A controversial law that could see patients who opt to stay in hospital while waiting for a long-term care spot charged $400 per day came into effect in Ontario on Sunday.
The mandatory daily fee for patients who refuse to go to a long-term care home arranged on their behalf is the latest component of Bill 7 to kick in. The law also allows for patients to be moved to care facilities up to 150 kilometres away from their homes for residents of Northern Ontario, and 70 kilometres away for residents of southern Ontario.
The measures can only be applied to patients who have been assessed and formally discharged by a physician or nurse practitioner.
But health-care advocates like Jane Meadus say the province's More Beds Better Care Act ignores the rights of hospital patients, many of whom are elderly.
"They have rights and they have a right to get proper care in our health-care system," Meadus told CBC Toronto.
"This is really just throwing everything out and saying 'We don't care, you're just a cog in a wheel that we've decided doesn't belong here,' and you're gone."
Meadus, a staff lawyer and institutional advocate at Advocacy Centre for the Elderly in Toronto, says people are being forced to go to places that they don't want. She says some long term care homes could be out of the way for patients and their families.
"A 70-kilometre radius, if you're here in southern Ontario, that could be a whole town, two towns, three towns over," she said.
"If you have an elderly spouse, if you have family members, they may not be able to visit you and do the essential caregiving and provide the support that you need."
'A hospital is not a home,' government says
The government has said that the measures are necessary to ensure there is room in hospitals for people who need the kinds of acute care they provide.
In a joint statement, the ministers of health and long-term care — Sylvia Jones and Paul Calandra, respectively — said the policies within the law were developed with input from medical professionals.
"We want to be clear about what this policy does: it frees up hospital beds so that people waiting for surgeries can get them sooner; it eases pressures on crowded emergency departments by admitting patients sooner," the pair said, adding that other provinces use similar measures.
"We also want to be clear that a hospital is not a home. This policy only impacts those patients who a doctor or nurse practitioner has said no longer need hospital care and would be better cared for at home with the support of home care, in a community setting or in a long-term care home, where residents benefit from social activities like dining, recreation and physical activity," the statement continued.
Jones and Calandra said the policies will be "implemented compassionately."
'That's structural coercion,' doctor says
Dr. Samir Sinha, director of geriatrics at Sinai Health and University Health Network, says the act is "a major change" and does not foster a good relationship between hospitals and patients.
"It basically says that if you don't accept the plan that a hospital has for you, either to go to a long-term care home or even go back to your own home, they are mandated now by the Ontario government to punish you and to charge you $400 a day. That's structural coercion," he said.
Sinha says all patients are being impacted, not just the elderly.
"If you don't like the care plan that's being proposed, you're going to be punished," he said.
"When you're being told already that if you don't like the plan that might be proposed to you, the hospital will be mandated to charge you $400 a day, that's not the greatest way to start off a conversation usually," he added.
Sinha is concerned the new law is "going to create more friction and more animosity and actually poison the relationships between hospital care providers, patients and families to actually find the best path forward."
'The NDP will never support this,' MPP says
In August, Ontario's Progressive Conservative government used its majority to pass the controversial legislation.
The government has faced criticism over the vague wording of the legislation, and that it opted not to send the draft bill to committee — meaning no public feedback was gathered before it was passed. None of the opposition parties supported the bill.
France Gélinas, the NDP MPP for the riding of Nickel Belt, says it takes away the rights of frail elderly people to consent to treatment, a right that all Ontarians have.
"Bill 7 took the rights of free elderly people to give consent and to keep their private health information private," she told CBC Toronto.
"I will never support this. The NDP will never support this. Whether you're young or old, frail or the strongest man on Earth, we should all have the same rights, and now they don't. Bill 7 took those rights away."
Gélinas says she's at a loss as to why Bill 7 was necessary in the first place.
"I can't believe that we've come to this. I can't believe that we can be so cruel toward elderly people," she said.
"They are human beings like you and I. Why are we treating them like this? I can't stand this. I can't stand it."
Critics of the new law say they will be releasing details about a constitutional challenge — called a Charter Challenge — to Bill 7 on Monday.