For the first time, the Ontario government has confirmed seven people have been charged fees under a controversial law that says patients who refuse to move out of the hospital and into a long-term care bed must pay $400 a day.
This comes after the government repeatedly denied any charges under Bill 7, the More Beds, Better Care Act, since it took effect in November 2022.
It also comes after CBC News told the Ministry of Health and Ministry of Long-Term Care that it has seen a copy of a $5,200 invoice paid by a Chatham-Kent resident last year.
Tamara Moir told CBC News that her father-in-law paid the bill after the family refused to move him from a Chatham-Kent hospital and into a long-term care home that they didn’t choose.
But more than once over the last year, media reported the Ministry of Long-Term Care and the Ontario Hospital Association have said no charges have been levied under the bill.
Most recently, Long-Term Care Minister Stan Cho told media he wasn’t aware of any fees charged.
“I’m getting tired of hearing that no fines were issued when our father-in-law was issued a fine,” said Moir.
The discrepancy around whether patients have been billed adds to the controversy surrounding the law. Advocates have previously said the bill violates the Charter of Rights and Freedoms, and are now raising questions around how the law has been enforced and how the government is measuring its impact if it wasn’t aware of when it was being used.
Chatham-Kent resident Tamara Moir says she she felt that care coordinators were intimidating and tried to bully her family into taking the first available long-term care bed.
Chosen LTC home wasn’t in convenient location
Moir said her father-in-law, who is now 93, spent February 2023 in hospital with pneumonia. After a short stay at his assisted living residence, he landed in hospital again and suffered a severe fall that left him with a large gash in his head.
On March 13, he was eligible for long-term care and days later was accepted to a home that wasn’t one of his top choices, Moir said.
She added that since the location wasn’t convenient for the family, they decided to turn it down. She said they were also given assurances by their preferred long-term care home that a bed would soon be available.
Moir said they knew moving her father-in-law twice would be hard on him.
Another key concern for Moir was if her father-in-law went into a long-term care home they didn’t want, he would no longer be considered an urgent priority for the one he wanted.
But once they declined the bed on March 16, Moir said, the doctor officially discharged her father-in-law from hospital and the family was told there would be a daily fee.
“It’s just the whole process of the way they went about it — they really bully you and try to pressure you into that decision, and it’s stressful enough when you’ve got somebody in the hospital and then you’re trying to make decisions like that,” she said.
“He wasn’t in the greatest of health when this whole thing was happening. It was like they just wanted to get him out of there as fast as they could. That’s how we felt.”
‘They need to be accountable’
A spokesperson for Chatham-Kent Health Alliance said the hospital has relied on Bill 7 once to “help reduce wait times in hospitals and free up public hospital beds for those who require acute care.” The spokesperson said it couldn’t provide comment on the specific situation, citing patient confidentiality.
Moir’s loved one was accepted into a long-term care home they wanted on March 28 and moved out of the hospital the next day. The bill they received charged them $400 a day from March 16 to March 28.
On April 24, Moir said, the $5,200 total was paid in full.
While Moir said she understands the purpose of Bill 7, she believes its enforcement should be handled on a case-by-case basis.
“A lot of people at that stage of their life can’t afford that … so it’s very taxing on someone,” she said.
She also said government claims around the charges haven’t been accurate.
“They need to be accountable for what they’ve done… the Ministry of Long-Term Care or whoever should know if fines have been issued,” said Moir.
“If they’ve put [the bill] in place, they need to follow up and be accountable for it.”
Charges to be shared ‘moving forward’: province
When CBC News first reached out to the Ministry of Health and the Ministry of Long-Term Care, they responded with a joint statement on March 26 that said, “No hospital has reported to Ontario Health or to the Ministry of Health or Ministry of Long-Term Care that a charge has been laid.”
But after CBC News asked more questions, the Ministry of Health said on Tuesday that Ontario Health and the Home and Community Care Support Services “were aware of charges under Bill 7, [but] that knowledge was not shared with the Ministry of Health and Ministry of Long-Term Care, nor the respective minister’s offices.”
“Moving forward, this information will be shared with both ministries as well as [ministers’] offices,” reads part of the statement.
It continued to say that of the 20,000 patients who have been transferred to long-term care homes under Bill 7, seven have been charged.
The statement said that when a person gets discharged from hospital and refuses a long-term care bed, the care co-ordinator is required to report that to the Home and Community Care Support Services’ chief executive officer.
The CEO is then expected to inform Ontario Health and an Ontario Health regional officer, “with a letter that includes the name of the hospital where the [alternative level of care] patient refused to be discharged to a long-term care bed.”
“At that point in time, Ontario Health and Ontario Health regional officer should have been reporting these instances of charges to the Ministry of Health as well as the Ministry of Long-Term Care. This last step was not being completed,” read the statement.
The Ministry of Health and the Ministry of Long-Term Care previously told CBC News that the bill is meant to free up hospital beds to relieve crowded emergency departments and allow people waiting for surgeries to get them sooner.
“A hospital is not a home and Bill 7 allows [alternate level of care] patients to receive the restorative, rehabilitative and supportive care they need, in the right place,” reads part of the March 26 statement from the ministries.
Lawyer says no oversight is ‘very concerning’
Jane Meadus, a staff lawyer and institutional advocate at the Advocacy Centre for the Elderly in Toronto, said she’s not surprised the government hasn’t been properly tracking charges under Bill 7.
But she said if the reporting requirements weren’t made clear to those enforcing the rule, it makes her wonder “whether [the government] made it clear as to what they’re supposed to be doing with respect to those charges in the first place.”
“It’s a lack of oversight by the government when it comes to … seniors and fees that are charged in hospitals and in other sectors that are in addition to what we pay under our health system,” she said.
Meadus said it’s “very concerning” it has taken more than a year for the government to find out there have been charges.
Knowing that only seven of 20,000 people accepted the charge also shows how “this is being used to force people,” into homes that they might not want, Meadus said.
She added the government should be keeping a record to look back on, especially if there are ever concerns that the bill is being misused.
Meadus said the improper enforcement of the bill — like charging family members rather than the patient or charging incapable patients — are situations that might need to be reviewed at some point.
“This is publicly funded health care, and so when you are going outside of that and they’re saying that these people are no longer entitled to publicly funded health care, they better have their T’s crossed and their I’s dotted, to make sure that these charges are in fact legal, and if they’re not reporting the situations to the ministry, I think that it’s very fertile grounds for things to go awry very quickly.”