Into the Abyss: Adventures in Long-term Care

At our annual general meeting in November 2009, Jane Meadus, lawyer at the Advocacy Centre for the Elderly, spoke about the complex system of rules and regulations that make up Ontario 's long-term care system. She focused on the common misunderstandings and issues with which ACE deals most often. Here are some highlights from her presentation.

A frequent issue concerns hospital policies around discharge to long-term care homes. When a patient no longer requires acute care but cannot safely return home, hospitals often encourage the patient to choose a long-term care home with a short waiting list, even if it is not a home of choice for the patient. Patients may be told that they will have to pay the full cost of their hospital bed if they refuse. ACE believes that although the law is somewhat unclear, hospitals can only charge the same daily amount that the patient would pay in a long-term care home. Hospitals also sometimes discharge such patients to retirement homes. This can be problem because retirement homes are unregulated as far as the provision of health care is concerned. Jane emphasized that this issue is very complex. How does one balance the need to free-up beds in acute care hospitals against the right of individuals to apply to the long-term care home of their choice?

On admission to a long-term care home, the new resident (or his/her substitute decision-maker/SDM) is often asked to sign an admission contract. This is not a requirement. It is not necessary to sign the contract agreement on admission. The resident can take the time to read it over at leisure and sign it later. It is also possible to remove parts of the contract, if desired, before signing. The contract may include stipulations that aren't required. For example, it is not necessary for the resident to have a guarantor. ACE suggests that residents only sign the admission contract if it enhances their rights.

Jane also spoke about level of care agreements that SDMs are sometimes asked to sign. These agreements speak to the level of care residents would receive in situations where they are unable to speak for themselves (level 1 means only palliative care, level 4 means all possible care and treatment). There are many problems associated with these agreements, and ACE does not recommend signing them. It is expected that the regulations which will accompany the new Long-term Care Act will resolve these issues.

Consent issues are a major concern for ACE. Jane notes that one should never give blanket consent. A consent should be specific to the issue. A resident/SDM must give informed consent to medications and treatment, including transfer to a secure unit in the Home, before the treatment is given.

Jane also fielded many interesting questions from the audience about a variety of related topics. Concerned Friends is most grateful to Jane and to the Advocacy Centre for the Elderly, not only for her interesting and informative presentation at our annual general meeting, but also for their help and advice to Concerned Friends over the years.

Board of Directors