Patients left in hospital, requests unfilled as home care staffing crisis worsens

“Our staffing crisis is mission critical,” says Sue VanderBent, CEO of Home Care Ontario, which represents most home-care providers in the province. PHOTO BY SUPPLIED/HOME CARE ONTARIO

Article originally provided by HomeCare Ontario and published in The Ottawa Citizen by Elizabeth Payne.

Staff shortages are so dire in Ontario’s home-care system that calls are going unanswered and hundreds of patients can’t leave hospital because there are no nurses or PSWs to care for them at home.

Ottawa is one of the hardest hit parts of the province, according to home-care officials.

“Our staffing crisis is mission critical,” said Sue VanderBent, CEO of Home Care Ontario, which represents most home-care providers in the province. “I have never seen anything like it in my whole career.”

VanderBent says health care agencies are being deluged with calls they do not have the staff to respond to, leaving thousands of vulnerable Ontario residents without home care.

Home care has long been underfunded and understaffed compared to other parts of the health system, VanderBent said. The pandemic has turned that chronic issue into a crisis that has reached new levels in recent weeks. Without a functioning home-care system, the entire health system breaks down, she said.

Agencies that provide care for people in their own homes have lost around one-third of their nurses since the pandemic began, among other staff, a crisis that has worsened with the Omicron wave of COVID-19.

In the Ottawa area, nearly two-thirds of all home care requests for patients ready to leave hospital cannot be met.

Prior to the pandemic, home-care agencies across the province were able to, on average, respond to 96 per cent of requests to support patients in their homes who were being discharged from hospital — what is known as a 96-per-cent acceptance rate.

Today, the province-wide acceptance rate is 56 per cent. In Ottawa, it is just 36 per cent.

“Never before have I seen numbers that low,” VanderBent said.

That means almost two-thirds of patients ready to leave hospital to receive care at home are forced to remain in hospital beds because it is unsafe for them to leave without home care.

The situation is worsening hospital overcrowding at a time when hospitals are struggling to cope with staff shortages, COVID-19 and overcapacity. The Ottawa Hospital has recently been putting patients in an unused rehabilitation gym and other unconventional spaces.

VanderBent says the situation means that home care has essentially stopped for 6,000 Ontario residents whose calls for care are going unanswered because the system does not have enough capacity to respond. About 580 Ontario residents are waiting in hospital for home care.

In the first two weeks of January alone, people in need of wound care, chemotherapy and post-stroke, dementia and diabetic support were unable to get help at home.

Steve Perry, CEO of Carefor, a not-for-profit home care provider that is one of the largest in Eastern Ontario, said his company, like other home-care agencies, faced critical staff shortages going into the pandemic.

“It has become magnified as this pandemic has dragged on.”

In the days leading up to Christmas, about 20 per cent of the agency’s were off because they were at risk of, or had, COVID-19.

Staff shortages leave people unable to get the help they need, he said.

“It is challenging. It is beyond critical, really.”

Among other things, he said, patients at end of life have to remain in hospital instead of going home, where they want to be, because there is no one to care for them there.

Home-care providers are paid less than their counterparts in hospitals and long-term care, a gap that has widened with efforts to attract front-line workers to the health system during the pandemic. Personal support workers in hospitals and long-term care homes earn as much as $5 an hour more than home-care workers, for example.

Home Care Ontario is asking the province for $460 million to address those wage inequalities.

Without home care, the entire health system will continue to be overcapacity, Perry said. And fixing home care is a less costly solution that serves the growing demand by people to be cared for, and to die, at home.

“For those of us who work in home care, it seems simple. If we are not so depleted, we can redirect people from long term care longer and get people out of hospital quicker at a very low cost point,” Perry said. “That really mitigates the need for increased capital funding to build new hospitals or new long-term care homes. We will never have enough long-term care beds.”