Some health care institutions serving the Francophone community in Ontario have concerns about the early adoption of a bill allowing patients who no longer require hospital care to be temporarily admitted to a home long-term care (LTCH) without their consent. Bill 7, from the government of Doug Ford, could be adopted as early as Wednesday after being introduced on August 18.
The bill is part of a series of measures presented by the government in August to unclog the health system. According to the government, there are approximately 5,000 patients requiring an “alternate level of care” (ASN). These patients occupy a hospital bed, but could be cared for elsewhere. About 40% of them — or about 1,900 patients — are waiting to be transferred to an LTCH.
According to attorney Jane Meadus of the Advocacy Center for the Elderly, ALC patients are currently all considered “in crisis,” meaning they are not limited to five choices of homes where they would like to be housed, as is the case for the rest of the community. The patients targeted by the bill, she says, are likely to be those who have made only one or two choices. An out-of-hospital placement coordinator might select more FLDS for the patient in hopes of finding a bed.
Normally, the patient can stay in the hospital and pay around $60 a day — similar fees to an FLDS — while waiting for a place in one of the chosen homes. If the patient is accepted in one of them and refuses to move there, he may have to pay around $1,500 a day, as if he were uninsured, under a government directive dating from 2012. When the bill passes, an NSA patient could face these same fees since they were refused an LTCH on their list of preferences imposed on them without their consent, but legally, by the coordinator, thinks Jane Meadus, creating some pressure. On Tuesday, Premier Ford indicated that would not be the case, but he did not specify what the charges might be.
The government has not yet clarified whether French-speaking NSA patients will be placed in French-speaking LTCHs, despite the new law. Hôpital Montfort, in Ottawa — one of the largest French-speaking hospitals in Ontario — believes that the language of patients “must be taken into account when choosing accommodation”. 59 NSA patients are currently hospitalized at Montfort; 23 of them are waiting for a place in an FSLD. If the bill does not take into account the linguistic characteristics of these patients, it could “significantly reduce access to services in French,” notes the hospital.
It is also possible that the few FLDS offering services in French will obtain English-speaking patients, which would limit the number of places for French-speakers. Because of the bill, Sean Keays, executive director of Foyer Richelieu in Welland, expects “the majority of people admitted” to FLDS will become NSA patients and not those who are not hospitalized. “If there are no Francophones in the hospitals, we will take an Anglophone,” notes Sean Keays.
Complex care offer
Various studies have demonstrated in recent years the importance of obtaining care in one’s mother tongue. This element justifies, according to some experts, the importance of placing French-speaking ALC patients in an establishment that employs French-speaking people. In August, Ontario researchers notably demonstrated that patients suffering from delirium whose preferred language was not English were more likely to be physically restrained by a medical team than English-speaking patients.
According to Dr. George Heckman, a graduate geriatrician from Laval University who teaches at the University of Waterloo, the hospital stay of a person who was once independent can cause this delirium. “People don’t fall asleep because of the lights, they are unable to move around since they have IVs or catheters,” lists the geriatrician. If now the patient is moved to a place he does not know and where the caregivers do not speak his language, “it can make the delirium persist”, he continues.
In addition, there are few French-speaking FLDS in the province—there are about 30 of them—which means that a patient could be moved away from his family by a placement coordinator. “If you go to Hearst, in northern Ontario, there’s only one long-term facility,” notes Michel Tremblay, the executive director of the Fédération des Ainés et Retraites Francophones de l’Ontario ( FARFO). The second closest is in Kapuskasing, an hour away.
There are currently no beds available at the Hearst Pioneer Home according to the general manager, Nathalie Morin. The home has 67 beds; 65 are occupied, but one must remain free for isolation and the other is unoccupied due to an outbreak. The Hearst hospital did not respond to questions from the To have to. The Kapuskasing Francophone home, managed by the company Extendicare, did not want to say if it had beds available. “We will continue to serve seniors who need long-term care,” the company says.
The solution to the problem?
There are many issues affecting Ontario’s health care system. At the beginning of August, two doctors admitted to the To have to that not all Ontario patients were getting the care they needed. Over the past few weeks, around 20 hospitals have had to reduce their activities due to lack of staff. The bill, however, notes Jane Meadus, “will not solve this problem”. “Long-term care homes are also understaffed,” she says.
Despite the problems the bill could cause, Manon Lemonde, a professor at Ontario Tech University who is interested in palliative care, thinks it is a good idea. She thinks that a “reasonable zone” should be created in which the NSA patient can be moved, but that it is better to place the patient in FLDS. “The patient who is in the hospital has no stimulation, there are four of them in a room, sometimes they don’t get their meals in bed,” she says.