The Canadian Press published an interesting article this week regarding the transfer of patients from Ontario hospitals into long-term-care facilities. The article follows-up on Bill 7, which became law in 2022 and gave Ontario the right to relocate patients from hospitals into long-term-care facilities if they no longer required hospital care.
Forgive a bit of jargon, but the context is important: the patients subject to transfer are so-called ALC patients (for "alternate level of care"). ALC patients no longer require the full level of care offered in a hospital setting but still require some care. That level of care can be provided in long-term care, for a patient who will no longer be able to live on their own. It can be provided in a rehabilitation facility, for a patient that will be able to return to independent living but requires a period of recovery and perhaps therapy. It can also refer to patients who can be returned to the community but may require some support from a nurse or personal support worker — support they can receive at home. Lastly, it can also involve shifting a patient into mental-health-care support, whether in a facility or in the community. It's important to note that these forms of care are less expensive, on a per-patient basis, than keeping said patient in a hospital. Keeping a patient in hospital when they could be moved to another form of care is a tremendous drain on resources.
And, as readers well know by now, those resources are more than just financial. Ontario’s hospital system does not have enough beds and it does not have enough staff. There is a hard limit to how many patients can be cared for on any given day inside our hospital system, and for every patient that can be transferred out but hasn't yet been there is another patient who needs to get into a hospital but cannot get in. The math doesn't work any other way. Bottlenecks in the supportive care systems create delays in getting people out of hospitals, and those delays in turn delay new patients from getting into hospital in the first place. If there is anything you should know about health-care dysfunction in Ontario, that's it. (There are other things, but that's probably the most important one.)
BIll 7 seeks to partially address this by allowing the government to transfer ALC patients from hospitals into long-term care. Patients are typically able to select their preferred long-term care home or make a short-list. Generally, they choose the ones that keep them close to home and loved ones, but other factors can be involved, such as choosing a culturally or religiously appropriate facility. Patients still get that choice. But Bill 7 gives the government the legal authority to transfer a patient from a hospital to an LTC facility that is not on their list, even against their will, if their health-care team believes they could be cared for elsewhere.
The Bill says (for whatever that's worth) that patients are only to be transferred against their will after "reasonable efforts have been made to obtain the consent of the ALC patient or their substitute decision-maker." Patients who refuse to move can be billed $400 a day for every day they remain in a hospital bed their care team has determined is no longer necessary. Patients who are transferred to a facility that is not on their preferred list may be (and a ministerial source confirmed to me, are) moved to a preferred facility when a bed becomes available.
The CP article notes that, so far, just over 400 patients have been transferred against their consent using the new powers. The opposition is furious, as you'd imagine, but what struck me as fascinating was the media framing of the issue. In the CBC News version of the wire story, the outlet added a subheading noting that Bill 7 is controversial, and forces difficult choices on families.
That's true, of course. But it strikes me as more relevant to note that Bill 7 only exists because the entire system faces difficult choices. The real story here is that 400 hospital beds were made available.
Bill 7 is, in its own way, a form of triage. It's not as brutal as the kind found on battlefields or mused about during the worst COVID-19 waves, but, fundamentally, Bill 7 is a recognition that system demand exceeds system capacity. Someone is going to pay the price for that. The price can be paid by the patients (and their families) who do not need hospital-level medical care, or it can be paid by the patients (and their families) who do need hospital-level medical care. This is a binary issue. Someone is going to lose. Bill 7 decided who that is.
And this (clearly) sucks. But it is also the foreseeable — indeed, foreseen — consequence of our decision to underinvest in our long-term-care system for decades. Ontario has fallen tens of thousands of beds behind what our aging population (predictably) needs in hospitals and long-term care. (The rest of the system isn't exactly thriving either, but those are the two relevant to this column today.)
It's not quite apt to say that Bill 7 is good. Its very existence is a recognition of policy and leadership failures that mean genuine suffering for real people. But Bill 7 is, in its own way, a sign of something we see all too rarely in our politics: a frank acknowledgement of the facts as they are, not as we'd prefer them to be. Our long-term care system does not have sufficient capacity to place everyone into a desirable home in a timely manner. Our hospital system cannot keep ALC patients without compromising the health-care needs of others. Bill 7 recognizes that reality, and offers a rational (and appropriate, in my view) solution to that awful situation.
Bill 7 should be repealed one day. It should be repealed after this government and its successors invest enough in health care to make it unnecessary. Until then, it is — and these transfers allow patients into hospitals who cannot otherwise get in.
That is the higher priority, and it is to our collective shame that we find ourselves in a place where we have to make these kinds of decisions. The opposition parties can be outraged about that. They should be. We all should be. But not making the tough calls just makes things worse. And is, too often, the Canadian way.
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