My brother has been living and working in Alberta for several years. He now has terminal cancer and wants to return to Ontario to be with family during the time he has left. Will he be able to get medical care?
Unfortunately, he will not be immediately eligible for coverage under the Ontario Health Insurance Plan (OHIP).
People returning after a long absence – and newcomers – must live in Ontario for three months before they are considered a permanent resident of the province and qualify for OHIP benefits, says David Jensen, a spokesman for the Ontario Ministry of Health and Long-Term Care.
However, this doesn't mean your brother will be without any public-health coverage. His former home province, Alberta, will be responsible for his basic medical expenses – such as medically necessary doctor and hospital visits – during the transition period.
All the provinces and territories have similar residency requirements and cost-sharing agreements to deal with migration within Canada.
For many patients, the basic coverage paid by their former home province is usually sufficient to get them through any medical emergencies that might arise during the first three months in their new location.
But it may not be enough for patients with additional needs – such as those who are terminally ill – because their former home province will not cover a lot of the "extras" such as home care and drug coverage.
"We get patients who want to be near family at the end of their lives," says Dr. Darren Cargill, who is the medical lead of a palliative-care team in Windsor, Ont.
"Because of the three-month rule, we are not able to provide them with the best possible care."
Cargill points out that home-care services in Ontario are normally provided through Community Care Access Centres (CCAC). Patients must wait until they qualify for OHIP before they can tap into CCAC.
"Without CCAC, they likely won't have any home nursing, no personal support worker, no assistive devices and, most importantly, no drug coverage for pain medication like opioids," he says. All those services are often essential for patients who want to die at home.
Of course, patients at the end of life can be admitted to an acute-care hospital and then their medical bills would be covered. "But this is not the most appropriate place for a patient who could be managed at home," Cargill says.
During the past year, Cargill and his medical colleagues in Windsor have cared for three patients who returned to Ontario to die. In all three cases, the patients were admitted to a local residential hospice, even though they weren't entitled to a full range of support services, including nursing staff. "We were trying to take care of them with one arm tied behind our back."
Cargill, who is the section chair on palliative care for the Ontario Medical Association, believes many other doctors must be grappling with the problem of patients caught in a similar position.
He says he understands the reason why the provinces have a three-month residency requirement. And the reasoning for this policy is quite simple. Not all provinces pay for the same list of medical services and health-related benefits. For instance, some provinces have more comprehensive drug and in vitro fertilization (IVF) coverage than others.
If a waiting period did not exist, Canadians could visit another province that offered more generous health benefits when they needed them and then head back home – which would be a form of "medical tourism" within Canada.
As a result, the provinces have a vested interest in making sure newcomers plan to stay before they are permitted to make use of the local health services. "These measures were adopted to preserve the integrity and future viability of the health-care system," Jensen said in an e-mail.
Even so, Cargill believes that an exception should be made for terminally ill patients. "We are talking about people who are at the end of their life. Their time may be short – measured in a few months, weeks or even days," he says.
"What's needed is some kind of 'compassionate clause' that would allow us to provide these patients with the appropriate care in the time they have left."
Cargill says he has reached out to his local member of the Ontario legislature, Lisa Gretzky, for help. Her office produced a letter that was sent to Ontario's Health Minister, Dr. Eric Hoskins. The letter, signed by both Cargill and Gretzky, draws attention to the "critical gap in services" for dying patients who have recently returned to their home province.
With a new federal government in Ottawa, and signs of greater national co-operation on health matters, Cargill is hopeful "a reasonable and rational solution can be found" for end-of-life patients moving across Canada.
Paul Taylor is a patient navigation adviser at Toronto's Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. You can find him on Twitter @epaultaylor and online at Sunnybrook's Your Health Matters.