Progressive Conservative MPPs voted on Wednesday to pass a bill that will make it easier for hospitals to free up beds by transferring patients to long-term care homes.
Bill 7, the More Beds, Better Care Act, allows for alternate level of care (ALC) patients in hospitals to be admitted into a long-term care home without their consent.
ALC patients are given that status by an attending clinician, such as a doctor or nurse, who deems they no longer require the intensity and resources of hospital-level care.
The bill does not allow for patients to be physically moved from a hospital to a long-term care home without consenting to it.
While the bill will now become law, it remains unclear how high the charges could be for hospital patients who refuse to be moved to a long-term care home. This uncertainty, along with the bill's consent removals, has been the focus of opposition parties since it was introduced less than two weeks ago on Aug. 18.
NDP, Liberal and Green MPPs voted against Bill 7 on Wednesday.
On Tuesday night, Premier Doug Ford said he could "pretty well guarantee" patients who refuse to move to a long-term care home that's been chosen for them against their will won't have to pay as much as $1,800 a day to stay in a hospital. The uninsured rate that Ontario hospitals charge is as much as $1,800 a day at certain hospitals.
"I'll tell you right now — I can't say 100 per cent — but $1,800 dollars is absolutely ridiculous," Ford said. "We'll have to work out the costs and the hospitals have to work out the cost. The people who are determining that, it's not me personally, it's the hospitals and Ontario Health."
Neither Ford nor Long-Term Care Minister Paul Calandra would make the same promise on Wednesday when asked in question period.
While speaking to reporters a week ago, Calandra described the rate patients refusing transfers could face as a "co-pay — the same as somebody who is in a long-term care home."
All long-term care residents pay a co-pay rate of up to $88.82/day to cover the cost of their accommodation and meals.
After Bill 7 passed, Calandra's spokesperson told QP Briefing that the government was still determining a rate, in collaboration with "stakeholders." It will be Ontario Health's responsibility to "operationalize" it, the minister's spokesperson added. Ontario Health was unable to provide more information about what this meant by the time this story was published.
A spokesperson for the University Health Network said Wednesday that until the bill's regulations are in place that its use — like how much patients who are pressured by Bill 7's law changes to move out of a hospital could be charged for refusing — can't fully be known. Calandra has said the government will finalize the bill's regulations one week after it passes.
Jane Meadus, a lawyer with the Toronto-based Advocacy Centre for the Elderly, said Wednesday that she's still very concerned patients will be threatened and possibly charged with fees much higher than either co-pay rate.
Meadus said she's heard from multiple people about being threatened with having to pay a hospital's uninsured rate when they've been designated an ALC patient, but have refused to leave a hospital.
She also cited two other documents, both of which she provided to QP Briefing. One is a 10-year-old memo that was signed by the Ministry of Health's then-assistant deputy minister, which says patients should be advised that "if they refuse a bed offer for a LTC home they apply to, a determination may be made that they are no longer in need of treatment in the hospital. A discharge order may then be communicated to them, and the hospital may charge them an unregulated daily rate if they choose to remain in hospital."
The other was a notice from Joseph Brant Hospital's website that states that discharged patients who refuse to leave the hospital will be charged $1,707.59/day to stay.
Meadus' organization, and the Ontario Health Coalition, and Canadian Union of Public Employees, were signatories to a letter they sent Tuesday to the Ontario Human Rights Commission asking for it to rule whether Bill 7 is in violation of age-based discrimination laws.
Another aspect of the bill that opposition parties were put off by was the government's move to fast-track it. The PCs used their majority to vote to skip a committee study and shorten the length of time MPPs spent debating Bill 7.
The NDP's France Gélinas, her party's health critic, said when the government moved to axe parts of the typical passage process that the government "cancelled the opportunity to be heard, because what people will say is that they completely disagree with what this government is doing."
"(Hospital CEOs), families, the patients, health-care workers ... all of them would have explained to this government that this bill is wrong," said Liberal MPP and health critic Adil Shamji, who spent his career as an emergency physician before being elected, on Wednesday. "I have no doubt about it."
"This legislation is an attack on the rights of the frail and elderly and should never have become law without proper public scrutiny," Green Leader Mike Schreiner said in a statement after the bill was passed.
In question period before the vote that passed Bill 7, Ford said that people who've been discharged from hospitals by a doctor should be "put in a proper home with proper care to make sure they have a better quality of life."
Bill 7 is one part of the government's plan to relieve stress on the health-care system. Its law changes will help open up at least 250 hospital beds in the first six months, the PCs' "Plan to Stay Open" says. In total, the plan's measures are meant to free up 2,500 hospital beds.
Ford and Calandra have said there are 6,000 ALC patients in Ontario hospitals right now, and 1,000 more than there were one month ago. Among them, there are 2,000 seniors waiting to be moved to long-term care homes, according to Calandra.