The latest report card on the quality of health care in Ontario shows a system under increasing strain, with hallway-medicine getting worse and the opioid crisis growing.
The report from Health Quality Ontario — the arms-length agency that monitors the quality of the health system — signals that the province is once again heading into a flu season with overcrowded hospitals.
As well, it shows that Ontario has experienced its largest annual jump in opioid-related deaths, indicating the epidemic has not yet crested.
Both patients and workers are paying the price for increasing pressures, warns the 76-page report, titled Measuring Up 2018, tabled in the Legislature late Friday afternoon.
“It is not that these are new pressures but we are seeing them get bigger,” remarked HQO interim president Anna Greenberg. “When we see the trends for some of these issues going in the same direction that we don’t want them to, it is concerning.”
“(This) can lead to compromised care for patients and burnout among doctors, nurses and other health-care providers,” it warns.
Demographic changes, including an aging population and more people with complex health needs, are increasing pressures throughout the system, particularly hospitals.
Hospital overcrowding is a “symptom and a source of cascading pressures throughout the health system, which includes longer wait times, insufficient access to mental health and addictions care, wide variation in quality of care among long-term care homes and rising levels of distress among unpaid caregivers,” the report says.
Of every seven days that patients spent in hospital in 2016/17, more than one was taken up by patients awaiting transfer elsewhere, for example, to long-term care homes or rehabilitation facilities. That’s the highest rate in five years and the equivalent of more than 10 large hospitals being occupied every day by patients waiting for care elsewhere.
The overcrowding creates bottlenecks in emergency departments. Wait times for admission to hospital from the ER hit their highest peak in six years. In 2017/18, patients spent an average of nearly 16 hours in the ER before being admitted, more than two hours longer than in 2015/16.
ER visits increased by 11.3 per cent over the past six years, to 5.9 million in 2017/18 from 5.3 million in 2011/12. Visits by high-acuity patients — those with more serious conditions — rose at an even higher rate, up by 26 per cent to 4.1 million from 3.3 million.
Compounding the problem of overcrowded hospitals is the ongoing opioid epidemic.
The report shows that visits to the ER due to opioids more than tripled to 54.6 per 100,000 people in 2017, from 15.2 per 100,000 in 2003.
As well, it reveals that Ontario saw the highest annual jump in opioid-related deaths between 2016 and 2017. Two years ago, the death rate was 6.2 per 100,000 population, while last year it was 8.9 per 100,000 population.
The death rate has nearly tripled since 2003, when there were three deaths per 100,000 population.
Premier Doug Ford campaigned in the run-up to June’s election on a platform that included making headway on hallway medicine and the opioid crisis.
While the time period covered in the report precedes Ford’s victory, it nevertheless reveals an unfavourable trajectory.
“Trying to fix the problems in any one single setting is not going to be enough,” Greenberg said, explaining that transitions between various parts of the health system need to be improved.
“What it will take is different parts of the system working together so that patients are able to be cared for in the right place as their needs change,” she added.
The stresses within the health system are resulting in increased caregiver distress, the report shows. Among clients who received home care for six months or longer, in the first half of 2017/18, more than one in four had a primary family or friend caregiver who experienced continued distress, anger or depression in relation to their caregiving role.
That’s up from 20.8 per cent in the first half of 2012/13. The increase represented 13,244 additional caregivers experiencing continued distress, anger or depression.
Toronto resident Craig Lindsay knows this kind of distress all too well. The retired paramedic had a tough time being caregiver to his mother as she was dying of cancer six years ago.
“She wanted to die at home and I tried to manage her at home until it overwhelmed me,” he explained.
It was a difficult juggle, he recounted. He did the overnight shift at his mother’s home in the weeks leading up to her death. The family paid out of pocket for private nursing help during the day.
Their bad experience is reflective of disparities in availability of palliative care services across the province. At the time, service levels were spotty in Scarborough where Lindsay’s mother lived.
Lindsay also had his own health problems to contend with. Suffering from kidney failure, he requires three weekly visits to hospital for dialysis.
On top of all this, he had his immediate family to care for.
“It was very stressful. It compromised my health. I felt depleted,” he said.
In the end, Lindsay was unable to cope. His mother ended up dying at Providence Healthcare where she spent the last three days of her life.
“To be blunt, I think I failed her,” he said of being unable to meet her wishes to die at home. “I think about that often. I don’t think that is how she envisioned her last days.”
HQO’s report contained some good news. For example, longevity is increasing. The life expectancy for someone born in Ontario between 2014 and 2016 is 82.5 years. That compares to 80.8 years for a person born between 2005 and 2007.
Additional bright spots cited include a decreasing rate of hospital-acquired C. difficile infection and a meeting of wait-time targets for most cancer and general surgeries.
Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle