Ontario bails out nursing home over $1.7M cost of caring for resident with obesity

A Brampton nursing home that needed a $1.7-million bailout from the province to avoid bankruptcy over the soaring cost of care for a resident who is severely obese is now considering legal options to have him moved, the Star has learned.

So far, efforts to persuade the man’s family to place him at a nearby facility with beds for patients with obesity have been rebuffed, given they prefer he remain at the Brampton home, said sources, speaking confidentially in order to freely discuss the situation.

Bariatric care — which is care related to the treatment of obesity — is available in at least two long-term-care facilities within Greater Toronto, including at Humber Meadows in the city’s northwest, less than half an hour away.

“The resident is severely bariatric and is bedridden,” says a report by the Ministry of Long-Term Care, obtained by the Star. “The resident requires eight (personal support workers), 24 hours a day, seven days a week to provide for his daily care needs (e.g. for turning, repositioning, feeding). The home has a significant financial shortfall as they are unable to sustain the level of operating expense necessary to care for this resident and have fully utilized the existing line of credit.”

The resident moved into the facility in 2017, and at that time his care was manageable, the report says.

However, since then, his weight has more than doubled to 700 pounds. He supplements the meals provided by the home with regular takeout orders, as is his right, sources say.

The cost of the personal support workers runs an average of $138,000 a month, the report says.

While the situation is unusual, experts say there are concerns about how Ontario’s health system will handle the rising number of patients who are dangerously overweight.

“We need to be thinking about the diversity of bodies that we are going to see in health care, especially as the population gets older and especially as we know there are a large number of Canadians living with obesity and living in larger bodies,” said Ian Patton, director of advocacy and public engagement for Obesity Canada.

The ministry report says the resident has received quality care to date, but that employees at the home — which the Star is not identifying for privacy reasons — have “threatened work refusal if staffing levels are reduced to contain costs and have reported elevated levels of stress, mental health impacts and risk of physical injury in caring for this resident,” noting three workers have WSIB/on-the-job injuries to date.

“The home is in financial distress because it is a not-for-profit home, has limited funds and cannot afford to financially sustain the care of this bariatric resident at current staffing levels with no increased funding.”

In addition, some $16,431 spent by the home on equipment for the resident will soon be obsolete as he will exceed the weight limit for it, the report notes.

“The home has explored discharge options without any success to date and the resident and their family have indicated that their preference is to stay at this home,” says the report, adding “if a mutually agreeable alternative location was found, the home would incur costs until the resident was safely transferred.”

The home, and a second long-term-care facility run by the same operator, would have been insolvent without the provincial funding, putting the care of almost 300 residents in jeopardy, the report warns, and “this ($1.7 million) funding above the regular base level … is expected to be required on an ongoing basis while the resident remains in the home.”

Long-term-care facilities are not allowed to charge residents or their families for additional care.

Under provincial regulations, there are limited circumstances to force residents to move out, including if their needs have changed and the home can no longer meet them, or that it’s no longer safe for them or staff. Residents, however, must be allowed to provide input, have a place to go and be given advance notice.

Lawyers have further advised the province there are “provisions which require a home with the advice of their legal counsel and medical advisory team to discharge a resident if there is a significant health and safety concerns,” says the report.

Neither the operator of the home nor the Ministry of Long-Term Care wished to provide any details on the situation, citing privacy concerns.

Fire safety was flagged in a recent inspection. Sources said it would taken an estimated 10 firefighters to evacuate the resident from his upper-floor room, and the report says the home is working on a new emergency evacuation plan.

The union “is aware of the issues of staff safety and working to resolve them” with the home’s administrators, said a spokesperson, calling it a “tough situation” for all involved.

The spokesperson said when caring for bariatric patients, staff are particularly worried about back, neck and wrist injuries.

Patton, of Obesity Canada, said there are few options for people with bariatric needs, and in some cases they remain in hospital because there is nowhere else to go.

The ministry report notes there is a specialized 10-bed program at Toronto’s Grace Hospital that serves patients with obesity, though it has a wait-list of at least two years.

“People are still deserving of fair, equitable, respectful care, and part of that is having spaces available that accommodate them,” Patton said, and that includes lifts, proper beds, toilets that can support higher weights and even blood pressure monitors that fit larger arms.

Dr. Mehran Anvari, chair of the Ontario Bariatric Network and a professor of surgery at McMaster University, said there has been a fourfold or fivefold increase in the rate of obesity in the last 25 years, “and this is a significant burden on health care.”

“We have been pushing the government to ensure we have adequate services to support this,” he said, adding for bariatric patients it’s not always how much they eat but also the way their body metabolizes food.

They often feel judged, he added, “and there is a lot of prejudice against (them) and that has, unfortunately, even shown itself in the way we provide services.”

He said every hospital should be equipped appropriately and all new facilities should have wider doors to accommodate wider beds and proper equipment that can give the patient more independence, which in turn eases caregiving needs.

“I can see how people get frustrated,” Anvari said. “Nobody looks after these patients before they reach a point” where their health and well-being becomes difficult to manage, and primary-care doctors need to be referring patients for help much earlier.

Kristin Rushowy is a Toronto-based reporter covering Ontario politics for the Star. Follow her on Twitter: @krushowy