(April 11, 2025)<\/p>\n
By: Jack Hauen, The Trillium<\/p>\n
One 68-year-old man was\u00a0in the hospital for four years, hooked up to a feeding tube,\u00a0breathing tube\u00a0and a ventilator.<\/p>\n
An 82-year-old man required dialysis, a feeding tube and a mechanical lift to get out of bed.<\/p>\n
Another patient had a\u00a0bed sore down to the\u00a0muscle\u00a0and couldn’t move his arms or legs.<\/p>\n
All of them\u00a0were “alternate level of care” (ALC) patients,\u00a0meaning the hospital believes they should no longer be there \u2014 and if they or their loved ones disagree, they could be fined for refusing to move.<\/p>\n
Internal hospital documents obtained by\u00a0The Trillium<\/em>\u00a0illustrate the complex needs of these patients, who sometimes can’t afford private care, have no family to look after them and\u00a0medical issues advocates say are too severe for long-term care.<\/p>\n Hospitals give patients an ALC\u00a0designation when they deem them to\u00a0no longer require acute care.\u00a0An ALC patient\u00a0with intense needs will require\u00a0complex care for the rest of their life. Someone with fewer needs may be a fit for a long-term care home or home care. Retirement homes, which don’t require nurses on staff, are often good spots for seniors who are still somewhat independent.<\/p>\n The problem, seniors’ advocates say, is that hospitals, facing funding pressures from the province, have too few complex-care beds, meaning high-needs patients linger indefinitely in acute care \u2014 while the hospitals employ intense pressure to get them to leave, often to an inappropriate care setting.<\/p>\n A major part of the Ford government’s solution has been Bill 7, a law passed in 2022 allowing hospitals to fine ALC patients who refuse to go to long-term care homes.<\/p>\n Premier Doug Ford said in 2022 that Bill 7 was “absolutely necessary” because\u00a0“there\u00a0are 6,000 beds being taken up by alternative-level-of-care patients in hospitals … the highest number in the history of this country.”<\/p>\n In 2017, before she was the minister of health, Sylvia Jones called them “bed blockers,” a term advocates say is derogatory.<\/p>\n “Do you know why we call them bed blockers? Because they need to be served and assisted in some other form of health care. Many times it\u2019s long-term care,” she said.<\/p>\n The Ford government said its strategy has helped transfer over 30,000 people to long-term care.<\/p>\n \u201cBill 7 ensures people across the province receive the care they need, in a setting that is right for them,” Jones’ spokesperson, Hannah Jensen, said in a statement.\u00a0“It frees up hospital beds so that people waiting for surgeries can get them sooner, eases pressures on crowded emergency departments, and follows the lead of many other provinces, which have had similar policies in place for decades.”<\/p>\n Designating a patient ALC\u00a0“is exclusively a clinical decision made by a patient\u2019s attending physician who has determined that a patient\u2019s care needs are no longer met in a hospital,” she added.<\/p>\n The Trillium<\/em>\u00a0obtained weekly ALC patient notes\u00a0for three hospital sites run by Trillium Health Partners (no relation to this news\u00a0outlet): the Mississauga Hospital,\u00a0Credit Valley Hospital, and Queensway Health Centre, as well as its inpatient rehabilitation facility, the\u00a0Reactivation Care Centre.<\/p>\n The documents, which cover from the beginning of January to the end of March last year, were compiled by Trillium Health Partners\u00a0as part of the recently struck-down Charter\u00a0challenge of Bill 7<\/a><\/span>.<\/p>\n Many\u00a0ALC patients were\u00a0managing just fine on their own, but\u00a0then had a sudden injury, like a stroke or a fall.<\/p>\n At their age, their injuries are often long-lasting or permanent, and the patients now require\u00a0complex, ongoing care. Some have feeding or breathing tubes. Others require mechanical lifts to get into wheelchairs.\u00a0Many are severely cognitively impaired.<\/p>\n Their families are unable to care for them, and retirement homes are too expensive and often don’t provide the right type of care. Long-term care homes require a co-payment, and getting a rate reduction isn’t guaranteed.<\/p>\n In several cases outlined in the hospital notes, other medical centres\u00a0rejected a transfer, saying they couldn’t care for the patients either.<\/p>\n One patient\u00a0was\u00a0in the hospital for more than three years \u2014 more than a year\u00a0as an ALC patient. The 68-year-old man had a paralyzed diaphragm and recurring infections in the area between the lungs and the chest wall. He was on dialysis, needed a nocturnal vent, a breathing tube, chest tubes and a feeding tube.<\/p>\n He was rejected from rehab hospital\u00a0West Park Healthcare Centre, complex continuing care hospital Toronto Grace\u00a0Health Centre, and Michael Garron Hospital.<\/p>\n Credit Valley Hospital’s notes said it was exploring ways to discharge the man home, with in-home care.<\/p>\n “I don’t know if you’ve ever seen what you have to do to take care of somebody who’s on a trach (breathing tube). You have to stick tubes down\u00a0into their trach, and suction out their lungs and stuff. And they’re expecting families (to do that),” said Jane Meadus,\u00a0a lawyer with the Advocacy Centre for the Elderly.<\/p>\n Another 82-year-old man who was “mostly confused” was on dialysis and had a feeding tube, which his wife was “unable to manage … on her own.” The hospital wrote that it planned\u00a0to submit a long-term care application. He was an ALC patient for at least four months.