Ontario’s hospitals and long-term care are in crisis. Pretending they aren’t won’t solve anything

Posted on September 21, 2022 in Health Debates

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TheStar.com –Politics/Opinion
Sept. 19, 2022.   By Martin Regg Cohn, Political Columnist

There are no simple remedies for the long-term problems of long-term care. And no painless prescriptions for the short-term crisis in acute care hospitals, Martin Regg Cohn writes.

Hallway medicine dominated Ontario’s last two election campaigns.

Voters had their pick of politicians who promised quick solutions for our clogged hospitals.

Now, pick your poison.

There are no simple remedies for the long-term problems of long-term care. And no painless prescriptions for the short-term crisis in acute care hospitals.

Under pressure to take action, the Ontario government is implying it can dislodge hundreds of so-called “bed blockers” from overcrowded hospitals, blamed for taking up as much as one-third of all wards. The plan is to relocate patients to available nursing homes far and wide when they can be discharged — or face charges of $400 a day if they won’t agree to move.

Ontario’s hospital chiefs are solidly behind the move. Unless desperately-needed ward beds are freed up fast, a looming surge in flu and COVID cases this winter will trigger even more hallway medicine.

Fair enough? Utterly unfair, the critics counter.

Opposition politicians accuse the government of a cruel shell game, pointing out that many nursing homes are also short of beds — hence the traffic jam. Their argument is that charging an onerous daily fee amounts to railroading the elderly into facilities that aren’t their preferred choice, and that you can’t blame patients for waiting out those waiting lists in hopes of landing a highly-sought spot.

Pick your panacea.

The government pretends it can solve the problem by sending bed blockers the bill — even though there are limited placement possibilities. Patients must choose, it says.

The opposition blames the government for imposing hardship on seniors — without offering a serious alternative to deal with the continuing crisis in hospitals. Patients have no choice, they claim.

But life and saving lives are all about tough choices. That’s true for individual members of the public, but also for public policy decisions that affect everyone.

Ontario lacks capacity in both acute care hospitals and long-term care (LTC) facilities. In fact, the shortfalls have been a long time coming.

All three major parties (and many outside experts) called for efficiencies in a health-care system whose costs were spiralling out of control. They tried to turn doctors into gatekeepers, they limited the number of medical school spots, and they kept capacity lean.

But they weren’t banking on COVID. Nor were they ready, even pre-pandemic, for a new surge in old-fashioned flu cases that brought on the first wave of hallway medicine, with patients stuck in gurneys outside of overflowing hospital wards.

Equally, long-term care got relatively little attention from any political party in power, all of which relied on the private sector to pick up the slack. Now, we are all paying the price for years of wilful neglect of nursing homes.

With a waiting list of 39,000 names for LTC, finding open spots for those hospital bed blockers won’t be easy. But that doesn’t mean the government must throw up its hands and do nothing until that list clears.

The reality is that both systems, short term and long, are jammed for the foreseeable future. Something has to give, better sooner than later, which is where hard truths of triage come in.

Triage can seem heartless, but it can also save the lives of heart attack victims who need acute care more urgently than those who don’t. It is understandable that people who can’t get their first few choices want to wait in place until their preferred facility becomes available, but that doesn’t make the status quo defensible at all costs.

Sometimes personal preference must make way for public necessity, even if that means undeniable private hardship. After all, you can’t direct an ambulance to take you to a preferred hospital — you go where you are taken based on availability.

Yes, it feels unfair that people may be shipped out to nursing homes as far as 70 kilometres away (even further up north), forcing family members out of their way. But it’s also unsustainable to keep blocking a bed until they get their way.

That said, there is good reason for the government to revisit its plan to make patients pay the full fee for costly medical transfers to distant facilities, lest they be penalized twice. If a nursing home isn’t on a person’s list of preferred destinations, the health ministry should make up the difference in costs.

While hospitals have long been permitted to impose daily charges for patients who overstay — and other provinces already allow it — the latest legislation and regulations will legitimatize the practice. Hospitals are not monstrosities, they are health-care providers, and so it can reasonably be expected they will implement any fees with discretion and humanity (they are, after all, not-for-profit outfits, not the dreaded profiteers critics complain about in the nursing home sector).

These measures aren’t the end of the world. Nor will they end hallway medicine.

More than health-care crisis management, there is an element of political “issues management” at play. The government must be seen to be doing something — anything.

Both sides are posturing. But doing nothing won’t get us anywhere as flu season approaches and COVID encroaches.

https://www.thestar.com/politics/political-opinion/2022/09/19/pushing-seniors-out-of-ontarios-hospitals-is-tough-but-necessary-medicine.html

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