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Ontario’s controversial new law aimed at freeing up hospital beds for an expected surge of COVID-19 and flu patients this fall and winter takes effect Wednesday.

Known as Bill 7, and officially called the “More Beds, Better Care Act,” it allows hospitals to transfer elderly patients to nursing homes not of their choosing — providing they have been cleared for discharge and consent to the move.

While seniors in this position have typically selected five nursing homes where they would like to live, they often remain in hospital as “alternate level of care” (or ALC) patients while waiting for a bed in one of their preferred homes.

This can take weeks, months or years because there are 39,000 people on waiting lists for nursing-home beds that are always in short supply, part of a long-standing problem in the province.

Premier Doug Ford’s government says circumstances in the wake of the pandemic no longer make it feasible for elderly patients to remain in hospital when nursing home beds are available. Long-Term Care Minister Paul Calandra has repeatedly said “the status quo is not an option.”

Critics warn moving the elderly into homes away from their families is tantamount to coercion, will leave them isolated and put their mental and physical health at risk in their final months and years.

Here are some key points about Bill 7.

How will this process work?

Placement co-ordinators will look for nursing homes that can accommodate a patient’s particular needs and try to steer them there when beds become vacant, sharing health information as necessary.

How far away can patients be sent?

Within 70 kilometres in southern Ontario and 150 kilometres in the two northern Ontario health districts — and possibly further if no beds are available within that distance in the north, where there are fewer nursing homes than in the more populated south.

Who pays for the patient’s transfer from hospital to nursing home?

You do, even if the nursing home is far away and not on your preferred list. It may not be difficult if the patient can get into a family member’s car, but gets more complicated and expensive if a wheelchair or stretcher is required.

The policy is detailed in the province’s field placement guide: “ALC patients who are discharged from hospital for admission to a (long-term care) home are responsible for arranging and paying for their own transportation,” it states.

“Hospitals may be able to provide background and contact information to patients and their families about transportation options such as private patient transportation services, wheelchair transportation and stretcher transportation services for patients who must travel in a fully reclined position.”

In situations where patients have no means to arrange or pay for transportation, the guide directs placement co-ordinators to consult with the hospital discharge team and Ontario Health, the agency overseeing the province’s health-care system.

What if I refuse a bed in a nursing home that has been selected for me?

No patient can be transferred from a hospital to a long-term-care home without their consent. Patients who refuse a transfer to a home not of their choosing will remain on the wait lists for their preferred long-term care homes.

How long do I have to move into a nursing home after accepting a bed offer?

What about the $400 daily fee for people who refuse to leave hospital?

Starting Nov. 20, the fee will be charged to anyone, young or old, who chooses to stay in hospital once cleared for discharge to available care elsewhere, such as a nursing home, home care, community care or rehabilitation centre.

Is it true I can go to a nursing home that isn’t my top choice while I wait for a room to open up there?

Yes, but critics question how long the wait might be for a room in the preferred home when the government’s priority is to get hospital patients into the few vacant nursing home beds. The placement guidelines state “where possible, consideration should be given to patients who have been waiting in the hospital as ALC (alternative level of care) the longest when prioritizing available beds.”

What if I want to get into a nursing home that better fits my religious, ethnic, linguistic or cultural background?

Critics warn that such homes typically have longer waiting lists, making it more difficult to get into them. The government’s placement guidelines suggest finding other homes with appropriate supports, such as French-speaking staff for a francophone patient.

I can’t afford more than basic nursing home accommodation, but a better room is opening up and there are no basic rooms available. What can I do?

The government will consider “top-up” payments to move patients into “preferred accommodation” rooms, to cover the difference and pay that amount to the nursing home. Once a basic room becomes available, that resident would be moved into it and the top-up payments would end. Nursing home residents who can’t afford basic rates can apply for a rate reduction.

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