Pressure mounts for more answers on Ford government's controversial long-term care bill

The Ford government is facing mounting pressure to clarify how a new piece of health-care legislation could affect Ontario families, since it would allow hospital patients to be moved to a long-term care facility not of their choosing or potentially face hefty daily fees.

The spotlight comes just as the government moved a motion to advance the bill directly to third reading — which means it will not be considered by committee or subject to public hearing at that stage.

Long-term Care Minister Paul Calandra tabled Bill 7 last week. The legislation would give hospitals the authority to temporarily move patients no longer needing acute care into long-term care homes chosen by a placement co-ordinator. Hospitals would be required to make "reasonable efforts" to obtain patient consent, but the text of the bill says it could be done without consent if necessary.

The legislation has come under scrutiny this week from opposition parties and some health-care experts, who have raised concerns about its vague wording and questioned how it could ultimately impact patients and their families.

"The government has provided no clarity. And they are talking about moving people, possibly far away from their families and their support. You know, we're not moving livestock around here, it's not cattle. They are people. They are vulnerable," said interim Liberal Leader John Fraser at Queen's Park this morning.

Fraser and fellow Liberal MPP Dr. Adil Shamji held a news conference to air their own concerns about Bill 7 and encourage the Progressive Conservative government to withdraw the bill as it is written.

The Liberals said they have been told that, in Northern Ontario, a patient could be moved to a long-term care facility up to 300 km away. In much of southern Ontario, patients could be moved 100 km away from their homes, while in cities it could be up to 30 km, Shamji said. 

"It is actually cruel that the government is being so damn vague. There is no reason for it," Fraser said.

Situation 'demands action,' LTC ministry says

Calandra's office neither confirmed nor denied the Liberal allegations when asked to comment by CBC Toronto. But in an email response Thursday evening, the minister's press secretary, Jake Roseman, did say "the situation in our hospitals and acute care demands action."

Roseman added that the number of patients occupying hospital beds who no longer need acute care is the highest "ever recorded in Ontario's history," and that the ministry is consulting with stakeholders, "including LTC homes, LTC home and resident and family council associations, and health system planning and service delivery agencies."

"These consultations will inform the new regulations around geographic distance and field guidance," Roseman's statement reads.

The bill is part of a larger plan first announced two weeks ago by Health Minister Sylvia Jones to help ease pressures on the health-care system. Proposed changes aim to hire more health professionals, free up hospital beds and reduce surgical wait lists as emergency departments across the province close their doors for hours or days at a time due to staff shortages.

An especially controversial element of the legislation is exactly what steps hospitals could take if patients refuse to be transferred to a long-term care home not of their choosing. The legislation doesn't allow patients to be physically forced to move, but it's not clear what would happen if a patient refuses a transfer.

How hospitals can charge patients 

In an interview with CBC Radio's Metro Morning on Thursday, Dr. Samir Sinha, head of geriatrics at Sinai Health and the University Health Network in Toronto, explained how the current system works.

Patients list several long-term care homes they would consent to move to after they no longer require hospital care, he said. If the patient is accepted into one of those facilities, but cannot be moved right away, the hospital will charge about $62 per day for the interim period, the same co-pay amount the patient would face in long-term care.  

If the patient deemed no longer in need of acute care refuses to consider alternative facilities for care or to move after being accepted to one of their preferred long-term care choices, a spokesperson for the hospital network added, a hospital can formally discharge them and bill the uninsured daily rate.

That can be $1,500 or more per day. 

"Often, the discussion about the cost of remaining in an acute care bed is enough to start the discussions needed to support someone in an [alternate level of care] environment," said UHN senior public affairs adviser Rosa Kim. 

Unclear from the existing text of the legislation, however, is if a long-term care facility chosen by a placement co-ordinator for a patient then becomes a preferred choice, even if the patient has no interest in going there.

During a scrum at Queen's Park Wednesday, Calandra endorsed hospitals charging uninsured daily rates to patients who refuse to be transferred to a facility of their choice, saying the beds are needed for others.

"If someone refuses to move into a home, if someone refuses to move into a home of their preferred choice, then yes, should a hospital charge them? Absolutely. Because we need those spaces for patients who need acute care. We need them for surgery, we need them for emergency rooms," he told reporters.

Fraser said the looming threat of a steep bill should not be used to coerce patients to move into long-term care homes they have not chosen.

"The government needs to say — unequivocally — that this will not happen," he said.

Over 2,000 in hospital waiting for LTC bed: hospital association

According to the Ontario Hospital Association (OHA), there were 5,930 "alternate level of care" patients in hospital as of Aug. 17, of which 2,400  — 40 per cent — are waiting for an LTC bed. 

Anthony Dale, the president and CEO of the association, said this figure also includes hundreds of patients in reactivation centres — a level of care that was created a few years ago to "temporarily" address hospital capacity pressures.

"This is the highest number of ALC patients ever recorded in Ontario," said Dale in a statement.

Dale said capacity challenges are affecting all patients, including people who need urgent care, surgical procedures and diagnostics. He said the OHA supports the Ford government's new plan, particularly as hospitals head into the colder months, as it will "help maintain access to health services" for what's expected to be another challenging period.

"Ontario's hospitals are rapidly becoming the health-care provider of last resort for thousands of people who actually need access to home care, long-term care and other services. This is not appropriate for these patients."

But Bill VanGorder, the chief operating officer and chief policy officer for the Canadian Association of Retired Persons, said he was hoping to have a say at public meetings along with other advocacy organizations like the Seniors for Social Action Ontario and the Advocacy Centre for the Elderly.

He said his members have real concerns about the bill and its approach to easing pressures in hospitals and long-term care.

"It's looking at them from a system point of view, not from the point of view of the patient themselves," he said.

What comes next? 

The bill is currently in its second reading. No committee meetings have been scheduled to gather public input on it.

Sinha said he is already hearing from concerned patients and their families about what the bill could mean for them moving forward.

"They are scared. They are worried," Sinha told CBC Radio's Metro Morning on Thursday.

Because the proposed bill theoretically could see patients moved to long-term care facilities not of their choice, without their consent, or face crushing daily fees, it would leave many families in "horrific situations," Sinha said.

"This will only strain relationships and engender less trust between health professionals and their patients, between hospitals and patients."