Ontario’s long-term-care system isn’t ready for a ‘grey wave’ 

ANALYSIS: A new report from the province’s Financial Accountability Office projects a spike in the need for long-term-care beds — and suggests our system isn’t prepared for it 
By John Michael McGrath - Published on Oct 30, 2019
man at podium
Peter Weltman, the province’s financial accountability officer, presents his report on long-term-care at Queen’s Park on Wednesday.(John Michael McGrath)

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If Ontario had wanted to get ahead of the demographic wave it’ll be facing in coming years, it should have started building new long-term-care beds years ago.

Although it’s not stated explicitly, that’s the sobering message of a new report from the province’s financial accountability officer, Peter Weltman — who acknowledges that it’s not great news for the government.

“It is what it is, right? That’s the role of this office — to paint the picture, bleak or otherwise,” Weltman told reporters at Queen’s Park on Wednesday.

The Financial Accountability Office was asked to analyze the costs and implications of the Ford government’s commitment to building 15,000 new long-term-care beds across the province. The conclusion: if the government were to get all those beds built according to the current schedule, the provincial wait-list for beds in 2023 would still be worse than it was in 2018 (36,876 patients waiting in 2023 versus 34,862 in 2018).

According to the FAO report, that means the province is unlikely to see the end of “hallway medicine” anytime soon. The thousands of Ontario patients who end up receiving treatment (or simply waiting) in hospital hallways are there, in part, because patients are occupying hospital beds while they wait for long-term-care spaces to open up. So long as there’s a shortage of long-term-care beds, those people can’t move out of the hospital — currently, something like 5 per cent of the province’s hospital bed-days are taken up by people waiting for long-term-care beds.

This isn’t the result of the Tory government’s choices (they haven’t been in power long enough to do much on this file): it’s simple demographics. The baby boomers will start turning 75 in 2020, causing the demand for long-term-care beds to accelerate quickly. By 2030, the demand will start truly exploding: that’s when the baby boomers will begin turning 85 (today, nearly one in five Ontarians over the age of 85 are either in long-term-care beds or on the wait-list).

Just to maintain the current — too-long — wait-list levels, the province will need 55,000 new beds by 2034, and that’s on top of the 15,000 that the Tories have already announced. Weltman estimates that that would mean an annual cost (in 2019 dollars) of $3.5 billion. Actually reducing or eliminating the wait-list would cost even more.

If we’re trying to assign blame, some has to go to the Liberal government that was in power from 2003 to 2018. The demographic challenge the province is facing now hasn’t come as a surprise. After a government decides to build a new long-term-care home, it can take three to four years for those beds to become available (the building needs to be built; staff need to be hired), so, in order to prepare for 2020, the Liberals ought to have kicked off a wave of construction in 2016 or 2017. That didn’t happen.

Which isn’t to say that the Liberals did nothing: in the mid-2000s, they did build 10,000 new long-term-care beds; later, they also changed the province’s policies to emphasize home care, rather than long-term-care homes, for seniors. That was a good change for several reasons, not least that patients preferred it, and it did reduce wait-lists, at least for a time. But it merely postponed, rather than eliminated, the demand for new long-term-care homes. And, in theory, the time could have been used to build capacity. It wasn’t.

If the Liberal record on this file is mixed, the Tories are the ones facing the problem now. And the objective need for new spending doesn’t mix well with the Progressive Conservatives’ desire to cut taxes and shrink government. Care for aging Ontarians will cost billions more than the government has already committed, and that money will need to come from somewhere.

“We know we’re losing runway,” Minister of Long-Term Care Merrilee Fullerton told reporters on Wednesday. “The reality is, we have an aging population.” Fullerton says the government is looking at alternative technologies and care methods to try to reduce the need for massive new spending, but the example of the Liberal turn to home care suggests that much of the “low-hanging fruit” in the sector might already have been picked.

The Tories know that the public outcry over hallway medicine helped put them in power, so they’ve got a strong incentive to start spending money to solve the issue. As it stands now, they’ve got a big political problem: the wait time for long-term-care beds in 2022 is projected to be at least as bad as it is today — which means they’ll have to be prepared to explain to voters why things haven’t gotten better.

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