A flawed plan for hospital beds
Posted: November 29, 2022
(November 28, 2022)
By: Niagara Falls Review
Ontario Long-Term Care Minister Paul Calandra says legislation meant to encourage the transfer of patients our of hospitals and into long-term care facilities will help free up hospital beds. But critics says the province is using “coercive” tactics.
It’s not clear that Ontario’s More Beds, Better Care Act will produce more beds or better care.
The legislation was ostensibly enacted to free up hospital beds by transitioning from hospital to long-term care (LTC) homes patients deemed in need of an alternative level of care (ALC).
These patients, typically elderly or disabled, are among the 38,000 on the wait list for long-term care, but are staying in hospitals until one of their five preferred homes becomes available. Under the new law, however, they can be transferred to any LTC home within 70 km, or 150 km in Northern Ontario.
The coercive nature of the law became clear this week, since Ontario’s hospitals are now required to charge patients $400 a day if they refuse to accept any long-term care placement the province deems acceptable.
To be sure, Ontario does suffer from a shortage of hospital beds, but the shortage isn’t the fault of ALC patients. Rather, it’s largely a result of the lack of viable alternatives and the fact that Ontario spends less on hospitals, and therefore has fewer hospital beds per capita, than any province in Canada, according to the Ontario Health Coalition.
And while we don’t have a clear picture of how many beds will become available under this new law, it’s unlikely to resolve the shortage. As the Ontario Health Coalition notes, many ALC patients are waiting for other forms of care, including rehabilitation or mental health beds, and should not therefore be moved to LTC homes.
Minister of Long-Term Care Paul Calandra said last week that some 330 patients had agreed to move, but since the $400 a day fee had just kicked in, it’s not clear how many of the 330 patients agreed because their preferred home became available.
So while the effect of the law remains unclear, one thing is certain: Suggesting that ALC patients are responsible for the crisis, or that they ought to bear the brunt of resolving it, amounts to little more than scapegoating a vulnerable population.
There are, after all, legitimate reasons why people avoid moving to LTC homes, even when the only alternative involves spending every day lying in a hospital bed. Homes with vacancies are vacant for a reason — often because they have poor records of patient care, something we learned all too well from the horror stories heard during the pandemic.
Patients also resist moving to a more distant facility for fear that spouses and other family members will have difficulty visiting on a regular basis. And isolation from family exacts a devastating toll on people in long-term care — something we also learned all too well during the pandemic.
To avoid moving far away or to a subpar facility, many patients might simply choose to go home despite a lack of adequate support. And since the law creates an adversarial relationship between patients and providers, others might choose to avoid hospitals altogether, thereby further compromising their health.
Instead, Ontario could help solve the shortage by designing a long-term care system that allows people to age in places that are right for them. This means increasing funding for alternatives like home and community-based care, which could reduce the burden on both hospitals and LTC homes.
But as long as the province pursues an adversarial approach, it shouldn’t be surprised to learn that it cuts both ways. The Ontario Health Coalition and the Advocacy Centre for the Elderly has announced that they will be taking the province to court, with their lawyers stating that the law “represents an unprecedented and egregious deprivation of the Charter rights” of patients.
Indeed, sending vulnerable people into the wilderness, while perhaps acting as a Band-Aid solution to the hospital bed shortage, won’t absolve the Ontario government of its transgressions. It will only highlight them.