Unfortunately, I was not here to be able to hear the members speak to this portion of the debate. But on this side of the House, we have real questions and concerns about this bill. So a question that I asked to the minister yesterday, I will put back to the members who did have the opportunity to speak to this bill yesterday.

We’re greatly concerned about patients being charged when they refuse to leave the hospital and go to long-term care or to be sent home. This is something that I know I’ve heard in my office for years has been happening. This bill will definitely seem to seal the deal to allow hospitals to charge an uninsured amount to patients. Could the member answer what his government is doing to ensure that that does not happen to patients going forward?

What I said in my question is that, for years, patients have been charged and threatened to be charged—so that is existing legislation. Where in this bill does it protect patients going forward? The hospitals are going to have the ability to move ahead, to push people out of hospital into long-term care, particularly when they’re not wanting to be there. And if they’re refusing to do so, what is going to happen? Did the government think to put a protection in this bill to make sure that patients wouldn’t be charged any further?

I would appreciate a reasonable answer from this member instead of just throwing stones back on this side. Let’s talk—

To the member opposite: We’re starting off a new day, but apparently the same message will continue, as has been going on for several days from the opposition members going into last week, who still are incapable of reading the bill. Apparently, not enough time has yet passed for them to be able to do so. Mr. Speaker, I would really like to think of the words that you used earlier this morning, when you spoke about illusion to reality. Perhaps there’s more delusion than any of it at this point in time.

I’m really, really hoping that the member opposite, and all of the members opposite, will take the time to read the bill and see that there is absolutely no change in policy. There is no situation that is going to arise where their consent would not be obtained first.

That is really the goal and what we’re trying to accomplish, Mr. Speaker: to ensure we’re increasing that capacity by ensuring that we are making more space for seniors to have proper care where they need it most and the level of care that they need most. That’s freeing up room in our hospitals and ensuring that the individuals who need that level of care within the hospital system are receiving the appropriate level of care. I look forward to being able to speak about this a bit in further questions.

I can just look at my own hometown riding, where I recall a waiting list, when we first got elected in 2018, of over 400 people in my city of Sault Ste. Marie, many of whom were in alternate levels of care within the hospital. With the investments our government has made over the last four years, my community is now looking at having reduced that wait-list by half, with only 204 people now left on a wait-list that was well over 400 back in June 2018, after years of neglect by the opposition parties, the coalition Liberal-NDP government that existed for so long here in the province of Ontario, where a measly 600 beds were created over that entire span of time.

I think it’s absolutely critical and important that the opposition members recognize the outstanding work that our government is doing and that our Minister of Long-Term Care is doing to ensure that we are making more capacity within our hospitals, and that the people of this province—

Perhaps I can help, because there are two critical components in terms of the work that we are doing to support the long-term-care sector here in the province of Ontario. The first part of that, as I referenced in my comments yesterday, is that we’re ensuring that we’re improving staff levels and hours of care within our institutions. Specifically, a key pillar of that plan is making sure that we’re hiring more staff.

An additional key pillar to that plan we spoke about yesterday as well is to address the wait-lists, and we’re ensuring that we’re building more modern, safe and comfortable beds for our seniors.

At no point in time is anybody going to see them being moved without their consent and being billed for whatever—I’m not sure I understand the member’s question, because it’s premised on something false.

So it’s going to be important that the member opposite does read the bill so that they can appreciate what it is we’re actually doing.

I had the benefit of reading comments from the CAO of Windsor Regional Hospital, who reflected positively on this bill.

My question to the member today is about hospital capacity. How would Bill 7 play a role in supporting Ontario’s broader health care system and perhaps even create hospital capacity?

Good morning. Let us pray.

Prayers.

Resuming the debate adjourned on August 23, 2022, on the motion for second reading of the following bill:

Bill 7, An Act to amend the Fixing Long-Term Care Act, 2021 with respect to patients requiring an alternate level of care and other matters and to make a consequential amendment to the Health Care Consent Act, 1996 / Projet de loi 7, Loi modifiant la Loi de 2021 sur le redressement des soins de longue durée en ce qui concerne les patients ayant besoin d’un niveau de soins différent et d’autres questions et apportant une modification corrélative à la Loi de 1996 sur le consentement aux soins de santé.

