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Hallway health care: Ontario Health metrics put numbers to strained system

Posted: January 4, 2024

(January 3, 2024)

By: Jessica Smith Cross, The Trillium

On an average day, 1,326 people were on stretchers in Ontario emergency department hallways or other “unconventional spaces” at the end of the last fiscal year.

It’s one of the metrics Ontario Health (OH) uses to track the health of the health-care system, and it’s at its highest reported level since the province began tracking the stat in 2017, according to the health super agency’s latest annual report, recently tabled in the legislature.

The report notes that for this figure, lower is better — but the organization does not have a specific target it hopes to meet.

When Doug Ford’s Progressive Conservatives came to power in 2018, it was on a promise to “end hallway health care” altogether.

In 2017-18, before the Ford government was elected, there was an average of 1,087 patients in unconventional spaces and the figure stayed roughly at that level until dropping during the height of the pandemic to 713 in 2020-21. 

Since then, it has climbed steadily, now reaching its new high.

Many of the problems that caused hallway health care in the days of the Liberal government persist: patients are in hallway stretchers when there are no inpatient beds for them. One of the reasons there are not enough inpatient beds is that some people who don’t need to be in hospital any longer still are because there is no safe place for them to go.

They are called “alternate-level-of-care patients” and there were 4,565, on average, at the same time there were 1,326 people, on average, on stretchers in unconventional spaces. Of those ALC patients, 1,802 were waiting for long-term care beds, according to OH.

At the same time, 2,238 people deemed “crisis patients” were waiting for LTC in the community. That’s down slightly from the year prior. As of March 31, 2022, there were 2,546 — a little more than twice as high as the pre-pandemic baseline of 1,078 on March 31, 2019.

The high numbers were primarily driven by hospital patients taking priority over community patients on the waitlist, according to OH. The number of crisis patients in the community peaked at 3,199 in January 2022 due to the Omicron wave.

According to Home and Community Care Support Services, the median wait times for people seeking long-term care in 2022-23 was 202 days for those in the community and 75 days for those in hospitals. By comparison, the median wait for the year prior was 217 days for people in the community and 77 days for people in hospitals.

One of the ways the Ford government sought to ease hallway health care was to move ALC patients into long-term care with the controversial “More Beds, Better Care Act,” which allowed placement coordinators to select homes for ALC patients without their consent and fine them if they refused to move into them. According to a recent Auditor General report, 99 patients were moved into homes not of their choosing from the day the bill was passed in the fall of 2022 to the fiscal year-end of March 2023.

Two advocacy groups — the Ontario Health Coalition and the Advocacy Centre for the Elderly — are challenging the bill in court, arguing that the legislation infringes on the right to life, liberty and security of person under Section 7 of the Charter and discrimination based on age under Section 15 of the Charter.

The province initially said it expected the law to free up 250 beds in the first six months alone. While it’s not possible to measure how many patients made choices about their care they would not otherwise have made, had the law not been in effect, the auditor found that the proportion of people in hospitals who moved into a long-term care home that was not their first choice was 60 per cent, roughly equal to what it was before the law came into effect.

Emergency department closures

Some of the problems facing the health-care system are relatively new.

In 2019-20 and 2021-22, OH tracked unplanned hospital emergency department closures due to staffing shortages with the goal of having none — a goal it met in both years. Today, ED closures are a constant problem, but the agency no longer tracks that metric in its annual report.

According to figures compiled by the auditor general, there were 203 temporary emergency department closures in Ontario between July 2022 and June 2023, “involving 23 hospitals primarily located in rural or remote areas, largely related to a nursing shortage and other staffing challenges.”

While OH no longer publicly tracks closures, its annual report outlines some of the measures it’s taking to reduce them and says it averted 410 ED closures by providing crisis staffing support.

However, the closures have continued. For instance, three of four hospitals in the South Bruce Grey Health Centre network, serving southwestern Ontario, were closed overnight Tuesday.

In response to The Trillium‘s questions on the metrics in OH’s annual report, a spokesperson for Health Minister Sylvia Jones touted the province’s efforts to recruit and retain nurses.

“Ontario’s nurses are one of the highest paid nursing workforces across the country,” said Hannah Jensen. “Last year alone, our government is proud to have added 15,000 new nurses and through our Your Health plan, we are growing and supporting our healthcare workforce for years to come.

“We have broken down barriers to make it easier for internationally and interprovincially educated nurses to register and practice in Ontario, expanded the Learn and Stay program to provide tuition costs to more eligible nursing students with tuition while removing financial barriers for nurses looking to upskill, creating mentorship opportunities through the Clinical Scholar Program, adding a historic 121 new nurse practitioner education seats and continuing to work with our partners to expand nurses’ scope of practice, including recent changes that will allow registered nurses to prescribe contraception and deliver more immunizations.”

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