When it comes to the crisis in Canada’s emergency departments, some root causes are more obvious than others.
Take the shortage of nurses and other health professionals, a long-festering problem exacerbated by the pandemic. Every Canadian gets that emergency departments can’t deliver timely care or stay open 24/7 without enough staff. It’s as plain to see as an open wound. Also obvious to most Canadians is how this country’s primary-care system often leaves patients little choice but to line up at the ER on nights and weekends for care that should be provided by family doctors.
But there is another contributor to Canada’s clogged ERs that’s harder for the general public to see, and which therefore gets less attention than it deserves. It’s the problem of patients, mostly elderly, occupying acute-care hospital beds they do not need, and which are not right for them. Why are they are there? They have nowhere else to go.
Hospitals refer to them as alternative level of care patients. Oftentimes, ALC patients are formally discharged but remain in hospital because they are waiting for a spot in a long-term care home or rehabilitation centre.
This stopgap approach is bad for everyone. It’s bad for ALC patients who inevitably deteriorate in hospitals that aren’t meant for long stays. It’s bad for acutely ill patients who do need a bed, and instead languish in hallways. It’s bad for emergency departments and the people who rely on them, because the consequence of a no-vacancy hospital is a lobby teeming with admitted patients in need.
In Ontario, this long-standing problem has grown worse. In May, there were 4,933 ALC patients in the province’s hospitals, up from 3,299 a year earlier – an increase of 50 per cent. And that means 17 per cent of all hospital patients in Ontario were ALC in May, according to Ontario Health.
Canada’s most populous province is not alone in its struggle. ALC patients took up 17 per cent of acute-care beds nationally in 2020-21, the most recent year for which data are available.
Dwell on that for a moment: Nearly one in five hospital beds in this country is filled with people who don’t need to be in a hospital, would be better off somewhere else, and want to be somewhere else. It’s happening even as hospitals scramble to find beds for patients who need acute care.
On Thursday, Ontario announced that, to ease the crunch in the province’s hospitals, it intends to allow them to place ALC patients in nursing homes not of their choosing while they wait for a spot in one of their preferred homes. Doug Ford’s government has promised that it will not send patients to long-term care homes far from their communities, and if it honours that promise, this is good policy. Acute-care beds are for the acutely ill.
More broadly, the national ALC problem reveals a failure to reckon with the fact that many elderly Canadians will at some point need round-the-clock care that even the most committed of families aren’t equipped to provide.
If the problem seems daunting today, just wait until the baby boomers reach their 80s and 90s. The oldest members of the supersized cohort turn 76 this year.
Expanding publicly funded home care is necessary, but not sufficient, to meet the challenge. Two baths a week from a government-paid health care aide might cut it for a senior with bad joints and a healthy spouse, but it won’t for a widower with dementia who can’t dress or feed himself.
As a society, we must accept that many seniors need the care of a nursing home today, and many more will need it tomorrow. That doesn’t mean accepting the appalling conditions that COVID revealed in some nursing homes. Provincial governments can and must do better as they open tens of thousands of new long-term care beds.
Quebec’s move to build small-scale facilities with homey touches, based on the successful U.S.-based Green House model, is one to watch. Another is Ontario’s plan to award some of its new long-term care beds to hospital networks, paving the way for seamless care between hospitals and nursing homes.
Either way, it’s time Canada faced up to the need for a massive investment in long-term care. The alternative is continuing to warehouse too many seniors in hospitals, where their capabilities are bound to decline and their presence makes it harder for their children and grandchildren to access care in the emergency department.
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