The Ontario Hospital Association (OHA), the organization representing hospitals across the province, has noted that emergency department wait times hit record levels in the summer of 2017 and warns that the provincial health-care system is headed for a “crisis” unless proactive measures are taken.

In a statement to the Toronto Star earlier this week, the OHA noted that:

Many hospitals have operated through the summer under very unusual and worrying surge conditions…[t]he evidence strongly suggests that…further investments are urgently needed this fiscal year in order to ensure timely access to services for patients.

The Association has called for:

…rapid and aggressive new investment in hospital services, and services across the (health system), to avoid a possible capacity crisis within Ontario’s health-care system this winter.

Increasing Wait Times

The OHA notes that in July 2017, 10% of patients waited longer than the provincial average of 30.4 hours to be moved from the emergency department to an inpatient bed. This is the longest July wait time recorded in the nine years that wait times have been measured by the province.

Moreover, while hospital activity generally slows down during summer months, over the last few months, many of the largest hospitals province-wide were at higher than 100% capacity. According to the OHA, patient capacity at roughly half of Ontario’s 145 hospital corporations exceeded 100% and reached as high as 130% in some places. This does not take into account the surge that hospitals generally experience every winter when flu season is at its peak and when things pick up after a Christmas slow-down.

The hospitals that have struggled most have been large urban hospitals, regional facilities, and in some cases, community and rural hospitals and includes organizations in the GTA, Windsor, London, Hamilton, Kingston, Ottawa, Cornwall, and Sudbury

The OHA hopes that the provincial Liberals will include additional funding for hospitals in their upcoming fall economic statement, as was the case in 2016. The Association fears a repeat of last winter, when hospitals were forced to create so-called “unconventional spaces” for patients (including converting rooms such as hallways, sunrooms, lounges, staff offices, and other similar spaces into patient rooms) due to the number of patients admitted.

Some Data about Health Care in Ontario

It is surprising for many to learn that, relative to other countries in the Organization for Economic Co-operation and Development (OECD), Ontario has very low numbers of hospital beds. The province has 2.3 beds per 1,000 people. Among OECD countries, only Chile, Mexico, and New Zealand have fewer.

The province has shrunk its hospital system, which provincial policy-makers have pointed to as proof of a “highly efficient system”. In 1990, there were just over 33,400 acute-care hospital beds, today there are a little over 18,500. During the same time frame, Ontario’s population increased by 36% to 14 million.

Data from the OHA and the Canadian Institute for Health Information shows that:

  • The number of visits to Ontario ER’s grew by 5.6% to 6.3 million between 2012/2013 and 2015/2016. Incoming patients are both older and sicker than previously;
  • Ontario spends $1,427 per capita on hospitals, with only one province (Quebec) spending less;
  • The average stay for hospital patients in the province fell from 6.9 days in 1995/1996 to 5.7 days in 2014/2015.

Initial Response from the Government

The provincial Health Minister has acknowledged that there is always more work to be done, and that health care is a “top priority” for the government. He noted that the province increased operating funding for hospitals by 3.1%, or $518 million, this year, and that the government plans to spend more than $20 billion on hospital infrastructure in the coming ten years.

Sources of Pressure

The OHA notes that there are three main sources of the increasing pressures on hospitals:

  • An increasing and aging population that often arrives in the emergency room very sick;
  • A health-care system that is not sufficiently robust outside of hospitals (i.e. in long-term care homes, palliative care, rehab facilities and other alternatives);
  • Five years of budget freezes and minimal increases from the province.

An Aging Population

The OHA notes that senior and elderly patients are often at the root of the province’s capacity challenges. Many patients who are in hospital beds across the province are those who have received and finished acute-care hospital treatment and who no longer need to be there. Known as “alternate level of care” patients (ALC patients), they are usually elderly patients or seniors. ALC patients cannot always get access to the care that they require outside of a hospital setting as long-term care homes are equally crowded, they may not be frail or ill enough to require such a level of care, or they may not be able to afford the fees for long-term care homes and are waiting to subsidized rooms to become available. ALC patients are often tough to place in non-hospital settings.

The OHA notes that while the province has a plan in place to reform the system, it need to “pick up the pace”.

There has been a movement advocating for the creation of subsidized living situations for seniors, where individuals could receive regular help from health-care professionals and personal support-workers. NDP Leader Andrea Horwath has called for the upcoming public inquiry into the murder of long-term care home residents at the hands of nurse Elizabeth Wettlaufer to also look into the creation of more affordably living spaces for the elderly.

We will continue to follow developments in this ongoing issue, and will provide updates as they become available. At Wise Health Law, we provide exceptional guidance on health law matters to public hospitals and other health-care organizations across the province. We monitor trends and developments in health so that we are able to provide consistently forward-thinking legal and risk management advice to all of our clients. We have offices in both Toronto and Oakville, Ontario, and are easily accessible. Contact us online, or at 416-915-4234 for a consultation.

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