$400 fees, long-range patient transfers: What you need to know about Ontario's new long-term care rules

Ontario hospital patients awaiting spots in long-term care can be moved to nursing homes not of their choosing up to 150 kilometres away, with charges of $400 per day if they refuse, the province announced Wednesday.

Starting next Wednesday, patients in southern Ontario can be moved up to 70 kilometres away, while those in northern Ontario may be moved up to 150 kilometres away, Health Minister Sylvia Jones and Long-Term Care Minister Paul Calandra said.

Beginning on Nov. 20, hospitals will be required to charge patients who have been discharged by their doctor and refuse to be moved to a home not of their choice a daily fee of $400.

Jones said discharge planners will have to have "very challenging" conversations with patients about going into a home that they do not want to go to.

"Those conversations include 'Yes, we will need to charge if you refuse to take the long-term care bed that we have found for you,"' Jones told reporters.

"That part is to, frankly, make sure that people understand a hospital bed is for an acute patient, it is not for long-term care patient."

The ministers said the policy will only affect patients who are awaiting discharge from hospital and whose preferred long term care homes do not have available spots.

The changes will be reflected in regulations for the new law, which have not yet been made public. Until Wednesday, few details had been provided on how the law would work.

The province introduced legislation last month to allow hospitals to send so-called alternate level of care patients to a long-term care home not of their choosing on a temporary basis.

The province has said there are about 1,800 of those patients currently in hospital awaiting a spot in one of their five preferred choices in a long-term care home.

Legislation has sparked outrage

The bill, which was pushed through the legislature without public hearings, has sparked outrage from seniors and advocates.

The regulations announced Wednesday are part of an effort to free up hospital beds as the health-care system grapples with temporary emergency room closures and a massive surgical backlog.

Hospital emergency departments across the province have been closed for hours or days at a time in recent months, largely due to a nursing shortage.

Calandra said the distances will be calculated based on the location of a patient's preferred home.

"This gives us the maximum amount of flexibility so that we can put on the table for patients in hospital who want to transition into better quality care to long-term care more options available to them," he said.

In northern Ontario, if there are no nursing homes are available within 150 kilometres, the legislation allows hospitals to look at the next closest home outside the boundary with empty beds.

Patients who are moved into homes they do not want to go to will remain on the priority list for their preferred long-term care home, Jones said.

Couples will remain together and the government is working on a guidance document to respect religious, ethnic and language preferences.

First Nations homes will also be exempted, Calandra said.

New law designed to free up beds, minister says

The provincewide average length of stay in emergency departments before being admitted to hospital is 20.7 hours, according to Ontario Health data. Only 24 per cent of patients are admitted to hospital from emergency rooms within the target time of eight hours.

Jones said the new law will free up hospital beds, but wouldn't say how many or how it would affect emergency department wait times.

"If we can deal with a percentage of the alternative level of care patients in the province of Ontario, it will give us some flexibility and frankly, the ability to admit people sooner when those beds are available," she said.

Changes will put strain on seniors, NDP says

NDP long-term care critic Wayne Gates said the changes will put a strain on seniors and their caregivers.

"I think it's absolutely heartbreaking that they're going to expect our seniors and their families to travel 70 kilometres," he said, referring to the distance for patients in southern Ontario.

"Do not force seniors to go 70 kilometres away from their families. They need their families, they need their spouses."

Calandra said they want to keep residents "as close as possible" to their preferred long-term care home.

Placement co-ordinators would select long-term care homes within a radius of 70 kilometres from the patient's preferred location, except in the north, where the radius would be 150 kilometres.

Province punishing elders, Green Party leader says

Mike Schreiner, Ontario Green Party leader, said in a statement on Wednesday that older people should not be punished for the province's failure to invest in the health-care system.

"It is wrong to force elders to pay $12,000 per month if they refuse to go to an LTC home not of their choosing and far from family," Schreiner said.

"It is shameful to gaslight seniors and lead them to believe that the crisis in our hospitals is their fault. And moving them away from their loved ones and caregivers is actually going to worsen the staffing crisis by putting extra pressure on our already overworked PSWs and LTC staff.  Without question, this is going to put elders at risk."

Schreiner said the provincial government should do the following to treat people in long term care with dignity:

• Make investments in home care, which would allow people to receive care and age at home.
• Address the staffing crisis, with the first step being the repeal of Bill 124.
• Investing in not-for-profit long term care homes across the province.

As for the Ontario Liberals, interim leader John Fraser said the regulations will trample on the rights of seniors.

"The greater the distance you separate families, the greater the hardship."