The member for Hamilton Mountain.

I really want to thank the minister for that question.

I think we all should really thank the minister for the outstanding work that he has been doing on this file. When you look at the work that’s being done in reducing wait-lists and ensuring that patients—

Interjections.

It really is unfortunate that the members opposite don’t want to listen and they don’t want to read and they don’t want to understand that the work we are doing has helped so many people in our province. One only need look at the makeup of this room after June 2, 2022, and it’s evident that we are helping so many in our communities across all of Ontario, and the people of this province are seeing the results, are appreciating that response and responding in turn.

I look forward to being able to speak a little further in the next opportunity here about the outstanding work that we are doing.

It was interesting to hear the member for Niagara Falls talk about reading the bill, colleagues. He started off last week saying that we were going to move people into ward rooms. That was not correct. Then he switched it over to, we’re going to be moving people without their consent. That was incorrect. Then he said that hospitals were going to be discharging people again and moving them hundreds of miles away. That was incorrect.

Now they’ve trotted out a policy that has existed in the province of Ontario since 1979—and one of the previous governments to actually increase that rate was the Bob Rae government, the NDP government. The reason I think the member is having trouble finding that in this bill is because it’s actually not in the bill.

More importantly, I wonder if the member could expand on his earlier comment about how a policy like this, working with patients, actually improves the quality of care, to get the service where it is best for the patient, as opposed to what the NDP thinks.

It’s always an honour to rise in this place and speak on behalf of the people we represent in the communities that brought us here.

To anyone who is watching the proceedings this morning, I just want to provide some context for the debate that is under way today. This is the third government bill that has been brought to this floor in this very rare summer session of the Legislature. As the Speaker will know, typically the Legislature does not sit in the summer. But this government brought MPPs back in August to presumably engage in very important legislative debates about urgent issues that are facing this province.

The first bill that we considered was the budget bill. That was a bill that the government had tabled prior to the election. So that bill was brought to this floor.

The next bill was the strong-mayor bill. That was something of a surprise, because never in the election did we hear the government mention its priority focus on increasing the mayor powers in Ottawa and Toronto. Regardless, that was the bill, that was the second piece of legislation the government brought forward.

That brings us to today and Bill 7, the More Beds, Better Care Act. This is a bill that purports to address the health care crisis we are facing in this province. All of us are seeing in our communities that the health care system is crumbling before our eyes.

There are at least 25 emergency rooms across this province that have either closed or reduced hours over the past many months—and it hasn’t only just been this summer. This is a problem that we have seen in Ontario for quite some time.

As the representative of London West, I want to acknowledge that many of these closures have occurred in some of those small, rural communities in southwestern Ontario that surround London. Some of those closures are under way right now. We know that St. Marys hospital closed overnight hours this very week. This is the second closure of St. Marys hospital in August. Seaforth hospital closed its ER earlier in August. Walkerton and Chesley hospitals closed their overnight emergency services last week. What this means for London is increased pressure on London Health Sciences Centre because, of course, London Health Sciences Centre is a regional hospital that serves many of the surrounding municipalities. With those closures in those rural communities, there are increased pressures on LHSC, and we have seen that in London with changes in the emergency ward.

There was a story on CBC just recently about a Londoner who was 40 weeks pregnant with her first child, and her midwife had been bracing her for the possibility that she might not get a scheduled induction due to the shortage of support staff, nurses and doctors. That’s one example of the kind of pressures that LHSC is facing in its maternity ward because of some of these increased pressures.

LHSC’s epilepsy monitoring unit also had to reduce services. There is a temporary closure, until September, of the epilepsy monitoring unit, although critical care services will continue to be provided.

We are hearing about an ever-growing list of people in London who are facing incredible challenges accessing a family physician. For many people who don’t have an emergency that requires ER support, that’s the canary in the coal mine. That’s the first indication that something is fundamentally wrong with our health care system—when people cannot find a family doctor in order to get that preventive care that will keep them from having to access critical care in our hospitals.