<\/p>\n A 78-year-old man who was “previously independent” had a fall and a subsequent stroke. He was deemed ALC after ending\u00a0up with a breathing tube, feeding tube, catheter and non-specific wounds.<\/p>\n In a statement, Trillium Health Partners said it’s facing “extraordinary demand for health care \u2014 caring for a record-high number of patients during the respiratory illness season and more than ever in unconventional settings as patients wait for a bed.”<\/p>\n Spokesperson Priyanka Nasta said a “significant number” of ALC patients are best served in long-term care, complex continuing care or home care.<\/p>\n “This designation is made in consultation with the patient as part of a thorough clinical assessment. In these cases, long-term care and home care are much more appropriate environments to support comfort, healing and recovery,”\u00a0Nasta said.<\/p>\n Another group of patients in the documents shines a light on hospitals’ struggles to find placements for\u00a0younger patients who need mental health care. Some are described as “capable,” but because there are no other supports available, they linger in hospital for months.<\/p>\n One 20-year-old man with autism was “physically aggressive” with his mother and other patients in the hospital. He broke light bulbs, mirrors and screens at home.<\/p>\n “Mother has worked with available supports from [Community Living Mississauga], and [Developmental Services Ontario] but does not feel they are sufficient to keep her safe,” the hospital notes read.<\/p>\n The patient was in hospital for at least two months while he waited for placement in a group home.<\/p>\n “Community partners indicate there are not many homes that are equipped to deal with his high level needs,” the hospital wrote.<\/p>\n An “independent” 56-year-old man with\u00a0schizophrenia but no physical\u00a0health issues came from a group home. His behaviours included wandering, inappropriate urination and eating non-edible items, the hospital wrote. He was an ALC patient for at least\u00a0three months.<\/p>\n A 38-year-old homeless woman\u00a0had been living with friends but had\u00a0“limited … supports in the community.” Her only issue was that she couldn’t put weight on at least one limb. She\u00a0was an ALC patient for at least 40 days.<\/p>\n For many ALC patients, it appears there is simply nowhere to go. But loved ones\u00a0describe intense pressure campaigns from the hospitals to get them out.<\/p>\n “It doesn’t matter where,” said Natalie Mehra, the executive director of the Ontario Health Coalition.<\/p>\n NDP MPP Chris Glover’s brother was one such patient. After he fell into a coma following\u00a0a surgery, he had a feeding tube, a stage four bed sore \u2014 the most extreme type, exposing muscle, ligament or bone \u2014 and couldn’t move his arms or legs, Glover said.<\/p>\n “Every bodily function he had needed to be tended to,” he said.<\/p>\n The hospital, which Glover didn’t name, told the family they had 10 days to take him home or find a long-term care home, or it would discharge him, Glover said. The pressure was “immense,” he said.<\/p>\n “How do you discharge somebody \u2014 it’s not like they’re gonna put him in a taxi.\u00a0Like, you can’t do it. He’s got a (feeding) tube. He’s, at\u00a0best, in a gurney,” he said.<\/p>\n Glover said his brother\u00a0lives in a different city and works long hours, and his parents, 87 and 91, couldn’t care for him either.\u00a0Glover said his family phoned several long-term care homes but none would take a patient with a feeding tube.<\/p>\n “What they were saying did not make sense. It just was not feasible,” he said. “But my mother felt great stress because of these threats.”<\/p>\n The pressure these patients face isn’t just from the hospitals.\u00a0Since the Ford government passed Bill 7, at least five ALC patients have been fined for refusing to leave hospitals. One woman was fined more than $28,000<\/a><\/span>.<\/p>\n Glover said he was able to push back with the help of the Ontario Health Coalition.<\/p>\n “I have some understanding of the system, and I have people who can guide me, but so many other people in the province do not have that advantage,” he said. “And I think about other people being pushed out of hospitals when the patients obviously need care, and that’s just wrong.”<\/p>\n Glover said his brother is recovering well \u2014 his bed sore has mostly healed and he’s eating without the tube. He’s\u00a0now in a long-term care home, which is now the appropriate place \u2014 “but it just was not at that point,”\u00a0Glover said.<\/p>\n Trillium Health Partners said some complex health needs, like mobility challenges and feeding tubes, “can often be managed safely in community settings like long-term care or at home with the right support.”<\/p>\n Patients with more intense needs require complex continuing care before they can return home or to long-term care, its spokesperson said, adding that the hospital network\u00a0“has nearly 160 complex continuing care beds, which consistently operate at full capacity.”<\/p>\n “Our doors are always open to care for people in their time of need and the transition to home or community is done with compassion and collaboration with our patients and their families,” she said.<\/p>\n The problem of ALC patients in acute care beds is not insignificant.<\/p>\nMany ALC patients can’t go home<\/h3>\n
Others waiting for mental health care for months<\/h3>\n
‘Immense’ pressure from hospitals to discharge patients<\/h3>\n
Hospitals best for many ALC patients: advocates<\/h3>\n