Hamilton·In Depth

Hamilton and Niagara hospitals are consistently running over capacity

It's now the norm for hospitals to run over capacity — and Hamilton and Niagara general hospitals land among the top five most frequently overfilled sites in the province.

Greater Niagara General is the second-most frequently over capacity hospital in the province

Between January 1 and June 30, 2019, Hamilton hospitals were regularly operating over capacity, with some days clocking in at over 120 per cent. (Colin Côté-Paulette)

Hamilton General Hospital exceeded its total capacity almost every single day for acute care within the first six months of last year— 172 days total out of the 181 day stretch. 

While the General rates as one of the most crowded in the province, for the first half of 2019, most Hamilton hospitals and select hospitals in Niagara were regularly overcrowded and operating at over 100 per cent capacity for acute care. 

Data obtained by CBC News through a Freedom of Information request reveals that the problem of hallway medicine has become increasingly common across the province, as sites regularly exceed their capacities.

Out of 169 acute care hospital sites across Ontario, Hamilton General Hospital is the fourth most frequently filled beyond capacity. It's just seven overcrowded days behind Mackenzie Health's Richmond Hill hospital, which was over capacity for all but two days of the six-month period. 

At the Greater Niagara General Hospital in Niagara Falls, the average admitted patient waited 46 hours in the ER before getting a bed on a ward in November, the most recent month for which statistics are available.

Hamilton Health Science's McMaster location and St. Joseph's Healthcare Hamilton were similarly filled beyond capacity for acute care— the McMaster site ran at or above 100 per cent capacity for 113 days, while St. Joseph's ran at or above capacity for 139. 

Not sustainable

"We've got warning signs going off all over the province and the situation just isn't viable," said Anthony Dale, chief executive of the Ontario Hospital Association. 

"All across the province you have hospitals at extremely high levels of occupancy," said Dale in an interview with CBC News. "What we're seeing is that it's no longer just during the flu season but it's all year round."

The chronic nature of the overcrowding "is simply not sustainable, not for patients, not for people who work in hospitals," said Dale. 

Hospitals exceeding their capacity no longer happens jsut during the flu season, but all year round according to the chief executive of the Ontario Hospital Association. (Tony Talbot/AP)

Winnie Doyle, the executive vice-president of clinical operations and chief nurse at Hamilton's St. Joseph's Healthcare, said that the concept of operating beyond capacity isn't a new one. 

"Over capacity in acute care hospitals and in mental health and addictions is a very long standing issue where throughout the year, we'll have spikes in demand" she said. "So it's not a new issue. I would say it's a more persistent issue than it perhaps was around 10 years ago." 

She added that the hospital works hard through programs that allow in-home care and constant work with community groups to make space at the hospital. And when the hospital does get overcrowded, they open up other areas like day rooms or double up hospital rooms to ensure patients aren't in hallways.

Other shortages contributing

While the Juravinski Hospital and Cancer Centre has most of its days listed as "under review" in the data viewed by CBC, all 50 days reported so far exceeded the limit, with most punching in at over 120 per cent capacity. 

Ontario has fewer acute care hospital beds per capita than any other province — 1.4 for every 1,000 people, which is a rate in line with Mexico. It has stayed relatively the same for around 20 years despite the population of Ontario growing by 3 million people.

Shortages of care outside hospitals also contribute to the overcrowding. One out of six hospital beds is occupied by a patient who doesn't need to be in hospital, but cannot be safely discharged home — a phenomenon known as "alternate level of care" (ALC). 

Some main causes are lengthy waits for long-term care spaces, and a lack of available home or continuing care. While the number of ALC patients remained static between 3,500 and 4,000 for the first half of the 2010s, it grew over the past five years, exceeding 5,300 in September 2019, according to figures from the Ontario Hospital Association. 

Niagara health says that while there are multiple factors that go into hallway health care, one-quarter of patients in acute care beds could be safely discharged with appropriate supports. (Shutterstock)

Greater Niagara tied for second-most hospital over capacity   

The pattern of overcrowding extends across the Brant-Hamilton- Niagara-Haldimand region, with eight hospitals sites out of 14 averaging at over 100 per cent capacity for acute care. Five of them surpassed the 120 per cent capacity mark at least once. 

Niagara Health's Greater Niagara General Hospital is tied with Peterborough Regional Health Centre for having the second most over capacity days in the six months — 176 in total. 

In a statement, Niagara Health also confirmed that its occupancy rate continued to average at 104 per cent for the last half of 2019. 

They said while there are "multiple contributing factors" to hospital capacity, one quarter of the patients in their acute care beds "no longer need hospital care and could be safely discharged with appropriate supports."

Combating the problem

To combat the problem, they're focusing on helping patients learn to safely manage their chronic conditions at home to keep people out of the hospital. They say one of their programs that gives people support for 60 days after their discharge has shown "great reductions in emergency department visits, hospital re-admissions, and days spent in hospital." 

Another program supported by the Ministry of Health connects patients to a team of people who will provide in-home care up to 16 weeks.   

But other categories of care are also overwhelmed in the region — while Niagara's St. Catharines General Hospital operated at 99.5 per cent capacity for acute care, it regularly ran over capacity for mental health care, spending 152 days over capacity with four of these over 120 per cent. 

NDP leader and MPP for Hamilton Centre Andrea Horwath said that the numbers aren't surprising and reflect what people "already know" — that hallway medicine is "getting worse" and that hospital staff are run off their feet. 

During the 2018 provincial election, the Progressive Conservative government's campaign promised to tackle and end hallway health care. 

Hamilton will be among the first cities to undergo the provincial government's overhaul of the health care system and implement a "health team", which the city said would, at least in some part, address hallway healthcare. 

The Ontario Hospital Association's 2020 budget recommendations call for a 4.85 per cent funding increase to $922 million to "maintain access to care." It also says that Ontario spends less per capita on hospitals than any other provincial government. 

With files from Mike Crawley

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