How to start fixing hospital overcrowding

Ottawa’s ridiculously overcrowded hospitals are back in the news again, as they will be until the provincial government finally does something substantial to fix the problem.

Health-care experts agree a hospital should average between 85- to 90-per-cent occupancy, so it can handle surges of demand. Our local hospitals are full at the best of times and in the high-demand winter season have reached up to 120 per cent of capacity.

This is a problem that can affect patients’ ability to get timely, quality care and one that stretches hospitals’ resources beyond reasonable limits. Curiously, the problem is not that so many people are trying to get into the hospital, but that we are so bad at getting them out.

To function properly, a hospital requires flow. When a patient no longer needs the expensive acute care that hospitals provide, the next step is supposed to be home care or long-term care. Unfortunately, we are short of both of those resources, forcing hospitals to hang on to patients who are too sick to be sent home without extra help.

At The Ottawa Hospital, there are typically between 170 and 190 patients who shouldn’t be in hospital, but have nowhere else to go. That’s taking up a significant portion of the 950 beds the hospital has and is well beyond the 100 or so such patients the hospital can comfortably handle.

The problem is not new, but it keeps recurring because too little has been done to fix it. Our hospitals can’t do the work they are supposed to do because they are doing busy doing the job of the home-care and long-term-care sectors. So what should be done? The Ontario Council of Hospital Unions suggests that Ottawa get 200 more hospital

The problem is not new, but it keeps recurring because too little has been done to fix it.

beds. That would be the most costly and least sensible approach.

The Champlain Local Health Integration Network has been nibbling away at the cheap end of the problem, using extra provincial money to provide more intensive home care to those with significant medical needs, keeping them out of hospital or long-term care. It can help about 600 people at a time this way.

That helps, but it’s not enough. The fact that we have so many people waiting in our hospitals is proof of that.

The other piece of the solution is long-term care, and this is where the government really does a poor job. Our region has 7,600 longterm-care beds and about 3,639 people waiting for those beds. It’s a problem that’s just going to get worse. Between now and 2035, the percentage of our local population over 75 will more than double, to a little over 200,000 people.

There are 78,807 long-term-care beds in Ontario, up only 1,900 beds over the last seven years. Despite the clear lack of beds, the government has no plan to build more, focusing instead on renovating some of the shabbier facilities.

The Champlain LHIN says the average length of stay in long-term care has been reduced by four months, saving quite a lot of money. Is that because we are doing a better job of serving people at home or because they have to wait so long they are nearer to death by the time they get long-term care?

One would think that Health Ministry bean counters and their government bosses, desperate to control health-care costs, would want people to get into cheaper care right away. Strangely, that has not been the case.

Keeping people in hospital is far more expensive than home care or long-term care. A hospital bed costs between $1,000 and $1,300 a day versus $165 for long-term care. According to Home Care Ontario, the average cost of home care is $42.

The Champlain LHIN is expecting a consultant’s report soon that will outline the scope of the care problem here and possible solutions. The question is, what happens next?

The problem of hospital overcrowding is neither mysterious nor insoluble. Fixing it will require cash and political will. Both have been in short supply for years.