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June 29, 2009

Ontario Makes Patients Pay for Hospital Stay

Scott Stockdale

Scott StockdaleAlthough the policy has been in effect for over 12 years, many hospital patientsin the province of Ontario are going to be shocked to find that when they require what hospital officials deem an alternative level of care ALC), they may have to pay $1,578.02 per month or $51.88 per day to stay in the hospital.

 However, patients whose monthly income is below $1,578.02 are given a reduced rate.

Brantford resident Bob Vincent vividly remembers February 14, 2008 - the day a Brantford General Hospital official handed his mother, Claire Vincent, a co-payment fee authorization form to sign, requiring her to pay $1,000 per month to stay in the hospital.

The Brant Community Healthcare System (BCHC) co-payment form states:

Dear ... has been designated as requiring an alternative level of care (ALC). The Ministry of Health has made changes to the regulations under the Health Insurance Act and the Health Care Accessibility Act. These changes came into effect on January 1, 1997. The changes mean that the hospital must charge a co-payment fee for a patient who is either:

- in an acute care bed but who has been designated as requiring ALC or

- in a medically complex/reactivation bed.

The form also states that this co-payment is based on the patient’s income; there is a maximum amount, and the co-payment fee begins from the day the physician deems the patient ALC.

One may wonder how Mrs. Vincent, who worked throughout her adult life and paid into the system, could find herself in such an untenable situation. Her son Bob said she had previously been in intensive care for one and a half to two weeks, recovering from her first heart attack, when she was subsequently moved to a hospital floor in the heart ward.

Mr. Vincent said he wasn’t there when a doctor decided that Mrs. Vincent could go to the rehabilitation floor and start exercising. "It was more than she could tolerate. She had pain. They did a test and discovered she’d had another heart attack," Mr. Vincent said. The next day he was informed that Mrs. Vincent was going to have to pay to stay in the hospital.

"She (hospital official) handed mom the form without giving it to me first. It was a day after she’d suffered her second heart attack," Mr. Vincent said. "I was told, ‘If you don’t like it, that’s the hospital’s policy’."

Meanwhile, the hospital’s Policy/ Procedure manual states that the per diem fee for a hospital room only applies if an ALC patient refuses to move to the first available appropriate bed, or an ALC patient takes longer than seven days, after being deemed ALC, to select their two preferred and one alternative Long Term Care ( LTC) facilities to apply to.

When asked what happens to patients who’ve selected their preferred LTC facilities but there are no beds available, Gary Chauk, senior executive director of the Brantford General Hospital, said: "Nothing can be done."

He explained that there aren’t enough long term care facilities. "On a given day it’s not unusual for us to have 40 plus patients waiting for LTC and there are no beds." He added that while waiting for a bed in a LTC facility these patients must pay the co-payment fee for their hospital rooms.

However, a Ministry of Health and Long Term Care (MOHLTC) document entitled *"Complex Continuing Care (CCC) Co-payment 2008" *states that the co-payment fee doesn’t apply to patients receiving welfare, disability pensions or income assistance under the Ontario Works Act.

Moreover, Table 1 of this document, entitled "CCC Co-payment rate levels for 2008-2009", states monthly income levels and number of dependents a patient has to have in order to receive a reduced co-payment rate; for example, a patient with one dependent and a monthly income of $3,487 or less would have the co-payment fee waived. On a sliding scale, the table goes up to the category of four or more dependents. A patient in this category with a monthly income of $4,847 or less would qualify to have the co-payment fee waived.

One may wonder why Mrs. Vincent’s co-payment fees weren’t waived. Andrew Morrison, media relations co-ordinator with MOHLTC stated, in an email, that Table 1 figures are only for patients with dependents because their co-payments are calculated differently. The following is a purely hypothetical example Mr. Morrison gave to illustrate the calculations used to determine co-payment fees for patients with no dependents:

Monthly estimated income: $1,000

Comfort Allowance: $ 125

Income available $ 875

The monthly co-payment would then be the lesser of the maximum rate of $1,578.02 or the calculated rate of $875. In this example, the patient would pay $875 per month to reside in a long-term care facility.

While on paper this may seem like an equitable and fair way to charge hospital patients, this may not always be the case in real life situations.

After attending a meeting with Brantford General Hospital officials, Mr. Vincent mistakenly believed his mother’s problems were solved.

"They (hospital officials) told me that they couldn’t send her back home and I must find her a long-term care bed. I said that takes time. At the meeting they assured me they wouldn’t put her out (of the hospital). This was on a Wednesday; on Monday they phoned and told me she was going to be released on Tuesday or Wednesday."

Mr. Chauk said that due to a patient confidentiality agreement hospital officials can’t comment on individual cases.

Meanwhile, when Mrs. Vincent was released from the hospital, Mr. Vincent said she couldn’t go from her living room to her bathroom without his help. Three days later Mrs. Vincent had another heart attack. Mr. Vincent drove her to Hamilton - about a 30 minute drive - because the Hamilton hospital wasn’t charging co-payment fees. Because the MOHLTC leaves it up to the local hospital boards to decide their policies on co-payment fees, the ministry has no information on the number of hospitals charging these fees.

"By the time we got there she was a white as that sheet of paper, Mr. Vincent said. "They (Hamilton hospital staff) wheeled her in immediately... She was in the Hamilton hospital for one week, then home for two days before she was taken by ambulance to the Brantford hospital."

At the Brantford General Hospital, Mrs. Vincent was treated for her fourth heart attack and then put in a bed, on a regular floor in the hospital.

"They put her on a regular floor. She wasn’t even in palliative care or intensive care," Mr. Vincent said.

She died a week later, on March 8, 2008, after having suffered four heart attacks in a two month period. Her death occurred about a month after she was told to sign a co-payment sheet at the Brantford General Hospital.

Although it’s over a year later, Mr. Vincent said he still hasn’t heard back from any of the long-term care facilities he contacted.

"Who do you think is going to get the bed (long-term care bed), Mr. Vincent said, "the person who can pay $1200 (per month) or the person who can pay $1800? Is money the determining factor in whether you get care or thrown on the street."

 * Scott Stockdale is a freelance writer based in Toronto.

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