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Advocates, critics warn Ontario’s planned changes to long-term care are a violation of patient rights

Posted: August 20, 2022

(August 19, 2022)

By: Vanessa Balintec, CBC News

A group of senior care advocates and critics is warning planned changes to the long-term care sector are a fundamental violation of patient rights.

On Thursday, Long-Term Care Minister Paul Calandra introduced new legislation that, if passed, would allow hospitals to transfer patients awaiting a bed in their preferred LTC home to be placed in a “temporary” home after staff make “reasonable efforts to obtain the patient’s consent.”

Bill 7, More Beds, Better Care Act, authorizes certain actions to be carried out — such as the transfer of a patient to an LTC home — without the consent of patients if an attending clinician deems they require “an alternate level of care.”

Dr. Vivian Stamatopoulos, a long-term care advocate and professor at Ontario Tech University, called the legislation “morally repugnant.”

“How does all of this not send the direct message to seniors that their lives don’t matter?” said Stamatopoulos Friday at a news conference withthe Advocacy Centre for the Elderly and the Ontario Health Coalition.

“And frankly, does it matter what they want, what they need, what is in their best interests? Apparently, what is important is just making sure that all of these beds are full.”

Ontario LTC Minister on plan to send patients to temporary LTC homes to ease health-care pressures

“If you’re on the long-term care wait list, the best place to wait for long-term care is in a long-term care, freeing up those acute care beds for other people who really need them,” says Ontario Long-term Care Minister Paul Calandra.

Before the bill was introduced, Calandra said Thursday the legislation would not force anyone who doesn’t want to leave the hospital to go and wouldn’t make “any changes to the priority waiting list,” but would allow long-term care homes to be part of the solution to improving Ontario hospitals — many of which are under severe strain due to staffing shortages.

The Ontario Long Term Care Association has previously said the bill won’t address staffing issues. 

“There is a challenge in acute care, and long-term care is in a position to make a difference for the first time in generations,” said Calandra.

Potential legal action

There are about 5,800 patients now in hospital who could be sent to an alternate level of care if beds were available, the Ontario Hospital Association said this week.

The ministry said about 40 per cent of those patients are on a wait-list for long-term care. It says the legislative changes could mean 200 of those patients end up in nursing homes by the end of fall and up to 1,300 patients within six months.

Rainer Pethke, who lives in the Township of Berwick near Ottawa, says his heart sank when he heard of the bill.

Pethke is a caregiver to son, who has an aggressive form of multiple sclerosis and is in long-term care, and to his 95-year-old mother, who’s starting to suffer from dementia on top of a bad hip.

“My fear is they’ll move her into some location, lord knows where, where I can’t support my son, I can’t support her,” said Pethke.

“Eventually, I wouldn’t be able to support even myself.”

Rainer Pethke says moving his 95-year-old mother into a long-term care home — particularly a for-profit facility far from home, without giving her a choice and without her family and caregivers for support — would be terrifying for her. (Submitted by Rainer Pethke)

He says he’s wondered if he would encourage his mother to go through M.A.I.D.— medical assistance in dying — if she was sent to a long-term care home not of her choosing.

“No family should have to consider M.A.I.D. because of their government’s decisions to take away choice. That’s just horrible,” said Pethke. 

As it stands now, Jane Meadus, a staff lawyer at the Advocacy Centre for the Elderly, says the legislation takes away the fundamental right to consent to health care and could have dire results on a patient, particularly if they’re sent to a home unable to provide the level of care they need.

Meadus says while it’s hard to say what kind of legal action can be taken until further details are released, lawyers are already eyeing legal options.

“I know many lawyers are looking at this and are absolutely horrified at this breach of fundamental justice and fundamental rights of people, specifically the elderly and people who are disabled,” said Meadus. 

“It absolutely is something that we would be looking at, and are already discussing.”

Bill may deter elderly from seeking care, critic says

Dr. Samir Sinha, the National Institute on Ageing’s director of health policy research, says this legislation will impact hospitals and their ability to provide high-quality care to elderly patients.

“I fear that this is going to make it hard for people to want to even access hospital care when they know that the risk is that they might actually be forced to actually go to a home they never, ever wanted to end up in,” said Sinha, who is also the director of geriatrics at Mount Sinai and the University Health Network in Toronto.

Sinha says non-profit and municipal LTC homes generally have better track records and thus have longer wait lists, even though they represent only about a third of all homes in Ontario.

The homes that have vacancies are generally for-profit or older facilities, he says, struggling to fill their beds or meet their occupancy targets to get funds from the province.

“This is kind of a convenient way for homes to meet their occupancy targets because they’ve got beds, and now we have a mechanism to fill that, whether people want to go there or not,” said Sinha.

Geriatrician Dr. Samir Sinha calls recently proposed legislation to change LTC ‘horrifying.’ He says it fundamentally strips the human right of people ‘to actually make a choice about where they want to live.’ (Tiffany Foxcroft/CBC)

Sinha says this legislation mostly affects a population that is vulnerable, are often living with dementia, and can’t advocate for themselves.

Instead, he says the province could expand the number of preferred LTC homes patients in hospital could choose, from a minimum of one to five, and make collaboration a priority between hospitals and other organizations to get patients care within their own communities instead.

“If we take these rights away in these situations, this is a slippery slope to a whole bunch of other things that we could actually start doing to people as well,” said Sinha.

Opposition takes aim

Speaking to CBC’s Power & Politics, Calandra said he hopes to have the legislation passed no later than Sep. 1, with regulations guided by an “overriding principle” to place patients close to their preferred LTC home and loved ones to follow about a week after. 

Leading up to that time, he says he’ll be consulting with the long-term care sector.

Wayne Gates, the Ontario NDP critic for Long-Term Care, Home Care and Retirement Homes, says the legislation is terrifying for families.

“Consent is not required. Families have no idea just how far away their loved one could be moved in the final years of their life,” said Gates in a statement. 

The party says it takes issue with allowing seniors to be moved without their consent and the lack of limits on how far seniors can be sent away from loved ones built into the legislation.

A spokesperson for the ministry said Friday the government wouldn’t move people far from their communities.

“The government is making sure patients whose doctors have said they no longer need hospital treatment receive the right care in the right place, while ensuring they continue to stay close to their family and friends,” Mark Nesbitt said.

But the NDP also says the legislation paints a “dim picture” of moving seniors without their consent when the government has to specifically rule out physically binding a senior when carrying out the actions of the bill or transferring a patient.

“The regulations aren’t written yet, and can be written and re-written with the stroke of the premier’s pen behind closed doors,” Gates said.

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