Ontario’s next budget will set a roadmap for recovering from COVID-19, perhaps doubling as the Progressive Conservatives’ election platform, and many stakeholders are asking the government to shore up the health system by looking beyond hospitals.
From hospitals, to long-term care, to laboratories, the health sector bore much of the brunt of the pandemic’s impact.
The government pumped more than $5 billion into hospitals to add 3,100 beds since the start of the pandemic and the Ontario Hospital Association said those were welcome investments.
Now, to maintain financial stability for hospitals as they restart surgeries and procedures delayed by the pandemic and continue to manage other COVID-19 pressures, they require a 3.5 per cent increase in base operating funding, or $735 million, the OHA said in its pre-budget submission.
In addition, the hospital association is seeking dedicated funding for reducing the surgery backlog, and continuing funding for additional beds that was committed over the past two years.
The Progressive Conservative government is extending its own deadline for delivering the next budget to April 30, which is around when the campaign for the June 2 election will begin.
A spokeswoman for Finance Minister Peter Bethlenfalvy said he “understands the importance of investing in health care to create a more sustainable system in Ontario.”
Contributing to the pressures in hospitals is the need for greater funding elsewhere, the OHA noted. As of mid-January, there were 5,800 alternate-level-of-care patients — people who could be cared for in a different setting such as home care or long-term care — which is a record, the OHA said.
“ALC continues to be a clear and present danger,” the association wrote in its submission. “This situation reflects reduced and insufficient capacity in long-term care as well as for home and community services.”
Dr. Adam Kassam, president of the Ontario Medical Association, said even before the pandemic, in 2019-20, there were 1.3 million “hospital bed days” used by alternate-level-of-care patients, costing $650 million.
“The math is clear: Providing care in more appropriate settings would avoid hundreds of millions of dollars a year in health care spending,” he said.
Donna Duncan, CEO of the Ontario Long-Term Care Association, told the legislature’s pre-budget committee that while the government has doled out “unprecedented funding” to the sector during the pandemic, COVID-19 costs have exceeded original estimates.
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For the fiscal year ending this month, the sector is facing an additional $270 million in costs, and based on those trends, the costs for 2022 and 2023 are estimated at $800 million, Duncan said.
“Homes are focused on protecting their residents and staff and spending whatever it takes, but many are facing financial instability as a result,” she said.
Sue VanderBent, the CEO of Home Care Ontario, told the committee that the massive government investments in hospitals and long-term care have come at the expense of home care.
“We have lost almost 4,000 nurses, thousands of personal support workers and hundreds of therapists,” she said. “Many of these staff have been lured away by higher salaries offered in hospitals, long-term care and public health, where the government pays significantly more for people to work than it does in home care.”
Home care needs an immediate investment of $460 million to help stabilize it and address wage inequities, VanderBent said.
The government announced $548 million over three years for home care in its fall economic update.
Rick Firth, the CEO of Hospice Palliative Care Ontario, said caring for someone in a hospice bed is about one-third the cost of caring for them in a hospital. More than 40 per cent of hospice admissions come from hospitals, so better funding palliative care would ease hospital acute-care pressures, Firth said.
“Currently, only nursing and (personal support worker) costs are funded, and there are other costs, including patient care supplies, medical directors, psychosocial care, nutrition, and infection control cleaning and equipment, that are not funded,” he told the committee.
“In a hospital, all of those costs would be covered 100 per cent and at three times the cost.”
Hospice Palliative Care Ontario is seeking $43.2 million a year to fully cover those costs, Firth said.
The Ontario Council of Hospital Unions of CUPE is one of many public-sector unions urging the government to repeal Bill 124, which capped public-sector wage increases to one per cent. Meanwhile, inflation is at more than five per cent, leaving workers falling farther behind, said Doug Allan, a senior research officer with the union.
Dianne Martin, the CEO of the Registered Practical Nurses’ Association of Ontario, said a $3-per-hour pandemic pay top-up the government awarded to personal support workers — rightly so, she said — has led to wage compression for RPNs. In some cases, RPNs are being paid less than the PSWs they are supervising.
“As you can imagine, for RPNs, this is unfair and demoralizing and gives them very little reason to stay within the health care profession,” Martin said.
The temporary bump for PSWs — currently set to expire March 31 — should be made permanent, she said, and extended retroactively to RPNs.
The Medical Laboratory Professionals’ Association of Ontario is calling on the government to invest $6.2 million over four years in training and clinical placements.
Labs are already short staffed, the group said in a statement, and set to face even more pressures as the Ontario Medical Association estimates the pandemic has caused a backlog of 20 million surgeries, procedures, treatments, tests, and doctors’ visits.
The Ontario Public Health Association called on the government to reverse funding cuts to public health units made in its 2019 budget. In addition to a surgical backlog, the pandemic has caused a backlog in prevention services provided by public health units, including on oral health, sexual health and resources for new parents.
The Ontario Institute for Regenerative Medicine is also calling for the government to reverse its decision in the 2019 budget to cut the organization’s $5 million in annual funding.
“At a time when the unprecedented commercial value of stem cell technologies are just beginning to be realized, Ontario’s stem cell innovators are now at a crossroads,” it said in a statement.
“Without ongoing funding, Ontario stands to lose it competitive advantage and the opportunity to benefit from the burgeoning regenerative medicine commercial sector.”
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