Advocates are gearing up for legal battles against Ontario’s plan to move elderly and chronically ill patients out of hospitals and into long-term care homes, with lawyers warning the proposed change is a violation of human rights of the patients.
Under law presented last weekHospital patients deemed no longer in need of acute care but still in need of an “alternative level of care” could be admitted to a LTC home of their choice without their intervention, potentially away from their family and loved ones a critical role. in their day to day.
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Long-Term Care Minister Paul Calandra initially said no patient would be forced into a home they didn’t want to live in, but has since said those who refuse a placement. should pay the hospital expenses for his continued stay.
Doctors, lawyers and advocates say the government’s plan would force patients to make an impossible choice: live in a place they don’t want or suffer the consequences.
Here’s a closer look at what can and can’t happen under the Ontario government’s Bill 7, the More Beds, Better Care Act.
What would the law actually do, if passed?
When an attending physician believes that a patient no longer needs hospital care and could be eligible for an “alternative level of care,” he or she may ask a long-term care placement coordinator to begin the home admission process of LTC.
The placement coordinator must make “reasonable efforts” to obtain the consent of a patient or their surrogate, which may be a spouse, child or other caregiver, before:
- Determine patient eligibility for long-term care.
- Selection of an LTC house.
- Share private medical information with the home licensee.
- Empower the license holder to approve admission and admit the patient when they arrive.
The Ontario government’s plan would make it easier for hospitals to discharge eligible patients to long-term care homes. Here, a person is seen outside a long-term care home in Toronto on April 9, 2020. (Evan Mitsui/CBC)
The legislation does not specify what these “reasonable efforts” should entail and makes it clear that these steps can be taken without consent.
However, consent is required to physically move the patient to a long-term care home.
What if someone refuses to give consent?
Although the law says a patient cannot be physically transferred without their consent, they may feel they have little choice, given the potential consequences of refusing.
Advocates and doctors say some hospitals already have policies where patients who refuse to go to a long-term care home are discharged to a shelter or to a family member, who may have little ability to attend to them
Jane Meadus, an attorney and advocate for the Advocacy Center for the Elderly, has seen clients who were threatened with hospital bills of up to $1,800 a day for continued care.
Jane Meadus, an attorney and advocate for the Advocacy Center for the Elderly, says she has seen patients who refused to go to a long-term care home threatened with massive hospital bills, among other penalties. (David Common/CBC)
Meadus says he believes the government’s plan will force seniors and other vulnerable people to give their consent. “If people come in and threaten you with things, people are afraid and they’ll move.”
Trudo Lemmens, a professor of health law and policy at the University of Toronto, says the legislation appears to violate patients’ human rights as well as informed consent requirements, under which consent must be voluntary.
“Even if the government can pretend that this is giving people a choice, it’s clear that this is structural coercion,” he said.
How does the LTC process normally work?
Usually when a patient or their caregiver is considering it applying for LTCthey can choose up to five homes to be on the waiting list.
Key factors in this decision-making may include proximity to family, as well as cultural or community ties.
“I’m often taking care of people who are racialized, people who may not speak English as a first language,” said Dr. Amit Arya, a palliative care physician and assistant clinical professor at McMaster University in Hamilton.
“If you walk into a facility where people serve food that you relate to, the staff speaks a language you understand, they celebrate the religious and cultural holidays that are important to you, of course you will do much better during this long time…temporary care home. And I strongly believe it’s worth the wait.”
Others will consider who owns a LTC home, including whether it is public, nonprofit, or privately owned, the level of care it provides, and other services it provides.
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Palliative care physician Dr. Amit Arya says patients’ health will suffer more if they are transferred from a hospital to a long-term care facility where they don’t receive the right quality of care.
To which homes will the patients be sent?
The government says it will create “mandatory guidelines… to ensure patients remain close to a partner, spouse, loved ones or friends”. But he hasn’t revealed any details yet.
Arya reiterated that it is important for patients to remain close to family members, who often carry out day-to-day tasks in LTCs, such as feeding, bathing and administering medications.
“Not having your support network nearby can worsen your health outcomes and even lead to premature death in and of itself,” she said.
Given the long wait times for many LTCs, advocates fear that patients will end up being discharged to homes with only available beds because their living conditions are less than desirable.
“What people aren’t asking to get into are mostly older for-profit homes, many of which had one of the worst reputations during our pandemic… How do you force someone into that bed they don’t want to get into? create a legislation like this,” said Dr. Samir Sinha, director of geriatrics at Sinai Health System in Toronto.
Ontario Long-Term Care Minister Paul Calandra says hospitals “must” charge patients who refuse to go to a long-term care home that isn’t one of their preferences. (Chris Young/The Canadian Press)
Calandra has said patients would be moved temporarily, “while they wait for an available bed in their preferred home,” though there’s no guarantee that would be written into the legislation. And experts say that brings additional dangers.
“The storm, at this stage of life, becomes really dangerous. Because what happens, especially with cognitive decline, is that any movement carries with it an increased risk of death,” said Tamara Daly, director of the Research Center and Education from York University.
Will this worsen the LTC crisis?
The government did not respond to questions about what additional funds or other resources would accompany its plan.
The Ontario Long-Term Care Association (OLTCA), which represents the majority of LTC homes in the province, said in a statement that LTC homes urgently need more staff, especially registered nurses and personal support workers.
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Ontario’s plan to help solve its hospital bed crisis by moving some elderly patients out of hospitals and into long-term care homes is targeting “the wrong pocket of patients,” says Jana Ray of the of defense of the elderly CanAge.
Advocates want the government to expand access and resources for home care and community services, which would allow more patients to stay at home or with their loved ones, while easing pressure on the sector.
When will it come into effect?
The exact date is unclear, but the majority government is rushing the bill through the Ontario Legislature.
The Ministry of Health and Long-Term Care confirmed to CBC Toronto that 200 people who have been in hospital for six months, waiting for LTC beds, will be moved over the next three months, with a total of 1,300 moved by March 2023.