EDITOR’S NOTE: This article originally appeared on The Trillium, a Village Media website devoted to covering provincial politics at Queen’s Park.
Bonnie Luciano got to the Southlake Regional Health Centre around 4 p.m. on Oct. 5, 2023. She’d just gone through her second round of chemotherapy and was feeling severe side effects.
The 46-year-old Markham woman was in serious pain and soon realized a long wait was ahead.
“I cried softly in my husband's arms and held my head in pain while I waited and waited and waited,” she wrote last October in a letter to the editor of Newmarket Today.
She almost left the hospital, despite her pain, but finally heard her name called.
“I felt a sense of relief thinking I’d be taken to a waiting bed,” she wrote.
Her relief quickly turned to dismay. Luciano was given a bed in an “internal waiting room,” as she described it, that used to house mental health patients awaiting evaluation.
Neither her pain nor her wait stopped once she was admitted.
At 5:30 a.m. the next morning, Luciano had enough. She signed discharge papers because “for the sake of my health … (I) knew I needed to go home and get proper rest.”
Altogether, she spent over 12 hours in the hospital, much of it in what the provincial healthcare system calls an “unconventional space.”
“Unconventional spaces” is a bureaucratic euphemism for what many Ontarians know as hallway health care.
No beds available for the latest batch of patients? Stick them in a hallway. Or an old breakroom. Or anywhere the hospital can find space because there simply aren’t enough regular inpatient beds.
Luciano’s story is, in some form or another replicated thousands of times per day in Ontario.
In January 2024, nearly 2,000 patients per day on average were kept in unconventional spaces in hospitals across the province, according to data obtained by The Trillium through the freedom-of-information system.
That’s the highest number since Ontario Health started tracking it in July 2017, which data The Trillium received traces back to. It shows the province’s hallway health care problem is worse than ever.
From July 2017, when the data started, to June 2018, when the Tories took over, about 1,000 people were kept in hallways on an average day. It got as low as 826 patients in June 2018.
Hallway health care was a huge election issue in 2018. Then-potential Premier Doug Ford promised to fix it. The Tories have poured billions of dollars into the healthcare system — and not just on hospitals — over the past six years, but as Ontario’s population gets bigger and older, hospitals are still packed.
Use the dropdown menu in the graph below to find individual hospital corporations.
Hallway health care has long been a major issue. Its roots are deep and solutions are both complex and expensive. As the province continues to grow and age, it’s an open question about whether the measures currently being implemented will pay off.
Ontario has over 200 hospitals and nearly all have dealt with hallway health care at some point in the last seven-plus years. Most, however, aren’t busy enough to grapple with the issue regularly.
The data is presented by hospital corporations, not individual hospitals, which makes it impossible to do an actual hospital-by-hospital comparison.
Hospital corporations can include a single hospital or multiple hospitals coupled with other healthcare centres, like rehab or mental health clinics, managed by the same board of directors. Ontario has 140 hospital corporations.
For example, William Osler Health System — which serves well over a million people in Brampton, Etobicoke, Caledon, and other nearby areas — includes the Brampton Civic Hospital, the Etobicoke General Hospital, the Peel Memorial Centre for Integrated Health and Wellness, a reactivation centre and a withdrawal management centre.
Ontario Health also changed the definition of hallway health care on Feb. 18, 2020, to include patients held in unconventional spaces outside the emergency department. Previously, only patients in the emergency department counted toward the total.
It was a move toward greater transparency, said a source with deep expertise in emergency medicine.
The source said some hospitals have over-capacity protocols, meaning instead of housing all the hallway patients in the emergency department, the hospital will spread the risk around by putting a few patients in each ward. The pre-February 2020 definition didn’t capture these people.
Only some hospitals do this, and those that do usually only do it under extreme circumstances, so the number of patients captured by this updated definition is small relative to those in emergency departments, the source said.
Because the numbers are relatively small, the updated definition likely doesn’t have a big impact on the overall trajectory of the graph, the source said.
