Gridlock by design: no excuses for bed backlog

Imagine waking up in a hospital bed and being told by a doctor that you are well enough to leave, only to discover you cannot. Not because you want to stay, but because there is nowhere safe for you to go. No home-care support, no rehabilitation space, no long-term care bed.

This is unfortunately the daily reality for thousands of Canadians.

Being stuck in a hospital bed is a crisis from coast to coast. Our acute care hospitals are functioning as wildly expensive beds for vulnerable citizens awaiting a more suitable place to take them in.

A decade ago, policymakers fretted over this exact issue. Today, despite an aging population with increasingly complex needs and higher demand for hospital beds, the crisis has only deepened.

This crisis was foreseen. It could have been prevented.

The numbers should shock Canadians, but we have become dangerously numb to our governments’ ability to resolve the crisis. Across the country, thousands of scarce hospital beds are tied up. More than 18 per cent of hospital beds are occupied by patients ready for discharge in Ontario. In New Brunswick, the figure tops 20 per cent. Nationwide, a conservative 12 per cent gridlock translates to 6,400 blocked beds out of Canada’s 54,000 acute care beds.

The domino effect of misused hospital beds is catastrophic — for thousands of Canadians every day, and for the health of our acute care health system.

Because hospital beds are full, emergency departments cannot transfer severely ill patients upstairs for more appropriate care. The result? In Ontario, vulnerable patients are waiting in emergency rooms for an average of 17 hours, ambulances are idling outside hospitals because they cannot offload patients and patients suffer the consequences of backlogged surgeries.

Worse, prolonged hospital stays expose frail patients to hospital-acquired infections, hospital-acquired delirium and deconditioning caused by prolonged bed rest.

To understand how badly Canadian governments have failed, we look to Australia. They have the same challenge, but the scale of their crisis is roughly half of ours. About eight per cent of Australian hospital beds are blocked, representing some 3,200 beds.

Australians refuse to accept this as an unavoidable status quo. While queueing ambulances and overcrowded emergency rooms rarely make the nightly news in Canada anymore unless a tragedy occurs, in Australia, these issues remain front-page news and a top policy priority.

But the most damning contrast between Canada and Australia lies in who is responsible.

Australia’s health system is a jurisdictional quagmire compared with Canada. Their state governments fund hospitals while their federal government is responsible for funding aged care. This creates a game of hot potato where nobody wins: states blame their federal government for underfunding aged care while medically complex patients are stuck in state-funded hospital beds.

In Canada, there is no excuse. In our federation, provincial and territorial governments are solely responsible for the entire continuum of care — from acute care hospitals to step-down rehab facilities and long-term care homes. There is no other level of government to blame.

The buck stops entirely with our premiers and ministers of health.

Worse, rather than expanding our home care, rehabilitation and long-term care capacity, multiple provinces have instituted financial penalties to some of these patients stuck in beds. Provinces are effectively taxing vulnerable seniors for governments’ failures to build out community care where it is needed.

Our politicians are missing a massive opportunity.

By failing to solve the bed-blocking crisis, they are burning billions of dollars on ultra-expensive acute care stays that could otherwise be freed up to expand long-term care capacity or tackle skyrocketing drug costs. Yet British Columbia has indefinitely delayed construction of several long-term care homes which will further worsen problems in hospitals.

Maintaining the status quo is an impossibility as our population ages. Canada expects to have 25 per cent more seniors in 2040 than now. Provinces urgently need to pivot to modern funding policies which explicitly reward prevention and recovery through community care investments.

Creating more rehabilitation and long-term care beds is part of the solution.

This is not a problem of individual hospital managers whose responsibilities stop at the emergency department doors. If Australia can treat the problem as an urgent priority despite a system hardwired for finger-pointing, Canada’s political leaders have zero excuses for our healthcare system crumbling.

It is time to stop the decline and start building the way out.

Jason M. Sutherland is the UBC professor of health services and policy and director of the Centre for Health Services and Policy Research in the School of Population and Public Health at the University of British Columbia.