Alberta Health Services facilitates patient transfers to publicly funded continuing care facilities, but bigger policy problems are constraining the process.
It is a common yet difficult scenario. During a stay in hospital, it has become clear the individual’s existing housing arrangements are no longer sufficient. They need to move into continuing care.
The transition process can feel overwhelming because of the magnitude of the change, but also disempowering because there is so much information to digest. Sometimes patients may feel they are not the ones driving the decision about which facility they will transfer to. Alberta hospitals are over capacity and need to make acute care beds available to those in need, but there are limited continuing care options available. As a result, patients may feel pressured to accept an unsuitable placement in continuing care. Ideally, patients or their family members will reach a workable, if not ideal, solution by communicating openly with hospital staff. But that may not always be the case.
This article is for Albertans who find themselves or their loved ones in hospital and making the transition to publicly funded continuing care. It will provide information about the process, their rights and responsibilities during it, and some of the dispute resolution processes available to them. The transfer into privately funded care may follow a different process.
Charter challenge in Ontario
A lawsuit underway in Ontario highlights the fundamental importance of the rights in question when a patient is transferred from a hospital to continuing care. The Ontario government recently changed its provincial legislation (SO 2022, c 16) to put more pressure on patients to accept transfers from hospitals to long-term care.
A pair of organizations has challenged these new rules in that they violate the rights of patients as protected in The Canadian Charter of Rights and Freedoms. The organizations argue the new rules violate the equality protection in the Charter (s 15) because they will be used primarily against mentally and physically ill, as well as elderly, patients. Additionally, they argue the new rules violate the patients’ rights to life, liberty and security of the person (s 7) by coercing people into living and care situations they would not otherwise choose. As of the writing of this article, a court has not yet ruled on these claims.
The transfer process in Alberta
The process for transferring a patient from Alberta Health Services (“AHS”) into a publicly funded continuing care facility (called a ‘designated living option) is set out in a procedure document. AHS temporarily suspended this process during the ongoing COVID-19 crisis by a much briefer document that requires hospitals to expedite the transfer of patients into continuing care. It is unclear when AHS will lift this suspension.
When the ordinary procedure is in force, an AHS case manager facilitates the following process:
- A health care professional assesses the individual to determine what level of care they need.
- The case manager provides the individual with information about continuing care options, including which ones best meet the individual’s needs, the waitlists at the different housing options, and what will happen if the individual is not able to get into their preferred location.
- An individual indicates their “most preferred” continuing care option(s), in consultation with their case manager. The case manager can identify the most preferred option if the individual fails to identify one, or if there is only one facility that meets the individual’s needs.
- Individuals must then wait for a spot to open up. The waitlist prioritizes individuals based on criteria set out in the policy. For example, individuals who can no longer be safely cared for in the community have higher priority.
- While waiting for a spot to open up in their “most preferred” option, an individual may be offered a spot in a different continuing care facility.
When offered a spot in a continuing care facility, individuals have 48 hours to consider the offer and respond.
If an individual refuses the offer of a placement in a continuing care facility, the case manager will talk with them to understand why the individual refused and to identify another living arrangement acceptable to the individual. If available, a second continuing care option will be offered to the individual. If the individual refuses the second offer, and no other suitable arrangements are available, the individual may be transferred to an available continuing care facility or discharged from the hospital.
Hospital administrators have the power to transfer or discharge patients under the Hospital Act. An individual who stays in hospital after being discharged is trespassing. They can be fined or imprisoned, as can family members who are responsible for their care. Additionally, the individual or their family member may have to pay the costs of caring for the individual in hospital after they have been discharged.
Making a complaint and resolving disputes
Individuals who feel a hospital has failed to comply with the AHS policy on transfers can make a complaint to the Patient Relations department of AHS or the senior representative in their health zone.
The policy governing complaints says parties should be supported in negotiating a resolution to their dispute. If that approach is unsuccessful, the policy provides the complainant with a formal appeal process before an appeal board. The appeal board can confirm the transfer decision, or decide the hospital should provide the complainant with a different option.
In addition to the AHS policies, there are two sources of information an individual may wish to consult: the patient handbook of the hospital, and Alberta’s Health Charter.
First, the hospital in which a patient is located may have a patient handbook. Ask for a copy. It may contain additional information about how the hospital manages transfers to continuing care or how to raise concerns about the patient’s treatment in the hospital. Be aware that the hospital’s handbooks cannot override AHS policies.
Second, Alberta has a Health Charter, which the Government of Alberta adopted under the Alberta Health Act. It guides the conduct of the institutions and people who deliver health services in the province. It says patients can expect to “be treated with respect and dignity,” while being “informed in ways that [they] understand so that [they] may make informed decisions” about their care. The patient’s ability to raise concerns or ask questions will not be hindered by a “fear of retribution or an impact on” their care or their future situation. A patient who feels their health care providers have violated the Health Charter can contact the Health Advocate. The Health Advocate supports patients to advocate on their own behalf. The Advocate also has the power to review complaints, but with limited remedial power: the Advocate can make recommendations to any appropriate person about how to comply with the Charter in the future.
A comment on the current situation
We have heard that these dispute resolution processes may move too slowly to provide meaningful relief to patients who are mishandled during the transfer from a hospital to continuing-term care. After an elderly or frail patient has moved once, it may not be possible to move them a second time, even if an appeal board or Health Advocate recommends a move.
Moreover, bigger policy problems constrain the transfer process on both sides: the shortage of hospital beds and of satisfactory continuing-term care options. Even the most well-designed transfer process cannot address these bigger issues. This article aims to provide people navigating the existing transfer process with information about their rights. But much remains to be done to ensure that all Albertans have adequate healthcare and housing options.
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DISCLAIMER The information in this article was correct at time of publishing. The law may have changed since then. The views expressed in this article are those of the author and do not necessarily reflect the views of LawNow or the Centre for Public Legal Education Alberta.