Color & Control:

Against their will 

Will Ontarians be sent to LTC without choice?

The Ontario government unveiled its long-awaited plan to stabilize the over-stretched health care system after a series of emergency room closures across the province.

As part of that plan, the government said it would introduce legislation that would pave the way for Alternative Level of Care (ALC) patients—those who no longer need a hospital’s acute care services but have to stay in hospital while they await placement into a long-term care bed—to be temporarily sent to LTC homes not of their choosing while they wait for a permanent spot in their preferred home.

According to CBC Toronto, the Ministry of Health and Long-Term Care expects that under this new method, 200 people who have been in hospital for six months waiting for LTC beds will be moved within the next three months, with a total of 1,300 moved by March. 

The ministry also said it would introduce “mandatory guidelines…to ensure patients continue to stay close to a partner, spouse, loved ones or friends, and ensure these patients won’t be out of pocket for any cost difference between their temporary home and their preferred home.”

Long-Term Care Minister Paul Calandra was asked whether this meant patients could be forced into an LTC against their will.

“Ultimately, no, we are not going to be forcing anybody out of a home,” he told reporters. “The changes do allow us to continue that conversation to explain to somebody who is in a hospital why their needs can be met in a long-term care home.”

The NIA’s Director of Health Policy Research, Dr. Samir Sinha, said that while he hadn’t seen the text of the legislation or the proposed guidelines yet, he had deep concerns about it, noting that up until now, LTC residents in Ontario have always had the right to choose where to live.

“And the question then becomes, if you strip away people’s rights in that way, then you’re putting people in incredibly vulnerable situations, because what is the recourse if people are sent to a home that they never wanted to go to, that is not able to meet their needs for a variety of reasons, and they’re stuck there?” he told Zoomer Radio’s Libby Znaimer in an interview. “I’m all for having good conversations, I’m all for making sure that people can understand their options, but we’ve never stripped away the rights of people to actually choose where they want to go.”

In a separate interview with Amanda Pfeffer of CBC Radio’s Ontario Today, he also raised concerns about the government’s plan to free up LTC beds that had been set aside for COVID-19 isolation to accommodate more hospital patients. The government said it would make available 300 isolation beds for people on LTC wait lists by the end of the summer, with up to 1,000 more beds available within six months. But Dr. Sinha noted that isolation spaces play a key role in preventing the spread of COVID-19 and other infectious diseases, which residents in shared rooms are at increased risk of contracting.

“Remember that many people were living in three- to four-bedded rooms, and those are the homes where we saw the greatest spread of COVID-19, so I’m a bit concerned that we’re opening some of those up,” he said. Will future residents in these rooms be informed of this, and be given choice as to whether they want to live in these rooms?

Other proposals related to LTC and home care include:

• expanding access to specialized supports for LTC residents and those waiting to enter LTC, including behavioural supports for patients with dementia, on-site treatment and upgrading home equipment to match patient needs

• expanding adult day programs and supports for caregivers

• funding community paramedicine to provide additional care at home for older adults.


Right care in the right place

The National Institute on Ageing is a Toronto Metropolitan University think tank focused on the realities of Canada’s ageing population. Their mission is to enhance successful ageing across the life course and to make Canada the best place to grow up and grow old.

For the full document, visit Ontario’s plan will better connect seniors to the most appropriate care settings by providing faster access to care and reducing the number of emergency department visits, especially where people can receive care in the comfort of their own home. Based on advice from the Office of the Chief Medical Officer of Health, Ontario is taking immediate action to further increase bed capacity in long-term care homes by right-sizing the number of COVID-19 isolation beds, based on community demand and COVID-19 risk levels.

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