Where the most hallway health-care patients are
Unsurprisingly, hallway health care is a daily challenge for Ontario’s biggest hospitals and hospital corporations. And it’s only getting worse.
The hospitals and hospital corporations that treat the most patients in unconventional spaces — shown in the graph below — include William Osler, Mississauga’s Trillium Health Partners, Hamilton Health Sciences, and Durham’s Lakeridge Health network.
On an average day in January, each of those hospital corporations had over 100 patients receiving treatment in unconventional spaces. Trillium Health Partners was far and away the hospital system with the most hallway patients, with 185 people being treated outside regular rooms.
William Osler was second, with 121 patients treated in unconventional spaces on an average day in January 2024. Hamilton Health Sciences was a close third, with 119 patients. Lakeridge treated 100 patients in unconventional spaces.
Other hospital corporations with high numbers in January include Niagara Health Systems (92 patients), Newmarket’s Southlake Regional Health Centre (79 patients), Toronto’s Unity Health Centre (66 patients), York Region’s Mackenzie Health (62 patients), and Sudbury’s Health Sciences North (52 patients), which serves much of northeastern Ontario.
The only individual hospital to show up on the top-10 list for hallway patients is the Ottawa Hospital, which on an average day in January, treated 75 patients in unconventional spaces.
All of those hospitals and hospital corporations have had the highest numbers over the past seven years.
None of the above hospitals or hospital corporations, save for Hamilton Health Sciences and the Ottawa Hospital, responded to interview requests. Hamilton declined the request.
“During periods of increased volumes, the Ottawa Hospital prepares temporary unconventional spaces for patient care to help improve ambulance offload time and patient flow throughout the hospital. This includes the temporary care unit in the former ambulance bay at the general campus. These spaces are always adjusted to maintain patient safety, comfort and experience. Like all other areas throughout the hospital, patients in these unconventional spaces continue to receive high-quality care,” said Rebecca Anderson, a spokesperson for the Ottawa Hospital, in an emailed statement.
Health Minister Sylvia Jones wasn’t available for an interview but her spokesperson, Alexandra Adamo, defended the government’s record in an emailed statement. The statement did not address some of the specific questions posed by The Trillium.
“Ontario is leading the country with some of the shortest wait times in Canada. Under the leadership of Premier Ford, our government is making the largest investment in health care in the province’s history. Since 2018, our government has increased the healthcare budget by over 31 per cent, investing over $85 billion into the system this year alone,” she said.
Adamo touted several specific programs, including making it easier for internationally trained nurses to practice in the province, spending $4.6 million to help nurses upskill, opening more nursing spaces at post-secondary institutions, and more.
“Together these changes have allowed us to achieve significant progress to build a more connected and convenient healthcare system,” Adamo said.
Opposition leaders criticized the Tories for not living up to the 2018 campaign promise and attacked the government’s record on the issue.
“I wish I could say I was surprised, but everywhere that I've been, all across this beautiful province, people are worried about our healthcare system,” said NDP Leader Marit Stiles.
“It is more than fair to judge this government on their failure to fix hallway health care and let's be clear, because they ran on fixing it. They said they had a plan,” she said.
“Yes, many governments have struggled to keep up with health care needs in our communities, but the crisis we're experiencing now is unlike anything we've seen. It started for the most part under Mike Harris and his cuts and continued under the Liberals and now under Doug Ford. The reality we are facing is that things have gotten worse and not better,” Stiles said.
Liberal Leader Bonnie Crombie said she thinks the lack of progress is because the Ford government wants to starve the public system of resources to open room for privatization.
“This government has been an abysmal failure on health care. They came in saying they would solve hallway medicine. They said they would build housing. Their housing record is as abysmal as is their solving the health hallway medicine crisis,” she said.
“It is a crisis, and the reality is, Doug Ford is deliberately underfunding health care to justify the privatization agenda because he's selling it off to his rich friends. Because with Doug Ford, he's not in it for you,” she said.
“This is the result and the negative consequences of a government that has failed to make the necessary investments in our healthcare system,” said Green Leader Mike Schreiner.
