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The recent passage of Bill 7, the “More Beds, Better Care Act,” raises serious concerns about availability of responsive care for older adults in Ontario and, more broadly, about systematic discrimination based on age in the provision of health care in the province. This ageist legislation, pushed through without any public consultation, purports to solve Ontario’s health care crisis by shifting responsibility to the most vulnerable individuals in the system: frail older adults.

Currently, hospital patients who no longer need acute care but are unable to look after themselves if discharged are designated as “alternative level of care” (ALC) pending transfer to a long-term care (LTC) home of their (or their family’s) choice. Waiting times for transfer to LTC can last weeks or months, especially for the municipally operated or non-profit sector homes that two-thirds of Ontarians on the wait list for long-term care prioritize.

Bill 7 would permit hospitals to clear out approximately 2,400 of the 6,000 patients currently designated ALC who are waiting for a long-term care placement by transferring these patients to any long-term care home with a bed available. (The other approximately 3,500 ALC patients are waiting for hospice, palliative care, rehabilitation or home care placements.)

Patients and families legitimately fear that this policy will result in transfers of older adults to institutions far from their communities, to homes that are not compatible with their specific care, cultural or linguistic needs, or to homes with a poor record of IPAC and high mortality rates during the first and second waves of the COVID-19 pandemic, many of which are older homes in the for-profit sector.

The issue of distance from family members is particularly troubling since families perform numerous daily tasks such as bathing, feeding, and providing social contact for relatives in long-term care facilities. Moreover, research shows that premature discharge of ALC patients without considering their health complexity and needs leads to their higher chance of readmission and death, which eventually increases health care costs. Few would argue that the ability to exercise choice over one’s living situation (including location) is a fundamental Canadian freedom: why should this right be denied to people simply because they are older?

Furthermore, Bill 7 does not address the interconnected structural factors that have contributed to the current crisis in health care in Ontario. It is staff shortages — particularly with respect to nurses — that are fuelling the emergency room closures in the province’s cities and rural regions. Nurses are leaving the profession because of fatigue, burnout, and low wages. A key factor is the Ontario government’s 2019 legislation that caps wage increases for public sector workers to 1 per cent annually. Nurses have served the public with dedication during the pandemic: they deserve compensation commensurate with the level of physical and mental strain and the risk they take on in the workplace.

A second component of the structural crisis in health care is the inadequate supply of long-term care beds in Ontario. Currently, there are close to 40,000 people on the wait-list for long-term care placement in the province. Clearly, the problem is not simply a lack of hospital beds but an overall lack of beds in long-term care. Premier Ford claims that ALC patients will receive better care in long-term care homes, even those not of their choosing, than in hospitals. But long-term care is suffering from its own staffing crisis: as Ontario’s Long-Term Care COVID-19 Commission reported in 2021, staff shortages, reliance on part-time workers, and high turnover rates have plagued long-term care since well before the pandemic. Improving in-home and community-based support services and providing adequate compensation for the nurses and personal support workers dedicated to caring for our elderly would help to resolve this structural deficit and respect older adults’ right to choose.

The crisis in care for frail older adults is not going to disappear. Ontario is aging: demographic trends suggest that by 2043, almost one-quarter of the province’s population will be over 65. Forcing individuals to relocate without consent or choice is horrific. As concerned researchers, we urge the Ontario government to avoid short-sighted policies like Bill 7 that claim to solve health care problems but leave larger structural factors unchanged.

Instead, we advocate developing and implementing evidence-based, systemic policies and a co-ordinated provincial strategy to provide high-quality health care for all in the future.

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