CCBI News – Bill 7, More Beds, Better Care Act; Social Isolation Increases Risks From Heatwaves

September 9, 2022

Dear Friends of CCBI,

After a summer break, we resume sending CCBI News. Dr Bridget Campion has contributed both articles this week.

Considering Bill-7
Bridget Campion, PhD

On August 31, 2022, The CBC reported that the Ontario government had passed Bill 7, the More Beds, Better Care Act. It described the legislation as “controversial” and one that “could force hospital patients awaiting long-term care to nursing homes not of their choosing.” According to the report, the legislation is meant to free up close to 6,000 acute care beds currently occupied by alternate level of care (ALC) patients, 40% of whom are awaiting placement in long-term care. Regulations accompanying the Bill are to follow.

There is so much to say about Bill 7. It had its First Reading on August 18, 2022 and received Royal Assent thirteen days later. There were no public hearings. But I think it is best to begin by considering the contents of the Bill. I have provided a link below for those who would like to read it themselves.

Bill 7, which will be folded into the 2021 Fixing Long-Term Care Act (FLTCA), is concerned specifically with ALC patients. These are individuals (mostly seniors) who were hospitalized because of an acute care need. However, with the need resolved, they remain in hospital because they do not have the capacity and/or support to return home. Bill 7 aims to “facilitate” the movement of ALC patients out of acute care settings and into long-term care facilities.

According to my reading of it, Bill 7 divides ALC patients into two categories: those who agree to be discharged and those who do not. The Bill stipulates that in all cases, there must be “reasonable efforts to obtain the patient’s consent”. (Bill 7 “Explanatory Note” and 60.1 (4)) (Please note that substitute decision-makers are consulted and make the decisions for those patients who do not have decision-making capacity.) If the patient consents, then “the relevant portions of sections 49-54” of the Fixing Long-Term Care Act apply. It is possible that those portions will be modified in light of Bill 7, but as they stand, they include: the applicant applying to find out if they are eligible for a long-term care placement (FLTCA 50 (1)); the applicant receiving information about the process and choices available to them (50 (7)); the applicant making a selection of a home(s) (51 (1)). In providing the applicant with a selection of homes, the placement co-ordinator takes into account “the applicant’s preferences relating to admission based on ethnic, religious, spiritual, linguistic, familial and cultural factors.” (51 (4)). The FLTCA also sets out the elements of consent (52 (1)) and informed consent (52 (2)) including that consent “must be given voluntarily” and “must not be obtained through misrepresentation or fraud.” According to Bill 7, the patient may consent “at any stage of the process”, at which point “the relevant portions of [FLTCA] sections 49-54 apply.” ( Bill 7 60.1 (6)).

Those who refuse to be discharged do not have the protection of sections 49-57 of the FLTCA. (60.1 (5)) Instead, a placement coordinator may determine whether a patient is eligible for placement in long-term care (60.1 (3) 2i); may select a long-term care home or homes for the patient (geographic restrictions may apply) (60.1 (3) 2ii); may share the patient’s health information with the long-term care facility (60.1 (3) 2iii) and “[a]uthorize the ALC patient’s admission to a home.” (60.1 (3) 2iv). This may be done “with or without a request from an attending physician” (60.1 (3) 2) and may be done “in respect of an ALC patient without their consent or the consent of their substitute decision-maker, despite any provision of this Act, the regulations or any other Act”…. (60.1 (3)) The patient may appeal their eligibility for long-term care placement (60.1 (8)) and no restraints (presumably physical or chemical) may be used “to carry out the actions listed in subsection (3) [above] or to physically transfer an ALC patient to a long-term care home without the consent of the ALC patient or their substitute decision-maker.” (60.1 (7)) According to the Bill, the long-term care facility selected by the placement co-ordinator must approve and admit the patient unless there are reasons such as not having the required nursing care or physical accommodations as per 51 (7) in the FLTCA. (60.1 (3) 4 ii, iii)

This, then, is an overview of Bill 7. Next time: Reactions to Bill 7.

Sources:
CBC News, “Ontario government passes controversial long-term care bill without public input” https://www.cbc.ca/news/canada/toronto/bill-7-passes-ontario-long-term-care-1.6568125
To access Bill 7: https://www.ola.org/sites/default/files/node-files/bill/document/pdf/2022/2022-08/b007ra_e.pdf
To access the Fixing Long-Term Care Act: https://www.ontario.ca/laws/statute/21f39

Social Isolation Increases The Risks Posed By Heatwaves
Bridget Campion, PhD

According to the World Meteorological Organization (WMO), Tuesday July 18, 2022 was an astonishing day. For the first time since records were kept, the temperature in the UK rose above 40 degrees Celsius. A Red Alert was issued as was a “Level 4 Heat-Health warning by the UK Health Security agency – used when a heatwave is so severe and/or prolonged that its effects extend outside the health and social care system. At this level, illness may occur among the fit and healthy, not just in high-risk groups.”

In its article, “Health Impacts of Extreme Heat”, the Climate Atlas of Canada notes the dangers that prolonged extreme heat can pose to physical and mental health. Poverty can exacerbate these risks as people are often living in high-rises without air-conditioning and without access to cooling green spaces. But at least as lethal in heatwaves is social isolation. According to the Climate Atlas, a prolonged heatwave in Montreal in 2018 led to sixty-six deaths, with “[m]ost of the victims…older men living alone.” This is echoed in a study by Naël Shiab and Isabelle Bouchard who noted that, “Between June 25 and July 1, 2021, a heat wave scorched British Columbia and 619 people died because of the temperature. An analysis conducted by the province determined that the deaths mainly occurred in low-income neighbourhoods with few green spaces. Most of the victims were seniors who died in their dwellings. They also had another characteristic: they were isolated.”

Because of social isolation, people may not have access to or be able to comprehend without help information about weather and resources available to them. They may have mobility issues or mental health challenges that keep them isolated and vulnerable. They need neighbours.

The Climate Atlas reports that communities are rising to the challenge. The City of Montreal has a “heat response plan”, sending first responders “door-to-door in vulnerable neighbourhoods to check on residents and offer advice on how to stay safe”, increasing “available paramedics and ambulances”, making public pools and cooling centres available and issuing “alert bulletins”. In Toronto, a “group of faith organizations have banded together to open their doors during extreme heat events, creating a network of community-organized cooling centres and strengthening social resilience to the threat of extreme heat.”

According to the WMO, more frequent, more prolonged and more extreme heat events are likely to be the “new normal”. In response, the Climate Atlas suggests that building “a support network in your community can be an effective way to look out for people who may be more vulnerable.” In other words, being a good neighbour and part of a caring community can make the difference between life and death for isolated persons in this time of climate crisis.

Sources:
World Meteorological Organization, “’This heatwave is the new normal,’ says WMO Secretary-General” https://public.wmo.int/en/media/news/%E2%80%9C-heatwave-new-normal%E2%80%9D-says-wmo-secretary-general
Climate Atlas of Canada “Health Impacts of Extreme Heat” https://climateatlas.ca/health-impacts-extreme-heat
Naël Shiab and Isabelle Bouchard, “Here’s who lives in your city’s worst heat islands” https://ici.radio-canada.ca/info/2022/07/ilots-chaleur-villes-inegalites-injustice-changements-climatiques/en

Pope Francis’ Intention for September

Abolition of the Death Penalty
We pray that the death penalty, which attacks the dignity of the human person, may be legally abolished in every country

Bridget and Bambi