Advocates are preparing for legal battles against Ontario’s plan to move elderly and chronically ill from hospitals to long-term care homes, as lawyers warn the proposed change is a violation of patients’ human rights.
under The legislation was unveiled last weekHospital patients who no longer require acute care, but who still require an ‘alternative level of care’, may be admitted to the chosen LTC home without their input – likely to be away from family members and loved ones who play a critical role in their care daily.
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Long-Term Care Minister Paul Calandra initially said that no patients would be forced to go into a home they did not want to live in, but he has since said those who refuse placement You must pay the hospital fee for their continued residence.
Doctors, lawyers and human rights advocates say the government’s plan will force patients to make an impossible choice: live in a place they don’t want to, or suffer the consequences.
Here’s a closer look at what can – and can’t – happen under Ontario Government Bill 7, The More Family, Better Care Act.
What would the legislation, if passed, actually do?
When the attending physician believes that the patient no longer requires hospital care, and can have an “alternative level of care,” he or she will be able to ask a long-term care coordinator to begin the admissions process to the LTC home.
The placement coordinator needs to make “reasonable efforts” to obtain consent from the patient or the surrogate decision maker—which may be a spouse, child, or other caregiver—before:
- Determine patient eligibility for long-term care.
- Choosing an LTC home.
- Share private medical information with the home licensee.
- Enable the licensee to consent to the admission and to accept the patient upon arrival.
The legislation does not specify what those “reasonable efforts” should include, and makes clear that these steps can be taken without consent.
However, consent is required to physically transfer the patient to a long-term care home.
What happens if someone refuses to give consent?
Although the legislation states that a patient cannot be physically transferred without their consent, they may feel they have little choice, given the potential consequences of refusal.
Advocates and doctors say some hospitals already have policies in place where patients who refuse to go to a long-term care home are instead discharged to a shelter or to a family member, who may have little capacity to care for them.
Jane Meadows, an attorney and advocate for the Center for Elderly Advocacy, has seen clients who have been threatened with hospital bills of up to $1,800 a day for ongoing care.
Meadows says she believes the government’s plan will force the elderly and other vulnerable people to give their consent. “If people come up and threaten you with things, people get scared and they’ll move on.”
Trudo Lemmens, professor of health law and policy at the University of Toronto, says the legislation appears to violate patients’ human rights, as well as requirements for informed consent, under which consent must be voluntary.
“Even if the government claims that this gives people a choice, this is clearly structural coercion,” he said.
How does the LTC process normally work?
Usually, when a patient or caregiver thinks Apply to LTCthey can choose up to five homes to be put on the waiting list.
Key factors in making a decision can include proximity to family, as well as cultural or societal ties.
“I often care about people who suffer from racism, who probably don’t speak English as their first language,” said Dr. Amit Arya, MD, a palliative care physician and assistant clinical professor at McMaster University in Hamilton.
“If you walk into a facility where people serve the food you relate to, the staff speak the language you understand, and celebrate the religious and cultural holidays that matter to you, of course you will do much better in that long-term care home. And I feel very strongly that it was worth the wait.”
Others will consider who owns an LTC home, including whether it is public, nonprofit, or privately owned, the level of care it provides, and other amenities provided.
Palliative care physician Dr. Amit Arya says patients’ health will suffer more if they are moved from a hospital to a long-term care facility where they don’t get the right quality of care.
What homes will patients be sent to?
The government says it will put in place “mandatory guidelines … to ensure patients continue to stay close to partner, spouse, relatives or friends”. But she has not yet revealed any details.
Arya reiterated that it is important for patients to remain close to family members, who often perform daily tasks at the LTCs, such as feeding, bathing and administering medications.
“Not having a close support network can worsen your health outcomes and even lead to premature death in its own right,” he said.
Given the long waiting times for many LTCs, disease advocates fear that patients will end up in homes with only beds available because their living conditions are less than desirable.
“What people are not asking people to go into are often older for-profit houses; many who have had some of the worst reputation during the pandemic. … How do you force someone into this bed that they don’t want to get into? You are?” said Dr. Sameer Sinha, Director of Geriatrics. At Sinai Health System in Toronto: “We’re going to make legislation like this.”
Calandra said patients will be moved temporarily, “while they wait for a bed to be available in their preferred home,” although there is no guarantee for this written in the legislation. Experts say this comes with additional risks.
“Temporary, at this point in life, actually becomes dangerous. Because what happens, especially with cognitive decline, is that any movements come with an increased risk of death,” said Tamara Daly, director of the Center for Aging Research and Education at the University of York.
Will this make the LTC crisis worse?
The government did not respond to questions about additional funding or other resources that would accompany its plan.
Ontario Long-Term Care Association (OLTCA), which represents most LTC homes in the province, He said in a statement That LTC homes desperately need more staff, especially registered nurses and personal support workers.
Advocates want to see the government expand access and resources for home care and community services, which would enable more patients to stay at home or with their loved ones, while also easing pressure on the sector.
When will it come into effect?
The exact date is unclear, but the government – which has a majority – is currently speeding up the bill through the Ontario legislature.
The Department of Health and Long-Term Care has confirmed to CBC Toronto that 200 people who have been in hospital for six months, waiting for LTC beds, will be transferred over the next three months, totaling 1,300 by March 2023.
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