“It's clear that things were starting to get better when the Ford government was elected, and they've made it substantially worse. They've had six years to turn the ship around and it's gotten substantially worse. I mean, to go from 800 to 1800 average daily hallway health care patients is just completely unacceptable,” he said.
A growing problem
Large hospitals and hospital corporations struggling to find space shouldn’t come as a surprise given Ontario’s population has skyrocketed in recent years and the province’s bed count hasn’t kept pace.
The problem, however, now goes beyond those with the highest number of patients. It’s manifesting in smaller, more specialized health centres.
From July 2017 to April 2023, the Centre for Addiction and Mental Health (CAMH) seldom treated patients in hallways.
CAMH is a world-leading hospital and academic research centre. It has over 500 inpatient beds in multiple sites across the Greater Toronto Area.
On an average day from May to August 2023, between six and eight patients were treated in unconventional spaces. That spiked to 17 patients on an average day in September 2023. The numbers remained around there until January 2024, when the data stops.
CAMH did not respond to several email and phone requests for an interview.
The Meno Ya Win Health Centre in Sioux Lookout, located on the traditional territory of the Lac Seul Ojibwe Nation, has a similar story.
The hospital has 60 inpatient beds and a 20-bed extended care facility. On top of Sioux Lookout, the hospital serves Hudson, Pickle Lake, Savant Lake, and other First Nations communities in the area.
Like CAMH, Meno Ya Win rarely treated patients in unconventional spaces in past years. There was a small spike right before the pandemic but it subsided when COVID first hit as people stayed away from hospitals.
Another spike started in March 2021 and was briefly under control from December 2021 to January 2022. In February 2022, the numbers started going up and since then, they haven’t come down to the early 2022 numbers.
On an average day in January 2024, the hospital treated 15 patients in unconventional spaces.
Meno Ya Win did not respond to requests for comment.
A glimmer of hope
One hospital has been bucking the trend.
Humber River Hospital in northwest Toronto is one of the busiest hospitals in the province.
Before the pandemic, Humber’s hallway health-care problem numbers weren’t as bad as other major hospitals. From July 2017 to February 2020, the hospital treated an average of 11 patients per day in unconventional spaces. The pre-pandemic numbers spiked to 23 patients on an average day in January 2018.
Like most other hospitals, Humber’s hallway healthcare problem subsided during the pandemic because people stayed away from hospitals to avoid catching COVID.
Unlike other hospitals, however, Humber managed to turn a temporary reprieve into something more sustainable.
Since November 2021, Humber only has one recorded instance of patients in an unconventional space, in February 2022.
Humber River Hospital CEO Barbara Collins said the hospital’s decision to go all-in on cutting-edge technology has paid dividends.
In 2018, the hospital introduced a “command centre” to help it operate more efficiently.
The “command centre” is housed in a single room on the second floor with dozens of employees. One of the walls is composed entirely of TV screens replete with charts, graphs, and cameras — almost everything needed to understand hospital operations and patient health.
“We have data that is downloaded onto screens with machine learning and some artificial intelligence applied to it that tracks every patient in the emergency department,” Collins said.
“If they’ve got a bed, how long it’s taking to clean that bed. We look at the length of stay for patients in live time. The status is updated every four seconds. We look at any kind of test delays that we’re waiting for a patient to have so that you waste no time while the patient is in the hospital,” Collins added.
The screens “combine real-time data, early warning systems, machine learning and predictive analytics in an effort to alert staff of changes to patient status and potential risks,” according to the hospital’s website.
Collins said the command centre lets hospital administrators solve problems before they arise, significantly reducing wait times and clearing up more beds.
“So as a result of that we were able to create, even over COVID, 35 empty beds because we monitor this so closely and we move people quickly,” she said.
It’s also helped prevent people from getting worse while in the hospital.
“Our harm to patients is almost 60 per cent less than other hospitals. So you don't end up making people sicker while they're here and keeping them longer,” Collins said.
