Social Policy in Ontario

After over a decade of policy pronouncements from the Ontario government that the top issue on their health agenda is expanding community care, including home care, should we be surprised to learn that Health Minister Hoskins plans to temporarily reopen two closed and antiquated hospitals?

One should view it for what it is — a profound failure of the minister’s much touted “Patients First” policy. Patients do not want to be warehoused in reopened hospitals of dubious safety. Nor do they wish to languish in hospital corridors on gurneys or in the back of ambulances unable to find an emergency room willing to accept them.

You should be discouraged perhaps or disappointed, bordering on angry, but surprised — no. The failure to move some 4,000 patients who are still in hospital after their attending physicians have approved their discharge has been a very large canary in the hospital mine.

Inevitably, if you fail to move patients from hospital to home or to rehab centres or to palliative care or to nursing homes in a timely and supportive fashion, you must know that the default position is more hospital beds.

Was this an inevitable failure? No. Was the direction of expanding community care wrong? No. More care at home and in the community, was, and still is, the right direction. This failure is overwhelmingly a failure of delivery. At almost every point the political will was too weak, the sense of urgency almost completely lacking and the clarity of leadership muffled in rhetoric and lost in endless process. Now the impending election seems to have galvanized a frenzy of short-term, ill-advised decisions.

A few examples underscore these points:

• Inappropriate patient care. Most damaging is the recent report of the government’s own Health Quality Ontario. HQO noted that there are on average 3,961 patients in Ontario hospitals who were waiting for long-term care, rehabilitation or home care. Patients who no longer need to be in hospital occupied the bed equivalent of 10 large hospitals. Why, with hospital beds filled with patients not requiring hospital care, is the answer to reopen 1,200 hospital beds? It is not a decision-based on evidence.

• Urgency of home care visits. An excellent study by Dr. Ross Baker indicated that a home care visit on the first day after a hospital stay dramatically reduced hospital readmission rates. Instead of tasking existing home care providers to do first day visits, the Health Ministry directed the Community Care Access Centres (CCAC) — set up to manage home care — to hire their own government employed nurses to meet a target of a first visit within five days.

The Ontario Provincial Auditor reported that CCAC-delivered nursing, cost 40 per cent more than community home care organizations and that the five-day target established by the Ministry of Health for a first visit was frequently missed. Further, the Auditor General indicated that there had been no cost benefit analysis to inform this decision.

• Eighty per cent of Ontarians do not want to die in hospital. The beds that are actually needed in Ontario’s health care system are palliative care beds largely in hospice settings, not hospitals, to allow Ontarians to have a dignified death. Also needed is more robust palliative home care to manage pain and reduce the burden of families.

Who is to blame for this failure? There is lots of blame to go around. Entrenched interests in health care delivery resist change and cling to the status quo with a tenacity unmatched in any other sector.

The aging population of Ontario urgently needs support to manage diabetes, asthma, COPD and the other chronic disease that accompany the longer life expectancies Ontarians are experiencing. The common characteristic of these chronic diseases is that they are best managed in the home and the community. Chronic diseases are also best managed with the active and informed participation of the patient. Hospital care should be a last resort and is neither optimal nor cost effective.

The reopening of aged hospitals will not be a temporary measure unless the Minister of Health takes very determined action to actually fund the community health services necessary.

As I search for an understanding of recent Ontario health care policy decisions I find insight in the words of Groucho Marx who explained, “politicians look for problems, find them everywhere, misdiagnose them, and apply the wrong remedies.”

Reopening old hospitals is exactly that — the wrong remedy.

Michael Decter is a former Ontario Deputy Minister of Health and current chair of Patients Canada.

https://www.thestar.com/opinion/commentary/2017/11/01/reopening-old-hospitals-is-the-wrong-remedy.html