Ontario Maximizing Critical Care Capacity to Support Hospitals

Source: 
Ontario Ministry of Health

April 28, 2021 Ontario Ministry of Health

TORONTO — In response to the recent and rapid rise in hospitalizations, ICU admissions and the threat to the province’s critical care capacity, the Ontario government, in consultation with the Chief Medical Officer of Health, is taking further action to ensure hospital beds are available for COVID-19 patients in need of urgent care. To do so, the province is amending O. Reg. 272/21 under the Emergency Management and Civil Protection Act (EMCPA) to ensure patients receive quality care in the most appropriate setting during the third wave of the pandemic, driven by variants of concern.

This temporary emergency order will provide hospitals with the flexibility to transfer patients whose doctors have determined no longer require hospital care to long-term care or retirement homes without obtaining the consent of the patient or, where the patient is incapable, their substitute decision maker. The amended order can only be used during major surge events where the demand for critical care threatens to overwhelm a hospital and compromise care. Hundreds of individuals in hospital are waiting to be discharged to a long-term care home or another more appropriate care setting and first priority will be given to patients with less complex care needs and those who are able to be moved close to their preferred choice.

“The spread of COVID-19 variants continues to pose a significant threat to our health system’s critical care capacity and the lives of Ontarians,” said Christine Elliott, Deputy Premier and Minister of Health. “While this is an extremely difficult decision to make, the consequences of not doing so could be devastating if we don’t have the hospital beds we urgently need to care for the growing number of COVID-19 patients. Building on the more than 3,400 beds that have been added to the system since the beginning of the pandemic, our government will continue to take all necessary actions to ensure Ontarians have a safe place to be cared for in our hospitals.”

Hospitals may rely upon this order only when necessary to respond to a major surge event, when the attending physician is satisfied that the patient will receive the care they require at the long-term care or retirement home. Transfers will only be made when medical professionals are confident they will not compromise the patient's medical condition, and where all of the other conditions specified within the order have been met including agreement by the home that they can meet the patient’s needs. Every effort will be made to ensure these patients are fully immunized from COVID-19 before moving.

Patients who are not placed in their first choice of long-term care or who are transferred to a retirement home will retain their priority on the long-term care waitlist for their first-choice home.

On April 23, 2021, the government waived the co-payment for hospital patients with a destination of long-term care who are transferred to a long-term care home that is not their first choice until they transfer to their first-choice home or decide to stay in their current home. Similarly, the retirement home’s care and accommodation costs to the individual will be waived until they receive a placement offer from their first-choice long-term care home. Funding will be provided to the retirement home from the government.

“Ontario’s retirement homes can provide a safe and welcoming environment with the vast majority of residents being fully vaccinated during Phase One of the province’s rollout,” said Minster for Seniors and Accessibility, Raymond Cho. “As we work together to support Ontario’s health network, retirement homes are well positioned to assist by providing the appropriate level of care to patients in need.”

Quick Facts

  • Since the onset of the pandemic, the government has made significant investments to build capacity and maintain the integrity of Ontario’s health system, including investing $5.1 billion to support hospitals and create over 3,100 more hospital beds.
  • Based on the  latest modelling data, COVID-19 cases, hospitalizations and ICU occupancy are continuing to increase rapidly and are now at their highest levels since the start of the pandemic in March 2020. The Science Advisory Table projects that the number of COVID-19 patients in ICU will reach 1,100 and around 1,200 acute care COVID admissions by May.
  • As of April 22, there are 4,288 patients in hospitals who physicians have determined no longer require acute hospital care, of which 1,854 are waiting for a long-term care home (LTCH) bed. As of April 14, there are 5,401 LTCH vacant beds available for new residents.
  • As of April 27, 2021, over 4.7 million vaccine doses have been administered across the province, this includes 64,000 long-term care residents and 56,000 retirement home residents who have been fully vaccinated.
  • On April 20, 2021, the province updated  Directive 2 for health care providers, instructing hospitals to cease all non-emergent and non-urgent surgeries and procedures in order to preserve critical care and human resource capacity.
  • On April 9, 2021, the province  issued an emergency order authorizing hospitals to transfer patients between hospital sites without the consent of the patient or their substitute decision maker – in order to maximize system capacity. These additional measures will support building capacity of up to 1,000 critical care beds in Ontario for patients requiring more complex health care.
  • Ontario is also now allowing the redeployment of Ontario Health and Home and Community Care Support Services staff to long-term care and retirement homes to support these transfers and ensure patients receive the level of care they need. The government is also  exempting fully immunized long-term care home and retirement home employees  from restrictions that prohibit them from working in more than one long-term care home, retirement home or other heath care settings.