Ontario retirement homes will refuse admission to elderly patients being pushed out of hospitals to make room for COVID-19 cases until the government agrees on measures that keep current residents safe.

In a “bulletin” sent to its 614 members Thursday, the Ontario Retirement Communities Association (ORCA) asked homes hold off on requests to accept patients from hospitals and Local Health Integrated Networks until a safety protocol is set. ORCA said it is in “collaborative” discussions with the government on guidelines for admission of outgoing hospital patients.

As the coronavirus spreads, hospitals are trying to free up beds by moving out longtime alternate level of care (ALC) patients, many of whom are elderly and vulnerable. Hospitals are trying to find spaces in government-licensed nursing homes, which have few available beds, and privately operated retirement homes, which have higher vacancy rates.

Retirement homes can be luxurious or basic, offering seniors rooms, meals and, if required, assistance with daily needs, such as medication or bathing. They are inspected and licensed by a regulatory body. Long-term care homes are licensed and inspected by the Ontario government.

In its bulletin to members, ORCA wrote: “Over the last few days, you may have been contacted by your Local Health Integration Network (LHIN), local hospital or another health care provider about the urgent need to decant (remove) Alternate Level of Care (ALC) patients from hospital into your retirement community.”

ORCA “encourages members to delay entering into an agreement until the centralized guideline framework can be finalized with government,” while negotiations with the government continue, it said.

In a statement sent to the Star, association CEO Cathy Hecimovich said members “want to contribute where we can for the good of all Ontarians while balancing our obligation to safeguard the health and well-being of existing residents and staff.

“…We are in discussion with government about ensuring that we are available, where capacity exists, and in a co-ordinated manner, for patients for whom we can safely provide appropriate levels of care,” Hecimovich said.

She did not say when retirement homes would start accepting hospital patients.

The health ministry said “Many options and scenarios are being considered.”

The delay in accepting hospital patients comes as no surprise to seniors’ advocate Jane Meadus, a lawyer with the Advocacy Centre for the Elderly.

“We are in a very difficult time,” Meadus said. “Retirement homes are not going to be set up to provide care to people with high care needs.”

Many of the hospital’s ALC patients have complex medical needs, including dementia. They have been in hospital, waiting for a long-term care bed to become available.

Most retirement homes, which are privately owned and operated, were not meant to care for the most fragile seniors, including those with advanced dementia, Meadus said.

Instead, retirement homes attract older adults who are generally independent and willing to pay roughly $3,500 to $10,000 a month for room and services. It is not clear if patients sent out of hospitals would be expected to pay the full price of a retirement home room or be subsidized by the government.

Hospitals are also trying to send patients to long-term homes, where available beds are few.

The virus is now in at least 12 Ontario nursing homes, according to Advantage Ontario. Among a vulnerable population, the virus can spread quickly, impacting residents and workers.

Lisa Levin, CEO of Advantage Ontario, which represents not-for-profit, municipal and charitable homes, said many operators worry they don’t have proper isolation rooms if asked to take patients from hospitals. Some will isolate those new residents, and some will not, Levin said.

Of Ontario’s 626 long-term care homes, about 200 have a mix of rooms that are home to three or four residents, leaving limited options for solitary space. Some homes, Levin said, are considering using their auditorium in a COVID-19 outbreak.

To open up more beds, the ministry has changed the designation of some short-stay beds to long-stay, Levin said. It is also allowing some families to take their relative home, changing rules so it is less complicated for that person to return later, she said.

“There is not a lot of capacity in the homes, so this is one way to do it, but it won’t change overnight,” she said.

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Most worrisome, Levin said, is the desperate need for more personal protection equipment, such as masks, for staff.

“We need to make sure that we can get those supplies right away,” she said.

“We don’t want to have to wait for an outbreak to get them, we want to stop the spread of an outbreak.”