Improving consent practices in Ontario long term care homes

Informed consent respects an individual’s autonomy and right to decide on care they would want, however, true informed consent does not always get practiced in long-term care (LTC). This intent and practice dichotomy results in LTC residents receiving care they do not want and/or can not benefit from and increases transfers to emergency departments. In response to this dichotomy, the PoET Project was created; PoET helps Ontario LTC home staff and physicians align their habits, policies, and practices with Ontario’s Health Care Consent Act.

The PoET Southwest Spread Project (PSSP) was a collaboration between William Osler Health System’s Ethics Quality Improvement Lab and McMaster University’s Department of Family Medicine to implement and evaluate PoET in 54 LTC homes in Southwestern Ontario between 2019 and 2022. At the end of PSSP, our team was able to demonstrate that compared to matched control LTC homes, PSSP LTC homes reduced all-cause transfers to acute care by 27%; a larger 45% reduction was observed in PSSP LTC residents in their last 2 months of life. Across all settings, PSSP LTC residents experienced palliative physician encounters at a 147% increased rate.

PSSP shows that aligning consent practices to the Health Care Consent Act can make a large impact on the healthcare system. Investing in, and advocating for policies that support a LTC cultural shift towards proper informed consent will benefit all LTC residents.