The Ford government was elected with one firm health care commitment — to end hospital overcrowding.
Now, one year into its term, its seems confused about this important file. The premier recently announced that the problem would be solved in a year, while his health minister responded that solving hallway medicine would be a long-term goal.
Patients might be excused for thinking that this lack of clarity means solving hospital overcrowding is a complex problem. In reality, eliminating hallway medicine has a clear solution. The math is simple. However, Ontarians must wonder if their leaders are actually committed to solving hospital overcrowding.
The arithmetic of hallway medicine begins with understanding that Ontario has fewer hospital beds per person than any other Canadian province. In estimating how many hospital beds we need it is straightforward to recognize that the people who need hospitals most are frail senior citizens. Since Ontario’s population of citizens over 75 increases at 4 per cent each year, it sounds reasonable that our hospital beds should also increase by 4 per cent each year.
Fortunately for Ontario tax payers, our hospitals are both efficient and innovative. For years, hospitals have been reducing our health costs by shortening the length of stay in hospital for planned operations. Total knee replacements that previously required a four-day stay are now being performed as same-day surgery, allowing us to get by with fewer hospital beds.
However, hospitals cannot improve the length of stay for frail seniors admitted for treatment of chronic diseases, like heart failure, who are also encountering difficulty staying independent in their homes. These patients may be successfully treated but are unable to return to the community. These frail patients generally require transfer to long-term care (LTC — also called nursing homes) and cannot leave hospital until a long-term care bed becomes available.
These patients occupy about 15 per cent of Ontario’s hospital beds (4,500 beds), despite no longer requiring the complex care available in hospital.
With the number of Ontarians over 75 increasing at 4 per cent per year, it makes sense that long-term care beds should increase at the same rate. Unfortunately, these beds have not increased for years. This is the primary cause of hospital overcrowding.
Recognizing the need to expand LTC, the former government committed to an expansion of 10,000 long term beds and this commitment has been maintained by the new government. Although this seems like a major expansion, a 4 per cent annual expansion in our 75,000 bed LTC capacity would mean that we need 3,000 new long-term care beds per year, three times greater than the 10,000-bed 10-year government plan.
The government hopes that this gap between need and commitment to LTC will be filled by increasing home care for frail seniors. The economic rationale for this plan is obvious since home care is much cheaper than long-term care, which is, again, much cheaper than hospital care.
It is clear that hospital overcrowding will not be fixed until we start expanding both long-term care beds and home care for frail seniors. However, to date, there is no start to the much-needed expansion of nursing home beds and the government has destabilized home care delivery by eliminating the boards of Local Health Integration Networks (LHIN’s) that manage home care.
New long-term beds need to be located where there is demand. Unfortunately, high demand areas for nursing homes are usually located in urban areas with expensive land costs, making it difficult for operators to acquire property for construction.
There is plenty of cheap land in the province — but no one wants their parents or grandparents admitted to nursing homes distant from their community. And long-term care operators complain that the government’s revenue plan for nursing homes does not account for urban land costs.
Solving hospital overcrowding is a simple arithmetic problem requiring understanding that our population growth in frail seniors requires a 4 per cent annual increase in home care and nursing home beds. The government has damaged home care delivery by destabilizing LHINs and has no obvious solution to the land cost challenge that will allow new nursing home beds to be built where they are needed.
Until these two issues are resolved, simple math suggests that Ontario hospital overcrowding will worsen, not improve.
Bob Bell worked in Ontario health care for more than 40 years as a GP, surgeon, hospital CEO and Deputy Minister of Health. Follow him on Twitter: @drbobbell
