Leaving hospital: alternate level of care and Bill 7

Wei Chen is fifty-four, an accountant in Kingston, whose parents came from Guangdong in the seventies. His mother, Mei-Ling, is ninety, a retired seamstress who still beats everyone at mahjong. Three weeks ago she went into hospital with pneumonia. She's better now, but weaker, and this morning a placement coordinator handed Wei a list of long-term care homes he'd never heard of.

So here's the question. What happens when the hospital says your parent no longer needs hospital care, and what can you ask for?

First, this is general information, not legal advice. Families in this spot can get free legal advice from the Advocacy Centre for the Elderly, a legal clinic for older adults. Now the term. Alternate level of care means the treating clinician has decided your parent no longer needs the level of care a hospital provides. It's a clinical designation, and it starts the clock on what comes next.

Since twenty twenty-two, a law often called Bill Seven has changed that next step. After reasonable efforts to get consent, a placement coordinator can decide whether your parent is eligible for long-term care, share their health information, choose homes, and authorize admission, all without consent from your parent or from you. That's the law itself, the Fixing Long-Term Care Act, and the regulation under it.

There are limits. A home the coordinator picks has to be within seventy kilometres of where your parent wants to be, or a hundred and fifty kilometres in the North. And nobody can physically move your parent, or restrain them, without consent. But if a patient has been discharged and stays more than twenty-four hours past the discharge date, the hospital must charge four hundred dollars a day.

The Advocacy Centre, reading the law, says that charge usually comes up when an arranged bed is turned down, so get advice before you say no. The clinic also says the long-term care assessment can be done in hospital, that going home first with extra care is encouraged, not mandatory, and that families can't be forced to provide care at home. If your parent is found ineligible, there's an appeal board.

Now, their side. Mei-Ling has been in a bed for three weeks, hearing words she may not follow, in her second language. It's fair to guess she's frightened, and wants only to go home. Ask her what she understands about what's happening. Ask what going home would need to look like to be safe. And tell her what you know, plainly, before anyone hands her a form.

Let's change one fact. Mei-Ling's home isn't in Kingston. It's in Timmins, and she was flown south for treatment. The regulation gives the North a wider circle: a coordinator can pick a home up to a hundred and fifty kilometres from where she wants to be, and if no home exists inside that circle, the limit doesn't apply. So Wei should say early, and in writing, where his mother wants to be.

The mistake families make is saying we'll manage at home when they know they can't, safely. It comes from love, and from fear of the list. But a discharge home with too little help can end in a fall and another admission. Be honest about what you can carry, say it to the coordinator, and ask what support would make home possible. That's a stronger position than a promise you can't keep.

Here's the rule, in one breath. Learn the terms, ask who your coordinator is, and get advice before you turn down a bed.

This week, learn three terms, alternate level of care, discharge date and care coordinator, and ask who your parent's coordinator is. Then write down where your parent wants to be, and hand that to the coordinator.

Next time, a new module on health and safety at home, starting with falls and a safer house.