It’s interesting, Speaker; when you read some of the stories about why our system is experiencing these challenges, it’s pretty unanimous that one of the reasons for these closures is the staffing pressures in our health care system. Those are pressures that have been growing for years, in fact, because of the lack of health human resource planning, but they have certainly been exacerbated by COVID-19. Nurses and health care workers are exhausted. They’re burnt out. They are disrespected by this government, by its ill-considered policy to introduce a cap on any wage increases of 1%. That has been incredibly demoralizing for health care workers. We’re seeing nurses leave the profession in droves. They are going to the US to find better jobs, better working conditions, better salaries, or they are switching careers altogether. They’re retiring early. We have all heard these things.

As a result of these staffing pressures, what we’re seeing in our system is that hospitals, including those small, rural hospitals I mentioned, are having to spend money on temp agency nurses. There was a story last week in the Toronto Star that revealed that spending on temp agency nurses is up more than 550% since before the pandemic at a Toronto hospital. Speaker, that’s not a unique situation at that hospital. We know that hospitals all over this province are having to spend those dollars on agency nurses in order to deal with the workforce pressures they are facing.

So in light of this crisis in our health care system and in light of the fact that we were brought back here this summer to deal with some urgent issues, one would have thought that the government would have brought forward legislation that would actually deal with the problems we are seeing. One would have thought they would have brought in a bill to repeal Bill 124—because that is what the health care sector, including hospital CEOs, including physicians, certainly including nurses, including a whole gamut of health care workers, have consistently highlighted as a huge factor in the exodus of health care workers from our workforce.

One would have thought that this government might have brought in legislation to require long-term-care homes to make PSW jobs full-time jobs with proper salaries, with benefits, with job security, with paid sick days. That would have gone a long way to improving the quality of care that seniors receive in our long-term-care homes—and also those PSWs working in home and community care, because we know that seniors want to remain independent in their own homes as long as possible and rely on PSW support in order for that to happen. As I said, instead of bringing in legislation that dealt with the real problems, we have before us this bill entitled More Beds, Better Care Act.

I do want to acknowledge that the government has gone some way since we first came back here in August. When we first arrived back, we saw the Premier and the Minister of Health denying—“There’s no crisis in health care. This is all just part of the normal ebbs and flows.” Then we heard the Minister of Health blaming vacationing nurses for the closures of our ERs, which is reprehensible, to make that allegation. Finally, we saw the government realize that they had to do something, and last week they released a five-point plan. This is the signature legislation that accompanies that plan. It’s clear that they scrambled, because this signature legislation is exactly two and a half pages long. It is very thin on substance but deeply concerning in terms of its content.

I want to start with the title of the bill—as I said, More Beds, Better Care Act. The first half of this title, “More Beds,” clearly reveals this government’s fundamental misunderstanding of the issues that we are experiencing in our health care system. It is not beds that are the problem; it is staff to provide the care to the patients in those beds that is the problem. That’s why, again, I point to the urgency of repealing Bill 124. Unless we do something to increase our health care workforce, we’re not going to have the staff we need. The second part of the title, “Better Care,” suggests that, somehow, transferring alternate-level-of-care patients from hospital into long-term-care homes is going to automatically ensure they get better care.

Speaker, I have to say that Ontarians don’t have a lot of confidence, frankly, in this government’s ability to ensure that seniors in our long-term-care homes are properly protected. We heard about the iron ring around long-term care during COVID that never materialized. We saw more than 4,000 seniors die in long-term-care homes. We saw the military being called in to pull the curtain on the horrendous conditions that our long-term-care-home residents were facing.

Again, I want to say that the crisis in our long-term-care homes will not be fixed unless the staffing in those homes is improved.

