Discharge planning and community housing in Ontario

As hospital budgets in Ontario (and elsewhere) continue to shrink in the face of governmental fiscal pressure, bed closures lead to the discharge of increasingly vulnerable persons. Many of these persons have no family and no obvious place to go. Community supports to assist people outside the hospitals are not provided at a level commensurate with the need. The result is inadequate housing, social isolation, non-existent care and, in too many cases, reinstitutionalization and/or preventable deaths. This paper describes the process by which vulnerable adults wind in unsuitable community settings, as a result of ill-conceived in the province of Ontario.(1) It places a particular focus on the difficult role played by the discharge planner as conduit from hospital to community. The planner is often caught in the middle, facing hospital (and physician) directives to empty beds precipitously, alongside an acute shortage of suitable housing in the community. Departing patients are often sent to settings that lack any form of governmental inspection, regulation, licensure, or control: they are at the mercy of often indifferent and, at times, overtly rapacious landlords who may take the welfare cheque and give little in return. Selected case material, including one recent inquest, highlight the difficulties. While the long-term response clearly involves issues beyond the control of the discharge planner, this paper examines short-term remedies within a context of acute fiscal constraint. Suggestions such as better information flows or informal/secret 'blacklists' are assessed and critiqued.