and is almost certainly a house that people don’t want to go to, and is probably understaffed.
  6. Our public hospitals do not only provide acute care. This has never been the case. Hospitals provide chronic (complex continuing) care, rehabilitation beds, mental health care, palliative care, restorative care, and a range of other valid and important levels of care. Acute care is important; however, it is not more important than the other levels of care. Hospitals are not “acute care facilities”. “Eliminating patients” or “patients taking beds” are discriminatory, age-based, values-based statements that are unacceptable and cause enormous suffering.
  7. Nothing in this bill provides for better home care, primary care, assisted living and other care to prevent hospitalization and support Ontarians’ choice to live at home.

This bill was introduced without warning and tabled only a week ago. We understand that the government has no intention of sending this to committee hearings. Instead of holding public hearings and changing the law, the Ford government introduced a time allocation motion and is using its majority to quickly pass it, thereby limiting debate. The result is that new legislation can pass with only two hours of debate for second reading and two hours of debate for third reading. Additionally, second and third readings can be scheduled, voted on, and passed in a single day. This process is deeply undemocratic. •

The Ontario Health Coalition is made up of a board of directors, board committees as approved in the coalition’s annual action plan, local coalitions, member organizations and individual members. The Ontario Health Coalition represents over 400 member organizations and a network of local health coalitions and individual members. Follow their tweets on @OntarioHealthC.

About Antoine L. Cassell

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