What Ontario's new long-term care rules will (and won't) do for hospitals

Just how dire is the situation in Ontario hospitals? Premier Doug Ford's government is willing to face the almost inevitable public blowback from sending seniors up to 150 kilometres away for long-term care, all to free up a few hundred hospital beds. 

Under new rules that take effect next Wednesday, hospital patients in southern Ontario awaiting spots in long-term care can be moved to nursing homes up to 70 kilometres away, while for those in northern Ontario, the distance is 150 kilometres. 

The government is pitching this as a way of easing the pressure on the hospital system, plagued this summer by record long wait times and emergency room closures.

What's not clear is how big an impact the new rules for long-term care transfers will actually have on the hospital crunch.

A key barometer of the strain on the hospital system is the average time an admitted patient spends waiting in the emergency room until they get a bed on a medical ward. The latest statistics, released this week by Ontario Health, show that average wait hit an all-time high of 20.7 hours in July.   

One key reason for the backlog is Ontario's hospitals have a record number of patients who've been discharged by their doctors but are still occupying a bed. These patients are typically waiting for some other health care that isn't available, such as long-term care, home care or physical rehabilitation.

More than 6,000 such "alternate level of care" (ALC) patients are in Ontario's hospitals right now. That means roughly one in five hospital beds is taken up by someone who doesn't actually need acute care.

And that in turn leads to other patients waiting hours or days in the emergency room before they can get admitted to a hospital ward, or delays in scheduled surgeries because no post-op recovery beds are available.       

So how many of these 6,000 beds will be freed up by the government's new rules on long-term care transfers?

It took asking the question three times in three different ways, but Ontario's Health Minister Sylvia Jones eventually revealed a target. 

"We're very hopeful and confident that we are going to be able to have 400 alternate level of care patients placed in community," she told a news conference at Queen's Park.   

Four hundred patients is not an insignificant number but it only scratches the surface of the problem.

"This is all a political show," said Tom Closson, a former chief executive of the Ontario Hospital Association, on Twitter this week.

"There are almost 40,000 people in the community on wait lists to get into nursing homes," Closson added. "There are almost no spaces in any nursing homes for hospital ALC patients to be admitted into regardless of how far these homes are away."

Despite Closson's dismissal of the new rules, some current hospital CEOs are welcoming the move, part of the newly passed Bill 7, the government's More Care, Better Beds Act.

The government's plan "will improve patient flow, increasing patient access to the specialized acute care our hospital provides." said the CEO of the North Bay Regional Health Centre, Paul Heinrich, in a statement.

"Bill 7 will help ensure every bed available across the system is being used properly," said Heinrich. 

David Musyj, CEO of Windsor Regional Hospital, says the alternate level of care phenomenon has troubled the health-care system since before he started working in it, more than 20 years ago.

"Every single main political party had an opportunity to do something about this over the last two decades, but none of them have until now," said Musyj in an interview with Radio-Canada. "So it took courage to do what's being done now and I must applaud them for it."

Re-elected with an even bigger majority just three months ago, the Ford government has plenty of political breathing room to make potentially unpopular decisions, such as sending seniors far from home for long-term care.

There's no applause coming from the opposition New Democrats for the government's move.  

"What this government is doing is to shuffle people around from one overextended system to another, but it is not actually going to solve the problem that we're seeing in our emergency rooms and our operating rooms," said Peter Tabuns, the Ontario NDP's interim leader, in a news conference at Queen's Park. 

The government is not actually claiming the new long-term care transfer rules alone will solve everything. The problems are far too deeply entrenched and the bottlenecks too long-standing for one quick fix. 

For years, governments of all stripes squeezed hospital funding to the extent that Ontario has fewer beds per capita than all other provinces, in a country with fewer beds per capita than nearly every other wealthy nation.  

Layer on top of that the effects of the pandemic — staff burnout, pent-up demand for delayed care, and a growing burden of illness — and you have Ontario's current hospital crisis. 

The government's response is a five-point plan that, in addition to the long-term care rules, includes a push to tackle the backlog 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 physicians, is proposing a slightly different way to ease the surgical backlog: creating "integrated ambulatory clinics," stand-alone facilities for day surgeries, run on a not-for-profit basis, partnered with hospitals rather than privately run. 

Day surgeries are procedures that can be performed on an outpatient basis, typically not requiring a patient to be admitted to hospital overnight. 

Evidence from these in other provinces suggests they can perform outpatient surgeries 25 per cent more efficiently than hospitals, says Dr. Jim Wright, an orthopedic surgeon and the OMA's vice-president of economics, policy and research. 

"The experience worldwide is patients like it, the recovery is faster, and they find it a much more streamlined experience," Wright told a virtual news conference this week 

Hospitals are best-placed for emergency and inpatient surgeries, said Wright, while stand-alone clinics are far less likely to postpone scheduled day surgeries as often happens to outpatients.

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 create these stand-alone clinics, said Wright.

While they may eventually be a big part of the solution for Ontario's hospitals, they can't do anything to ease the pressure now, nor the even greater pressure that many in the health system anticipate will come in the fall and winter, when contagious diseases spread more easily and the patient load typically grows.