The More Beds, Better Care Act, 2022 adds section 60.1 to the Fixing Long‑Term Care Act, 2021 to create a special process for patients in hospital who are designated by an attending clinician as requiring an alternate level of care (ALC). The new framework authorizes placement co‑ordinators to determine eligibility, select homes (subject to geographic rules), provide assessments and authorize admission — and allows specified people and institutions to collect, use and disclose personal health information where necessary to carry out those actions.
Sections 49–54 of the Act do not apply to these steps; instead the regulations will prescribe procedures, criteria and any modifications or exemptions.
The statute limits the power in several ways: it requires reasonable efforts to obtain patient or substitute decision‑maker consent before proceeding without consent; it does not authorize restraints or physical transfer without consent; and an ALC patient may appeal an ineligibility determination to the Appeal Board. The Act also adopts the Personal Health Information Protection Act, 2004 definition of “personal health information” and amends the Health Care Consent Act, 1996 to clarify the relationship between crisis admissions and the new ALC admission mechanism.
At a Glance
What It Does
Creates an ALC patient category and authorizes placement co‑ordinators to assess eligibility, select long‑term‑care homes, deliver assessments (including personal health information) to licensees and authorize admissions without patient consent if reasonable efforts to obtain consent have been made. It removes the automatic application of sections 49–54 for these actions and substitutes regulatory procedures and criteria.
Who It Affects
Public hospitals and attending clinicians who designate ALC patients, placement co‑ordinators, long‑term‑care home licensees charged with reviewing and admitting approved patients, clinicians who conduct eligibility assessments, and anyone handling personal health information under the new process.
Why It Matters
The law shifts decision‑making power toward placement authorities and regulatory rules to speed transfers from hospital to long‑term care, while carving out limited, explicit exceptions to existing consent and admission procedures. That changes how hospitals manage bed flow, how LTC homes must process external authorizations, and how PHI may be shared across organizations.
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What This Bill Actually Does
The Act introduces a defined process for people who occupy hospital beds but no longer need the intensity of hospital care — labeled “ALC patients.” An attending clinician in the hospital must designate a patient as ALC; that clinician may request a placement co‑ordinator evaluate the patient for long‑term‑care admission. The placement co‑ordinator can, on that request or on their own initiative, determine eligibility, select appropriate homes subject to regulatory geographic rules, supply prescribed assessments and information to homes, and ultimately authorize the patient’s admission.
Those actions may be carried out without the patient’s or substitute decision‑maker’s consent only after reasonable efforts to secure consent have been made. If an ALC patient or their substitute later gives consent for any stage, the standard admissions procedures in sections 49–54 of the Fixing Long‑Term Care Act (and applicable regulations) apply to the consented stages, subject to any regulatory modifications.
The statute explicitly forbids using restraints or physically moving a patient to a home without their consent, so authorization does not itself permit forced transfer.The Act authorizes specific classes of people — physicians, registered nurses and certain other assessors — to perform eligibility assessments, and it obliges a licensee to review the materials provided and approve the admission unless statutory reasons for refusal apply. When the placement co‑ordinator has determined eligibility, a bed becomes available, and the placement co‑ordinator authorizes admission, the licensee must admit the approved ALC patient when they present themselves at the home.
The law also allows necessary collection, use and disclosure of personal health information by prescribed persons and entities to carry out these actions.Regulations play a central role: the statute removes the automatic application of sections 49–54 to these actions and directs that the regulations set procedures, criteria, restrictions, and any exemptions or modifications. The Act also clarifies that these provisions must be read consistently with the Residents’ Bill of Rights and amends the Health Care Consent Act to distinguish this ALC admission process from crisis admissions under that Act.
Finally, the Act imports the PHIPA definition of personal health information for use throughout the Fixing Long‑Term Care Act.
The Five Things You Need to Know
Section 60.1 allows placement co‑ordinators to authorize an ALC patient’s admission to a long‑term‑care home without that patient’s consent, but only after reasonable efforts to obtain consent have been made.
Sections 49–54 of the Fixing Long‑Term Care Act do not apply to actions under section 60.1; instead the regulations will prescribe procedures, criteria, restrictions and possible exemptions for those actions.
Placement co‑ordinators may select homes for an ALC patient subject to geographic restrictions that the regulations will prescribe, and they may transfer placement responsibility to another co‑ordinator.
A licensee must review provided assessments and approve and admit an ALC patient who is approved when the placement co‑ordinator has authorized admission and a bed is available, unless a statutory reason for refusal applies.
The Act permits specified persons and institutions to collect, use and disclose personal health information as necessary to carry out the ALC admission actions, and it prevents use of restraints or physical transfer to effect admission without consent.
Section-by-Section Breakdown
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Adopts PHIPA definition of personal health information
The Act inserts a single, cross‑cutting definition of “personal health information” by reference to the Personal Health Information Protection Act, 2004. Practically, this aligns data‑handling language across the Fixing Long‑Term Care Act with Ontario’s health‑privacy law and authorizes the ensuing provisions (including regulatory rules) to work with PHIPA’s concept of health information.
