The COVID pandemic has thrust long-standing issues in health care to the forefront of the provincial election.

The vulnerability of long-term care, overcrowded hospitals, burned-out workers, backlogged procedures and insufficient mental-health services were put in the spotlight as COVID exposed devastating gaps in Ontario’s health-care system.

Hamilton was hit particularly hard, to the point that local health care remains strained as voters go to the polls June 2.

Doug Ford’s Conservative government embarked on what it saw as the fix before the pandemic started — a massive overhaul of the health-care system called the biggest change since medicare.

Hamiltonians now get the chance to choose what party they trust to take the knowledge learned so far from COVID and apply it to making the health-care system better able to withstand an aging population, increasing costs, significant staff shortages, and the ongoing pandemic along with its fallout.

“This election you’re voting for your public health care,” said Cathryn Hoy, president of the Ontario Nurses’ Association. “I don’t think we’ve ever been in as much trouble as we are with health care.”

Public health restructuring

Ontario’s response to COVID-19 has depended on strong public health departments. But the future of public health is unclear under Ford’s sweeping changes to the health-care system, including amalgamating the 34 units down to as few as 10 and postponed cuts to funding.

The Progressive Conservatives’ 2019 budget slashed public health funding by decreasing the province’s 75 per cent share of the cost and upping the 25 per cent paid for by municipalities. Those cuts were put on hold by the pandemic but could be brought back at any time.

The uncertainty comes as public health departments work to get through pandemic backlogs while still responding to COVID, and working to kick-start a stalled vaccination rollout that has seen just 58 per cent of Hamilton adults boosted and only 16 per cent of youth age 12 to 17.

Hamilton public health estimates it will take three years to catch up from the pandemic after seeing massive drops in childhood vaccination, hundreds of missed inspections and troubling gaps in services where early intervention is key.

Health system overhaul

Hamilton was one of the first to adopt the Conservative government’s massive overhaul of the health-care system.

When the first Ontario Health Teams were announced in November 2019, a Hamilton bid was among them. The team consisted of local health and social-service organizations that banded together to oversee dramatic changes to how local care would be delivered and funded. The organizations were expected to work toward integrating services locally with one shared funding envelope, while also helping area residents navigate the system.

Overseeing the teams is a super agency called Ontario Health that is in charge of the entire health-care system — from hospitals to community services to cancer care.

Gone are the 14 independent regional health authorities, called Local Health Integration Networks (LHINs), including the one that covered Hamilton, Niagara, Haldimand, Brant and Burlington.

In addition, six agencies were absorbed into Ontario Health, including Cancer Care Ontario, Trillium Gift of Life Network and Health Quality Ontario.

The overhaul came into effect June 6, 2019, under the Connecting Care Act and has slowly continued over the pandemic.

Hospital overcrowding

Hallway medicine was routine in Ontario hospitals years before the pandemic hit. But COVID drove home how overcrowded hospitals have no surge capacity. Over the last two years, procedures and services were put on hold while lockdowns were necessary to protect the health-care system from being overwhelmed.

It has left Hamilton’s hospitals with a backlog of 14,585 surgeries at the same time they have more patients than funded beds. Occupancy was 117 per cent at Juravinski Hospital on May 25, 112 per cent at Hamilton General and 100 per cent at St. Joseph’s Healthcare. Ideal would be 85 per cent to 90 per cent to leave room for swells of patients.

With no space for overflow, Hamilton’s hospitals were on the brink during Omicron, resulting in 31 intensive care unit (ICU) patients being transferred out of the Hamilton, Niagara, Haldimand, Brant and Burlington area over the fifth wave.

Hallway medicine is most visible in overwhelmed emergency departments with ambulances stuck at hospitals, leaving too few on the road to answer new calls. During the fifth wave, there were 14 times over an eight-day stretch in December 2021 that one or no ambulances were left to respond to calls, which is known as a “Code Zero” event.

During the fifth COVID wave, there were 14 times over an eight-day stretch in December 2021 that one or no ambulances were left to respond to calls.

“I’m having a heart attack in my community and all of the ambulances are at the hospital waiting to offload,” Hoy said about what can happen.