Speaker, now I want to turn to what the government decided to do to deal with this crisis. This bill authorizes a whole range of actions that can be taken by placement coordinators at hospitals without the consent of an alternate-level-of-care patient. It authorizes a placement coordinator to determine eligibility for admission to a long-term-care home. It allows the coordinator to select a long-term-care home. It allows the coordinator to provide information about that patient, including personal health information, without the consent of that patient. Finally, it authorizes the admission to the home of an ALC patient without their consent. It’s very clear that all of these actions I have just described can be carried out without consent, provided that reasonable effort has been made to obtain consent—without any definition of what constitutes reasonable effort. As my colleague, our immensely capable health critic, pointed out, that leaves it open to the possibility that a patient could be asked, “Ms. Sattler, are you ready to go to a long-term-care home? We need your consent.” If I say no, is that a reasonable effort? Who knows? It’s not defined in this bill.

The only limitation on consent that is listed in this bill is the inability for a placement coordinator to put physical restraints on a patient and to physically transfer that patient to a long-term-care home. Other than that, there are all of those actions I previously described that can be carried out if the patient does not consent.

Speaker, moving an ALC patient, an alternate-level-of-care patient, into a long-term-care home that is not of that person’s choosing is, as critics have pointed out, a fundamental violation of the human rights of that patient.

The only right to appeal that is included in this bill is, if someone is deemed ineligible for a long-term-care-home admission, then they can appeal that. However, there is no appeal whatsoever for an alternate-level-of-care patient who is placed in a long-term-care home that is not of their choosing.

We have heard in the media and we’ve heard the minister talk in this House about the fact that no patient would be transferred out of their community, but that is not in the bill. If you read this bill, it indicates that the geographic restrictions around placement decisions will be outlined in regulations. We don’t see regulations—the regulations are written after a bill is passed. So this gives the government huge latitude to prescribe whatever geography they decide is appropriate, which means that an ALC patient in London could be discharged without consent from hospital, could be assessed for eligibility to long-term-care without consent, could be admitted to a long-term-care home without consent, and that long-term-care home could be in St. Catharines; it could be in Hamilton; it could be in Hanover; it could be in any number of communities that would take that person out of their circle of care and away from their family members, away from the support and the love they need in order to live out their final days with dignity and respect.

The bill also indicates that the regulations are going to prescribe what personal health information can be provided without the consent of the patient. That is very troublesome because everyone should have the right to consent to the use of their own personal health information.

What is entirely missing from the bill is any reference to charging alternate-level-of-care patients who do not consent to a physical transfer to a long-term-care home. I want to remind members who were here at question period yesterday that our interim leader asked the Minister of Long-Term Care, “Can the minister guarantee right now that if a senior refuses to go to a care home they don’t want, they will never be billed for their hospital bed?” And the minister responded, quite rightly, “That is not in my bill.” He’s absolutely correct; that is not in this bill. That is why it is so worrisome that this bill is silent on the question of whether a patient can be charged by the hospital if they refuse to go to a long-term-care home.

We hear this government suggest somehow that it’s the opposition who is fearmongering. But I want to highlight comments that were made by Jane Meadus, who is a lawyer with the Advocacy Centre for the Elderly, who shares these exact concerns about the possibility of patients being charged if they refuse to move to a long-term-care home. She provided a memo that says if patients “refuse a bed offer for a LTC home they apply to, a determination may be made that they are no longer in need of treatment in the hospital. A discharge order may then be communicated to them, and the hospital may charge them an unregulated daily rate if they choose to remain in hospital.” So unless this is explicitly prohibited in this bill, you can be sure that it will happen. That just increases the pressure on an alternate-level-of-care patient in a hospital who does not want to move to long-term care because it’s not the long-term care of their choice. It increases the pressure on those family members, those substitute decision-makers, who are having to decide in the face of these medical professionals what can be done with their loved one. And it makes it ever more likely that people are going to be moved against their will to a long-term-care home where they do not want to be.

Advocates, people who are involved in this sector, have called this bill “morally repugnant.” It is an assault on the fundamental human rights of some of the most vulnerable and frailest people in this province.

The Minister of Long-Term Care.

Further debate?

The member for Mississauga–Lakeshore.

I’ve been listening to this debate in the House for the last few days. The thing that seniors are most concerned about is that they will be forcibly transferred to long-term-care homes against their will. And the government keeps responding with diversions, with insults to the NDP—“Oh, you haven’t read the bill. There’s nothing in there about consent.”