Humber also uses robots — guided by real surgeons — for certain procedures like knee replacements and abdominal and neurological surgeries.
The precision offered by these robots means Humber has been able to send patients home 24 hours after a procedure, rather than a more typical wait of 72 hours, Collins said.
Humber’s success has turned Collins into an evangelist.
“If every hospital put a command centre in to save beds we wouldn’t have a hallway health-care problem,” she said.
It takes a lot of time and work, but “any hospital could do it.”
So what’s the holdup? Why doesn’t every hospital have one? Collins doesn’t have an answer for that.
“The minister (of health) knows about it. Ontario Health knows. I think our results speak for themselves. So I can't do much more than wish people would have implemented it,” she said.
Too many people, too few beds
One of the main, and most obvious, reasons thousands of Ontarians are treated in hallways is a lack of inpatient beds.
Ontario had nearly 50,000 hospital beds in 1990 for about 10 million people. By 1999, that dropped to 31,500, and the population rose to 11.5 million. For the next 20 years, Ontario’s bed count stayed at about the same level, according to a report by Ontario’s financial accountability officer.
In 2018, Ontario had over 14 million people. Now, it’s about 16 million.
To Anthony Dale, CEO of the Ontario Hospital Association (OHA), the mid-aughts saw a big inflection point.
“The roots of hallway health care lie in years of systematically choosing not to build health services capacity in parts of the health care services continuum outside of the hospital sector. And that choice, which really started around 2004 and 2005, in combination with not increasing at all the bed count for Ontario’s hospitals for more than two decades, that’s basically the recipe for hallway health care,” he said.
In the 1990s, the Mike Harris-led PC government struck a panel called the Health Services Restructuring Commission to modernize the sector and help it operate more efficiently, so more money could be spent on other healthcare priorities, like long-term care, Dale said.
Dale was a staffer in the premier’s office and health minister’s office during the Harris years.
At that time, Ontario’s bed count “stabilized” at around 30,000, he said.
The commission led to a massive buildout of long-term care homes, ending around the mid-2000s.
“When that capital expansion kind of finished up … the government chose not to significantly expand health services to keep up with the population,” Dale said. A few years later, hospital budgets flatlined.
“We went through about a half-decade with a kind of major austerity push that leaned out Ontario's hospitals,” he said.
Since then, the Ford government has embarked on a multi-billion dollar plan to build more hospital beds. When the Tories took over in June 2018, the province had 31,875 beds. By April 2024, that number rose to 35,060, according to figures provided by the Ministry of Health.
“That’s a tremendous piece of progress,” Dale said. “But we’re making up for lost time.”
Though Ontario’s hospital bed count was relatively static during those 20 years from the late 1990s to the early 2020s, the population kept growing and aging.
In 2000, seniors (aged 65 and older) made up about 12 per cent of the population. In 2024, it’s over 18 per cent.
That meant more people going to hospitals with more complex problems, creating serious capacity problems.
Wrong place at the wrong time
The population growth problem was exacerbated by another common issue in Ontario health care: people who don’t need to be in hospitals still receive care in them because there’s nowhere else to go.
These people are called “alternate-level-of-care” (ALC) patients.
For example, when an elderly patient is ready for discharge ready for discharge but can no longer safely live at home and is waiting for a space in long-term care.
As of June 6, there were more than 6,100 ALC patients in Ontario. That’s 6,100 of Ontario’s 35,000 beds occupied by people who could be receiving more appropriate care in a different setting. Nearly half of the 6,100 ALC patients are waiting for long-term care beds, according to the OHA.
Though waiting for a long-term care bed is the most common reason someone stays in the hospital past their discharge date, it’s not the only one.
About 11 per cent are waiting for supervised or assisted living, where staff assist with day-to-day living but in a less-intensive manner than in a long-term care facility, the OHA said.
Other reasons include people waiting for a physical rehab space, palliative care, mental health and addiction care, and more.
“If you could solve (the ALC issue) overnight, it would be a profound factor in improving flow in hospitals and dealing with overcapacity problems in various hospitals,” Dale said.
