One of the most distressing types of calls we receive are from families who have been told by the hospital that their loved one will be discharged…..tomorrow.
It is bad enough that their loved one is in the hospital, and to be told that they will be discharged with no time to make appropriate plans can be overwhelming for anyone, especially family caregivers. Many times the senior is either living alone or living with an aged spouse. The question to be asked is ‘who is supposed to care for them?’ Many times the recommendation is for Long Term Care but as we are all well aware, waiting times are long and resources limited.
I refer to the excellent article published by the Advocacy Centre for the Elderly and written by Jane Meadus, titled “ Discharge from Hospital to Long-Term Care: Issues in Ontario”.
As excerpted: Families are told that they must comply with the hospital policy. “These policies may “require” the patient or substitute decision-maker (SDM) to select possible LTC homes from a “short list” where a bed is or will soon be available. If they do not comply with the policy, the hospital threatens to charge the uninsured daily rate which ranges anywhere from $500.00 to $1,500.00 or more per day.”
“Placement into LTC is regulated by the LTCHA and its regulations. The placement coordinator form the CCAC must work with the applicant or the SDM, if the person is incapable, to ensure the needs of the person are met. No role in the placement process is given to hospital workers, such as discharge planners or social workers under the LTCHA…. While awaiting placement to LTC in hospital, the person will be designated by the physician as “Alternate Level of Care” or “ALC.” This simply means that the person is in hospital awaiting a different type of care somewhere else that is not presently available….Once the person is assessed by the CCAC as being elible for admission to a LTC home, the person will be asked to choose homes to which they wish to apply. A person may choose up to five LTC homes. This is the maximum number, unless the person is put in the crisis category waiting list (which is unlikely if they are in the hospital). …Hospitals often have policies requiring applicants to make one of the following so-called “choices”: accept the first available bed in any LTC home; return home to wait for their hoe of choice: go to a retirement home to await their home of choice; or pay the “daily rate” for the hospital bed (also known as the uninsured rate). However, the legislation is clear that this is not legal.
The question then becomes whether the hospital is required to keep the applicant while they wait for their choice of home. Many homes have lengthy waiting lists. Does the hospital have to keep the person until their choice becomes available?
The regulations to the Public Hospitals Act require a person to leave the hospital no later than 24 hours after a discharge order has been made. Looking at this provision, it would appear that once a patient no longer requires treatment, they must be discharged from hospital, with the only exception being a 24-hour grace period. However, the reality is that there are many people in hospital who no longer require treatment but who stay until a LTC home bed or other type of accommodation/facility becomes available. Hospitals rely on this section of the legislation to require people to comply with their internal policies about accepting the first available bed, moving to a retirement home or going home with some assistance from the CCAC. However, we do not believe that this is supportable in law.
First and foremost, one must understand that it is the attending physician, registered nurse in the extended class, midwife, or dentist who is an oral and maxillofacial surgeon who discharges, not the hospital. In almost all cases, it would be the attending or “most responsible” physician who must discharge. IF they discharge a patient inappropriately because of a “hospital policy”, this could be grounds for a complaint to their College or potential civil litigation.”
So at the end of the day, the take away message here is, everyone needs an advocate. Ask for a discharge meeting so plans can be discussed in advance. Know your rights, speak to the good folks at ACE if needed and be prepared to ask questions and sometimes ‘no thank you’ is the perfect answer.