Can Ontario force hospital patients into long-term care homes? It's complicated

Advocates are gearing up for legal battles against Ontario's plan to move elderly and chronically ill patients out of hospitals and into long-term care homes, with lawyers warning the proposed change is a breach of patients' human rights.

Under legislation unveiled last week, hospital patients who are deemed to no longer require acute care, but still need an "alternate level of care," could be admitted to an LTC home chosen without their input — potentially far away from family members and loved ones who play a critical role in their day-to-day care.

Long-Term Care Minister Paul Calandra initially said no patients would be forced to go to a home they didn't want to live in, but has since said that those who refuse a placement should have to pay hospital charges for their ongoing stay.

Doctors, lawyers and advocates say the government's plan would force patients to make an impossible choice: live somewhere they don't want to, or suffer the consequences.

Here's a closer look at what can — and can't — happen under the Ontario government's Bill 7, the More Beds, Better Care Act.

When an attending clinician believes a patient no longer needs hospital care, and could have an "alternative level of care," they would be able to ask a long-term care placement co-ordinator to begin the admission process to an LTC home.

The placement co-ordinator needs to make "reasonable efforts" to get consent from a patient or their substitute decision-maker — which might be a spouse, child or another caregiver — before:

The legislation doesn't specify what those "reasonable efforts" should entail, and makes clear those steps can be taken without consent.

However, consent is required to physically transfer the patient to a long-term care home.

Although the legislation says a patient can't be physically transferred without consenting, they may feel they have little choice, given the potential consequences of refusing.

Advocates and doctors say some hospitals already have policies where patients who refuse to go to a long-term care home are instead discharged to a shelter or to a family member, who may have little capacity to care for them.

Jane Meadus, a lawyer and advocate with the Advocacy Centre for the Elderly, has seen clients who were threatened with hospital bills of up to $1,800 a day for continued care.

Meadus says she believes the government's plan will coerce seniors and other vulnerable people into giving their consent. "If people are coming in and threatening you with things, people get fearful and they're going to move."

Trudo Lemmens, a professor of health law and policy at the University of Toronto, says the legislation appears to violate patients' human rights, as well as informed consent requirements, under which consent must be voluntary.