Dr. Richard Johnston knew the health care system was in trouble when he walked down a hallway at University of Alberta Hospital and saw an older woman housed in a linen closet instead of a proper room. At nearby Royal Alexandra Hospital, where he also worked as an intensive care specialist, elevators were out of service for months and a patient had to have his urgent surgery rescheduled because of the lack of recovery rooms.
"We just have to build a new building," he said.
The two Edmonton hospitals are among many across the country depleted by deferred maintenance costs. To balance tight budgets, hospital administrators choose to pay for more nurses or new equipment over investing in repairs, explained Dr. Johnston, president of the Alberta Medical Association.
And the price tag for these decisions is adding up.
A recent study has found Canadian hospitals have accumulated $15.4-billion in deferred maintenance costs – but this is a conservative estimate; the same study indicates it could be as high as $28-billion.
The preliminary findings from the study commissioned by HealthCareCan, a national body representing academic and industry health care associations, were presented Tuesday at the National Health Leadership Conference in Charlottetown.
"It's a constant chipping away at the quality and accessibility of care that we need," said HealthCareCAN president and chief executive Bill Tholl.
Many of the country's hospitals were built in the 1960s or earlier through a federal funding program. With these hospitals now reaching their "best before" date, it's time for the federal government to invest again, Tholl said.
HealthCareCan has reason to believe Canadians feel the same way. The organization also partnered with Ipsos Reid to survey 1,230 Canadians about their feelings on health care. The poll found that 77 per cent worry that the government is under-investing in hospitals, compared with roads and bridges.
Apart from structural problems such as leaky roofs, older hospitals are also at higher risk of outbreaks because of the facilities' poor ventilation, shortage of private rooms and overall design.
In some areas, such as Alberta's urban centres, age and space are a problem for hospitals. At the Royal Alexandra's patient care ward, the 600-bed facility primarily made up of shared rooms is often crowded, according to Dr. Johnston.
Investing in hospital maintenance was one solution on the agenda at Tuesday's health care conference. But current maintenance costs need between $2.8-billion and $3.21-billion every year, according to the HealthCareCan study – and the funding wouldn't address the years of work that was put off.
For the very old hospitals, renovations aren't a cheap or quick fix. Installing modern air conditioning systems into old lead or concrete walls alone would be extremely expensive, Tholl said.
"We're not advocating for renovating this old house, we're saying we need new facilities for the future."
The design of new hospitals is not only aesthetic. These facilities have natural lighting, better noise control and more private rooms that are comfortable for patients and prevent disease spread, said Dr. Michael Gardam, director of infection prevention and control at the University Health Network in Toronto.
New facilities also come with more storage space for modern equipment, taking the clutter out of hallways and reducing the risk for falls.
"Any new hospital built in Ontario over the last five years is a dramatic improvement over the old ones," Dr. Gardam said.
These recently built hospitals are a model for health care across the country.
The new McGill University Health Centre replaced four facilities, yet has fewer beds with the intention to be more efficient than the aging buildings it supplanted, Tholl said. Not only is the design better, but the building includes more medical services (such as equipment and testing) so that patients can access what they need faster. The Montreal example is one that could be replicated in other communities, he said.
But building hospitals is an expensive endeavour for individual provinces. And the new facilities don't make up for other challenges in the system, such as the shortage of long-term-care beds.
"If we build a new hospital and 20 per cent of patients should be cared for elsewhere, you're not going to get the benefit from that hospital," Dr. Gardam said.
HealthCareCan is advocating that the federal government invest in hospitals to take the pressure of provincial budgets.
"It's time for the federal government to help municipalities and provinces to build," Tholl said.
The complete findings of the HealthCareCan study on hospital's deferred maintenance costs will be released this fall.