The Ford government is facing calls to prevent alternative level of care (ALC) patients from being charged if they choose to remain in an acute care bed – a practice that’s used by hospitals as a measure of last resort.
The province has been facing backlash after tabling the More beds, better care act which would allow the province to explore viable long-term care homes on behalf of an ALC patient without their consent.
While the government has insisted that patients would not be moved out of hospital against their will, it has yet to clarify what would happen if a patient resisted a request once they’ve been discharged from the acute care bed.
Currently, ALC patients and their caregivers have to choose a list of five long-term care homes they would prefer to live in and are charged a co-pay fee – of roughly $62.18 per day – while they wait.
At the University Health Network, for example, health-care administrators can legally charge patients a daily fee of up to $1,891 — the cost of a funded hospital bed — if their choice of home becomes available but they refuse to leave the hospital.
“If they have been discharged from acute care by a physician, have not participated in the process of selecting other ALC facilities, and/or refuse to leave hospital when their first choice becomes available or don’t participate in discussions,” a hospital spokesperson said of the criteria for the charges.
The hospital network, which is currently caring for roughly 100 ALC patients, indicated the measure is applied once or twice per year in extreme circumstances.
Long-term care minister Paul Calandra told the Ontario legislature the ability to charge ALC patients for their beds is “a tool that has been in the toolbox for hospitals since 1979” and later doubled down on the availability of the tool when speaking to journalists at Queen’s Park.
“Are there instances when hospitals will be charging? Absolutely,” Calandra said. “If somebody refuses to move into a home, if they refuse to move into their home of preferred choice, then yes. Should a hospital charge them? Absolutely, because we need those spaces for patients who need acute care.”
Calandra was asked to clarify his comments specifically as to whether a patient who refused to be placed in a home that was not on their preferred list would be charged by a hospital — the minister deflected and instead indicated hospitals could use the law at their discretion.
Critics of the Ford government call the legislation “profoundly unethical” are now warning that the rarely-used right could be ramped up, as the province looks to clear out up to 250 acute care beds ahead of the fall flu season.
“A patient does not have to say yes to go into a long-term care home, but there is a very steep cost to saying no,” said Liberal MPP Adil Shamji, a physician-turned-politician. “If people say yes because they want to avoid paying a $1,500 fee, that is coercion and that is fundamentally wrong.”
Calandra sidestepped calls to repeal a portion of the province’s Health Insurance Act that allows ALC patients to be billed.
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