I’ve read the bill. The bill is right here, and I can see in this bill that it says “certain actions” are “to be carried out without the consent of these patients.... The actions cannot be performed without first making reasonable efforts to obtain the patient’s consent.” There’s a list of 13 actions that can be taken without the patient’s consent. That’s what this bill is about. It also says—and I think this is the most terrifying statement for seniors in the province of Ontario—“The section does not authorize the use of restraints in order to carry out the actions or the physical transfer of an ALC patient to a long-term-care home without their consent.” In other words, they set the bar at they will not handcuff seniors who are in hospital beds and refuse to be transferred, but they will do everything up to that.

So my question to this speaker is—

Yesterday, the Toronto Star editorial board wrote in support of Bill 7:

“Earlier this year, the Ontario Hospital Association estimated there were 5,800 patients waiting in hospital beds for what is known as ‘alternate levels of care.’

“The consequences of such hospital stays ripple through the system and impact others seeking care. With beds occupied, other patients can’t be admitted and emergency rooms back up.”

“Hospitals are not the ideal location for such patients. They don’t require the intensive medical care hospitals are meant to provide. Nor do they receive the variety of supportive programs offered at long-term-care facilities designed specifically for seniors.”

I’d like to give the member an opportunity to comment on the Toronto Star editorial.

We know that under this Conservative watch, close to 5,000 seniors—parents, grandparents, mothers-in-law, fathers-in-law—died in long-term care. Most died in for-profit homes. Forty seniors died just in the last two weeks alone. Knowing this, do you feel it’s okay to give medical information of patients, seniors, to long-term-care providers without consent?

I want to thank the member for her address this morning.

I’ve been here for nearly 19 years, and this is probably the most egregious example of NDP fearmongering since I’ve been here.

Since I’ve been here, ALC patients have been a huge problem in this province. We’ve got our vulnerable seniors in a place where they shouldn’t be, but no capacity was built in long-term-care homes to accommodate those seniors who would be best cared for in a long-term-care home.

This government has acted expeditiously and quickly, since the election, to bring in the proper legislation so we can actually move those patients to a home—

Interjections.

And now we have the NDP inventing all kinds of voodoo scenarios that do not exist.

So I do ask the member, could you please stick to what the bill actually says? No one will be going to a home that they’re not consenting to. Stop with the fearmongering—

I don’t think there’s any question that hospitals, alternate-level-of-care beds, are not the greatest place for people to be, but neither is a long-term-care home that is not of the patient’s choosing—a long-term-care home that likely has availability because no one wants to go there. We all know of those long-term-care homes that became notorious during COVID-19 because of their abject failure to protect the residents who lived in those homes.

Unless this bill is accompanied by a huge effort to improve PSW wages, to make those jobs good jobs, to improve supports for seniors in long-term-care homes, moving vulnerable people from one situation of crisis in a hospital to another situation of crisis in a long-term-care home will do nothing to solve the problem.

Clearly, I do not think it is okay to allow the provision of personal health information to any entity without the consent of the person whose information is being shared.

I did want to comment on the fact that private sector long-term-care homes are very likely to be the biggest beneficiaries of this bill, because many of the long-term-care homes that have the shortest waiting lists, that will be able to accommodate these alternate-level-of-care patients, are those private sector homes that other people don’t want to go to. They are the homes that were exposed as having the worst protections in place for seniors during COVID-19.

I’ve always been one to look at legislation—and words are very powerful. I know the member from Guelph talked about consent. If I’m sitting in a long-term-care home or if I’m a family member, I’m looking at this bill and I’m reading the first two sentences—it says, “The bill amends the Fixing Long-Term Care Act, 2021 to add a new provision for patients who occupy a bed in a public hospital and are designated by an attending clinician as requiring an alternate level of care. This new provision authorizes certain actions to be carried out without the consent of these patients.” What else could that possibly mean? It’s removing the consent of individuals. The outcome is what I’m concerned about. When you look at legislation, there are winners and losers. We see who the losers are going to be here.