ALC patient process: who can act and what they can do
This new section defines an ALC patient and sets out a menu of actions that attending clinicians, placement co‑ordinators, assessors and licensees may perform — from eligibility assessments to home selection and formal authorization of admission. It lists the professionals permitted to conduct assessments (physicians, registered nurses and others identified in the existing Act) and explicitly allows placement co‑ordinators to hand off responsibility to another co‑ordinator, creating a flexible operational chain for placements.
Privacy, consent limits and hard limits on coercion
The section permits collection, use and disclosure of personal health information by prescribed persons to carry out ALC actions, subject to the reasonable‑efforts standard: actions may proceed without consent only after reasonable attempts to obtain consent. Crucially, the provision forbids using restraints or physically transferring a patient to a home without consent, meaning authorization can trigger an obligation to admit but not a power to force transfer.
Regulatory power to govern, modify and exempt
The Act gives cabinet broad regulatory authority to prescribe procedures, eligibility criteria, restrictions and exemptions for ALC actions; to modify how sections 49–54 and the associated regulations apply in consented cases; and to identify additional persons who may handle personal health information. This delegates substantial detail to regulation and opens the door to tailored administrative rules — and to potential variations in safeguards depending on what the government prescribes.
Clarifies relationship to crisis admissions
The Health Care Consent Act is amended to exclude ALC admission authorizations made under section 60.1 from the general crisis‑admission interpretation, and to confirm that an ALC admission is distinct from an admission under s.47. This prevents overlap or confusion between crisis‑bed admissions and the new placement co‑ordinator pathway, but it also erects parallel admission mechanisms with different triggers and rules.
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Who Benefits
- Hospital administrators and bed‑flow managers — The Act creates an explicit administrative pathway to expedite placement decisions for ALC patients, which can reduce prolonged ALC occupancy and free up acute‑care beds.
- Placement co‑ordinators and regional placement networks — The statute grants placement co‑ordinators formal authority to determine eligibility, select homes and authorize admissions, increasing their operational role and streamlining placement responsibility.
- Long‑term‑care licensees (insofar as they want filled beds) — Licensees receive prescribed assessments and an obligation to admit approved ALC patients when a bed is available, shortening time between offer and occupancy for compliant admissions.
- System planners and funders — Faster movement from hospital to long‑term care can improve acute‑care capacity metrics and enable redeployment of costly hospital resources to higher‑acuity care.
- Some ALC patients who lack capacity or who have complex discharge needs — The scheme can produce faster placement outcomes for patients who would otherwise be delayed by protracted consent‑seeking or coordination gaps.
Who Bears the Cost
- Long‑term‑care homes required to admit approved ALC patients — Licensees may inherit residents whose preferences or needs create operational mismatches; they also must review externally supplied assessments and may face legal or care risks if information is incomplete.
- Placement co‑ordinators and hospitals — They will shoulder increased administrative responsibility, potential liability for eligibility determinations and the burden of documenting ‘reasonable efforts’ to obtain consent.
- Patients and substitute decision‑makers — The process narrows consent protections for certain stages of admission and expands cross‑institutional PHI sharing, raising privacy and autonomy concerns for vulnerable individuals.
- Privacy officers and PHIPA compliance teams — Broader authorized disclosures of personal health information to prescribed actors will require updated data‑sharing agreements, audits and safeguards to meet PHIPA obligations.
- Appeal Board and tribunal resources — The provision for appeals of ineligibility determinations may increase caseloads and require timely review mechanisms to prevent further placement delays.
Key Issues
The Core Tension
The core tension is between system‑level urgency to clear ALC hospital beds (speed and administrative authority) and the individual rights of vulnerable patients (consent, privacy and freedom from coercion); the Act nudges resolution toward efficiency through statutory authorizations and regulatory delegation, but that choice necessarily limits traditional consent protections and shifts the battle over safeguards into the regulatory drafting and implementation phase.
The statute delegates core procedural detail to regulations and suspends the default application of sections 49–54 for the ALC pathway, which concentrates substantive rule‑making power in regulation. That creates two practical uncertainties: first, the effectiveness and scope of safeguards will depend on regulatory design (who may collect PHI, what documentation constitutes reasonable efforts, how geographic restrictions work); second, different regulatory choices could materially alter patient protections without further legislative debate.
The “reasonable efforts” threshold is central but undefined in the Act and will be a focal point for disputes. What counts as reasonable — how many contact attempts, which communication methods, and what documentation suffices — will determine whether the process meaningfully respects consent or permits operational shortcuts.
There is also an operational gap between authorization to admit and the statutory ban on forcible transfer: placement co‑ordinators can authorize admission, and licensees must admit approved patients when they present, but the Act does not create a mechanism to compel a patient to leave hospital or to make a home accept an uncooperative person. That mismatch could produce stalemates where authorization exists but transfer does not, undermining the goal of freeing hospital beds.
Finally, permitting broader collection, use and disclosure of personal health information “if necessary” leans heavily on administrative judgment. Without explicit minimum privacy safeguards in the statute, data‑sharing could expand in ways that strain PHIPA’s usual consent‑based norms.
The appeal route for ineligibility determinations is a check, but it addresses only denials, not approvals where patients assert their rights were overridden. These tensions highlight how regulatory details — not the statute’s headline powers — will determine whether the law speeds placements while protecting patient autonomy and privacy.
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