The revelation comes less than two weeks after the Star reported that the problem of hallway medicine — or overcrowded hospitals — has also hit new peaks.
A long-term care tracking report for July — the most current monthly report created by the health ministry’s data branch — shows that the number of patients waiting to move into long-term care jumped by 441 from the previous month and by more than 2,460 from a year earlier.
Dr. Alan Drummond, an emergency room physician from Perth, Ont., and co-chair of public affairs for the Canadian Association of Emergency Physicians, said the numbers are concerning because there is no way hallway medicine can be eased if the waiting list for long-term care is growing.
“The issue is the need and urgency for long-term care beds given the contribution of the ALC patient to the greater issue of hospital crowding and hallway medicine in the emergency department.”
ALC refers to “alternate level of care” patients, typically frail seniors who no longer require hospital care but continue to occupy hospital beds while they wait for space to open in a care facility.
This, in turn, creates bottlenecks in emergency departments while patients admitted to hospital from the ER wait for in-patient beds to be freed up. They often wait on gurneys in hallways, and sometimes even in “unconventional spaces” — such as staff classrooms and storage rooms — until in-patient beds become available.
In the run-up to last year’s provincial election, the Conservatives ran on a platform of eliminating hallway medicine, partly by increasing the supply of long-term care beds. They committed to creating 30,000 new long-term care beds — 15,000 within five years and 30,000 over 10 years.
In July this year, Premier Doug Ford promised that the problem of hallway medicine would be eradicated in 12 months, a pledge later walked back by Health Minister Christine Elliott.
Drummond said the latest data on health-system capacity contribute to doubts about those promises.
“Every emergency physician in the province knew that it was a vacuous promise and that probably little of substance would come from the Premier’s Council, which contained not one expert in hallway medicine.”
The Premier’s Council on Improving Healthcare and Ending Hallway Medicine was created in October last year to advise the government on health-system reform.
Long-Term Care Minister Merrilee Fullerton said the problem of increasing waits for long-term care did not develop overnight.
“The Liberals neglected Ontario’s long-term care system for 15 years, leaving it operating at close to 98 per cent occupancy, with 34,000 Ontarians on wait-lists. The unmet demand created pressures in hospitals, causing hallway health care and has left people waiting and unsupported.”
Government officials have continued to state that more than 34,000 people are waiting for long-term care, but the latest government tracking data shows that number is much higher.
Meantime, the Star reported earlier this month that hospital overcrowding for the month of June also hit a record high this year. Data provided by the Ontario Hospital Association showed that this was the worst June on record dating back to 2008, when the province began collecting the data.
The average wait time to be admitted to a hospital from an ER was 16.3 hours. At the same time, the number of “alternate level of care” patients increased by 450 for the month of June from a year earlier, topping 4,500.
Many of these ALC patients are waiting to move into long-term care homes. But the vast majority of patients waiting for long-term care live in the community, usually in their own residences.
This past Wednesday, Health Minister Christine Elliott announced $11 million in additional funding for home and community care with a view to easing hospital overcrowding. The money is to be used to support patients discharged from hospital or to prevent their admission in the first place.
The Ontario Hospital Association (OHA), which represents the province’s 141 hospitals, is concerned about the growing capacity pressures, especially given that flu season is around the corner.
“The lack of a forward-thinking capacity plan that takes into account Ontario’s growing and aging population is not new. For many years, hospitals and other health system stakeholders have warned that the system is out of balance,” said OHA president Anthony Dale.
“Unfortunately, progress towards increasing long-term care capacity has been slow for over a decade,” he added.
The latest government data shows that the number of long-stay beds (the majority of beds in long-term care homes) grew by only 0.2 per cent to 77,371 between July last year and this year.
The tracking report indicates the supply is expected to slowly increase in the near future.
“Supply is expected to grow by 201 (0.3%) in the next 6 months and grow by 77 (0.1%) in the next 24 months,” it states.
Supply can contract after growing because beds become temporarily unavailable as homes are refurbished.
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Fullerton said the government is endeavouring to increase the bed supply. This year alone, funding has been allocated for the creation of 1,814 new beds, and the government has reaffirmed its commitment to build 6,085 previously allocated ones, she said. “That’s real progress, not just talk,” she said.
The minister also said that the government is working to speed up the construction of the new beds.
“We’re working with industry partners to streamline processes and get shovels in the ground faster, so we can get people off wait-lists sooner. Our government is building a 21st-century, long-term care system that meets the needs of Ontario’s most vulnerable people.”
Dale acknowledged the government’s efforts to increase supply but said it will take time for new beds to open.
“In the meantime, hospitals require a bridge strategy to maintain access to care,” he said.
Drummond said that until the province gets the balance in the health system right, more hospital beds are needed. “A safe hospital is defined as a hospital with 85 per cent bed occupancy rates. Currently most hospitals in Ontario try to function, and fail miserably, at 100 per cent occupancy rates and some are even more than that.”
Donna Duncan, CEO of the Ontario Long Term Care Association, said the sector is encouraged by the government’s commitment to open new beds. Operators of homes are actively applying for licences for the beds, she noted.
But she said that creating new beds is a complicated process, involving numerous ministries, municipal zoning challenges, environmental assessments, development charges and property taxes.
As the health system evolves, so too must thinking about the best place to care for patients, Duncan said.
“There is a recognition that we need more capacity in the system and we need to think differently about where people fit into the system relative to hospitals, community, home care. We need to look at where supportive housing fits and what the full continuum of care looks like,” she said.
Lisa Levin, CEO of AdvantAge Ontario, which represents non-profit senior care providers, including long-term care homes, said the solution to hallway health care is a multipronged one, requiring increased capacity in many parts of the health system.
“We have been encouraged by this government’s commitment to building new long-term care beds and to investing in community-based programs and supports, such as more funding for supportive housing and increasing the supply of affordable housing. These are critical investments that will help to address a major gap in the system and that will enable more seniors to live independently at home,” she said.
Drummond said “a sense of urgency” about hospital crowding is lacking.
“Hallway medicine is bad medicine and represents minimal care at best. … Care is really non-existent when your sick and elderly loved one is parked in a stretcher down the hallway and sometimes in a broom closet,” he remarked.
It’s dangerous to have patients languishing on stretchers in ER hallways, awaiting transfer to in-patient beds, Drummond charged.
“The hallway is associated with greater complications, medical error, delayed treatment and higher death rates. … There are other issues — increased risk of delirium, violence, costs to the health-care system, ambulance off-load delays leading to inadequate ambulance response times and system gridlock so rural hospitals cannot transfer their patients to university hospitals for advanced care,” he said.