Ontario pushes to bill elderly patients who refuse to leave hospital
According to the provincial government, close to 2,000 people are currently in hospitals waiting for a long-term care bed, and the wait list could last months.
Currently, these patients can be charged the equivalent of a daily rate for a long-term care home until one is made available.
Ontario is signalling a harder line as the province tries to free up hospital beds to ease emergency room and surgical backlogs with the winter flu and COVID-19 season approaching.
Elderly hospital patients cleared for discharge but who refuse to move into a bed at a nursing home they have already chosen could soon face daily co-payments of $62 if they are not being billed already, says Long-Term Care Minister Paul Calandra.
Hospitals should trigger the charges they’ve had the power to levy since 1979 under Progressive Conservative, Liberal and NDP governments, he said.
“Absolutely, because we need those spaces for patients who need acute care,” Calandra said as he scrambled to defend legislation introduced last week aimed at encouraging patients to accept interim long-term care rooms in homes not on their preferred list of five homes.
The $62 daily charge would go to the hospital to cover the costs of food and operating the bed, not to the government. The payments are identical to what is paid for a long-term care bed.
While some hospitals are charging such co-payments, it’s not clear how widespread the practice is or how many patients, who have been offered nursing home beds at homes they have chosen, are refusing to move.
Calandra said there are about 1,800 patients in Ontario hospitals awaiting nursing home beds for which they have applied — a long-standing problem. Under the nursing home application process, the elderly or their families are asked to identify five homes where they would like to live and rank them in order of preference.
Amid confusion about what fees would apply and when, opposition parties raised concerns about the prospect of elderly patients being charged the full daily uninsured rate for a hospital bed — which can be as much as $1,500 or more. Hospitals are allowed to charge patients the uninsured rate but only in certain circumstances.
“These charges are just going to go into overdrive,” said New Democrat MPP Sandy Shaw (Hamilton West-Ancaster-Dundas), acknowledging such high fees are “rare.”
Calandra’s office would not detail when that could happen but the University Health Network, which operates Toronto General and Toronto Western hospitals, told the Star that charge would apply only in certain circumstances at its campuses. At UHN, it’s about $1,800 a day.
Those circumstances are: If a patient has been discharged by a physician but has not selected five nursing homes where they would like to live; if that patient refuses to leave hospital when the home that is their first choice has a room available; or if that patient refuses to participate in a discussion about receiving supportive care in a home setting.
“Often, the discussion about the cost of remaining in an acute care bed is enough to start the discussions,” said UHN spokeswoman Gillian Howard.
Green Leader Mike Schreiner said he fears “seniors who do not consent to being moved to a long-term-care facility that they don’t want to be in” could face the uninsured charges and called on the government to clarify the situation.
Interim Liberal Leader John Fraser said the $62 co-payment is “reasonable” because the province doesn’t want people using the hospital system to avoid the fee. But he agreed with concerns about hospitals charging uninsured rates and “coercing” patients into long-term-care homes that could be far from their families.
“What the government’s proposing right now is a blunt instrument and that is because this government gets itself into a crisis … and then it acts in haste.”
Interim Ontario NDP Leader Peter Tabuns strongly criticized Calandra’s stance.
“This is the government saying they’re going to clean out all these hospital patients. Clean them out,” Tabuns said.
“So what are they going to do? Not give them popsicles on Wednesday? They’re going to put tremendous pressure on them to get them out.”
Calandra says the provincial government made the move to ease pressure on Ontario’s beleaguered hospitals, which are facing severe nursing staffing shortages that have forced emergency departments across the province to close for hours or days at a time this summer.
About 24 per cent of patients in Ontario hospital beds require a different form of care — like long-term care, which creates a backlog of patients and contributes to hallway medicine.
Earlier this week, Calandra moved to allay fears that the legislation could force seniors to move into nursing homes they don’t want, saying “we will not move people without their consent.”
The legislation, known as Bill 7, would allow for elderly or chronic patients no longer requiring acute hospital care to be moved into other nursing homes if doctors say they are ready to be discharged.
The government is hoping to free up 2,500 hospital beds for an expected winter surge but long-term-care providers have warned their homes are facing worse staffing shortages than hospitals.
Dr. Amit Arya, a Toronto palliative care physician, says that the government is taking away a patient’s right to choose.
“We can ask people to broaden their choices while waiting in a hospital. I don’t know why the government’s announcement doesn’t call for more investment into palliative care options.”
Dr. Arya says that the average life expectancy of someone admitted to long-term care is 18 months. That means for many; it’s much shorter.
“If we expanded even home-based palliative care options, some people may be willing to take their loved ones home with proper support.”
Reported by the Star on Aug 25, 2022.