Critics of Ontario Premier Doug Ford spent the week calling him a cruel, despicable bully. He’s sending Granny to the Gulag, they said.
What was Mr. Ford actually doing? Following the advice of hospital leaders and implementing a policy of moving out people who don’t need a hospital bed, so that patients who need to be hospitalized can move in.
On Wednesday, Ontario passed Bill 7, a package of amendments to the Fixing Long-Term Care Act that allows hospitals to send so-called alternate level of care, or ALC, patients to nursing homes not of their choosing while they wait for a spot to open on their short list of preferred homes.
Patients listed as ALC have technically been discharged from hospital, because the care they need is not what hospitals offer. Most are elderly, and most are in the queue for a nursing home or publicly funded home care.
Before Bill 7, an Ontarian who qualified for long-term care could put herself on waiting lists for up to five homes. She could limit her list to just one or two places, the most coveted of which could take years to get into. If her health deteriorated and she wound up in hospital, the hospital would be obligated to keep her until a bed opened at one of her preferred facilities – even if a nursing home down the street had room to spare.
As elderly patients waited in hospital beds that weren’t right for them, new patients in need of a hospital bed languished on gurneys and spilled out of emergency departments. If anyone spoke up this week for patients in hallways, it wasn’t audible over the yowls of protest about Bill 7, a sound legislative change the Ford government did a lousy job of defending.
The government should have explained that it makes no more sense for an ALC patient to wait in an acute-care bed than it does for a lung cancer patient to wait in a dental office. Both are in the wrong place.
Mr. Ford’s real sin is not his plan to send some seniors to nursing homes they don’t like. It’s his failure – and that of a string of governments before his – to grasp the magnitude of the ALC crisis, and the disaster it spells for the health care system. Bill 7 does little more than nibble around the edges of that crisis.
Consider the scale of the problem. In August, there were about 6,000 ALC patients in the province’s hospitals, the highest on record, according to the Ontario Hospital Association. Nearly 4,000 occupy acute-care beds. The rest take up post-acute beds, such as mental-health beds or “reactivation” beds, a category the former Ontario Liberal government created when it reopened a couple of mothballed hospitals to care for ALC patients the last time their numbers threatened hospital operations.
About 40 per cent of Ontario’s ALC patients are waiting for long-term care, while 16 per cent are waiting for home care or community supports, and 12 per cent are in line for supervised or assisted living spaces.
Those sectors are all grappling with staff shortages made worse by the pandemic. And it’s not as though the only people waiting are in hospital. The nursing-home queue has more than 39,000 people in it, according to Ontario’s Ministry of Long-Term Care.
What COVID revealed is that Canada has a massive health care capacity crisis, one that’s been building for decades. In Ontario, successive governments cut capacity until the province had the fewest hospital beds per capita of any province. If it were a country, Ontario would rank near the bottom of the OECD in terms of hospital capacity. (Canada as a whole ranks only slightly higher.)
And after a building blitz in the 1990s, Ontario opened vanishingly few new long-term care beds, a mistake made by the Dalton McGuinty and Kathleen Wynne Liberals that the Ford government is now scrambling to rectify.
Home care, delivered largely by unpaid spouses and children, and therefore a bargain for government, was supposed to fill the gap. But the sector could never attract and retain enough personal support workers to reinforce family care, and the shortage of home-care PSWs is now dire.
When it comes to health care capacity, Ontario is in a deep hole. So is the rest of the country, and it’s a problem that will only get deeper as the Baby Boomers age. Bill 7 is part of the solution. Unfortunately, it’s only a small part.
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