In Hospital With No Where To Go

December 14, 2011; By: Audrey Miller
All About Estates

Staying in the hospital over any holiday period can be difficult.  There is often a desire by families and hospitals alike to move people out of the hospital and back into the community.   One of the all too common themes is the push to have patients accept the first available bed for placement within a long term care facility.  Geographic location was not a concern for the discharge planner, nor all too often, the wishes of the client, family or substitute decision maker.  The Advocacy Centre for the Elderly ( has taken a lead role in clarifying the Ministry of Health and Long Term Care’s policy as well as challenging  hospital’s discharge policies.

The following excerpt is from the Advocacy Centre for the Elderly’s  March 1, 2011 memo, titled REVIEW OF THE MINISTRY OF HEALTH AND LONG-TERM CARE MEMO RE CRISIS DESIGNATION AND FIRST AVAILABLE BED POLICY. “In general, hospitals were attempting to enforce “policies” regarding long-term care choices. Hospital patients and their families or substitute decisions makers (SDMs) were told that they must comply with such policies, or be charged the “daily rate”: that is, the uninsured rate, which could run anywhere as high as $1800 per day. Such policies also included the patient being required to move to the first available long-term care home bed in the area whether it was one of their “choices” or not; to choose specific numbers of homes from a “short list”, or to go to specific homes. Some hospitals went so far as to “complete” the choice sheets for the applicants.”

On February 23, 2011, Ruth Hawkins, Assistant Deputy Minister (A), Health System
Accountability and Performance Division of the Ministry of Health and Long-Term Care issued a memo to all LHIN CEOs, and copied it to the Ontario Hospital’s Association and all Community Care Access Centre (CCAC) CEOs, in which she clarified the Ministry’s position regarding Crisis Designation and First Available Bed Policy.   

Among the general statements made in that document, are the following:
1. Hospital policies and practices must comply with the legislation, including the
Long-Term Care Homes Act, 2007;
2. Such policies and practices must not be made at the expense of patient
consent and choice;
3. Hospitals do not have the authority to require applicants waiting for a bed in a long-term care home to take the first available bed because this practice is not
consistent with the Long-Term Care Homes Act, 2007;
4. The fee charged to patients who require chronic care or who are more or less a
permanent resident of a hospital or other institution, including ALC patients,
cannot exceed that found in section 10, Regulation 552 under the Health
Insurance Act of $53.23 per day;
5. Pursuant to the Long-Term Care Homes Act, 2007, it is the CCAC that is
responsible for determining eligibility for admission, priority for admission,
monitoring waiting lists, and authorizing admissions to long-term care homes.
Hospitals have no such authority;
6. A hospital cannot choose a long-term care home for a person;
7. Before an admission can be authorized the CCAC, the person or their
substitute decision-maker must provide valid consent to the admission.

Thank you ACE.

While these are great steps in the right direction, and while we hope that placement into a long term care facility from the hospital is undertaken in a thoughtful  and respectful manner , this is not always the case.   Unfortunately, there continue to be bed shortages in long term care facilities and while we are living longer and keeping these beds occupied, these challenges will continue.

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