Conference Case Study 2023
The following is a fictional case study based on current occurrences in Ontario’s healthcare system.
Your conference team must formulate a solution to the case described by using the information given as well as your own research to inform your opinions. You will pitch this solution to a panel of judges in the form of a 10-minute presentation.
Included below are several guiding questions to consider incorporating into your answer.
BACKGROUND
Ontario’s More Beds, Better Care Act (also known as Bill 7) was assented into law on August 31, 2022. Bill 7 requires that “alternative level of care” patients be transferred out of hospital to the nearest available long-term care bed when they require ongoing care, but their condition no longer requires the intensive, acute care that a hospital setting provides. The Bill stipulates that clinicians can select a long-term care home for patients to be allocated to with or without that patient’s request, at a radius of up to 300 km from their local hospital. Patients can either comply with being moved to long-term care, stop care altogether and return home, or pay a fine of $400 per day to remain in the hospital setting.
CASE
You are a primary care worker in geriatrics at a large hospital in Toronto. B is an 85-year-old female patient with late-stage Lewy body dementia. She has been in the acute monitoring unit of the hospital for 12 days after suffering limited physical and mental distress following a fall in her kitchen.
Before hospitalization, B had been living with her 51-year-old daughter, C, who had been acting as her primary caregiver. C has three children and her and her partner both work full-time. C and her partner are the only people B recalls at this stage in her dementia, and they care for B when they are not at work. For the past year on Wednesday and Saturday afternoons, a personal support worker comes to their home to help B bathe.
As B’s condition is declining but she is in no immediate harm, she is classified as an “alternative level of care” patient. C and her partner are worried about how B would fare being allocated to long-term care given that her condition is slowly declining. They are anxious about B potentially being moved several hours away from their home as she will be isolated from the only people she remembers, and C and her partner cannot take adequate time off of work to visit her frequently. C wishes her mother could stay close to home.
Despite this, they no longer have the ability to support B as her primary caretakers at home. They would prefer that B remains in-hospital but do not have the financial means to pay nearly $3000 per week in fees. B herself has limited capacity to make decisions about her situation and can no longer understand what it would mean to be moved home or to long-term care.
With patient safety and healthcare quality improvement in mind, discuss how you would advocate for the patient in this situation.
GUIDING QUESTIONS
Use the following questions to guide your thinking and answers. Note that providing answers to each question in your presentation is not mandatory, however you may want to use these questions to inform the content of your answer.
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How does Bill 7 affect patients and their families in a negative way?
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What are the benefits of Bill 7 and why, given the current state of Ontario’s hospitals, was it enacted?
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How does the status of long-term care homes as reported by the Canadian Armed Forces during the 2020 COVID-19 pandemic inform your opinion on this case? If the quality of care administered there changed, would your opinion change with it?
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Many patients wishing to stay in-hospital cannot afford the daily fee. Is there some body a clinician could turn to to aid a patient in getting financial assistance with this matter?
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How are alternative level of care patients supported by clinicians and care workers when Bill 7 is not enacted, and how does this differ now?
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How might Bill 7 affect both primary care (i.e., hospitals) and secondary care (i.e., long-term care homes) settings, in terms of cost, operations, and personnel?
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What is the current state of personal support workers in Ontario? Would it be easy or difficult to advocate for increased at-home care for B?
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Are there any cases from the past where similar laws were put into place, either in Canada or elsewhere in the world? If so, what were the impacts of these laws?
Direct any questions related to the case or presentation instructions to:
Information used to formulate this case was derived from the official statute for Ontario's Bill 7.