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Fairness by design — implementation of the More Beds, Better Care Act, 2022

To anticipate the changes from the More Beds, Better Care Act, 2022, our Fairness by Design resource helps hospitals and Home and Community Care Support Service organizations proactively review the fairness of their processes and decision-making.

Resident Experience

The complainant contacted Patient Ombudsman on behalf of a family member who had been waiting more than 2 ½ years to transfer to a long-term care home that was closer to the family. The long-term care home where the resident was living was more than 200 kilometres from family, which made it difficult to visit and support the resident’s care. The resident had no family or friends close to their home and was completely isolated. The complainant was concerned that because recent changes to the regulations governing long-term care home placement gave priority to hospital patients, the resident would wait even longer for a transfer and may even die before a transfer could be arranged. Patient Ombudsman facilitated discussions between the family and the Home and Community Care Support Services placement coordinator to ensure that all possible options were explored.

Discharge and transitions of care represent a significant portion of complaints to Patient Ombudsman: 12% of hospital complaints, 6% of home and community care complaints, and 5% of long-term care home complaints.

Most of these complaints involve discharges from hospitals, and many include issues with transitions from hospitals to other care settings. Patients and caregivers report concerns about lack of coordinated discharge planning, lack of patient and family engagement in planning and poor or coercive communication.

In 2022/23, Patient Ombudsman dealt with 136 complaints related to long-term care placement. Three quarters of the complaints were about placement into long-term care from hospitals, and the rest reflected concerns about placement from the community into long-term care, or long-term care home residents waiting for transfers to preferred homes.

In September 2022, the Ontario government amended parts of the Fixing Long-Term Care Act, 2021 to expedite the process of moving hospital patients who require “alternate level of care” to long-term care homes. The amending legislation, the More Beds, Better Care Act, 2022, allows placement coordinators to determine eligibility for and authorize admission to a long-term care home without a patient’s consent in some circumstances. Related changes to the regulations allow patients to be placed up to 70 kilometres from their preferred location in southern Ontario and up to 150 kilometres in the North. In addition, patients moving to long-term care homes from hospitals must be placed in the “crisis” category (unless they qualify for a higher priority category), giving them priority over many others waiting for placement into long-term care from the community or transfers between homes. Patient Ombudsman received a number of complaints from patients and caregivers concerned about the possible impact of the legislation, but ultimately did not receive complaints from patients directly affected by this legislation. We did receive a number of complaints from people waiting for long-term care placement from the community or to transfer to another long-term care home who were affected when hospital patients were prioritized. We continue to monitor these types of complaints.

Patient Experience

The complainant contacted Patient Ombudsman’s call centre to express concern about the More Beds, Better Care Act, 2023. The complainant’s partner was in hospital and had just been designated as “alternate level of care.” The complainant, who was in their 80s and couldn’t drive very far, had been advised that their partner could be placed in a long-term care home up to 150 kilometres from their home. Although there is a long-term care home only five minutes from home that is the complainant’s preferred destination, they had already agreed to add additional homes in their city to their choice list. Patient Ombudsman encouraged the complainant to discuss their concerns with Home and Community Care and provided contact information for the complainant’s Member of Provincial Parliament to express their views about the legislation.

Our response

In anticipation of this significant change, Patient Ombudsman released its first Fairness by Design resource in November 2022 to proactively address stakeholder concerns about the controversial legislation.

The resource is meant to help inform hospitals and Home and Community Care Support Services organization about the procedural safeguards that are needed to ensure that the long-term care placement process is fair and reasonable, whether placement occurs with or without the consent of the patient and substitute decision-maker. It allows health sector organizations to proactively review their processes to ensure greater fairness for residents and their families.

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