Waiting on the ER: Ontario Government targets for shorter ER times puts pressure on ALC patients

A recent initiative taken by the Ontario government aimed at shortening wait times and improve patient satisfaction in Ontario’s hospitals may come at the expense of people still needing care but not in hospital, often older patients.

Ontario’s recently-announced $109 million investment includes:

$38.5 million to Ontario’s 23 poorest performing ER’s.

$22 million in new priority funding for Ontario’s 14 Local Health Integration Networks (LHINs).

$4.5 million in new nurse-led outreach teams.

Click here to see the Ministry of Health and Long Term Care’s news release

Click here to visit the Province’s Wait Times Strategy Website

In a laudable effort to reduce waiting times in emergency rooms, the McGuinty government’s initiative set two benchmarks hospitals must meet: the first sets a maximum wait time for patients with minor or uncomplicated conditions, at four hours; the second sets the maximum wait time for patients with complex conditions at eight hours.

But an unintended consequence is that to shorten wait times, people still in need some care may be pushed out of emergency rooms into the cold. To clear busy ER rooms, hospitals designate those who are in an acute-care hospital bed waiting for a transfer to another facility as ‘alternate level of care’ patients (ALC). These post-acute patients are seen as responsible for clogging ER rooms. So to make space in ER, they’re being sent to other health care facilities.

“Doctors are telling us that they are being pressured to clear beds,” says Judith Wahl, executive director Advocacy Centre for the Elderly in Toronto. “Yet ALC patients are quite often not ready to return home. Their needs are such that they are unable to function on their own, and need rehabilitation and more comprehensive care then families are often able to provide.”

According to the government of Ontario, close to 19 per cent of patients currently in a hospital bed in Ontario are in need of ALC. With hospitals under immense pressure to reduce waiting times, these patients are either being forced to take a placement in a Long Term Care (LTC) facility sometimes many miles away, or in some instances when there are no LTC beds available, they are being pushed into private retirement homes.

“We are getting calls from people who are being told by the hospital that they have to go to a home with the first available bed, but legally they have the right to chose,” says Wahl.

Further complicating the issue is the fact that Ontario regulates LTC facilities but not private retirement homes. “Many of the [private] homes still operate as D-class facilities and many have subsequently been shut down,” says Wahl, raising the possibility that post-acute patients are being fast-tracked into institutions that are either inconveniently located or don’t meet their specific care needs.

The government is aware of the need to better provide for ALC patients and re-capped its initiatives to relieve the ALC pressures in Ontario hospitals. In 2008/09, the government announced:

– $94 million as part of the Aging at Home Strategy – a four-year, $1.1 billion initiative to provide support to seniors and caregivers

– $38.5 million for increased home care, personal support and homemaking services and enhanced integration between hospitals and Community Care Access Centres

– $22 million in new priority funding for Ontario’s 14 Local Health Integration Networks (LHINs) to invest in local solutions to further address ALC pressures