Complex continuing care is also called “chronic care”. It is hospital-based care providing ongoing, medically complex and specialized services in either freestanding hospitals or in designated beds within acute care hospitals. Patients in these units no longer require acute care, but have high levels of care which cannot be met in other settings. Complex continuing care patients generally have long-term illnesses or disabilities that are unstable or complex and requiring skilled, technology-based care that cannot be managed in other settings. The legislation does not define or provide any specific information about the type of care that can be offered in complex continuing care. Complex continuing care facilities set their own admission criteria. Applications for admission are made directly to complex continuing care in some areas, but may also be managed by some Home and Community Care Support Services (HCCSS). While there are no specified criteria or appeal processes, hospitals must make fair and transparent decisions regarding admission.
The regulations to the Health Insurance Act state that a hospital may charge you a chronic-care co-payment in two circumstances. One of those occurs when your doctor has determined that you require complex continuing care/chronic care and are more or less a permanent resident in the hospital, meaning that you are expected to stay in that unit forever and not have a discharge plan. You must be in a hospital specified in s. 10(2)(a) of Reg. 552 to the Health Insurance Act. The maximum you can be charged is set by the government, and is currently $62.18 per day for a part of a month, or $1,891.31 monthly. Rate reductions are available for patients who are low income, for patient spouses/partners who are low income and over the age of 65, and where the patient is supporting certain types of dependants under the age of 65. The Ministry of Health publishes “Hospital Chronic Care Co-Payment: Questions and Answers” that explains the co-payment, when it can be charged, rate reductions, etc. You cannot be charged the chronic care co-payment if you are in a complex continuing care bed receiving slow-stream rehab or other services, as you are not more or less permanently resident in hospital.
Yes. If you are “alternate level of care” or “ALC” waiting for admission from certain hospitals to a long-term care home, you can be charged the chronic care co-payment. You cannot be charged if you are returning to your home, going to a retirement home, or to any other place to wait to go into a long-term care home. You must be in hospitals specified in s. 10(2)(b) of Reg. 552 to the Health Insurance Act. If you had private insurance covering a semi-private or private room while in acute care, it is generally not covered while you are ALC, so you may need to move to basic accommodation, or you will be charged hundreds of dollars per day for the room in addition to the chronic care co-payment. Check with your insurance provider to determine your coverage.
There are no fees for hospital-based rehabilitation services. You can receive rehabilitation services either within a rehabilitation unit in a general hospital or in a hospital dedicated to rehabilitation. This is even if the patient is receiving slow-stream rehabilitation in a complex continuing care/chronic care bed.
Palliative care, or end-of-life care, is intended to provide comfort measures and lessen the pain and suffering of a person who is dying. There is no charge to the patient for palliative care. Patients will not receive active treatment other than painkillers and comfort care while in a palliative care unit. While some hospitals will try to limit palliative care to certain time periods, there is no legislative authority to do so. Hospitals may not charge a co-payment for palliative care.
No. Anyone can apply for long-term care. You will need to be aged 18 or over, and have an OHIP card (it is also possible to apply if you have a health card from another province, but not if you only have coverage through the Interim Federal Health Program as a refugee). Your health also has to be stable as you must be eligible on the date you apply. You can contact the HCCSS office in the hospital (call the switchboard and request to be put through) or the general HCCSS office for the area that the hospital is in to start an application.
Placement into a long-term care home is governed by two pieces of legislation, the Fixing Long-Term Care Act and the Health Care Consent Act. Under these acts, it is up to the person or their substitute decision-maker (if they have been evaluated and been found incapable of making a placement decision) to decide which homes to apply to. It is up to Home and Community Care Support Services (HCCSS) (formerly the Local Health Integration Network (LHIN)) to process the application. Since the implementation of amendments to the law which came into effect on September 21, 2022, patients who are deemed “alternate level of care” (ALC) in hospital are subject to new rules. Doctors and other hospital personnel may start applications and play a part in the placement process. If it is determined that the patient or their substitute decision-maker are not complying with the process, the HCCSS case worker can commence the application, including releasing personal health information without consent, choosing home(s) within regulated distances, and accepting the bed on behalf of the patient. No consent is required for any of these steps. While the patient cannot be physically forced into a long-term care home against their will, if they remain in hospital, as of November 20, 2022, the hospital will be required to charge them the daily rate of $400. For a complete discussion of the issues related to these new rules, see “More Beds, Better Care Act: How Will It Impact Me”?
No. Currently all persons in hospital who are on a waiting list for long-term care are put in the crisis placement category.