Ford vowed to fix hallway medicine in the last election, but it’s a complicated problem involving the entire health-care system. Part of the blame can be put on years of frozen budgets or increases well below inflation that left Hamilton Health Sciences alone cutting roughly $130 million from 2013 to 2019 from its more than $1.2 billion budget.

But money alone won’t fix hospital overcrowding. A big problem is bottlenecks that occur because staggering numbers of patients can’t get adequate primary care, home care or long-term care. Many get stuck in hospital while waiting for services in the community.

The issue is so acute that Hamilton Health Sciences and St. Joseph’s opened up the Satellite Health Facility at 150 King St. E in October 2020. The 120-bed facility cares mostly for vulnerable seniors on waiting lists for long-term care.

Staff shortages

Hamilton’s hospitals were short 738 staff as of May 3 — almost half of those vacancies were nurses. Very few were applying to the jobs, said Hamilton Health Sciences.

It’s a long-standing and widespread problem considering Ontario was estimated to need 22,000 more nurses before the pandemic even began. COVID has only made the shortfall worse as burned-out health-care workers retired in droves, left the profession altogether or were recruited in what has become an increasingly competitive global market for scarce human health resources.

“Building buildings, saying you’re going to hire, it’s not going to work,” said Hoy. “Every nurse that’s licensed that wants to work now is working.”

The staff shortages are wreaking havoc on every part of the health-care system from long-term care to home care to primary care to cancelled surgeries in hospitals.

“We have to have a rebuilding plan,” said Hoy.

Ford offered nurses a $5,000 retention bonus in March — half before the election and half afterwards. But the Conservative government also passed Bill 124 in 2019, which limits public-sector wage increases to one per cent annually over three years.

Devastation in long-term care

One month before COVID-19 hit, personal support workers were warning that long-term care was in crisis and at its breaking point. Roughly six months before the pandemic, Hamilton families talked about how they were considering hiring private caregivers to ensure their loved one’s needs were being met in seniors’ homes. Serious issues in long-term care were flagged for years to multiple provincial governments.

Hamilton's worst outbreak at Grace Villa saw 234 infected and 44 die from Nov. 25, 2020, to Jan. 19, 2021.

But it wasn’t until seniors’ homes became the epicentre of the pandemic that Ontarians took notice of the devastating gaps in long-term care. Hamilton’s worst outbreak at Grace Villa saw 234 infected and 44 die from Nov. 25, 2020, to Jan. 19, 2021. Workers alleged war-zone conditions of residents lying on bare mattresses soaked with urine and suggested deaths could have been prevented with better hydration. At least one personal support worker was diagnosed with post-traumatic stress disorder while others resigned or went on leave.

COVID also spread rapidly through retirement homes, leaving them in crisis as well. The Rosslyn Retirement Residence had to be evacuated in May 2020 after almost all of its 64 residents got COVID and there were no staff left to care for them. The evacuation was so chaotic, one resident was left behind without care for 18 hours.

The pandemic has left difficult questions about for-profit versus non-profit ownership, staggering staff shortages, insufficient hours of care per day and years-long wait lists. It has also drawn attention to the shift to inspections that respond to complaints and critical incidents. As a result, when The Spectator conducted an investigation in February 2021, it found no Hamilton long-term care home had undergone a comprehensive resident quality inspection since November 2018.

Many of the long-standing issues in long-term care also plague home care. It’s significant considering the 2021 census shows the number of seniors over age 85 is expected to triple in the next 25 years.

Demands on mental-health care

A year into the pandemic, McMaster Children’s Hospital reported an “unprecedented” spike in eating disorders. It also saw the number of cases admitted with substance-abuse disorder, in particular opioid-use disorder, double. From October 2020 to January 2021, hospitalizations following a suicide attempt more than tripled.

Social isolation and loss of control during the pandemic has contributed to a sharp rise in demand for mental-health care, particularly for youth. But the system was stretched thin long before COVID. Nearly a year before the pandemic, a Hamilton study found no one in Ontario was ultimately responsible for children’s mental-health care or accountable for the massive gaps in service that resulted in two-thirds of kids going without the specialized care they need.

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