An Ontario court began hearing a constitutional challenge on September 23, 2024, to a law that can move some discharged hospital patients into long-term-care homes they did not choose. The Advocacy Centre for the Elderly and Ontario Health Coalition argued that the policy unfairly burdened older people and people with disabilities.
The law addressed alternate-level-of-care patients
Ontario’s More Beds, Better Care Act, commonly known as Bill 7, applied to patients whom clinicians said no longer required acute hospital treatment but who needed long-term care. It allowed placement coordinators to begin applications and share relevant information without the patient’s consent.
The province said the measure freed hospital beds for people needing acute care.
Patients could be offered a distant home
The rules allowed selection of a long-term-care home up to 70 kilometres from a patient’s preferred location in southern Ontario and up to 150 kilometres in northern Ontario, subject to specified circumstances. Patients could remain on waiting lists for preferred homes after a transfer.
Distance matters because family visits can provide emotional support, communication and oversight of care.
Refusal could carry a large daily charge
A patient who declined the selected placement could be charged $400 for each day they continued occupying a hospital bed. Supporters described the charge as an incentive to accept available care; challengers said it created coercive pressure on people with limited practical choices.
The charge was not a criminal penalty, but its financial effect could be severe.
The applicants alleged Charter violations
The advocacy groups argued that compelled placement and information sharing infringed rights to life, liberty and security of the person and had discriminatory effects. They said the law singled out frail older patients rather than solving shortages throughout the health system.
Those were arguments before the court, not findings at the opening of the hearing.
Ontario defended the policy as necessary
Government lawyers said patients had no constitutional right to remain indefinitely in an acute-care bed after discharge and characterized the consequence as economic. The province pointed to transfers achieved under the policy and the need to improve hospital flow amid population growth.
A policy can serve a legitimate capacity goal and still require judicial review of how it affects individual rights.
Capacity data showed a persistent system problem
Provincial figures indicated that 2,243 alternate-level-of-care patients were waiting in hospital for long-term care at the end of January 2024, accounting for nearly 200,000 hospital days. Critics said the number of such patients had increased after the law took effect.
These figures illustrated the shortage but did not alone prove whether Bill 7 caused or reduced it.
Only a small number had reportedly been charged
The court heard that relatively few patients had received the $400 daily fee. That limited use could indicate restraint, but the possibility of the charge may still influence decisions before a bill is issued.
Evaluation should therefore examine consent, distance, family impact and outcomes, not only invoices.
The deeper issue was inadequate suitable care
Hospitals are expensive and often unsuitable for long stays, while an inappropriate nursing home may disrupt relationships or fail to meet language, cultural or clinical needs. More long-term-care beds, home care and community services could reduce the conflict between individual preference and hospital capacity.
The court challenge tested whether Ontario’s method respected constitutional limits; it did not erase the operational crisis. A durable solution required transparent placement data, genuine patient participation, effective appeal routes and investment in appropriate care near people’s communities. Treating every delayed discharge as a simple refusal would overlook the constrained choices that created the dispute.
