Background
The media reports regularly on patients’ frustrations with their health care experiences in the post-pandemic environment, including delays and wait times, staff shortages and insensitive, unresponsive or poor-quality care. At the same time, there is evidence of increases in incidents of workplace violence in hospitals and other health care settings, including verbal and physical abuse of care providers by patients and caregivers.1,2,3 BIG Healthcare, a consulting company that collects and analyzes operational and financial data from Ontario hospitals, reports substantial increases in hospital expenditures on measures intended to provide safe, secure environments for staff, patients and visitors since 2020.4
One practice that hospitals, long-term care homes and other health care settings use is the issuing of “no trespass” notices to patients and visitors deemed to have exhibited inappropriate, aggressive or assaultive behaviour. While sometimes necessary to protect the safety of workers, patients and visitors, no trespass notices can have serious impacts by limiting people’s ability to enter a health care facility to access care or visit loved ones.
In 2023/24, Patient Ombudsman addressed 62 complaints from patients and caregivers challenging the fairness of no trespass notices.
Seventy-four per cent of the complaints involved hospitals, 23% involved long-term care homes and 3% were about other settings outside of Patient Ombudsman’s jurisdiction.
In our 2017/18 report, Patient Ombudsman reviewed more than 50 complaints from patients and caregivers who had restrictions placed on their access to health care settings or their ability to visit family members in hospitals or long-term care homes. Patient Ombudsman identified the factors that are considered in reviewing the fairness of no trespass notices and other restrictions on access to health care settings:
- Ensure there is detailed documentation of the incident and the assessed risks.
- Ensure there is a documented process for reviewing the restrictions at reasonable intervals.
- Ensure the reasons for and conditions of the restriction are clearly explained to the patient or caregiver and should be no more restrictive than necessary to ensure the safety of patients/residents and staff.
- Consider and communicate what would be required to ease the restrictions, if appropriate.
For no trespass notices that are issued to family members or caregivers, health sector organizations should consider how the restrictions will affect the patient. These considerations continue to inform Patient Ombudsman’s review of the fairness of complaints about no trespass notices.