The Ford government has tried to chip away at the ALC issue and free up more beds. In 2022, then-long-term care minister Paul Calandra introduced a controversial bill to allow hospitals to force ALC patients into long-term care homes not of their choosing, or face a $400-per-day fine.
In the past two years, over 20,000 patients were moved from the hospital to a long-term care home. Over 400 were moved to homes they didn’t choose. Only seven patients have incurred a fine, but one family is facing a $26,000 bill, according to recent reporting by The Canadian Press.
The Tories have also earmarked billions for a massive LTC bed buildout. The plan calls for 31,000 new beds, plus 28,000 revamped to 21st-century standards, by 2028.
Building more LTC beds is the most important factor in solving the problem, Dale said.
“In terms of ALC, our system is heavily reliant on an expansion in long-term care to make serious progress with getting people into the right, most appropriate setting.”
But adding hospital and LTC beds won’t be enough, according to a report by a panel struck to advise Ford on solving hallway health care.
“Simply adding more beds to the system will not solve the problem of hallway health care. For example, community mental health and addictions services, as well as community rehabilitation services are two areas where additional access to services could help relieve some of the pressures causing hallway health care,” the first of two reports said.
Beefing up things like home care and mental health and addictions programming will also help keep people out of hospitals in the first place, and ensure they receive the proper care in the proper setting once they’re ready to leave the hospital, the second report said.
Beds aren’t the only thing in short supply
Keeping people healthy and out of hospitals raises the issue of primary care, which, like Ontario’s hospitals, is in a state of crisis.
Over two million Ontarians don’t have a family doctor. That number is expected to double in the next few years, according to the Ontario Medical Association.
When people don’t have a family doctor, they go to hospitals, which Dale calls the “backstop of our healthcare system.
The hospital “is open 24/7 … it’s universally insured and universally available,” he said.
In 2023, Ontario’s auditor general found that one in five patients go to the hospital because they don’t have a family doctor — and many of these cases were for non-urgent care.
The Ford government says it’s added over 10,000 new doctors since 2018 and has opened hundreds of new spots in medical schools.
The government’s efforts to get more family doctors into the health-care system are butting up against some strong headwinds. Interest in the profession is declining, according to residency matching data, and many doctors are considering leaving the profession altogether, according to the OMA.
“Underfunding in OHIP revenue, complicated with rising inflation pressures have made family practice unsustainable,” said OMA president Dr. Andrew Park in January.
What’s a bed without a nurse?
Primary care physicians aren’t the only healthcare professionals in short supply. Ontario’s facing a severe dearth of nurses.
In 2023, Ontario’s Financial Accountability Office released a report saying the province will be short 33,000 nurses by 2028 even as the Tories pour money into health care.
As demand grows alongside the population, Ontario’s expected to “have less hospital capacity” in 2028 compared to 2020, the report said.
The shortage “will jeopardize Ontario’s ability to sustain current programs and meet program expansion commitments.”
It’s led to scores of emergency room closures over the past few years and has hospitals relying on agency nurses — which cost a lot more — to fill the staffing gap.
Data from the Canadian Institute of Health Information shows the number of registered nurses in Ontario barely increased from 106,547 in 2013 to 108,040 in 2022.
The number of nurse practitioners nearly doubled, though, from just 2,158 to 4,135.
The Ford government’s now-repealed Bill 124, which limited public sector pay increases to one per cent per year for three years, led scores of nurses to leave the profession over low wages, critics say.
Blame the system
Despite her painful experience, Luciano said she had no ill will towards the frontline workers she dealt with while in an “unconventional space” at Southlake Regional Hospital.
Her anger was reserved for those in charge of the system.
“These young doctors and nurses I encountered are facing their own trauma of being caught in the cross-hairs of politics and witnessing the frontline collapse of the current healthcare system and its lack of funding for more hospitals and walk-in clinics. They are really trying hard to do the best with what they have and are doing so under a great deal of stress, overworked and on little sleep,” she wrote.