Under new rules that take effect next Wednesday, hospital patients in southern Ontario waiting for long-term care slots can be transferred to nursing homes up to 70 kilometers away, while for those in northern Ontario, the distance is 150 kilometers. The government is proposing this as a way to ease pressure on the hospital system, which has been plagued this summer by long waiting times and emergency department closures. What’s not clear is how much of an impact the new long-term care transfer rules will actually have on the hospital crisis. A key barometer of pressure on the hospital system is the average time an admitted patient spends waiting in the emergency room before being admitted to a medical ward. The latest statistics, released this week by Ontario Health, show the average wait reached an all-time high of 20.7 hours in July.
A key reason for the backlog is that Ontario hospitals have a record number of patients who have been discharged by their doctors but are still occupying a bed. These patients are usually waiting for some other health care that is not available, such as long-term care, home care, or physical rehabilitation. Ontario Health Minister Sylvia Jones is announcing that hospital patients waiting for long-term care slots could be transferred to nursing homes not of their choice up to 150 kilometers away, for a fee of $400 a day if they refuse. (Christopher Katsarov/The Canadian Press) More than 6,000 such “alternative level of care” (ALC) patients are currently in Ontario hospitals. This means that about one in five hospital beds are occupied by someone who does not really need acute care. And that in turn leads to other patients waiting hours or days in emergency rooms to be admitted to a hospital ward, or delays in scheduled surgeries because no post-operative recovery beds are available.
So how many of those 6,000 beds will be freed from the government’s new long-term care transfer rules? It took asking the question three times three different ways, but Ontario Health Minister Sylvia Jones finally revealed a goal. “We are very optimistic and confident that we will be able to have 400 alternative care patients placed in the community,” he told a press conference at Queen’s Park.
Four hundred patients is not an insignificant number, but it only scratches the surface of the problem. The latest statistics from Ontario Health show the average time an admitted patient spent waiting in the emergency room before being admitted to a medical ward hit an all-time high of 20.7 hours in July. (Evan Mitsui/CBC) “This is all a political show,” Tom Clawson, former CEO of the Ontario Hospital Association, said on Twitter this week. “There are almost 40,000 people in the community on waiting lists to enter nursing homes,” Clawson added. “There are hardly any spaces in any nursing home to admit ALC patients to the hospital, no matter how far away those homes are.” Despite Closson’s rejection of the new rules, some current hospital CEOs welcome the move, part of the recently passed Bill 7, the government’s More Care, Better Beds Act. The government’s plan “will improve patient flow, increasing patient access to the specialist acute care our hospital provides”. North Bay Regional Health Center CEO Paul Heinrich said in a statement. “Bill 7 will help ensure that every bed available across the system is used properly,” Heinrich said. David Musyj, CEO of Windsor Regional Hospital, says the alternative level of care phenomenon has plagued the health care system since before he began working on it more than 20 years ago. Windsor Regional Hospital CEO David Musyj says it took courage for the Ford government to change the rules so patients can be transported longer distances to long-term care. (CBC News) “Every major political party has had an opportunity to do something about this in the last two decades, but none of them have until now,” Musyj said in an interview with Radio-Canada. “So it took courage to do what it is doing now and I have to applaud them for that.” Re-elected with an even bigger majority just three months ago, the Ford government has plenty of political room to make potentially unpopular decisions, such as sending the elderly away from home for long-term care. There is no applause from the opposition New Democrats for the government’s move.
“What this government is doing is shuffling people from one overstretched system to another, but it’s not really going to solve the problem we’re seeing in our emergency rooms and our surgeries,” said Peter Tabuns, Ontario NDP. interim leader, at a press conference at Queen’s Park. The government is not actually claiming that the new long-term care transfer rules will solve everything on their own. The problems are too deep-rooted and the bottlenecks too long-standing for a quick fix. For years, governments of all stripes have squeezed hospital funding to the point that Ontario has fewer beds per capita than all other provinces, in a country with fewer beds per capita than almost any other wealthy nation.
The Ford government is promising to create 30,000 new long-term care spaces by 2028. Most facilities are still in the planning stage before construction. (Michael Aitkens/CBC) Layer on top of that the effects of the pandemic — depleted staff, limited demand for delayed care and a growing burden of disease — and you have Ontario’s current hospital crisis. The government’s response is a five-point plan that, in addition to long-term care rules, includes a push to tackle backlogs of more than 200,000 scheduled surgeries by performing more of them in private for-profit clinics.

How stand-alone surgical clinics could help

The Ontario Medical Association (OMA), which represents doctors, is proposing a slightly different way to ease the surgical backlog: creating “comprehensive ambulatory clinics,” stand-alone day surgery facilities that operate on a not-for-profit basis, partnering with hospitals and not private. Day surgeries are procedures that can be performed on an outpatient basis, usually not requiring the patient to be hospitalized overnight. Evidence from them in other provinces shows they can do outpatient surgery 25 percent more efficiently than hospitals, says Dr. Jim Wright, an orthopedic surgeon and OMA vice president of finance, policy and research. Dr. James Wright, pediatric orthopedic surgeon and head of finance, policy and research at the Ontario Medical Association. He says stand-alone day surgery facilities, run on a not-for-profit basis, could help solve the problem. (Riziero Vertolli/OMA) “The experience around the world is similar for patients, the recovery is faster and they find it a much more improved experience,” Wright said at a virtual news conference this week. Hospitals are better positioned for emergency and inpatient surgeries, Wright said, while freestanding clinics are much less likely to postpone scheduled day surgeries, as outpatients often do. The theory is that this would shift some of the surgical burden away from hospitals, allowing them to focus their resources on acutely ill patients. But there’s a catch: It will “optimistically” take 12 to 18 months to set up these stand-alone clinics, Wright said. While they may ultimately be a big part of the solution for Ontario hospitals, they can do nothing to ease the pressure now, nor the even greater pressure that many in the health system expect to come in the fall and winter, when communicable diseases spread more easily and the patient burden usually increases.