Award-Winning Ontario Project Cuts Unnecessary ER Trips for Seniors at End of Life.
Bramption, Ontario - Too many seniors in Ontario long-term care homes are being sent to emergency departments when they don’t want to go — and often don’t need to go. An award-winning Ontario project is proving that a simple shift in how consent decisions are made can dramatically reduce those transfers, improve end-of-life care and save millions of dollars in the health-care system.
The project is called POET — Prevention of Error-Based Transfers. It recently won the Improved Value and Sustainability Award at the Ontario Health System Quality and Innovation Awards, recognizing its impact on patient care and system efficiency.
“The headline is that this helps to reduce unnecessary and non-beneficial transfers from long-term care to the hospital by helping long-term care homes align their work with Ontario’s Health Care Consent Act,” said Jill Oliver, one of the project’s leaders.
Fewer trips to ER especially at the end of life
An independent evaluation led by McMaster University looked at 54 long-term care homes that participated in POET and compared them with control homes.
The results were striking.
“We had a 27 per cent reduction in emergency department transfers, and a 45 per cent reduction in end-of-life transfers — transfers that happened in the last 60 days of a person’s life,” Oliver said.
“We also found a 147 per cent increase in palliative care encounters for residents in the homes that participated.”
Those end-of-life transfers are often the most distressing for residents and families, and the least likely to align with what seniors actually want.
“They don’t really want to go but we’re making them go anyway” said long term care support worker.
At the heart of the problem is confusion about consent.
Under Ontario law, if a resident is capable, they -and only they- get to decide whether they go to hospital. But in practice, staff often defer to family members or outdated paperwork signed years earlier.
“Too many people are being sent to hospital from long-term care for the wrong reasons,” said Dr. Henry Yu-Hin Siu, a family physician and McMaster University associate professor who led the evaluation.
“We’re asking the wrong person for permission. A lot of times, that person should be the long-term care resident.”
In simple terms, he said:
“They don’t really want to go, but we’re making them go anyway.”
That can have serious consequences. Hospital stays increase the risk of delirium, infections, functional decline and distress — especially for frail seniors near the end of life.
Changing culture, not adding paperwork
POET doesn’t rely on new forms or technology. Instead, it works directly with long-term care homes over four weeks, mostly virtually.
“The first week we learn how decisions are made in that home, who’s involved, what beliefs or myths exist,” Oliver explained.
“Then we present a change plan, usually about 10 changes, to help them better align with the Health Care Consent Act.”
That can include removing misleading forms, changing documentation practices, and even giving staff scripts so they feel confident explaining consent properly.
“It’s really changing their decision-making practices,” Oliver said.
Tiziana Rivera, Executive Vice President of Quality, Research and Chief Nursing Executive, said the project tackles a deeply ingrained culture in long-term care.
“There’s a very low threshold for transferring residents to the emergency department,” Rivera said.
“The first trigger is often, ‘Get them out.’ This program changes that on its head.”
Savings for the system and dignity for seniors
The financial implications are significant. Based only on ambulance and transfer costs — not hospital stays — scaling POET to roughly 43 per cent of Ontario’s long-term care homes could save about $8.6 million.
“That’s cost avoidance,” Rivera said.
“Ambulances, ER visits, hospital admissions, all of that adds up. And this is a very low-cost intervention.”
But for those involved, the real value goes beyond dollars.
“It centres the person in the decision-making process,” Dr. Siu said.
“This isn’t a new medication or a piece of technology that goes away in five years. It’s a cultural shift.”
A solution waiting to be scaled
So far, about 70 long-term care homes in Ontario have participated. With current staffing, POET could reach nearly half the province within five years, faster with more provincial support.
“This is an easy win,” Rivera said.
“Residents in long-term care should have their wishes respected. We know how to do this — now it’s about making it the standard.”
For families who have watched loved ones shuttled back and forth to hospital against their wishes, that change can’t come soon enough.
As Dr. Siu put it:“We’re not giving them a good quality of life, and we’re not respecting their dignity by forcing them to go when they don’t want to.”