Number of ALC patients in Ontario is growing

TORONTO – The number of hospital beds occupied by patients who don’t need to be there and are waiting to receive healthcare elsewhere could fill 10 large hospitals, according to an annual report by the agency that monitors the performance of Ontario’s health system.

The report by Health Quality Ontario (HQO) confirms that “hospital capacity” is a significant problem in the province. It reveals that in 2015-16, an average of 3,961 Ontario hospital beds per day were occupied by patients, most of them elderly, waiting for long-term care, rehabilitation or home care.

These patients are also known as alternate level of care (ALC) patients – defined as patients who are occupying a bed in a hospital but do not require the intensity of resources provided in this care setting.

The proportion of inpatient days which hospital beds were occupied by these patients rose to 13.9 per cent that year, up from 13.7 per cent from the previous year.

That equates to an increase of 25,000 in the number of days that hospital beds were occupied by patients who did not need to be there.

“Hospital capacity is an important indicator of how the healthcare system as a whole is functioning,” said HQO president Dr. Joshua Tepper (pictured), adding that the system is clearly “under pressure.”

When inpatient beds are full, it means patients coming into the emergency department must wait for these to be freed up before they can be admitted.

As well, the report shows that patients spent on average 90 minutes longer in the ER this past year before being admitted to inpatient beds.

The organization’s 100-plus page report, Measuring Up 2017, states that fewer people are getting hip-and-knee replacement surgery within maximum wait-time targets.

HQO found that one in 12 Ontarians reports having trouble paying for expenses that are not covered by public or private health insurance. This includes prescription drugs and dental care.

Variations in access to care is a big concern for the agency, which compares performance among 14 geographic regions known as “local health integration networks” or LHINs.

For example, the proportion of people who had high “continuity of care” ranged from 66.5 per cent in the South East LHIN (based in Belleville) to 49.8 per cent in the Central West LHIN (based in Brampton).

This measure looks at after-hours care and continuing consistent care over time with the same primary care physician.

A comparison of premature mortality rates reveals that the potential years of life lost is 2.5 times higher in the North West LHIN than the Central LHIN (located mostly above Toronto). There are 7,647 potential years of life lost per 100,000 people in the northwestern part of the province, compared to 3,026 years in the central part.

“We think a publicly funded healthcare system would be inherently equitable, but our data shows that certain groups have clearly poorer health outcomes,” Tepper said.

An assessment of how caregivers of home-care patients are faring revealed they are under increasing pressure. About one in four family members or friends who serve as main, informal caregivers feels continuing, increasing distress.

“This is an important, almost hidden workforce that we don’t acknowledge enough,” Tepper said.

This is the eleventh year that HQO has reported on the performance of the province’s health system, but it is the first time it has provided data on how long cancer patients wait for their first appointment with a surgeon.

It found that six out of seven patients who had cancer surgery had their first surgical appointment within target wait times in 2016/17.

This report also marks the first time HQO reported on patient involvement in the development of home-care planning. It shows only 56.7 per cent of patients felt strongly involved in this planning.

Ontario is providing “excellent care for many, but not all,” the report states.

The good news is Ontarians are living longer, more are getting cancer-screening and more are seeing the same family doctor with regularity.

In addition, residents of long-term care homes are receiving better care, with fewer experiencing daily pain, receiving unnecessary antipsychotics and being physically restrained.

The bad news is access to help for people with mental illness and addictions remains problematic, as do smooth transitions for patients moving from one care setting to another.