Solidarity, social dignity & Ontario’s Bill 7 (Part 1)

Monique Lanoix suggests that Bill 7 will harm people who are forced to move to a long-term care home that is not their choice.

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Ontario has proven itself adept at mismanaging health care. This was particularly evident during the pandemic, as workers and residents in long-term care residences had to live with poor infection control and lax regulations. The lack of oversight at many homes meant that residents did not have adequate care, which proved fatal in many cases. Once again, the government is showing its disregard toward individuals who require long-term care.

The latest move by the Ford government has been to introduce and pass Bill 7 without any consultation. Bill 7, titled “More beds, better care”, will amend the Long-Term Care Act of 2021. The bill targets “patients who occupy a bed in a public hospital and are designated by an attending clinician as requiring an alternate level of care.”  This new provision authorizes the placement of those requiring alternate levels of care to a facility that is not of their choice and without their consent. For patients in southern Ontario hospitals, that facility could be located as far as 70 kilometers away, whereas in northern Ontario it could be up to 150 kilometers. Starting November 20th, patients who refuse to move will be charged $400 per day.

Photo Credit: Etan J. Tal/Creative Commons. Image Description: Two individuals (one on a wheelchair) behind a glass wall looking out.

Faced with a crisis in many hospitals, the government has concluded that the way to “create” more beds is simply to move some patients from hospitals. Bill 7 essentially treats those who need long-term care as obstacles to the provision of acute care. Notably, the number of beds will remain the same in hospitals. The apparent shortage of beds is in reality a shortage of nurses. Bill 7 shifts the discussion from nurse shortages, which is the real problem.

As anyone who has contemplated moving into an assisted living facility or finding a nursing home for a loved one knows, it is not an easy decision. Many factors are taken into consideration, for example: whether the home feels comfortable, has an appropriate level of care services and staff, whether it is clean, has good infection control and, importantly, whether the staff speaks the language of the person requiring assistance. This will be, after all, their home. Location is also crucial, as the future resident of a long-term care facility usually wants to be close to relatives and friends. However, families, usually balancing paid work and family duties are likely to find a long drive daunting, especially in winter.

Another consideration is the need for stability. For persons living with dementia or cognitive impairment, stability is of primary importance. Once a person moves from one location to another, they often regress and it may take a while for them to gradually adapt. The legislation implies the person will be transferred from the hospital where they have a room to another facility and then eventually to the home of their choice. These additional moves are a problem especially if the person is transferred to a facility that is not accessible to family and friends because it is too far. The removed person might not have the support they would need to adjust to the change in environment.

Even if the government claims this is a temporary measure, they have not given a time line. Importantly, the median wait time for a long-term care home of one’s choice is 188 days. The average length of time an older adult will spend in a long-term care home is 18 months. If this is taken into account, many older adults’ final days will be spent in a home that was not of their choice. The government has plans to build more facilities; however, it will be too late for those forcibly removed.

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Monique Lanoix is Associate Professor in the Faculty of Philosophy and in the program in Ethics, Social Justice and Public Service at Saint Paul University in Ottawa.

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