OP-ED: 60 hours in a hallway – Ontario’s unfinished promise to end hallway medicine

"Mrs. James is an 80-year-old widow who’s been waiting nearly a year for a long-term-care bed. She lives alone in Etobicoke and can no longer prepare meals, dress, or shower without assistance."

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Author: Ingrid Gahsner

Mrs. James is an 80-year-old widow who’s been waiting nearly a year for a long-term-care bed. She lives alone in Etobicoke and can no longer prepare meals, dress, or shower without assistance. Last Wednesday morning, she fell in her apartment and struck her head. Unable to stand, she called out for help until a passerby alerted the landlord, who unlocked the door.

Paramedics brought her to Etobicoke General Hospital. There, she spent the next 60 hours on a stretcher in a hallway, waiting for an inpatient bed.

For more than two days, she lay under fluorescent lights, surrounded by noise, foot traffic, and the constant activity of a busy corridor. She was given pain medication to keep her comfortable. When she was finally transferred to a ward late Friday night, she woke the next morning, looked at her son, and asked what day it was — shocked to learn it was Saturday. Mrs. James does not have dementia, but after drifting in and out of sleep in full light, medicated, and with no sense of time or privacy, it was entirely reasonable for her to believe she was still in the first day of her admission.

This may sound over dramatized, but it isn’t. It is the new normal in Ontario’s hospitals, happening to ordinary patients every single day. And to be clear, Mrs. James’s wait was not the result of neglect by nurses or doctors. It was the direct result of overcapacity — a predictable consequence of structural problems in healthcare that remain unaddressed year after year.

A System That Can’t Keep Up

Mrs. James isn’t my client — but her daughter-in-law is. And when she told me what happened, I wasn’t surprised. It’s the kind of experience I hear about every day — the inevitable consequences of a healthcare system where small tears have been ignored for so long that the entire fabric is now beginning to unravel.

Hallway medicine isn’t happening because we have bad doctors or indifferent nurses. Ontario’s healthcare professionals are working past the point of exhaustion, delivering exceptional care within a structure that has not been meaningfully updated in decades. They are holding the system together, not causing its failures.

Hospitals are overwhelmed because every part of the care continuum depends on the one before it — and when one link falters, strain spreads across the entire chain. A delay in long-term care becomes a delay in discharge. A delay in diagnostics becomes a delay in treatment. A delay in primary care becomes a surge in emergency rooms. Each pressure point compounds the next until the entire system buckles under cumulative strain.

And to be clear, overcapacity isn’t the cause — it’s the result. It is the predictable outcome of a healthcare model that has not been structurally modernized in more than forty years. Let’s look at some of the reasons why situations like Mrs. James’s 60-hour wait are no longer unusual.

First, patients who no longer need hospital level care — often seniors — can’t be discharged because there is nowhere else to send them. Long-term-care homes and rehabilitation facilities are full, so these patients remain in hospital beds that another patient urgently needs.

Second, the diagnostic system is congested. Ontario has fewer MRI and CT scanners per capita than most OECD countries — a trend consistently highlighted in national and international comparisons, and most operate only during the day. Because diagnosis is required to move patients through the system efficiently, delays in imaging slow down every subsequent decision, keeping patients in hospital longer.

Third, hospitals are funded to operate at maximum occupancy and are penalized financially if they’re not full. This forces hospitals to run at 95–100 percent capacity on a normal day just to maintain their funding, leaving no room for seasonal surges, staffing shortages, or unexpected spikes in demand. In practice, our system requires them to operate like a fully booked hotel at all times.

Fourth, the collapse of primary care is driving unnecessary ER visits. Millions of Ontarians cannot find a family physician or get timely appointments, pushing them into emergency rooms for issues that should be handled in the community. ERs are now performing the role of primary care clinics — a role they were never built to handle.

Fifth, staffing shortages are not a shortage of people — they are a shortage of sustainability. Ontario is losing nurses due to burnout, mandatory overtime, unsafe patient ratios, and the moral stress of not being able to deliver the highest level of care. When a hospital has 30 physical beds but staffing budgets for 22, the remaining eight beds sit empty, deepening the capacity crisis without the public ever seeing it.

