'It's not sustainable': Hospitals in northeastern Ontario at or over capacity

Four major hospitals in northeastern Ontario are being stretched to the limit with more patients than they have received funding for, which is forcing patients into "non-conventional spaces" or stuck waiting in emergency rooms for a proper bed, CBC News has learned. 

Statistics from the Health Sciences North, Timmins and District Hospital, North Bay Regional Health Centre and the Sault Area Hospital paint a picture of facilities that are bursting at the seams and a fractured healthcare system. 

According to the data compiled by CBC News, these hospitals are experiencing regular capacity issues that are leading to patient overcrowding, hallway medicine and a strain on the regions key emergency departments.

For years, stories of long wait times, patients being left in hallways, and the call from hospital officies for additional funding have made headlines. However, it is rarely revealed just how bad the capacity problems facing these hospitals are. 

A spokesperson for North Bay Regional Health Centre said officials normally attempt to look at capacity as 80 per cent of beds filled. But as staff from the four major hospitals in the region acknowledge, that's simply not realistic anymore, explaining they look at capacity as having every funded bed full. 

It's a reality that exists in Sudbury's hospital over 90 per cent of the time, according to the data CBC News compiled. The hospitals in Timmins, North Bay and Sault Ste. Marie report being at or over capacity around 70 per cent of the time.

While the primary cause of the capacity problems isn't a new issue, it is one that persists. Too many patients are remaining in hospitals who do not require acute care, but aren't healthy enough to return home without medical supports, Ontario Hospitals Association says. 

As a result, patients wait for either home-care to become available or for a long-term care bed to open up. These patients are called "alternate level of care" patients of ALC. 

Sudbury: A problem since the 'one site hospital' opened

Dominic Giroux, the chief executive of Health Sciences, told CBC News that operating a hospital where almost every day they are full or too full is a challenge. 

"It's not sustainable in the long term," he said. "Looking back at 2018 we've been at overcapacity every day except for 18 days."

That means patients are stuck in the emergency departments waiting to be admitted, or admitted patients aren't in traditional rooms, meant for patients. Giroux says 20 patients are currently in "unconventional bed spaces", such as hallways.

"These are beds that typically do not meet clinical standards," he explained.

Health Sciences North is the one hospital that came out of cuts in the 90s. The original project went over budget and resulted in a downsizing of the final hospital, according to Giroux.

"The working assumption was that there would be zero alternate level of care [ALC] patients at HSN," he said. "Well today we have 86 ALC patients in the exact same number. So if that reduction of 86 beds had not been done in 2003 we would not be having capacity issues today."

Giroux says the mistakes of the past are why he is pushing for forward looking planning including a new capital plan, a strategic plan and working with the Ford government to end hall way health care.

"We want to create more bed spaces," Giroux says. "We want to create more space for mental health and addictions, we want to create more space to allow for more programming for kids and youth to be delivered here in the region."

Despite the chronic capacity challenges, and recent budget cuts which led to staff reductions, Giroux says Health Sciences North is still a high performing hospital.

Since November 2017, additional government funding has allowed HSN to open 18 more beds, which has helped relieve capacity loads, says Giroux.

Timmins: Socio-economic pressures adding to problem

Timmins and District Hospital is at or over capacity almost 70 per cent of the time, often spilling over into the emergency room. 

"Understandably when we're not having turnover in our acute care inpatient units we can't pull up patients from the E.R. into those beds and we have to house them in our E.R.," said Wait Time Coordinator Tiina Guillemette​.

Recent funding for additional beds by the North East Local Health Integration Network which is confirmed through to the end of March, has taken the pressure off a bit, say hospital staff. 

TADH spread the funding for 10 acute care beds to create 12 ALC beds. They did so by adjusting staffing models for the ALC beds to match the staffing levels found in long term care facilities.

A higher ratio between nurses to patients and added PSW's since those patients don't have urgent medical issues requiring the care of nurses and doctors as frequently.

"When we had our 16 admitted patients waiting for beds [recently], we were able to expedite some discharges. Had we not had the 12 beds it would have been a disaster," said Dr. Harry Voogjarv, Chief of Staff. "Our emergency department would be stuck seeing one or two people at a time as opposed to being able to assess their usual 20 people at a time."

Hospitals including the Timmins and District Hospital have been asked how many additional beds they can handle. 

"In addition to the twelve beds that we currently have in place throughout the hospital we have the capacity for another 20," said Joan Ludwig, VP Clinical, Chief Nursing Executive, Timmins and District Hospital.

Officials acknowledge socioeconomic realities further exacerbate the problems in the health care system.

"Some people simply cannot afford to go to a [private] retirement home setting," said Guillemette. "[Publicly funded] long-term care is the only option available to them."

When publicly funded long-term care is not available, patients stay in hospital until such care opens up.

North Bay: 'Patient flow crisis' since summer 2017

Staff at North Bay Regional Health Centre say the closure of the 66-bed Lady Isabelle Nursing Home has caused a 'patient flow crisis' since the summer of 2017. 

Spokesperson Kimberley McElroy says capacity issues have persisted since then and acknowledged the precariousness of the situation ahead of possible impacts by this year's flu season. 

"The ideal occupancy for acute to maintain optimal patient flow is 80-85%," McElroy said. Despite that, most hospitals in the region examine capacity based on 100% use.

Sault Ste Marie: Recent surge funding has helped

"We have been struggling with capacity for some time for sure we would be probably quite similar in our pattern with other community hospitals in Ontario," says Ila Watson, Sault Area Hospital Interim President and CEO.

On Friday, Sault Ste. Marie MPP Ross Romano announced funding to support an additional 10 new beds for the Sault Area Hospital. 

Watson says bridge funding like this is critical to relieving pressures on the hospital system in the short term. 

"So those types of investments and commitment are enabling us to be more plentiful and ensuring that we're able to open beds that are appropriate for the medical patients that we are getting rather than having people stay as admitted patients in an emergency department," she says. 

The Sault Area Hospital has recently converted several areas in the hospital to have overflow beds. While not traditional clinical spaces, Watson says the hospital needs to be creative to address the challenge.

"If we change nothing our costs increase at rates greater than our funding has been increased and that has been a continual pattern. We've done a lot of things to create efficiencies and some of the lower hanging fruit is now gone. One of the most significant recent pieces of work that our organization has done is focus on senior friendly care."

That senior focus, Watson says, is just as important as adding long term care capacity.

"We have also made some significant strides in the way in which we care for the elderly," she said. "People who might otherwise in years past been destined to either stay in hospital or to move to a long term care facility are now managed in different ways that focus on bringing them back to the state that they were before they came into hospital." 

This allows patients to return to their homes as opposed to requiring home-care supports or needing long-term care.