Patients overstaying in hospital at all-time high
Experts have their say on how next premier can fix health care
The number of patients who occupied hospital beds even though they no longer required hospital care hit a record level in Ontario this past winter, the Star has learned.
As a result, emergency room wait times also hit an all-time high.
Almost 5,000 patients, most of them frail and elderly, were stuck in hospital beds because long-term-care homes were full or because it was unsafe for them to return home without more support, according to newly audited data from the Ontario Hospital Association (OHA) and the province’s Health Ministry.
This caused a bottleneck for patients admitted to hospitals through emergency departments. The 90th-percentile wait time for transfer to an in-patient bed — meaning the maximum time that 90 per cent of the patients spent waiting in the ER — was 40.9 hours.
It’s not surprising then that “hallway medicine” has become a major theme in the June 7 provincial election. There has been a lot of talk on the campaign trail about hospitals housing patients in “unconventional spaces” such as bathrooms and storage rooms. Health care always ranks as a top concern among voters, but rarely gets this kind of attention.
While health-care leaders are pleased that the topic is being debated, they are disappointed by the simplistic solutions being offered.
The health system is struggling to meet today’s demands and is nowhere near prepared for the challenges that will come in 20 years, when the number of seniors will double, they warn.
“It is refreshing that for the first time in a political election we are talking about bed capacity,” said Alan Drummond, an emergency doctor from Perth, Ont., and spokesperson for the Canadian Association of Emergency Physicians. “But we’re just reacting. We’re not planning.”
Drummond says Ontario is not prepared for the looming onslaught of dementia and Alzheimer’s cases: “We have no system. We have silos of health. There is no comprehensive long-term vision or plan for how we are going to pay for it.”
Of the 30,000 acute and nonacute beds in Ontario’s 143 hospitals, 4,756 were occupied in January by what are known as “alternate level of care,” or ALC, patients. These patients no longer required hospital care, but were stuck in hospitals while w home care, according to the new data. (Acute care beds are typically found in hospitals with emergency rooms, while non-acute beds are located in rehabilitation, complex continuing care and psychiatric hospitals.)
The previous record for ALC patients was set a year earlier when 4,553 were stuck in hospital beds. The longest ER wait times prior to January were in 2008, when the 90th percentile wait was 40.2 hours. (The province began tracking ALC numbers in 2011 and ER wait times in 2008.)
Overcrowding peaked in January even though officials opened 1,200 extra hospital beds and created 200 new supportive housing units for frail seniors leaving hospitals. They also facilitated the development of 600 new “transitional spaces” for ALC patients in community settings, such as former retirement homes.
Had that not happened, there would have been a “calamity,” said OHA president Anthony Dale. The creation of the transitional spaces was a “lifesaver,” he said, adding that more such innovative solutions are urgently needed.
“All the data shows that Ontario’s health system is continuing to race toward a very serious and growing capacity challenge,” Dale said. “It’s time to move beyond the election cycle and implement genuine evidence-based long-term planning for all health services.”
Health-care leaders are disappointed they are not hearing about more innovative solutions on the campaign trail. They note that the three major parties are vowing to fix crowded hospitals largely through the creation of more long-termcare beds.
“The current high-pitched narrative of ‘hallway medicine’ is once again encouraging simplistic, knee-jerk responses like ‘We just need to build more beds,’ and I worry this will cause us to lose focus on understanding how we got here in the first place and how we can fix and prevent it from happening altogether,” said Dr. Samir Sinha, director of geriatrics at Sinai Health System and University Health Network, and architect of the province’s seniors strategy.
The Liberals are promising to build 5,000 new long-term-care beds by 2022 and more than 30,000 over the next decade; the Conservatives are pledging 15,000 new long-term-care beds within five years and 30,000 by 2028; and the NDP are promising 15,000 over five y
Dr. Danielle Martin, vicepresident of Women’s College Hospital, says Ontario’s health system is built upon a “20thcentury model” and requires “21st-century solutions” to work better.
She said there are many demonstration projects and areas of excellence that should be scaled up. They achieve the triple aim of reducing costs, improving patient outcomes and enhancing patient experiences, she said.
Senior officials in the Health Ministry and local health integration networks (LHIN) say they have also been looking at solutions, and have creatthese ed plans to “scale and spread them” should they prove effectt overcrowding.
ducing hospital
But it will take political will from the next government to get such innovations off the ground, Dale said, by making health care a top priority at the cabinet table.
“There is so much potential in change and innovation, but the truth is that for the next several years the system will be under massive strain as new ideas are implemented and new capacity is created,” Dale warned, explaining that it will take time for new long-term-care beds to be built.
