Ontario's PC government unveiled scores of changes to Ontario’s health-care system today in an effort to address overlapping crises in the sector that have caused immense strain on hospitals. 
Health Minister Sylvia Jones and Long-Term Care Minister Paul Calandra released the plan at Sunnybrook Hospital in Toronto, flanked by Ontario Health CEO Matt Anderson and Sunnybrook Health Sciences Centre CEO Andy Smith. 
“Today's 'Plan to Stay Open' will provide the support our system needs to address urgent pressures and prepare for a potential winter surge,” Jones said. “This is a five-point strategy to further bolster Ontario's health-care workforce, expand innovative models of care and ensure hospital beds are there for patients when they need them.”
The plan “will ensure that Ontarians continue to have access to the health care they need and deserve, and long-term care plays a critical role in our plan,” Calandra said. “That's why, to support the stability and recovery of our health system, we're moving on a suite of permanent changes that will ensure Ontarians are getting the right care in the right place while avoiding unnecessary hospitalization.”
The 18-page “Plan to Stay Open” includes changes to nursing, long-term care (LTC), paramedical services and more. Though it was just released, criticism has poured in from opposition benches and health-care experts. 
The plan, coupled with past moves, aims to free up 2,500 hospital beds and add 6,000 more health-care workers, the document said.
Likely anticipating criticism, the government lined up a boatload of stakeholders — many of whom receive public funding — to provide positive comments in the release announcing the plan.
Representatives from the Ontario Medical Association, the Registered Nurses' Association of Ontario, the <a href="https://www.oha.com/strategicplan/our-system/funding-methodologies">Ontario Hospital Association</a> and more all voiced support for the plan.
The government introduced legislation on Thursday to formalize some of the changes to long-term care placements. 
Some of the more controversial changes include reworking how patients can be transferred from a hospital to a long-term care home, capping the number of isolation beds in such homes, opening the door to more OHIP-covered surgeries at independent health clinics, and a vague promise to clamp down on exorbitant nursing agency fees. 
Additional changes, like allowing paramedics to send patients to places other than the ER depending on need, were already announced. 
NDP MPP France Gélinas, her party’s health critic, was visibly emotional when talking to reporters about the changes. She blasted every measure as inadequate and misguided. 
“I can’t stand for this. This is disrespectful. This is not the way health care should be,” she said. 
On the changes to LTC patient transfers, the government introduced a bill that allows patients to be placed in an LTC home without their consent while waiting for a spot to open in their preferred home, so long as a doctor agrees they no longer need hospital treatment.
These patients are referred to as “alternative level of care” patients. Someone is deemed ALC when a qualified health-care professional says they no longer need acute care in a hospital. 
The bill "does not authorize the use of restraints in order to carry out the actions or the physical transfer of an ALC patient to a long-term care home without their consent," its explanatory text states.
“There will be mandatory guidelines used by placement co-ordinators to ensure patients continue to stay close to a partner, spouse, loved ones or friends, and ensure these patients won’t be out of pocket for any cost difference between their temporary home and their preferred home,” the plan said. 
“There are unfortunately those patients who doctors say no longer need to be in a hospital but can't go home either because they require additional care. These amendments, if passed, will make it easier to temporarily transition these patients into an LTC home where they can receive more appropriate care in a more comfortable setting,” Calandra said. 
The government said the move will free up at least 250 hospital beds in six months. They're also bolstering certain supports to help LTC residents or those in home care avoid hospitalization altogether.
Gélinas wasn’t buying it. 
Some LTC homes have space to take in patients because they’re in terrible condition and residents are treated poorly, she said. 
“There are presently in Ontario, right now, 6,500 beds available in our LTC homes that nobody wants to go to. Why? Because they are old homes with four people to a room with no air conditioning.”
The change will be particularly hard for northern Ontarians, she said, because they’ll probably have to drive extremely far to visit their loved ones. 
“You want them to go to the home that is the closest to where you live so you don't have to drive two hours to go visit them. None of this will be available anymore,” Gélinas warned. 
“You will be placed in the first bed available. I can guarantee you that the first bed available will be in a private for-profit home that hasn't been renovated in 50 years and has four patients to a room,” Gélinas added.
For-profit homes tend to have shorter wait times, largely due to demand factors, <a href="http://healthcareathome.ca/champlain/en/care/Documents/LTCHWaitTimes_EN.pdf">according to government data</a>.
Green MPP Mike Schreiner voiced the same concerns around family travel.
"The announcement today could have unintended consequences of actually putting more pressure on our health-care system because family members do so much work enhancing the care of their loved ones," he said.
Reporters pressed Calandra on the potentially coercive nature of the change, and he pushed back.
