Ontario aims to transfer 1,500 hospital patients to long-term care homes to ease capacity pressures

After the Ontario government turned to the hospital sector to support long-term care homes in crisis in the first two waves of COVID-19, the government is now turning the tables and asking long-term care homes to help overwhelmed hospitals.

The province says it has issued a call to action, seeking to admit 1,500 hospital patients to long-term care homes over the next two weeks as a "first step."

The Ontario Long-Term Care Association (OLTCA) briefed the media on discussions with the province on how the sector can take patient transfers from hospitals. The LTC sector has 6,000-plus empty beds — many in the hardest-hit homes where there were high losses of life earlier in the pandemic, as families are now avoiding sending their loved ones to them, said CEO Donna Duncan.

"Especially given the vaccines, long-term care is very safe now," she said.

The numbers show the vaccines have had an incredible impact on the sector, which has vaccinated nearly all residents: as of Thursday, there were 22 active cases of COVID-19 among residents, down from peaks of 2,831 in the first wave and 1,650 in the second. There have been five deaths of residents with COVID in the past month, compared to 787 in May, the peak of the first wave, and 774 in January, the peak of the second.

Duncan said her organization is in discussions with the provincial government about how long-term care homes could ease capacity pressures on hospitals by taking additional patient transfers on an expedited and perhaps temporary basis. The association is asking that they would be vaccinated and in some cases, come with additional human resources support.

Her organization issued a statement saying homes are committed to assisting hospitals, but she said that the patients transferred from hospitals would likely have high medical needs that could be challenging for the LTC sector, which is experiencing a significant shortage.

The sector has experienced a significant exodus of workers in recent weeks, especially of registered staff such as nurses, who have been recruited to other work doing COVID-19 testing or vaccinations or infection prevention and control in hospitals, public health units and private industry such as film and television, said Duncan.

Long-term care staff are also "exhausted and traumatized" after this year, said the OLTCA.

Prior to the pandemic, the long-term care sector was running at near-complete occupancy, with a wait list for beds of about 35,000 people. Today, the waitlist is 38,500. The 6,000 beds are currently empty because of staffing shortages and policies in place prohibiting admissions during outbreaks. However, the province recently changed the definition of an outbreak in long-term care from one staff or resident case, to two or more lab-confirmed cases within a 14-day period that are epidemiologically linked and where at least one person could have reasonably acquired their infection in the home. The new definition allows more homes to accept new residents.

Other beds remain vacant because the province has limited admissions into three- or four-bed ward rooms so that no more than two residents can share a room, in an effort to allow for better infection prevention and control. Long-term care homes are receiving funding to subsidize the government's portion of funding for empty beds, currently set to expire at the end of August.

Another factor is resident choice:  Duncan said many of the vacancies are in homes that experienced devastating losses during the pandemic and people are avoiding them.

The OLTCA's comments come after Ontario Health issued a call to action last Friday to long-term care homes. A source provided QP Briefing with a slide from that meeting asking homes to accept additional residents from hospitals, targeting two or three residents per week, in order to help hospitals in "staying functional over the coming weeks."

Meanwhile, Solicitor General Sylvia Jones, who is responsible for the province's emergency operations, was asked about the potential to transfer thousands of hospital patients to long-term care homes at a media briefing. She replied that the province has given itself additional tools "to spread out the individuals who must be hospitalized or are in an ICU [in an effort to] take some pressure away from some of the hospitals that are experiencing very high intensive care beds."

What she's referring to is unclear: on Friday evening, the province issued an emergency order allowing hospital patients to be transferred to other hospitals without their consent when the hospital they're in is experiencing a major surge event or to otherwise optimize critical care resources. However, long-term care homes are not included in the order.

While the Ministry of Long-Term Care provided a statement on plans to transfer residents, provincial officials did not answer a request for clarification concerning Jones' comments.

"As a first step, the Ministry of Long-Term Care and Ontario Health issued a written call to action on April 11 for homes to do everything they can over the next two weeks to safely admit or readmit hospitalized patients waiting for a space in a long-term care home," it said in a statement. "We want to immediately fill vacancies that meet individual needs and where the home has the necessary staff to accommodate these moves without compromising the care of current residents."

The new admissions will not include placing people into spaces needed for isolation or into ward rooms already occupied by two people.

Reaction to the news ran the full gamut. One hospital CEO — Alex Munter of the Children's Hospital of Eastern Ontario (CHEO) — said it would be "enormously helpful" for hospitals.

This would be enormously helpful. In our region, there are hundreds of vaccinated frail seniors in hospital beds who no longer need acute care. At the same time, over-full hospitals are trying to accommodate rising numbers of Covid patients. https://t.co/1lBY4vjuao

— Alex Munter (@AlexMunter) April 15, 2021

Others raised concerns. NDP Leader Andrea Horwath said it brought to mind all of the tragedies that occurred in long-term care earlier in the pandemic.

"It's heartbreaking and it's horrific," said Horwath, adding that there are still questions about whether there is sufficient staffing to take care of people.

"Putting more people into a broken system isn't a solution."

If it comes to it, Horwath said she hopes the government provides long-term care homes with the staffing support and resources they need to care for the additional residents.

But Liberal health critic John Fraser said the move is overdue.

"It's not to be unexpected but there has been capacity in long-term care homes since November," adding an anecdote about a modern long-term care home in his riding that has had hundreds of empty beds, despite a long waiting list of people seeking admission.

"We should have done it months ago," he said. "To say that we're thinking about this now is just an indication that the government is always two weeks, two steps behind this virus."