Pay $1,800 a Day or Get Out: Hospital

Theresa Boyle Health Reporter
Published On Fri Feb 18 2011

Angela Cornacchia was bowled over when she learned the “consequences” her mother, an 82-year-old hospital patient, was threatened with if she refused to move to the first bed that became available from a shortlist of nursing homes.

A social worker at Sunnybrook Health Sciences Centre told Cornacchia her mother could be billed $1,800 a day, the same daily, non-OHIP rate that out-of-country patients are charged.

Some Ontario hospitals are using the coercive tactic to force nursing-home-bound patients out of hospital as quickly as possible. It’s a sign of just how
desperate overcrowded facilities are to free up beds to make way for new patients coming through clogged emergency departments. The bottleneck starts outside of hospital and is caused by a shortage of both home and long-term care.

“It’s crazy. They just want her out of there. She shouldn’t have to pay $1,800 a day. She’s a Canadian citizen and she’s covered by OHIP,” exclaims Cornacchia, her eyes welling with tears.

This is just one of many problems the Scarborough woman has encountered while trying to navigate Ontario’s complex, confusing and often frustrating health system on behalf of her frail, Italian-born mother, who speaks little English.

Cornacchia’s life has been turned upside down since finding her mother, Giuseppina Guarrasi, collapsed on Dec. 26. Guarrasi had previously suffered two strokes that left her in a wheelchair and she has had ongoing health problems.

Guarrasi’s condition stabilized in hospital and she was told she was ready to be discharged on Jan. 7. Yet Guarrasi remained in hospital because there was no place else for her to go. She couldn’t get the amount of home care she needed and nursing homes in the province are full with average waits of 105 days, triple the number from 2005.

She was designated an “ALC patient” and joined the ranks of 4,558 other patients in the province who require an “alternative level of care” such as home
care or long-term care.

Sunnybrook vice-president Craig DuHamel concedes it was a mistake for Guarrasi to have been told she might have to pay $1,800 a day. The “bed-refusal” practice was an ill-conceived idea introduced sometime last year “as a last resort” to move large numbers of patients through the hospital, he explains.

“I believe the history on it is, quite honestly, was to reduce ALC numbers and ensure that we are able to bring people who are in the emergency department up to acute care beds. It’s one of those things that I think you look at all kinds of strategies to help free up beds and not all of them are the best idea,” he says.

Sunnybrook halted the practice late last year after the Advocacy Centre for the Elderly warned it contravened the Health Insurance Act. But DuHamel says
some staffers obviously didn’t get the message.

“It’s definitely coercive,” says Jane Meadus, counsel for the advocacy centre, adding that the organization received about 160 similar complaints last year.

Yet the practice continues. In Windsor, where a healthcare crisis was declared last week, overcrowded hospitals began threatening patients with charges
of $600 a day unless they moved to the first available nursing home bed.

Meantime, Cornacchia would just prefer to bring her mother home. The hospital social worker told her about a program that would allow her mother to wait
for a nursing home bed in her own home, with about five hours of home care daily. Often seniors in this program improve to the point where they no longer need to move to a nursing home. But the social worker changed her mind when she realized Guarrasi lived in Scarborough. The program isn’t available there, though it is in North York.

The Star looking into this and found that Scarborough and North York are located within the jurisdictions of two different community care access centres,
which organize home-care services. There are 14 of these centres across the province service levels vary from one to another. The provincial auditor highlighted this is his recent annual report, blaming significant funding disparities.

“Why are we being discriminated against because of where we live? Are the citizens of Scarborough second class?” Cornacchia asks angrily.

Finding a nursing home has been difficult, with wait time of three years or more. Guarrasi has been told by the social worker and CCAC that she must pick
five potential homes, with some of them being from a shortlist of homes with waits of less than three months. Advocates argue there are no such requirements and that patients and their families are being misinformed. Nevertheless, Cornacchia spent many days in a panic, researching homes on the Internet and phoning a visiting them.

Janet Lum, co-chair of the Canadian Research Network for Care in the Community, says the difficulty patients and families encounter when trying to navigate their way through the health system speaks to the very serious problem of a lack of integration of services.

“When I’m sick and vulnerable, I should be able to get help without trying to figure out how the health and community care system works, what is available, or who else to call,” says Lum, an associate professor in the Department of Politics and Public Administration at Ryerson University.

Today, the hunt for a nursing home is temporarily on hold. Guarrasi suffered a minor setback and has been taken off the list to be removed from hospital
because she once again actually requires hospital care.

Her daughter wants her mother out of hospital as soon as she is stable. Patients are at risk of getting hospital-acquired infections such as C. difficile.
What’s more, their physical and mental abilities can decline because they are not active.

She’s astonished at how difficult it is for seniors and their families to navigate the health system.

“The whole thing is very stressful. It is unbelievable that this is happening out there. There should be more information available to the public to help
make informed decisions,” she says.

The reporter can be reached at

Reproduced from–pay-1-800-a-day-or-get-out-hospital