Finally, Ontario functions within a fragmented national healthcare structure. Canada does not have a coordinated, integrated healthcare system — it has 13 provincial and territorial models operating independent of each other. This leads to drastic regional differences and prevents hospitals from balancing patient loads across borders even when nearby facilities have space.

These are not frontline failures. They are design failures — the real reason why Mrs. James spent 60 hours in a hallway without a single room becoming available.

According to the Ontario Medical Association and Ipsos (2025), 59 percent of Ontarians feel the provincial government has failed to deliver on its 2018 promise to end hallway medicine. Based on situations like Mrs. James’s, that perception is not misplaced. The average wait for patients admitted from Ontario emergency departments is 19.2 hours, according to Health Quality Ontario — and that’s just to get a bed, not to receive treatment. For unknown reasons, Mrs. James waited three times longer.

The Political Math Doesn’t Add Up

Premier Doug Ford’s promise to end hallway medicine was made seven years ago. Yet this practice still defines Ontario’s hospitals today — not because of a lack of effort by frontline staff, but because the underlying structure isn’t evolving.

Ontario’s population has grown by more than one million people in the past five years, while the number of staffed hospital beds has barely changed. According to the Financial Accountability Office of Ontario, the province faces a $21.3-billion funding shortfall in the health sector between now and 2028. Nearly half of Ontario’s hospitals ran budget deficits in 2024.

Meanwhile, billions continue to flow toward temporary staffing agencies just to keep wards open. A report by the Canadian Centre for Policy Alternatives found that Ontario hospitals spent $9.2 billion on private agency nurses and temporary staff between 2013 and 2023. That isn’t a solution — it’s a symptom of a workforce stretched too thin, and a funding model built on short-term patches.

But the pressure isn’t only provincial. Ottawa’s latest budget signaled a shift that will make stabilization even more difficult. Days ago, the federal government confirmed that while the Canada Health Transfer will increase by 5 percent annually until 2028, future growth will fall to a minimum of 3 percent per year — tied to nominal GDP.

In practical terms, this marks the end of meaningful federal health funding escalation. Provinces already struggling with overcapacity, staffing shortages, and structural bottlenecks will now be expected to manage rising demand with slower funding growth. How they are supposed to do more with less remains unclear — especially as the population ages and the complexity of care increases. What is clear however is that this funding trajectory moves in the opposite direction of the province’s needs, narrowing the space for real, long-term reform.

When Access Becomes the Risk

In risk management, we assess not just the severity of a threat, but its likelihood. Delayed access to care in Canada has now become both predictable and widespread — which means it’s a risk that must be anticipated and planned for. Mrs. James’s experience is heartbreaking, but far from unique.

We call our system universal — available to everyone, regardless of income, age, status, or circumstance. But universality means little when access is rationed by time. If you can wait, you’re covered. If you can’t, you face the consequences. A universal promise without timely care is universal in theory, not in practice.

This isn’t an indictment of public healthcare — it’s a reality check on what happens when structural reform is replaced by political reassurance. Each year brings a new announcement, a new funding envelope, a new initiative. Yet none of these address the core design flaws. Until the foundation changes, hallway medicine will remain inevitable.

And this is precisely where Access Risk emerges — the risk of not being able to obtain care when you need it. For decades, Canadians planned for what happens after a medical crisis: disability, recovery costs, lost income, even death. We’ve never had to plan for the possibility that the system itself wouldn’t deliver. Now that delayed care is predictable, the risk created by those delays becomes predictable too.

That means planning is no longer optional. Families must consider not only the medical event, but the wait attached to it — and what that wait will cost in health, independence, and financial stability. Access Risk is no longer theoretical. It has become one of the most significant and overlooked risks facing Ontarians today.

A Promise Unkept

Mrs. James was eventually transferred to a room, stabilized, and placed back on the waitlist for long-term care. She remains in hospital, occupying a bed she no longer medically needs.

Ending hallway medicine was supposed to restore dignity to patients like her. Seven years later, we’re still waiting for that promise to reach them.

Ingrid Gahsner is a Risk Management Consultant and author of Off the Waitlist: A Practical Strategy for Canadians Who Can’t Afford to Wait.