Ontario hospital patients could face charges if they refuse to go to long-term care

The Ford government is facing calls to prevent alternative care level (ALC) patients from being charged if they choose to remain in an acute bed – a practice used by hospitals as a last resort.

The province faced backlash after the bill was submitted More beds, better care Law that would allow the province to explore viable long-term care homes on behalf of an ALC patient without their consent.

While the government insists that patients are not removed from hospital against their will, it has yet to clarify what would happen if a patient resists a request after being discharged from the acute bed.

Currently, ALC patients and their caregivers must select a list of five long-term care homes where they would rather live and are charged a co-payment fee of approximately $62.18 per day while they wait.

At the University Health Network, for example, health 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 were discharged from acute care by a physician, did not participate in the selection of other ALC facilities and/or refuse to leave the hospital when their first choice becomes available, or do not participate in discussions,” said a hospital spokesman said the criteria for the charges.

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The hospital network, which currently serves around 100 ALC patients, said the measure is used once or twice a year in extreme circumstances.

Long-term care minister Paul Calandra told Ontario lawmakers that the ability to bill ALC patients for their beds “is a tool that’s been in hospitals’ toolboxes since 1979,” and later doubled the availability of the tool as he spoke to journalists at Queen’s Park.

“Are there cases where hospitals charge fees? Absolutely,” Calandra said. “If someone refuses to move into a house, if they refuse to move into the house of their choice, then yes. Should a hospital charge you? Absolutely, because we need these rooms for patients who need acute care.”

Calandra was asked to specifically clarify his remarks on whether a patient who refused to be placed in a home that wasn’t on her preferred list would be charged by a hospital – the minister deflected, instead pointing out that Hospitals could apply the law at their own discretion.

Critics of the Ford administration have called the legislation “deeply unethical” and are now warning that the rarely used right could be expanded as the province looks to vacate up to 250 acute care beds ahead of the fall flu season.

“A patient doesn’t have to say yes to go to a long-term care home, but it costs a lot to say no,” said liberal MPP Adil Shamji, a doctor-turned-politician. “When people say yes because they don’t want to pay a $1,500 fee, that’s coercion and that’s fundamentally wrong.”

Calandra dodged calls to repeal part of the province’s health insurance law that allows ALC patients to bill.