The issues surrounding moving elderly or chronic care patients out of hospital care into a long-term care home is one that Ontario has been struggling with in recent years.
The concern rose again last week over the fact that Ontario has introduced new legislation that could let the province place a hospital patient into a long-term care home without that patient's consent.
The Ontario plan was more than that, with five distinct goals, but the main point was to ensure hospital capacity as there is an expectation that COVID-19 cases will spike in the fall and put a new demand on hospitals.
Not everyone is in favour of the plan.
When it was announced last week, official opposition health critic France Gélinas spoke out against it. She said there are solutions that do not require shipping elderly patients to LTC homes if they do not want to go there.
"There are many solutions. First of all, many elderly people would safely stay at home, if we had a strong home-care system," said Gélinas, who is also the MPP for Nickel Belt.
"Home care right now is broken; it fails more people than it helps. But if you were supported at home, then you would not end up in a hospital. Your physician would feel comfortable sending you back home because they know that you would have the strong support that you need to stay home safely."
The province argues the current pressures on the health-care system — from widespread staffing shortages to lingering impacts of COVID-19 to a lack of homecare capacity and long-term care spaces — are unprecedented and require an unprecedented response.
The idea to move chronic patients to long-term care, according to the province, is to free up hospital beds being used often by mainly elderly patients whose doctors say they no longer need to occupy an acute care hospital bed but who are too frail to live unassisted at home.
These patients are referred to as alternate level of care (ALC) patients.
The legislation would allow the province to move that patient to a "temporary" LTC home while the patient is waiting for a bed space in a home of their preference.
Patients can’t simply be moved on the province’s say-so though; a transfer requires the approval of the patient's physician.
The plan is to free up 300 beds across Ontario by the end of summer and to increase that number to 1,000 freed up beds within six months. The new legislation proposals were introduced last week by Ontario Health Minister Sylvia Jones and LTC Minister Paul Calandra. Many critics believe the province is being too heavy-handed and that ALC patients will bear the brunt of it.
"We are introducing legislation that, if passed, will support patients whose doctors have said they no longer need hospital treatment and should instead be placed in a long-term care home, while they wait for their preferred home," said the provincial plan.
The issue is not entirely new in Ontario. In recent years, when the number of ALC patients at Sudbury's Health Sciences North would peak at certain levels, HSN would take steps to move ALC patients out of the hospital.
At one point in May of 2019, there was a spike of roughly 100 ALC patients at HSN. That was roughly 20 per cent of all the hospital beds at HSN.
One solution was to have the NE LHIN (North East Local Health Integration Network) designate several of these patients as being in crisis. This would allow for those patients to bypass the existing waiting list and be placed into a LTC home right away. A patient "in crisis" was one deemed to be at risk of becoming more ill by staying in the hospital.
But the overriding concern was the need to free up acute care beds for people who are genuinely sick and needing acute care. One very obvious example in Sudbury came on the heels of the declaration of the COVID-19 pandemic in March of 2020. The hospital held a news conference on April 1, 2020 to outline a plan of action.
Not knowing how many beds would be required by an expected influx of COVID patients, the hospital took steps to free up to 95 ALC beds by moving patients out to the Clarion Hotel in collaboration with St. Joseph's Continuing Care Centre.
