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Long Term Stays in Acute Care Hospitals

The Memos

Over the weekend I posted some memos from the Ministry of Health and Long-Term Care's Assistant Deputy Ministers. I want to lend some context to them and in doing so I think that I will help clear some of the mud that is the Ministry and the policies, legislation, regulations and programs that make up this jungle. But before I do that, this area of the law is full of names, agencies, and other assorted mouthfuls. So we're going to need to fix that.
I'm going to post a glossary of terms, so that from here on out, we're all on the same page. In the meantime, I'm going to try and call the Ministry of Health and Long-Term Care "the Ministry." It's often just written as its acronym - MOHLTC, but I'm going to buck the trend and call it Ministry. Assistant deputy ministers are ADMs. Substitute decision makers are SDMs. Let's not confuse those two, since they're very much unassociated.

Stuck in Acute Care

Now - Back to the issue at hand. The Ministry Memos and what they mean. I read an article by Maria Cook recently; it was in the Citizen on January 2 of this year. I think everyone interested in this area of the law or facing the Ministry, hospitals or the CCAC for themselves or a loved one should read it. It's on point and serves as a poster for what is wrong with the system and the agencies in it. Read it here. It illustrates well the position of the hospitals and how they often forget that they are bound by the regulations and legislation. The memos I posted last week were sent out over the past three years to address the exact sort of issue faced by the family in Maria Cook's article. 

Hospital Pressures

The short version of the story is this - Barbara Korwin, the SDM for her 89 year old mother was called into the Ottawa Hospital for a meeting and given two options - put mom in a retirement home or take the first available long term care home bed. Korwin refused both options. The Korwins are just two of many victims of a new practice favoured by many local hospitals. The idea isn't born out of evil, it is just impractical, dangerous and ill-concocted. The scheme is meant to help hospitals trim their ALC patient numbers (ALC - Alternate Level of Care) by moving those patients out of the system. The idea is meant to be a solution to the Ministry's chronic lack of space/beds. The problem, other than the fact that it has serious implications for families, is that it is about as effective a long term solution as using a squirt gun would be practical to put out a four-alarm blaze (maybe I'm exaggerating - but I doubt it).

Alternate Level of Care

The problem is that most of ALC patients are seniors who are unable to go home and wait. The big problem is that Ontario Retirement homes are not IN ANY WAY tied to the Ministry. They are residences. As ACE (Advocacy Centre for the Elderly, a clinic operating out of Toronto for low income senior citizens, and a loud, effective advocate for all seniors) will tell you, they receive complaints related to discharge regularly. So much so that they've authored papers dedicated entirely to this subject.
The Korwins' problem illustrates the fact that there just aren't enough LTC beds in the province. And we all know this is just going to get worse. Many families find out the hard way that the wait list for Long Term Care facilities is long. Really long. It can take years to get a bed.

Home First Policies

The hospitals in the area are following a home first policy. It's meant to help with the Ministry's problems by promoting an age at home philosophy and is meant to keep seniors in their own homes while they wait for their LTC bed to be ready. And that's great - when it's appropriate. The CCAC (Community Care Access Centre) can provide significant supports to their clients. They can offer nursing, therapy and personal support. The CCAC can provide some of these supports up to 24 hours a day for qualifying individuals for up to two months after discharge. But here's a snag - remember that waitlist? It's probably not going any faster two months down the line. Instead, mom or dad are now at risk of being cut off from services that they need. Many seniors waiting for admission to LTC homes need to get the services available. They don't want them, they NEED them. They could be suffering from Alzheimer's Disease or Related Dementias (ADRD). They could be living in a home that is not suitable for them. There may be too many stairs.

Stay with the kids

Some hospitals are suggesting that the family take their elders in. And many would like to, if they could. But again, many, if not most homes may not be suitable for an elder individual to live in for up to 5 years with or without family and community support. Other hospitals suggest and even pressure their patients to leave to Retirement Homes. The problem again - is that retirement homes are not part of the Ministry mandate or covered under the same rules or regulations. They are also not cheap. With a risk of being too trite, most elders are on a fixed income and may have limited savings to draw on. While they may be able to afford a basic retirement home, they are likely not able to afford a home with the level of supports they will need, CCAC assistance or not. Many Retirement Homes will also be unwilling to take a new resident on from the Hospital. They may not have the right space available.

Choice

At the same time, while the CCAC is responsible for LTC home placement, they cannot force homes upon anyone. Your choices are your choices. While there may be longer wait times, it may be because you and your loved one have selected homes that you liked. What the CCAC can do, but may not always offer - is place you or your loved one on an interim bed waitlist. This is a bed that can be chosen as an interim, temporary placement until one of your choices becomes available. I don't know the Korwins, I really wish them the best, but I don't know if they were provided this option. It is an important option, because it can mean getting out of acute care a lot faster without sacrificing LTC choices, or risking going home or to a new retirement home without adequate facilities.
It is all about choice, and the choices, rights and options you have for yourself, or your loved ones if you are an SDM. If you are having issues dealing with decisions made by a hospital, a LTC home or the CCAC, you're not alone. You're also not without assistance. Feel free to contact us to see if we can help.
Remember, everyone's situation is unique. The blogs posted on this site are informational. They are not intended to be taken as legal advice for your situation. It is always a good idea to seek professional legal advice before making any decisions related to your particular case.
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