Hospital center - Palliative end-of-life care – Inaccurate information and vague standards

Not wanting his wife to receive palliative care in a semi-private room in a hospital centre, a man asked for her to be transferred to a private room. His request was granted. The hospital charged him for her stay.

The man’s complaint concerned:

• The fact that according to the government policy on palliative end-of-life care, hospital centres should not charge additional fees for a private room to an individual receiving palliative care.

The Québec Ombudsman’s investigation revealed that:

• The Regulation respecting the application of the Hospital Insurance Act sets out the invoicing rules for private and semi-private rooms in hospital centres for short-term care;
• Two specific cases are mentioned where fees cannot be charged for private or semi-private rooms: when no other room is available and when a doctor asks that the user be admitted to this type of room;
• The government circular titled “Facturation pour l’occupation de chambres privées ou semi-privées et pour la disponibilité du téléphone alloué aux usagers” (invoicing for the occupation of private or semi-private rooms and for the availability of the telephone allotted to the users) specifies the scope of the Regulation but does not add any new information;
• Neither the Regulation nor the government circular specifically deals with private or semi-private rooms in relation to palliative care;
• The user’s doctor asked for the patient to be admitted to palliative care, without specifying that she should be placed in a private room;
• Usually, this hospital centre places users in palliative care in a semi-private room and then transfers them, when possible, to a private room as death approaches.

After the investigation, the Québec Ombudsman determined that the invoice for the private room had been made in compliance with the regulations in effect. The government policy on palliative end-of-life care is vague, however, and could lead to confusion. Furthermore, the Ministère de la Santé et des Services sociaux has not updated the measure proposed in this policy on the need to define and standardize the financial contribution made by users in order to offer equal access to palliative care.

The Québec Ombudsman recommended that the Ministère de la Santé et des Services sociaux:

• Specify the scope of the government’s palliative end-of-life care policy: With regard to hospital centres and CHSLDs, the financial adjustments to adapt the end-of-life care (private room, additional nursing staff, etc.) must not lead to additional fees for the users;
• Define and standardize the financial contribution for users receiving palliative care;
• Inform the health and social services agencies and the institutions in question.

The Ministère de la Santé et des Services sociaux accepted and followed through on the Québec Ombudsman’s recommendations.