"Ultimately, we are not going to be forcing anybody out of the hospital, but the changes do allow us to continue that conversation, to explain to somebody who is in a hospital why their needs can be met in an LTC home," he said. No transferred resident will lose their place on the priority waiting list, either, he said.
Calandra's explanation didn't sit well with one LTC expert.
"Why would you be changing the legislation" if not to try to put some pressure on ALC patients to move, pondered Vivian Stamatopoulos, a professor at Ontario Tech University specializing in the LTC sector.
Given nearly 200 of Ontario's 627 LTC homes are currently dealing with a COVID outbreak, <a href="https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-weekly-epi-summary-report.pdf?sc_lang=en">according to recent government figures</a>, and the severe staffing shortages plaguing homes, attempting to use the sector to bail out hospitals is fundamentally wrong.
"You have one sector (LTC) that is failing even worse than acute care, and you somehow think they're the solution to improving acute care?" Stamatopoulos said. "This is so bait and switch. It was never a solution."
Further, separating residents from their families has horrible consequences on family and residents alike, she said, <a href="https://www.tandfonline.com/doi/full/10.1080/17482631.2022.2075532">citing a recent study</a> she and fellow researchers published looking at how past LTC isolation orders affected residents.
Shoring up the public LTC and home care systems and repealing Bill 124 would go a long way to solving the problems, she said.
The government is also hoping to free up even more LTC beds by limiting, or "rightsizing," according to the document, the number of COVID isolation beds in LTC homes.
The government expects this to make 300 beds available by the end of summer, "with a potential of 1,000 more beds available within six months."
This move will "increase the outbreaks that are happening in LTC right now," Stamatopoulos said. "For you to take away critical cohorting that helps blunt the curve of outbreaks in these homes, it's only going to get worse."
Another big change is the government "exploring opportunities to improve the efficiency of surgical delivery, including a system for distributing high-demand surgeries among all available surgeons" to cut down on the surgical backlog, the document said.
"We will also consider options for further increasing surgical capacity by increasing the number of OHIP-covered surgical procedures performed at independent health facilities."
When questioned on the plan, Jones was quick to say that "health care will continue to be provided to the people of Ontario through their OHIP card."
Neither the document nor the ministers provided further detail, such as which surgeries and which clinics, on the plan. Jones didn't answer a question on whether she'd allow more private clinics in Ontario.
Anderson did say no staff would be pulled from the public to the private system.
To Cathryn Hoy, president of the Ontario Nurses' Association, looping in more independent clinics is a stalking horse for more privatization.
"This is a blatant move that will line the pockets of investors, nothing more," she said in a release.
She's also concerned that opening certain surgeries up to private clinics risks patient health.
"I wouldn't want to have an endoscopy at a private surgical suite. What if they perforated my bowel? I need to be in an advanced operating room with an intensive care unit," she said in a separate interview.  "And you can't depend on an ambulance to come get you because they're backed up at the hospital."
The plan also included a vague promise, at the end of the document, to do something about exorbitant nursing agency fees. Premier Doug Ford recently said he's not keen to intervene in the private market, but the new plan promises action.
"We are seeing an increase in agency nursing, and we want to have those conversations to make sure that, frankly, unduly impacts our health-care system," Jones said.
Doris Grinspun, head of the Registered Nurses' Association of Ontario, is a fan of some parts of the plan.
"It's a good start," she said. "Number 1, recognizing we have a crisis in Ontario, and in particular a nursing human resources crisis."
And "for the first time, tackling internationally educated nurses that have been wanting for years to work in the province," she said.
The province will temporarily cover the costs of application, examination and registration fees for internationally trained and retired nurses, which can save a nurse up to $1,500.
The College of Nurses of Ontario is also proposing to temporarily register as many as 6,000 internationally trained nurses, in response to a directive Jones sent them two weeks ago.
READ MORE: <a href="https://www.qpbriefing.com/2022/08/18/ontario-nursing-college-proposes-to-temporarily-register-international-nurses/">Ontario nursing college proposes to temporarily register international nurses</a>
Ontario also says it will modify a program that will allow nurses and nurse practitioners to be deployed full-time across multiple hospitals.
Other changes are specific to rural and northern Ontario.
The province will launch a new peer-to-peer program to provide real-time support and coaching from experienced emergency physicians to help doctors deal with patients in rural emergency departments. It will begin in five hospitals, before being rolled out in up to 37 small and rural hospitals across the province.
Liberal MPP Dr. Adil Shamji was no fan, either.
"Instead of investing in health-care workers and repealing Bill 124, Minister Jones has instead chosen to invest in for-profit independent health facilities that will lead to poorer health outcomes for patients and pull our health-care workers out of the public system where they are needed most," he said in a statement.
- With files from the Canadian Press

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