Can I Get There From Here? Long-term Care (LTC) in Ontario

Imagine that you are a patient in a hospital in Ontario - you have undergone acute care and are now ready to enter a Long-term Care (LTC) facility for additional care. Now imagine that you have entered a complex maze, like the Waterloo County Corn Maze, only much trickier. Why?

You see, there is a severe shortage in LTC beds in Ontario and hospital administrators are becoming increasingly aggressive in their quest to make beds available for new patients – and you may need to be your own advocate in how you are discharged, and to where. You may need to find your own way through the maze, though there is help out there.

8 FAQs: Getting Discharged From an Ontario Hospital as an ALC Patient

1. What is an ALC patient?

If you are in a hospital and are waiting for a placement in an LTC facility, your doctor will label you as an Alternative Level of Care or ALC patient. An ALC patient is one who is in a hospital, or another acute care facility, who no longer needs acute care but does need a different level of care in another place - where there is currently no room.


2. Does a doctor or a hospital discharge a patient? Who decides?

A doctor is legally and practically responsible for safely discharging her patients from a hospital in Ontario. This is an extraordinarily important piece of knowledge as a patient can communicate directly with her doctor about whether it is safe for her to be discharged at a particular time and in a specific way.


3. Does a patient have to leave a hospital within 24 hours of being discharged, even if she has nowhere to go?

While a busy hospital is no place to languish longer than necessary, obviously, you should know that many ALC patients are, as you read this sentence, in Ontario hospitals, waiting for a space in an LTC home. Hence it is not true that discharged patients must always leave the hospital premises within 24 hours.


4. If a hospital representative requests that a patient enter a retirement home to await a space in an LTC facility, does the patient have to comply?

A retirement home is not equal to a LTC facility. An LTC facility is part of the Ontario health care system while a retirement home is not, and the latter requires that rent be paid. According to the Advocacy Centre for the Elderly in Ontario, you do not have to enter a retirement home whilst waiting for a LTC facility. You do have a choice in this matter.


5. Should a patient be agreeable to leaving a hospital and entering a retirement home, does she have the right to choose which retirement homes to apply to?

Part III of the Health Care Act and the Long-term Care Health Act (LTCA) both dictate that it is the patient, or the patient’s substitute decision-maker (SDM), that has the right to choose which retirement homes to apply to.


6. Do patients have to follow the policies of the Ontario Community Care Access Centre (CCAC)?

Hospital representatives sometimes tell patients that they must comply with the policies of the CCAC, which could mean returning home with a defined amount of CCAC care or moving to a retirement home from a short list approved by the CCAC - or paying for your hospital room.  According to the director of communications for the minister of health and long-term care in Ontario, the patient must give consent to the course of action being recommended. Period.


7. If a patient does not make an application to a specific retirement home, can a CCAC worker sign this patient up for admittance to said retirement home?

While an aggressive CCAC worker may strongly advocate for placement in a specific retirement home, she does not have the authority to request that a retirement home accept a patient who has not proactively applied for residence there.


8. Is it possible for a patient to make changes to a short list of LTC homes that they previously provided a CCAC worker with?

A patient has the right to remove an LTC home from their preferred list and to add another home: this flexibility is considered essential to a making an eventual decision regarding an LTC home that works.  A placement coordinator is not legally permitted to attempt to restrict a patient’s choice, by trying to require her to choose from a limited list of choices.


If you have questions about how ALC patients are discharged from hospitals in Ontario, the Advocacy Centre for the Elderly can provide answers.


Written by Lorna MacNeil

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