Thousands of patients in Ontario hospitals should be in other care facilities 

While there has long been a lack of capacity in Ontario hospitals, the COVID-19 pandemic worsened the situation and although hospitalizations caused by acute COVID infections are down significantly thanks to a mixture of vaccine and infection-derived immunity, long wait times for beds are still making headlines. 

One thing compounding the ongoing capacity crisis is the fact that in Ontario, thousands of patients who should be in other facilities are stuck in hospital beds.

The Ontario Hospital Association (OHA), which serves hospitals across the province, recently told insauga.com that as of late January, there were more than 4,500 patients who require an alternative level of care (ALC) occupying acute care beds. 

The OHA says that almost 40 per cent of those patients are waiting for space in a long-term care facility. 

According to the Canadian Institute for Health Information (CIHI), the term ALC is used to refer to patients who occupy a bed but do not require the intensity of services provided in that care setting. While many ALC patients are waiting for long-term care beds, others might be waiting for space in a rehabilitation facility or to be released to adequate home care. 

In January, the OHA estimated that the province has about 22,000 “staffed and available” acute care beds in total. While plans to add more beds to the system have been announced over the past few years, a recent Ontario Council of Hospital Unions report says more must be done to address bed and staff shortages in the province’s health care system. 

The report, The Hospital Crisis: No Capacity, No Plan, No End, says CIHI data indicates that Canada overall lacks capacity.

“According to the most recent CIHI data, Canada as a whole (including Ontario) has 7.7% more hospital beds per capita than Ontario. Ontario also has a much lower number of beds than almost any other developed nation,” the report reads.

“The result is very high hospital bed occupancy, cancelled surgeries, and inpatients being treated via hallway healthcare.” 

The report suggests that the province’s plan to add 3,000 new hospital beds over the next decade won’t suffice, especially with an aging population that will require more health care services in the coming years. In the report, the union suggests capacity will need to grow by about five per cent a year–or 1,891 beds per year. 

Major hospitals in Ontario say that hundreds of beds–which have been needed during a busy respiratory virus season that has seen people hospitalized with flu, COVID and RSV–are occupied by those who would fare better in other facilities. Finding ways to shift patients to more appropriate settings will also become more pressing as Ontario grapples with an aging population and the pressure it will inevitably place on the system. 

Health care experts are also noticing an increase in severe illness post-pandemic. 

“Growing wait times and high levels of hospital occupancy are also directly related to Ontario’s very rapidly changing population,” Anthony Dale, president and CEO of the OHA, said in a news release. 

“A huge spike in population growth in recent years, and a growing population of elderly people with complex health needs is increasing demand for health services, alongside an increase in the acuity levels of patients presenting in emergency departments.” 

Trillium Health Partners, which operates Credit Valley Hospital, the Mississauga Hospital and the Queensway Hospital, told insauga.com that on any given day, it cares for more than 200 ALC patients better suited for long-term care, rehab or home care. 

“This is in part due to a rising number of seniors in our community,” a THP representative told insauga.com in an email.

“In Mississauga, the number of seniors over the age of 65 is growing at one of the fastest rates in the province, with many having two or more chronic conditions. In addition, post-COVID, we are seeing more patients coming into the hospital with advanced disease and/or increased complexity of care needs.” 

THP currently operates over 1,450 hospital beds across its sites. 

Halton Healthcare, which operates Georgetown Hospital, Milton District Hospital and Oakville Trafalgar Memorial Hospital, also says it’s experiencing increased pressure. 

Halton Healthcare spokesperson Laura Zilke told insauga.com that in late January, there were 52 ALC patients waiting for either long-term care or home care to be available before they could be discharged. 

Zilke said the number of ALC patients varies at given times and that the hospitals will work with health care partners to shift patients during times of high demand. 

“During periods where there are a high number of patients coming to our hospitals, we work closely with our partners – home and community care support services, rehabilitation services, long-term care facilities and neighbouring hospitals – to try and accommodate all patients who need acute medical care,” Zilke says. 

