Thread by @NathanStall, Today #Ontario enacted a new emergency measure providing hospitals with the authority [...]

Today #Ontario enacted a new emergency measure providing hospitals with the authority to transfer patients who no longer require acute care (so-called "alternate level of care" or ALC patients) to #LTC and retirement homes without their consent.

https://news.ontario.ca/en/release/1000020/ontario-maximizing-critical-care-capacity-to-support-hospitals

1/15

This action is being taken to create additional room in #Ontario's acute care sector for the 3rd wave of #COVID19.

There are currently 4,288 ALC patients in hospital, and 1,854 are waiting for #LTC beds.

There are also 5,401 vacant #LTC beds available for new admissions.

2/15

The reality is that many of the #LTC homes with large vacancies are those that had the deadliest #COVID19 outbreaks (e.g., Tendercare, St. George's, Orchard Villa).

Residents (and their families and caregivers) will be justifiably hesitant to move into these #LTC homes.

3/15

According to the news release, transfers can only happen if:

-The patient's medical condition will not be compromised
-The home can meet the patient's needs

Additionally, "every effort will be made to ensure these patients are fully immunized from #COVID19 before moving"

4/15

The #Ontario government is promising to:

-Retain patients' priority on the #LTC waitlist for their first-choice home.
-Waive the co-payment for patients transferred to a #LTC home that is not their first choice
-Waive the costs for patients transferred to a retirement home

5/15

I recognize the extreme stress that hospitals are facing in caring for acutely ill patients during #Ontario's 3rd wave of #COVID19, and the need for more beds.

It is very unfortunate, however, that this is being done at the last minute without more comprehensive planning.

6/15

There are many details & safeguards I'm hoping will accompany this order:

1. It is imperative that #LTC homes have the necessary staffing in place to accommodate a bolus of new admissions on short notice—without ample staff, the care for all residents will be compromised.

7/15

2. Residents can never again be placed in 3- and 4-bedded rooms—the government did make this commitment.

Today's Auditor General report ( https://www.auditor.on.ca/en/content/specialreports/specialreports/COVID-19_ch5readinessresponseLTC_en202104.pdf) & our own research ( https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2772335) showed how deadly this crowding was during the #COVID19 pandemic.

8/15

Association Between Nursing Home Crowding and COVID-19 Infection and Mortality in Ontario, Canada

This cohort study examines the association between nursing home crowding and COVID-19 cases and mortality in the first months of the COVID-19 epidemic in Ontario, Canada.

https://www.auditor.on.ca/en/content/specialreports/specialreports/COVID-19_ch5readinessresponseLTC_en202104.pdf

3. New admissions must be fully vaccinated (at least 2 weeks beyond receiving the 2nd dose of a #COVID19 vaccine).

Today's news release says that "every effort will be made to ensure these patients are fully immunized"—this must be non-negotiable.

https://news.ontario.ca/en/release/1000020/ontario-maximizing-critical-care-capacity-to-support-hospitals

9/15

Relatedly, essential caregivers of those patients being transferred must be immediately offered access to #COVID19 vaccines.

This will protect #LTC homes and ensure caregivers can continue providing essential care after patients are admitted to their temporary new homes.

10/15

4. There must be a limit on the distance with which patients can be transferred—unlike acute care transfers, these ALC patients will remain in #LTC homes for weeks and months until admitted to their 1st choice homes.

They must remain close to their family and caregivers.

11/15

5. There must be a time limit on these transfers—it can take months or years for patients to be admitted to their 1st choice #LTC home.

If they cannot place them after a reasonable amount of time (e.g. 90 days), they should have the option of being readmitted to hospital.

12/15

Residents, families & caregivers must have access to resources to support them during this period.

This includes professionals who can assist them if the transfer is not working out, a resident's care needs are not being met, or if they are deteriorating after admission.

13/15

Given the complexity of these transfers, an incident management structure (IMS) should be established (the same way the GTA IMS table oversees acute and critical care transfers: https://www.theglobeandmail.com/canada/article-ontario-hospitals-relying-on-patient-transfers-to-cope-with-crush-of/). There must be resident and caregiver representation on the IMS Table.

14/15

Ontario hospitals relying on patient transfers to cope with crush of COVID-19 cases

Even with a record number of hospital transfers easing the burden, some hospitals in the Greater Toronto Area are preparing new protocols in case they run out of beds

https://www.theglobeandmail.com/canada/article-ontario-hospitals-relying-on-patient-transfers-to-cope-with-crush-of/

I recognize that this was an "extremely difficult decision to make" by the #Ontario government.

But with the order overriding the #LTC Act (and ostensibly suspending the basic rights of these ALC patients to consent to #LTC transfer), reasonable safeguards are necessary.

15/15

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