Hospitals across Ontario lack available acute care beds as a portion of these beds are occupied by patients who no longer require acute care services. These patients are referred to as “alternative level of care” or “ALC” patients.
ALC patients no longer require acute care but are not able to be discharged home, as they still need another level of health care, such as complex continuing care, rehabilitation or long-term care. Unfortunately, due to a shortage of spaces, these patients have no option but to wait in hospital pending transfer.
Recently, ACE staff have learned about special programs being offered to ALC patients awaiting transfer to a long-term care home (LTCH). Hospitals are entering into agreements with local retirement homes to temporarily house patients, instead of allowing patients to wait in hospital. Additional care and nursing supports for patients staying in the retirement home may also be provided through the local Community Care Access Centre (CCAC).
This article will highlight some of the legal issues that may arise from these arrangements. It is intended to help seniors and their families decide whether or not to agree to a transfer into a retirement home pending admission to a LTCH.
Your Consent is Necessary
Even if you are in hospital, no longer require acute care and are eligible for admission to a LTCH, the hospital discharge team cannot make you accept a bed in a retirement home without your express consent. You may consider such a move as one possible option, but no one can require you to accept this option.
Retirement Homes are Not Regulated Facilities
Unlike hospitals and LTCHs, retirement homes are not regulated health facilities but tenancies regulated by the Residential Tenancies Act (RTA). This legislation regulates all landlord and tenant arrangements. Retirement homes are referred to as “care homes” under the RTA. They are described as rental accommodations where you may also purchase a variety of “care services” from the landlord. Examples of care services include nursing care, supervision of medications, an emergency response system and assistance with activities of daily living. However, there is no government regulation or oversight regarding how care and services are provided within retirement homes.
When you agree to live in a retirement home, you enter into a tenancy agreement with the landlord in the same way you do in any other apartment (even if you only rent a single room or share a room within the care home). The landlord is required to provide you with a written tenancy agreement which must set out how much you pay for rent. The landlord may charge any amount that he or she chooses, subject to the RTA provisions regarding rent increases.
Hospitals, on the other hand, cannot charge ALC patients more than the ALC rate as set out in the regulation to the Health Insurance Act. Currently, the rate is $51.88 per day but it will increase to $53.07 on July 1, 2009. This is generally the same rate daily rate as is charged for basic accommodation in a LTCH. The ALC rate in a hospital can similarly be reduced if you cannot afford the full rate. No rate reduction scheme exists under the RTA and it is up to individual landlords to decrease rates as they see fit. (It is important to remember that when you are in a LTCH or hospital, the government pays for your nursing care, food and other services but you must pay for everything in a retirement home.)