Chapter 4: Immediate and long-term capacity pressures
Chapter 4: Immediate and long-term capacity pressures
Capacity pressures are also contributing to the problem of hallway health care in Ontario. There are several causes to the capacity challenge:
- Ontario may not have the appropriate number of hospital, or long-term care beds to meet the health needs of the population,
- there is insufficient capacity in community care systems – like home care and mental health and addictions care – to prevent people from needing to go to hospital and to enable them to return home from hospital quickly, and
- the province is not using the beds across the system as effectively as possible. In practice, this means that there are people across the province who are spending time in hospital beds because they can’t access other options for health care.
There are many patients in Ontario who are waiting in the wrong place in the system, and who require an alternate level of care (ALC). For example, in October 2018, almost 16% of days in hospital were spent by patients that were waiting for care in another setting.
In addition to being high, the ALC rate is different depending on where you are in the province, and can change depending on the time of year. As of October 2018, the range of ALC rates across Ontario was between 5% and 34% - with some challenges more pronounced in the northern part of the province and in the Greater Toronto Area.
There are many examples of people waiting for health care in the wrong spot across the system that could benefit from a different kind of support. For example, over 9% of people designated as requiring an ALC who have been waiting more than 30 days are people who have specialized mental health needs
Another area where we can see the direct impact of capacity pressures is in how difficult it can be to find space in long-term care homes. The largest proportion of cumulative ALC days (province-wide), are currently attributed to patients waiting to be discharged to long-term care (59%).
Waiting for care in the wrong spot: Understanding alternate level of care (ALC)
A common approach for measuring the appropriate use of space for patients is by tracking the number of patients who require an ‘Alternate Level of Care.’ When a patient is occupying a bed in a hospital and does not require the intensity of resources or services provided, the patient is designated as requiring an alternate level of care.
ALC rates and volumes are just one way to measure how effectively the health care system is flowing patients through to different care settings. It is a designation that refers to patients who remain in hospital although they no longer require hospital-level care.
A high-performing health care system would have a low ALC rate, which would mean that patients are receiving appropriate care for their needs in the right setting.
Population aging & health care services
According to population projections, Ontario’s senior population (individuals 65+) is expected to almost double from 2.4 million, or almost 17% of the population in 2017 to 4.6 million, or almost 25% by 2041.
Population growth by age group, 2017 to 2041
2017
2021
2026
2031
2036
2041
(Source: Ministry of Health and Long-Term Care, 2019)
One of the challenges associated with an aging population is an associated rise in the number of patients with dementia. Close to 228,000 Ontarians are currently living with dementia, and this number will grow to over 430,000 by 2038.
Between 2008 and 2038, dementia will cost Ontario close to $325 billion.
Approximately 64% of residents in long-term care homes have dementia.
And while we focus on the rising number of seniors requiring different health care services, it is also important to note that in the next twenty years there will be more than 560,000 more children (0-18 years of age) in Ontario.
Social determinants of health
The social determinants of health are the economic and social factors that impact our health. They play a critical long-term role in health care, particularly for those suffering from chronic conditions. Having a job, eating healthy food and having a safe place to sleep are foundations to good health.
Population growth & health care services
In addition to the anticipated growth among the aging population, Ontario’s general population is also growing larger. Demographic projections suggest that the province will see an increase in its population by roughly 30% by 2041.
This population growth will not occur evenly across the province, which will have an impact on how the health care system plans to handle this future growth, and where it allocates its limited resources to address the anticipated increase in demand for services.
In particular, projections suggest that the Greater Toronto Area (GTA) will be the fastest growing region of the province. By the year 2041, the GTA’s population is expected to grow by 41% or by approximately 2.8 million people compared to the year 2017. Similarly, population growth will be slower in certain parts of the province, which will impact the system in different ways.
If no action is taken, these demographic changes will significantly impact the availability of health care in the province. With no additional capacity created – or no other efficiencies in the system found – the hospital bed rate in Ontario will decline from approximately 222 beds per 100,000 people in 2018 to approximately 173 beds per 100,000 people in 2041.
The projections are more concerning for the long-term care bed rate, which is projected to decline from 72 beds per 1,000 people aged 75 or older to 29 beds per 1,000 people aged 75 or older by 2041. This is a total decline in the long-term care bed rate of about 60%, or the equivalent of 48,000 bed closures by 2041 if nothing is done.
Simply adding more beds to the system will not solve the problem of hallway health care. For example, community mental health and addictions services, as well as community rehabilitation services are two areas where additional access to services could help relieve some of the pressures causing hallway health care.
Given the current pressures on capacity and the implications of future demographic shifts, the Council will be looking for innovative solutions to remove unnecessary barriers preventing Ontarians from receiving culturally appropriate, timely, and fair access to health care.
Footnotes
- footnote[23] Back to paragraph Cancer Care Ontario – Access to Care. (2018). Provincial Monthly Alternate Level of Care Performance Summary, November 2018
- footnote[24] Back to paragraph Cancer Care Ontario – Access to Care. (2018). Provincial Monthly Alternate Level of Care Performance Summary, November 2018
- footnote[25] Back to paragraph Cancer Care Ontario – Access to Care. (2018). Provincial Monthly Alternate Level of Care Performance Summary, November 2018
- footnote[26] Back to paragraph Cancer Care Ontario – Access to Care. (2018). Provincial Monthly Alternate Level of Care Performance Summary, November 2018
- footnote[27] Back to paragraph Cancer Care Ontario – Access to Care. (2018). Provincial Monthly Alternate Level of Care Performance Summary, November 2018
- footnote[28] Back to paragraph Cancer Care Ontario – Access to Care. (2018). Provincial Monthly Alternate Level of Care Performance Summary, November 2018
- footnote[29] Back to paragraph Cancer Care Ontario – Access to Care. (2018). Provincial Monthly Alternate Level of Care Performance Summary, November 2018
- footnote[30] Back to paragraph Canadian Institute for Health Information. (2017). Seniors in Transition: Exploring Pathways Across the Continuum.
- footnote[31] Back to paragraph Ministry of Finance. (2018). Ontario Population Projections Update, 2017-2041.
- footnote[32] Back to paragraph Ministry of Health and Long-Term Care. (2019). MOHLTC Data.
- footnote[33] Back to paragraph Ministry of Health and Long-Term Care. (2016). Developing Ontario’s Dementia Strategy: A Discussion Paper.
- footnote[34] Back to paragraph Health Quality Ontario. (2016). Developing Ontario’s Dementia Strategy: A Discussion Paper.
- footnote[35] Back to paragraph Health Quality Ontario. (2018). Measuring Up 2018: A Yearly Report on How Ontario’s Health System is Performing.
- footnote[36] Back to paragraph Ministry of Finance. (2018). Ontario Population Projections Update, 2017-2041.
- footnote[37] Back to paragraph Ministry of Finance. (2018). Ontario Population Projections Update, 2017-2041.
- footnote[38] Back to paragraph Ministry of Finance. (2018). Ontario Population Projections Update, 2017-2041.
- footnote[39] Back to paragraph Ministry of Health and Long-Term Care. (2019). MOHLTC Data.
- footnote[40] Back to paragraph Ministry of Health and Long-Term Care. (2019). MOHLTC Data.