Ontario is hoping to ease health-care pressures by increasing publicly covered surgeries at private clinics, waiving the exam and registration fees for internationally trained nurses, and sending patients waiting for a long-term care bed to a home not of their choosing.
On Thursday, Health Minister Sylvia Jones announced the plan that aims to hire more health professionals, free up hospital beds and reduce surgical wait lists. The plan comes as nursing staff shortages have seen emergency departments across the province close throughout the summer for hours or days at a time.
On long-term care, the government plans to introduce legislation today that will allow patients awaiting a bed to be transferred to a “temporary” home while they await space in their preferred home. It’s also taking 300 beds that had been used for COVID-19 isolation and making them available for people on wait lists, and says there is a potential to do that with 1,000 more beds within six months.
However, Long-Term Care Minister Paul Calandra said the legislation would not force anybody who doesn’t want to leave the hospital to go, nor would it make “any changes to the priority waiting list.”
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Calandra also said the legislation would “allow us to continue the conversation” of moving patients temporarily to homes when they no longer require hospital care but their preferred long-term care home has not yet become available.
“The changes do allow us to continue that conversation to explain to somebody who is in a hospital why their needs can be met in a long-term care home,” said Calandra.
Changes won’t solve the core problem, critics say
But NDP health critic France Gélinas said the province would be better off bolstering the home-care system with more full-time personal support workers.
“Giving people the choice of where they want to be is to respect them,” she said. “Now, hospitals will have the right to put a ton of pressure on you and on your family to move you to the first bed available, not the bed of your choice… This is disrespectful, this is not the way health care should be.”
Gélinas suggested the first available beds would likely be “in a private, for-profit home,” some of which were the subject of a scathing military report in 2020 after suffering some of the worst COVID-19 outbreaks in the province.
In the provincial document, there is mention of “mandatory guidelines used by placement coordinators to ensure patients continue to stay close to a partner, spouse, loved ones or friends.”
While the the new investments provide important resources and funding to the sector, Donna Duncan, the CEO of the Ontario Long Term Care Association, says it’s not enough to address the day-to-day staffing challenges facing all homes, and particularly those in rural and remote communities.
“To support safe admissions from hospital, we need to ensure that our homes have the health human and other workforce resources, especially as we move into the anticipated fall flu/COVID season,” wrote Duncan.
The association says it represents nearly 70 per cent of Ontario’s 630 long-term care homes, in a mix of private, not-for-profit, charitable, and municipal settings. Duncan says the association faces an LTC wait list of nearly 40,000 people, with seniors “needing quality care close to loved onces and their communities.”
“All health sectors are facing severe workforce shortages and we are all looking to hire from the same pool of available health professionals,” said Duncan.
More of a role for privately delivered services
The province’s plan outlines more of a role for privately delivered but publicly covered services, with the government saying it will invest more to increase surgeries in pediatric hospitals and existing private clinics covered by OHIP. It is also considering options for further increasing surgical capacity by increasing the number of those procedures performed at “independent health facilities.”
Jones said Ontario needs to be “bold, innovative and creative” when looking for ways to improve the health system.
“There are some who will fight for the status quo no matter what,” she said at a news conference announcing the plan. “They’re ideologically opposed to change or improvements. We won’t accept that. We can’t accept that. People want better health care.”
Jones did not directly answer a question about whether she would consider allowing more private clinics in Ontario.
“Health care will continue to be provided to the people of Ontario through the use of your OHIP card,” she said.
“We see the value of having some of those independent health facilities that have existed in the province of Ontario for literally decades to take some of the pressure off of our health-care partners and many of those independent health facilities have arrangements and work directly with their local community hospital.”
Nurses’ association opposes more privatization
Cathryn Hoy, president of the Ontario Nurses’ Association, slammed the plan to increase services in private clinics.
“This is a blatant move that will line the pockets of investors, nothing more,” she said in a statement.
“The evidence is clear: health-care privatization provides worse health outcomes to our patients and has much higher overhead costs which will be paid by taxpayers. Ontario is deep-diving into privatization that will only benefit shareholders.”
Hoy called it “puzzling” that the plan also outlines steps to support emergency department doctors, but not nurses.
“The government missed a huge opportunity here to bolster nurse compensation as a key to retention and recruitment to curb additional closures,” she said.
In a statement, Liberal health critic Dr. Adil Shamji called the plan “a series of empty promises” that showed the government “did not learn any lessons from the pandemic.”
“Rather than ignoring her responsibility to strengthen our publicly funded healthcare system by asking the for-profit sector to solve the problems,” the MPP said the health minister “must provide real solutions that address the root causes of the extreme pressure facing our healthcare system.”
Viable solutions include creating “a robust nursing workforce by repealing Bill 124,” Shamji said, along with increased funding for community and primary care operations that would reduce ER visits. Until then, he said, “this crisis will continue to spiral out of control.”
Ontario is extending a program that sees physicians from across the province help staff hospitals in northern and rural communities, launching a new program to provide support and coaching from emergency physicians to rural emergency departments, as well as introducing a new program that links physician residents with physicians in northern and rural emergency departments.
Ontario to cover fees for some nurses
The province will temporarily cover the exam, application and registration fees for internationally trained and retired nurses, saving them up to $1,500, and plans to invest up to $57.6 million over three years to increase the number of nurse practitioners working in long-term care homes.
Jones said she is expecting a plan today from both the College of Physicians and Surgeons of Ontario, as well as the College of Nurses of Ontario, on how they intend to expedite the applications of those professionals still waiting to be accredited and licensed in Ontario.
The plan also includes modifying a program that can deploy nurses full-time across multiple hospitals in a region, and expanding a program for mid-to-late career or retired nurses to mentor newer nurses.
“There are many pieces that are part of this plan and they aren’t done,” Jones told reporters.