Home First program deprives some elderly patients of right to apply for long-term care, lawyer says

Published on November 13, 2012


OTTAWA — Some seniors are being pushed out of hospital too soon under the province’s Home First policy, says a lawyer who advocates for older people.

“Patient safety is at high risk,” says Jane Meadus, a lawyer with the Toronto-based Advocacy Centre for the Elderly (ACE). “While many patients will do well at home with extra home-care services, there are many who are too sick to be cared for at home.”

The Home First strategy aims to reduce the number of people occupying costly hospital beds, going into long-term care. The thinking is that too many patients going into nursing homes could manage at home with adequate support.

But, Meadus said, some elderly patients are being “forced” to go home to recuperate without being given the option to apply for long-term care and waiting for a bed while in hospital. And that might violate their legal rights.

In other cases, people are being pressured to enter private retirement homes, which can cost $5,000 a month and might not be able to provide the care needed, she said. “There have already been cases where people have died due to being forced into them while really requiring long-term care.”

ACE has received about 250 complaints from across Ontario in the past year, including from Ottawa, about hospital discharges. “Discharge from hospital is the No. 1 issue in our office,” said Meadus.

Queensway-Carleton Hospital has formally adopted the Home First approach. Other hospitals in the city are at various stages of implementation.

“Our philosophy has changed,” Maureen Taylor-Greenly, Queensway-Carleton’s vice-president of patient services and chief nursing officer, said recently. “If you came from home, there’s only one place to go — home. We don’t talk about long-term-care any more.”

Meadus says that in her opinion, this policy runs contrary to the provincial Long Term Care Homes Act.

“When making decisions, people must be told of all of the options,” she says. “Where a person may require long-term care, this is one of the options. Without being provided with the correct information, they cannot make an informed choice as is required by the law. Hospitals cannot require physicians to discharge before the person can be safely cared for in the appropriate destination.”

In response to Meadus’s criticism, however, Taylor-Greenly said most people prefer to be home. “Our default is to plan for home, and involve the CCAC early in those discharge discussions.

“We will absolutely facilitate completing papers for long-term care if a discharge to the community is not possible.”

Chantale LeClerc, head of the Champlain Local Health Integration Network (LHIN), the region’s health authority, said she was not aware of local people being denied the opportunity to apply for long-term care.

“The Home First program is designed to make sure that every possible option is explored to help provide the right level of service that the person needs in order to go home before making a decision to go into a long-term care home,” said LeClerc. “If that’s not possible ... then the person would be able to make an application to a long-term care home. But it’s being used as a last resort. What they still might explore is whether the person could wait for their long-term care at home. Sometimes families are able to rally if they know that it’s for a short period.”

She notes that unlike some parts of Ontario, the Champlain region has 24-hour home-care through the Champlain Community Care Access Centre. Patients can receive intense nursing, therapy and personal support for two months after discharge.

If it is a crisis situation, they will be moved up the waiting list for a care home, says LeClerc.

Meadus says hospitals, physicians, and the CCAC could be liable for any harm which may occur.

“To suggest that people can go home on their own, to be cared for by spouses who are frail and unwell, or by relatives who cannot manage them, amounts to negligence,” she says.

People are entitled to wait in hospital, paying a copayment, until a long-term care bed becomes available, she says.

Across the region, there was a 27-per-cent drop over six months in the average weekly number of people in acute hospitals waiting to be transferred elsewhere — from 348 last March to 256 in September.


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