‘It’s immoral on every level’: Health advocates, MPPs decry PC plan to charge patients $400 a day for refusing hospital transfers
A Bill that has been labelled “grotesque”; the “worst and most cruel Bill” the Ontario Legislature has ever seen, was approved by Premier Doug Ford’s PC majority last month, paving the way for hospital patients to be billed $400 a day if they refuse to be transferred to an alternative setting like a long-term care home or an assisted living facility.
Titled the More Beds, Better Care Act, or Bill 7, it received Royal Assent on August 31, and allows hospitals to set up the transfer of patients to a different care setting, even without their consent. These patients need an alternative level of care (ALC). Often ALC patients are cleared to no longer be at a hospital, but remain there due to the lengthy waitlists for long-term care or a retirement home space.
The Ontario government website states the permissions created by Bill 7 “cannot be performed without first making reasonable efforts to obtain the patient’s consent.” But if that consent is not achieved, the hospital placement coordinator can move forward with choosing a long-term care home for an ALC patient; provide personal health information to these potential facilities; and authorize admission to the home (even if it is against the transfer). There are certain geographic restrictions on where these transfers can occur. The Bill allows placement coordinators in southern Ontario to transfer patients to any long-term care or retirement facility within 70 kilometres and 150 kilometres for patients in the northern parts of the province.
The legislative changes have drawn the ire of opposition MPPs and health advocates who have labelled it as ageist and discriminatory toward the elderly population who will be disproportionately impacted, and unprecedented in that it allows personal healthcare information to be shared without consent. This is despite the fact that the government’s own website states when it comes to sharing personal health information, it must abide by regulations set out in the Freedom of Information and Protection of Privacy Act (FIPPA) which details that obtaining consent is a core pillar.
“The fundamental change that the Act makes is that it allows hospitals, the placement coordinators, to override the patients right to consent,” states Natalie Mehra, the executive director of the Ontario Health Coalition (OHC).“They have singled out the elderly, the frail, the patients with disability to overside their fundamental rights…It is grotesque.”
During the limited debate on the subject at Queen’s Park, Opposition critic for long-term care Wayne Gates (Niagara Falls, Fort Erie & Niagara-on-the-Lake), labelled Bill 7 as “ one of the worst and most cruel bills I’ve ever seen before this Legislature” and detailed the toll these forced transfers could have on the individuals impacted.
“It’s completely shameful that this government refuses to understand the real human impact it’s going to have. This bill will cause stress, and in some cases moving away from their family and community will cost lives. The people will never forget what you did to cause such pain. What makes this even worse—these wonderful residents, seniors, who built this province are being targeted by this government, and this government doesn’t seem to care about them,” he said in the Legislature on August 30, accusing the government of being too scared to hold public hearings on the Bill.
“This Bill is cruel, it’s awful, and I’m begging all of you, all my MPPs here, to vote this bill down.” His plea was ultimately in vain, but he was not the only MPP surprised by the PC decision.
Despite the passage of Bill 7, Niagara-area MPP Wayne Gates continues to speak out against it in the Legislature.
(Screengrab from Twitter)
“You are setting up for hundreds of people who will give up on life because of the decision you are making right now,” said France Gélinas (Nickel Belt), the NDP’s health critic. “Think about it. We have a responsibility for everybody in Ontario. We have a responsibility for frail, elderly people in Ontario. And the decisions you are making right now will lead them to decide that they don’t want to live anymore. I cannot live with that…I just can’t. We can’t fix this.”
Yet the PCs have vehemently stood behind the Bill, with Health Minister Sylvia Jones (Dufferin-Caledon) and other PC MPPs labelling it as necessary in order to create capacity inside Ontario hospitals and clear the backlog of surgeries that have built up as a result of cancellations during the COVID-19 pandemic.
Natalia Kusendova (Mississauga Centre) defended her party’s Bill, saying in the Legislature that there are 5,000 ALC patients in beds across Ontario with 39 percent of them waiting for long-term care.
“That is the equivalent of 11 large community hospitals. This is a staggering number. To ease off the pressures of our emergency rooms and acute care and patient units, and to allow for surgeries to go back to pre-pandemic levels, we simply must make the room. The status quo will simply no longer be acceptable,” she said.
The Bill also received the support of Mississauga’s healthcare provider Trillium Health Partners, which released a statement noting the changes are “a much needed step towards ensuring that people are able to get the right care in the right place at the right time.”
“When a patient is ready to be discharged and has been designated as Alternative Level of Care (ALC), but continues to wait for long-term care in a hospital bed, it means another patient who required surgery or admission from the emergency department may be left waiting until a bed can be made available,” the statement reads. “This puts at risk our ability to deliver the specialist and diagnostic services only a hospital can deliver. It also means that a patient who is ready to leave the hospital for the next phase of their health care journey is not receiving the type of care that is best tailored to their health care needs.”
The OHC claims that when it comes to ALC patients in Ontario, only a minority of them are waiting for long-term care.
“A significant block of ALC patients are waiting for hospital beds—complex continuing care (chronic care), rehab, mental health beds and others. A small number are waiting for home care. (Most patients waiting for home care are discharged home, where that care may or may not ever happen),” an OHC release reads.
Health minister Sylvia Jones has defended Bill 7 as a necessary measure to free up hospital capacity.
(Government of Ontario)
Advocates have pointed out that the province is essentially playing a shell game with patients in the healthcare system. There is no denying that Ontario hospitals are currently in the midst of a capacity crisis—but so is the province’s long-term care sector, something that was revealed in horrific detail during the COVID-19 pandemic and led to the military being called in to help in the worst hit care settings. According to the Province’s own data, as of May 2021, there were 38,000 people on the waitlist for a long-term care bed in Ontario and the average wait time for placement was approximately 171 days.
“I think it’s going to end up with people dying in the community or in long-term care homes that they don’t want to be in,” Jane Meadus, a staff lawyer with the Advocacy Centre for the Elderly (ACE), said.
During an OHC press conference, Meadus explained that under the changes enacted by Bill 7, long-term care homes, many of which are failing to meet Ontario standards for care and cleanliness after nearly three years of disarray created by COVID, will be forced to take on more patients they may not be able to properly care for, noting that homes do not have the ability to turn patients down under the new Bill, even if they do not have the staff to adequately care for new residents.
“They will be pressured to take people they can not provide care to,” she said. “I really do believe that this is going to be a disaster for many Ontarians.”
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