Transitional care trend cited as one more way elderly being shortchanged by health system

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The transfer of elderly patients into retirement homes and converted hotels to free up hospital beds is a worrying trend in Ontario, say groups calling for a human rights inquiry into age discrimination in the province’s health care system.

Among facilities cited during a press conference by the Advocacy Centre for the Elderly, the Ontario Health Coalition and CUPE Wednesday was Ottawa’s recently opened transitional care unit at Greystone Village Retirement Home.

The retirement home in Old Ottawa East, which was about to open when the pandemic hit, was transformed into a transitional care unit, overseen by Bruyère hospital and managed by a private company — Integrated Care Solutions, which is owned by Bayshore HealthCare. The company says it works with hospitals to improve patient outcomes and “provide a seamless transition from hospital stay to in-home care.”

Greystone has beds for 120 so-called ALC (for alternate level of care) patients.

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At the time it was opened last fall, Bruyère President and CEO Guy Chartrand said the kind of transitional care being offered in the facility is badly needed in Ottawa and will help ALC patients get the care they need.

“These 120 beds will help alleviate some of the pressure on the health-care system and on our acute-care partners, while helping people access the care they need at a crucial time in their journey.”

But the groups who have called for a landmark inquiry into elder discrimination in health care say it and other programs that target mainly the elderly offer a lower quality of privatized care that doesn’t meet their needs and represents the discriminatory trend of moving the elderly out of hospitals.

Jane Meadus, a lawyer with the Advocacy Centre for the Elderly said such facilities fall into a kind of legal limbo because they aren’t regulated the way long-term care homes are. She suggested they might be illegal.

Queensway Carleton Hospital has also transferred ALC patients offsite during the pandemic — to Fairfield Inn & Suites on Terry Fox Drive. The unit is staffed by hospital workers and physicians.

Across the province, more than 2,200 ALC patients were “decanted“ out of hospitals during the pandemic to transition units funded by the provincial government.

The groups say the transition units are the latest example of the de-hospitalization of the elderly that began decades ago when Ontario dramatically reduced chronic care hospital beds, leaving it with the fewest hospital beds per capita in the country, and among the lowest in industrialized countries. At the same time, the elderly in care have become sicker.

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The elderly, they say, have been disproportionately affected by that trend and end up being pushed into underfunded long-term care or into expensive nursing homes that don’t meet their complex health needs. Nor is home-care available or sufficient to meet the needs of many elderly with complex mental and physical health issues.

The elderly, the groups say, continue to bear the brunt of a badly underfunded and disconnected system.

“COVID-19 has shone a harsh light into treatment of the elderly in health care,” said Meadus. “This is not a new issue and it is not specific to COVID. These are the issues (the Advocacy Centre for the Elderly) were dealing with prior to COVID and have been dealing with for 20 years.”

The groups say the ongoing commission investigating issues in long-term care during the pandemic does not go far enough. They want to see a broad investigation into what they call systemic elder discrimination within the entire health system.

Representatives of the three organizations said Ottawa has experienced the disproportionate impact of the pandemic on the elderly. Of 450 Ottawa residents who have died from COVID-19, at least 282 were long-term care residents and 50 lived in retirement homes. The vast majority of deaths have been among people over 65.

In Ottawa, more than 30,000 people are waiting for long-term care homes, some for as long as five years.

“Every bed is full in long-term care homes, every bed is full in hospitals. As a consequence, the elderly are pushed around to places that are not safe and do not provide adequate care,” said Natalie Mehra, who heads the Ontario Health Coalition.

Among other things, groups say some ALC patients in Ontario were “decanted” from hospital to long-term care homes that were in the middle of COVID-19 outbreaks. At least one elderly patient died after being transferred.

Michael Hurley, who heads the Ontario Association of Hospital Unions, said a high proportion of long-term care residents who died from COVID-19 did so without being sent to hospital.

“Most died without having any access to palliative care, respiratory therapists, respirologists, any advantages of modern medicine. How could that happen?”