“Some options include utilizing spaces such as vacant wards, reviewing scheduled and non-urgent care and expediting discharges.”

When asked what actions are being taken to address the challenge, a spokesperson for Ontario’s Ministry of Health referred to Bill 7, the More Beds, Better Care Act, which came into effect in the fall of 2022. The bill, which requires hospital patients awaiting long-term care to transfer to nursing homes not of their choosing on a temporary basis, was conceived and passed to free up beds and create capacity at a time when emergency department closures (which still occur, especially in smaller municipalities) began making headlines. 

According to the bill, patients who refuse to move could be faced with monetary penalties of up to $400 a day. 

“If there is no bed available in a long-term care home that is on the patient’s preferred home list, the placement co-ordinator may authorize the patient’s admission to a home where the patient can live while they continue to wait for a spot in one of their preferred homes,” the bill’s factsheet reads.

According to the factsheet, placement co-ordinators are expected to consult with patients and their caregivers and “make reasonable efforts to seek the patient’s consent at each stage of the placement process” and consider such factors as the patient’s personal preferences, travel time for loved ones and cultural and religious connections. 

As for how individual hospitals handle high patient volumes and capacity challenges, health care insiders say communication and coordination with community partners are essential. 

“Osler’s health care teams work together with patients, their family or substitute decision-makers, to identify appropriate options for transition out of hospital based on the patient’s individual needs, including those designated as ALC, adopting a ‘home first’ approach, whenever possible,” a spokesperson for William Osler Health System, which operates hospitals in Brampton and Toronto, told insauga.com. 

“Working in partnership with Ontario Health and community partners, Osler is committed to supporting patients and families through this process, discussing all available options for care, such as transitional care beds, behavioural supports and connecting them with the most appropriate setting to ensure a smooth and comfortable transition.” 

THP also says it works to connect patients who no longer require hospital care to supports outside the facility. 

“Over the last year, THP has been able to successfully transition more patients to long-term care than ever before,” a THP spokesperson says. 

THP says some steps taken to ease pressure on the hospital system include opening a new long-term care home with 632 beds, adding 30 beds at its Reactivation Care Centre and launching its THP@Home home care program. The health care organization also reopened its urgent care centre at the Queensway Health Centre. 

THP says the additions help prevent readmissions at a time when patients can wait quite a while for an inpatient bed.  

“THP has one of the busiest Emergency Departments (ED) in the province. Last year alone, THP saw over 214,000 ED visits,” a spokesperson says. 

“Patients with more complex inpatient care needs also typically need additional testing and assessment in the ED, resulting in a longer length of stay. The increased volumes seen in the ED, combined with the increasing complexity of our patients’ health needs, have contributed to the wait time for an inpatient bed.”

Health groups are also hoping to relieve pressures on emergency departments by telling people where to go if they’re sick or ill but not in need of emergency medical attention.

Zilke, who represents Halton Healthcare, says they direct residents to its Know Your Healthcare Options website so they can better decide what level of care is appropriate for them or their family members. The health care organization also utilizes Remote Care Monitoring, which offers in-home care and monitoring for patients to prevent unnecessary hospital visits. 

Zilke also says Halton Healthcare takes advantage of technology where possible, using point-of-care ultrasound devices in its emergency departments to diagnose ailments more rapidly. 

“These devices allow clinicians to perform rapid diagnostic scans right at the bedside to answer specific questions such as whether a patient has kidney stones or signs of lung infection. This allows for quicker decision-making and care for patients,” Zilkie says.  

“We will continue to explore new avenues and plan for the increasing healthcare demands projected for our region as the population grows and ages.” 

But while health care advocacy groups say more must be done at the provincial level to increase staffing and capacity, OHA President Dale said in a news release that there are some things patients can do to protect themselves, especially during respiratory virus season.

“In total, more than 6,000 of [available] beds are occupied by patients who should be in another more appropriate setting, or who, in some instances, may have been able to avoid admission had they been vaccinated against the seasonal respiratory viruses that continue to pose a threat to the health of many Ontarians, especially our most vulnerable.”