Who is going to benefit from this legislation? Who is this for? That’s the question that I’m asking the member.

It’s always an honour to rise and participate in the debate—today, on Bill 7 at second reading. For members opposite and for people watching at home: One of the reasons second reading debate happens is so that concerns can be raised and addressed—and amended at committee. Advocates for the elders, seniors, doctors, and health care policy experts have all raised serious concerns about the implications of this bill and the possible unintended consequences.

I understand that we are facing a health care crisis and that that crisis predated the existing government, but it has been made worse by the existing government because of their failure to invest in the people who deliver care. Nurses, front-line health care workers and doctors have all said that wage caps and benefit caps are a significant contributor to the inability to retain nurses and other front-line workers in our health care system. Yet the government—after calls from almost everybody across the province, including the opposition—has failed to say, “Maybe we need to make an adjustment and invest in the people who deliver care.”

One of the concerns that seniors have is the consent provisions in the bill. I’ve heard the argument about, is there consent or is there not consent? Well, I guarantee you, Speaker, that elders deserve clarity around the consent provisions in this bill, because when you combine this bill with legislation that I know has been there since 1979, they could charge elders up to $1,500 a day if they do not consent to being transferred to a long-term-care home they do not want to be in. One of the reasons they may not consent is that they would be a long distance away from their family, which is one of the unintended consequences of this bill. We already have a home care system and a long-term-care system that’s underinvested, understaffed and overwhelmed. Family members play a key role in providing additional care for elders. It will be incredibly difficult if elders feel forced to consent to agree to move a long distance away from family and lose that additional care, which will then put additional pressure on existing staff.

I would say to the official opposition and to the government: Listen to the concerns that people have and amend this bill at committee, because we know that properly placing alternate-level-of-care patients is important to the health care system.

First of all, repeal Bill 124 so nurses and front-line health care workers can negotiate fair wages, fair benefits and better working conditions. Speaker, do you know what it’s like to be overworked in understaffed wards and feeling underappreciated and disrespected by government? Do you know what it’s like to not be able to access mental health benefits, for example, because your benefits are capped, let alone being able to have your wages keep up with inflation?

Second, two years ago, we were asking this government to fast-track the accreditation of internationally trained health care professionals. They are now finally starting to do that. According to the RNA, that was 15,000 to 20,000 nurses or other front-line health care workers who could have been part of the system, taking a burden off the system, if the government had acted on that two years ago.

Speaker, I have more solutions I’d like to offer, but I know my time has run out.

So I encourage the members opposite: Listen to the advocates, listen to the seniors, listen to the health care policy-makers who are putting forward concerns about this bill and address those concerns, because we know that we need a better process for properly and justly placing seniors who have alternate-level-of-care needs.

It’s great to be able to take part in debate here today and in questions and comments.

While I do have a great working relationship with the member from Guelph, I do have a few concerns with what he has brought up here today, when we talk about this bill going to committee or some of the different provisions of the bill.

Again, as part of the kinder, gentler Mike Harris that we’re all experiencing here in the 43rd Parliament, I want to give the member an opportunity to share some solutions, rather than just trying to carve up the problems. Let’s hear some solutions. What can we do to get ALC patients out of hospital? How can we move forward with making sure that those people are still looked after in the way they need to be here in Ontario?

Thank you.

The member for London West can reply.

That is pathetic.

Thank you to the member opposite for her contributions today.

It’s no secret that the health care system is under immense pressure, and if we do nothing, we could see a shortage of 2,400 hospital beds by the peak of a potential flu or a COVID-19 wave later this year. Our government is seeing this potential wave on the horizon and we’re proposing real steps to address it, to help ensure that our health care system is properly resourced to deliver the care Ontarians need.

Meanwhile, the opposition seems content to sit around and oppose, much like they were content to support the Liberals between 2011 and 2018—propping up that Liberal government when they built only 611 beds for 176,000 new, elderly patients over the age of 75.

My question is really simple: Are you content to sit back, support the status quo and do nothing when action is clearly needed?