Ontario seniors to pay $400/day to stay in hospital instead of moving to LTC

The Ontario government says hospital patients who are waiting for space in long-term care homes can be moved to other locations not of their choosing up to 150 kilometres away or be billed $400 per day if they refuse.

Bill 7, also known as the “More Beds, Better Care Act,” allows for the temporary transfer of senior hospital patients waiting for space in a long-term care home to another home not of their choosing. It received royal assent at the end of August.

Advocates have previously indicated concern, saying that seniors would be transferred to long-term care homes far away from family, or that they would be charged exorbitant fees to remain in hospital if they choose to refuse the offer.

As part of the new rules released Wednesday afternoon, the government set firm guidelines as to how far a patient can be moved.

As of Sept. 21, if there is no space at a discharged patient’s home of choice, they can be transferred to a home within a 70-kilometre radius in southern Ontario or a 150-kilometre radius in northern Ontario.

If there is no long-term care home or if there is limited vacancy within this radius, placement coordinators can select the next closest home to the patient's preferred location.

"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,” Long-Term Care Minister Paul Calandra said.

If patients refuse the spot, the hospital is allowed to charge a daily fee of $400.

The charges would begin 24 hours after discharge as of Nov. 20 and apply to any discharged patient who refuses to leave hospital, not just those being transferred to long-term care.

Prior to these regulations, the maximum rate for alternative level of care (ALC) patients choosing to stay in hospital rather than move to one of their five homes of choice was $62.18 per day, or close to $1,900 a month.

Health Minister Sylvia Jones told reporters the $400 amount is meant to provide a strong incentive for families to “have those challenging conversations.”

“We chose $400 because we believe it is enough of a concern for people to have those challenging conversations with the placement coordinators to make the effort, as a family, to have the conversations about where do we want our loved ones as they travelled through their next journey,” she said.

“The bottom line is acute care hospital beds need to be for acute care patients.”

The minister said the fees are not meant to be seen as coercion, but rather just an indication that the patient is not in need of hospital care.

“We are making sure that you are most appropriately placed and that appropriate place is not in an acute care facility, where you no longer are in need of acute care.”

The government said these restrictions were based on input from the health-care and long-term care sector, although they did not elaborate on who those partners were.

NDP Long-Term Care critic Wayne Gates argues the pressure involved with moving to a long-term care home not of their choosing—potentially further away from families or caregivers—will negatively impact the health and wellbeing of seniors.

“Imagine having to drive two hours to kiss your wife goodnight. Imagine the guilt of knowing you can’t afford to pay $400 a day to keep your dad in hospital, and having to put him in a for-profit long-term care home with a devastating record and disgusting living conditions,” Gates said.

“Forcing them to move will not ease our health care staffing crisis one bit. What we should be doing is addressing the staffing crisis at the heart of our health care crisis, not playing a cruel game of musical chairs that kicks seniors and people with disabilities out of hospital beds.”

Jones said that this policy could free up 400 acute beds in Ontario hospitals, and that patients transferred would remain on the priority list for a space in their preferred locations.

The province has said there are about 1,800 patients in hospital waiting for a spot in one of their top five long-term care homes.

Factors such as culture, religion and language will all be taken into consideration when finding a placement for senior patients. Couples will be placed together.

ADVOCATES AND HEALTH-CARE PARTNERS DIVIDED

Some long-term care advocates appeared shocked by the regulations Wednesday night while other Ontario health professionals have given the new policies their backing.

Trillium Health Partners said they “fully support” the changes in Bill 7, adding that the longer a patient remains in hospital, the fewer patients doctors can see.

“When a patient is ready to be discharged and has been designated as Alternative Level of Care, but continues to wait for long-term care in a hospital bed, it means another patient who requires surgery or admission from the emergency department may be left waiting until a bed can be made available,” the health network said in a statement.

“This puts at risk our ability to deliver the specialist and diagnostic services only a hospital can deliver.”

The Scarborough Health Network agreed with this sentiment. The interim CEO said that an average of 150 beds are occupied by ALC patients who will be better served receiving care at home or in a long-term care facility.

“We know that the longer it takes to be admitted to hospital or receive required surgeries, the worse the outcome is for the patient. This increases the stress and anxiety for patients and their families,” David Graham said.

“The best course of treatment sees patients receiving care in the appropriate setting.”

Meanwhile, advocate Dr. Vivian Stamatopoulos said that unless the government addresses the chronic staffing issues within the health-care sector, Bill 7 won’t be much more than a “band-aid.”

“Seniors are already the most impoverished groups in Ontario and that figure has increased exponentially over the past few decades,” she told CP24. “You are threatening them out of a place where they feel secure and safe, into homes presumably 70 to 150 kilometres away from their families.”

The CEO of CanAge, Canada’s national senior’s advocacy organization, took to social media to say they were “livid and horrified” at how Bill 7 is being rolled out.

“Bill 7 will cause social isolation, family breakdown and likely increased requests for Medical Assistance in Dying. This is a disaster,” Laura Tamblyn Watts said on Twitter. “And it happen to totally violate health care consent.”

The government has maintained that no patient will be moved or transferred without their consent or the consent of a decision maker.