The Star canvassed healthcare and opinion leaders across the province to seek examples of innovative solutions to the system’s challenges. Here are ome of their responses:
Dr. Andy Smith, president of Sunnybrook Health Sciences Centre
One solution to improving hospital wait times is, interestingly, not investing in hospitals but instead building community resources such as “transitional spaces” for patients who no longer require hospital care and are waiting to move into long-termcare homes or other settings.
Pine Villa is a new “reactivation care centre” on Eglinton Ave W. and since February it has been accepting patients from Sunnybrook, many of whom have lost muscle mass and strength because of inactivity and bed rest in hospital.
At Pine Villa, they get stronger with the help of recreation therapy, rehab and social activities. Some 20 per cent improve so much that they no longer require long-term care and can return to their own homes.
Kevin Smith, president of the University Health Network What if your health care could be provided by a single team that includes all care providers so that frustrations often experienced at points of transition — from primary care to hospital to home care — are eliminated?
This is possible under a “bundled care model” that has been piloted throughout the province. Instead of patients seeking out every aspect of their care independently, providers from different sectors work together on the same team to care for you. A care co-ordinator from one of these sectors, say home care, takes charge of organizing your entire journey through the health system. One organization, say the same home-care agency, is funded to make this model of care work and is held accountable.
Dr. Samir Sinha, director of geriatrics at Sinai Health System and University Health Network Here are three ways we can provide better care to frail older
, reduce 911 calls, and take pressure off hospitals and longterm-care homes.
When doctors make house calls to patients who are homebound because of physical, cognitive and social problems, these patients get care they likely would not otherwise receive. It may sound expensive, but it has been proven to be cost-effective. Chronic conditions are less apt to flare up, so patients make fewer calls to 911 and fewer trips to hospital.
By doing more preventive care, rather than just the “you call, we haul” care, paramedics can connect seniors to primary care and home-care providers and to services such as Meals on Wheels. A small amount of Health Ministry dollars allowed Toronto paramedics to last year establish a community paramedicine program for frequent 911 callers. It cut 911 calls in half and hospital visits by 67 per cent.
Naturally Occurring Retirement Communities — or NORCs — are condominiums, apartment buildings and other
mmunities where more than 70 per cent of residents are seniors. The Health Ministry, through the LHINs, recently began supporting NORCs with a view to helping seniors age in place. It does this by funding a mix of meal, social and personal care services.
Candace Chartier, CEO, Ontario Long Term Care
A
Some people waiting in hospital for long-term care have severe behavioural issues related to dementia and/or mental health conditions. They can be highly aggressive and need more intensive and specialized, flexible staffing support than is available in traditional longterm-care homes.
It’s time to look at this problem from the perspective of the entire health system, using new models of care and a dose of innovative and disruptive thinking. The goal is to leverage existing expertise in long-termcare homes to provide a better care environment for people who need support, while simultaneously relieving pressure on hospitals and community.
In one case study we looked at,
with additional government funding and specialized and f care home was able to enhance their services to care for a senior who had previously been in the hospital for two years.
Dr. David Urbach, surgeon-inchief, Women’s College Hospital Transforming common in-patient surgeries like joint replacements into ambulatory procedures takes pressure off hospitals. Patients are operated on and discharged within the same day. Emerging post-operative virtual-care technologies — including new tablet apps — allow hospitals to follow up with patients when they return home. Single wait lists for surgery help to cut wait times. When patients get to the front of the queue, they see the next available surgeon.
Sue VanderBent,
, Home Care Ontario Home care is key to taking pressure off hospitals. Families want and need more home care, but an aging population and government underfunding has meant patients are getting less. Front-line home caregivers have been asked to do more with less for too long. Here’s what we need to do: Improve scheduling of visits and eliminate 15-minute visits; direct all funding to front-line care rather than administrative duplication; and better utilize technology, for example, by giving visiting nurses access to realtime patient information, such as recent medication changes.
Dr. Ritika Goel, family physician, Inner City Health Associates
The top 1 per cent of health-care users account for about 30 per cent of health-care costs, and are more likely to be seniors
nd those living on low incomes. This makes sense as the main determinant of one’s health is not access to doctors, nurses and hospital beds, but one’s income and housing. In Canada, one in eight seniors lives in poverty and makes up an increasing proportion of our homeless population.
If we truly want to start tackling health-care costs and keep seniors at home, we must look upstream. This means expanding the basic income policy which has been shown to decrease emergency room usage and downstream costs. It means investing in affordable housing units, which cost much less than avoidable hospital visits. Rather than having fewer seniors in hallways, let’s keep them out of our hospitals altogether.
“All the data shows that Ontario’s health system is continuing to race toward a very serious and growing capacity challenge.” ANTHONY DALE OHA PRESIDENT