Just imagine the howls that would emanate from the opposition benches if an Ontario Liberal government rammed through legislation, bypassing committee hearings and public consultation, to expedite the transfer of patients from hospitals to long-term care homes. The Progressive Conservatives would be apoplectic: “This arrogant Liberal government thinks it knows best when it comes to our vulnerable seniors,” they’d huff, citing their own party’s fidelity to the conventional democratic process. “Instead of listening to families, to health care professionals and to advocates for the elderly, they are taking a ‘government knows best’ approach to people’s lives. This is totally wrong!”
Alas, we all know that indignation is contingent on which team is bypassing conventional democratic processes and which is standing impotently on the sidelines. That’s why members of the PC caucus are apparently A-okay with rushing through legislation without the input of stakeholders and experts.
Bill 7, the “More Beds, Better Care Act,” which was passed Wednesday, allows hospitals to transfer patients to long-term care homes not of their choosing, without their consent, in order to free up acute-care hospital beds (notably, patients cannot be removed by force, but they can be pressured to leave by hospitals exerting their existing powers to charge patients uninsured rates that some critics say could be as much as $1,800 per day).
The legislation concerns patients designated as “ALC,” or “alternative level of care,” who do not require the level of care provided in a hospital setting but often remain in hospital anyway as they wait for an opening at a long-term care home of their choosing or for alternative accommodations such as in-home or hospice care. The Ontario Hospital Association (OHA) said in mid-August that almost 6,000 people – the highest number ever recorded in the province – were considered ALC patients, with about 40 per cent waiting for a long-term care placement.
We have known for years that the bottleneck of ALC patients in hospital beds is a major contributor to overcrowding in Ontario hospitals. In 2011, the Toronto Star published a front-page story about a woman named Ivy Chand who had been in a Brampton, Ont., hospital for six months waiting for placement in the facility of her choice. The hospital had threatened to charge her $700 per day unless she moved to a home with a spot available, though the Liberal health minister at the time, Deb Matthews, told the hospital to cut it out. The then-president of the OHA, Tom Closson, was quoted as saying that “the real problem is that we have never developed a capacity plan in the province for the frail elderly.”
And we still haven’t – not really, anyway. The OHA held round-table discussions in 2012 and produced a report with four specific actions for the government, local health networks and stakeholders to pursue in order to ameliorate and expedite the transition of ALC patients out of hospitals to long-term care. The OHA also commissioned research studies in 2015 looking into ALC patients in mental health and complex continuing care beds, and various working groups have produced ALC best practices guides outlining strategies for the optimal delivery of care. But without meaningful, structural improvements to the system of long-term care, which has been neglected by successive governments in Ontario, the problem of ALC patients occupying hospital spaces will persist.
Now, with the health care system in total crisis, this government has run out of time. That is ostensibly why Bill 7 was rushed through – not out of some nefarious disdain for public consultation, but because the Ford government got caught sleeping on health care yet again and needs to do something, anything, to address (or be seen to address) the crisis in hospitals. Premier Doug Ford’s promised improvements to long-term care will take years to implement fully, which is why seniors are being asked – or rather, ordered – to sacrifice themselves for the sake of the wider health care system.
Needless to say, the government is wading over morally (and potentially legally) treacherous waters by ramming through legislation that effectively tells seniors – those who are capable of informed consent – that their opinions don’t matter. But perhaps the government has reasoned that these waters are not politically treacherous, given the public’s ephemeral concern for seniors’ welfare during the pandemic, which yielded to other matters as the months and years dragged on. Indeed, if the public was willing to re-elect the government that let thousands of seniors suffer and die in long-term care homes despite its promised “iron ring” of protection during the pandemic, why wouldn’t it tolerate a little coercive relocation now? Even if the opposition starts howling, who will really pay attention to their cries?
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