Operational Direction: Fall/Winter Readiness and Response 2024-2025

Thank you for your ongoing efforts over the spring and summer to advance key access and capacity measures, as outlined in April’s Operational Direction: Priorities for Spring/Summer 2024. We have seen progress in several priority areas, with early implementation of primary care team expansion, development of primary care networks, increasing enrollments in the Ontario Structured Psychotherapy Program, and reductions in ambulance offload times.

Even with this progress, the number of patients in hospital designated as alternate level of care remains high, contributing to high hospital occupancy heading into the fall. Hospital measures serve as an important proxy for the overall system.

Current projections for fall/winter suggest that respiratory viruses will follow a similar pattern to last year. COVID-19 and RSV activity will likely begin to rise in September, influenza activity will begin to rise in November, and hospitalizations will peak in January 2025. To prepare for this seasonal surge, we will continue to work to advance access and capacity measures while using tools such as vaccination, COVID-19 treatments, and new RSV prevention products to reduce the impact of respiratory viruses.

This operational direction outlines priorities for fall/winter readiness and response, building on experience and learnings from past respiratory illness seasons. As always, your Ontario Health regional and provincial teams are available to respond to questions and for support. Thank you for all that you do to provide care for the people of Ontario.

Operational direction

All sectors:

• Prioritize collaborative efforts to achieve a 10% reduction in ALC volumes to support fall/winter surge.
  • Implement Operational Direction: Home First and adhere to the ALC Leading Practices Guide.
• Promote Health811 for non-urgent health inquiries and questions to support appropriate use of services.
  • Use the communications materials on the Health811 Resource Hub to promote awareness of Health811, including key messages, social media imagery, digital screen content, and posters (contact communicationsandengagement@ontariohealth.ca for access).
• Review and update your organization's Healthline profile to ensure that hours of operation and other information is accurate. This will ensure that patients are directed appropriately via Health811.
  • To update your profile, find your location on the Healthline webpage and click “Submit content”.
• Ensure patients are aware of services available through pharmacies, including influenza and COVID-19 vaccines, COVID-19 treatment, and treatment for minor ailments.
  • Refer to the public-facing information available from the Ontario College of Pharmacists.
• Implement strategies to maximize uptake of influenza vaccines, COVID-19 vaccines, and RSV prevention products among health care providers, patients, residents, clients, and caregivers.

Primary care:

• Prioritize immunization, testing, and treatment for COVID-19, influenza, and RSV in accordance with the most recent guidance, in collaboration with public health units and other partners.
  • Proactively assess patients and residents to develop a treatment plan in advance of potential COVID-19 infection to ensure the appropriate treatment can be started as quickly as possible. Review Ontario Health's resources on the treatment of mild to moderate COVID-19.
  • Prioritize implementation of the newly expanded infant RSV prevention program. Review the Ministry of Health's resources for health care providers and patients, as well as the Provincial Council for Maternal and Child Health's resources.
• Engage with your local Ontario Health Team (OHT) to become involved in a Primary Care Network.
  • Refer to the guidance on primary care networks in OHTs.
  • Reach out to your Ontario Health region if you need contact information for your local OHT.
• Share information about where patients can access care in the community during the holiday season, including holiday practice hours, coverage, and other care options such as Health811 and virtual urgent care services in the region.

Home and community care providers:

• Implement section C of Operational Direction: Home First (released August 14, 2024), focused on supporting patients at home and returning patients home with the appropriate supports.
• Work with your Ontario Health region and local OHTs to finalize home and community care (Ontario Health atHome, service provider organization, and health service provider) surge plans, including:
  • Regional and local plans to increase discharge from hospital to home care and reduce open volume of ALC waiting for home and community care services; and
  • Regional and local plans to achieve wait times targets for home care clients who receive nursing and personal support (for clients with complex needs) within a minimum of 5 days from the date they were authorized for nursing or personal support services.

Community support service providers:

• Implement section D of Operational Direction: Home First (released August 14, 2024), focused on supporting patients at home and returning patients home with the appropriate supports.
• Participate in regional tables and structures (e.g., access and flow tables) to foster collaboration and increase awareness of supports available.
• Ensure local partners, including hospitals and Ontario Health atHome, are aware of existing capacity.
• For congregate living settings, connect with local Infection Prevention and Control (IPAC) Hubs to access IPAC expertise and support where needed (contact IPACHubs@ontario.ca for more information).

Mental health and addictions service providers:

• Develop referral pathways and refer clients with depression and anxiety-related disorders to the Ontario Structured Psychotherapy Program.
• For community-based mental health and addictions service providers, implement section D of Operational Direction: Home First (released August 14, 2024), focused on supporting patients at home and returning patients home with the appropriate supports.

Long-term care homes:

• Prioritize immunization, testing, and treatment for influenza, COVID-19, and RSV in accordance with the most recent guidance, in collaboration with public health units and other partners.
• Proactively assess residents and develop a treatment plan in advance of potential COVID-19 infection to ensure the appropriate treatment can be started as quickly as possible.
  • Review the Ministry of Health's Recommendations for Outbreak Prevention and Control in Institutions and Congregate Living Settings.
  • Review Ontario Health's resources on the treatment of mild to moderate COVID-19.
• Reduce transfers to the emergency department through improving clinical capacity of long-term care homes by the provision of best-practice on-site nursing care (e.g., expansion of NLOTs and attending NP program, where applicable), ensuring access to primary care, and increasing access to in-house or community-based diagnostic resources.
• Plan in advance to ensure appropriate resources and capacity are available during the holiday season to continue accepting new residents and maintain occupancy.
• Connect with local IPAC Hubs to access IPAC expertise and support where needed (contact IPACHubs@ontario.ca for more information).

Hospitals:

• Prepare surge plans to accommodate 120% inpatient capacity and increased emergency department volumes. For post-acute care hospitals, maintain an occupancy rate of at least 95% and work toward matching the occupancy levels of surrounding acute care hospitals.
• Implement sections A and B of Operational Direction: Home First (released August 14, 2024), focused on supporting patients at home and returning patients home with the appropriate supports.
• Aim to maintain coverage for specialty patient populations and services that require urgent access during holiday periods.
• Continue to maximize access to surgeries and procedures, including prioritization of patients waiting beyond clinical access targets in alignment with regional targets.
• For hospitals with emergency departments, leverage P4R funding as reflected in action plans to improve performance on P4R metrics.
  • Note that the provincial ambulance offload time (90th percentile) is now below the P4R target of 60 minutes thanks to focused efforts. Sites that have achieved the 60-minute target should continue their efforts with a new target of 30 minutes or less.
• For hospitals with obstetrics programs/birthing centres, prioritize implementation of the newly expanded infant RSV prevention program. Review the Ministry of Health's resources for health care providers and patients, as well as the Provincial Council for Maternal and Child Health's resources.

OHTs:

• Support collaboration and mobilization of OHT partners to respond to local, regional, and provincial priorities (e.g., fall/winter surge), including in primary care and in developing equitable care pathways for priority populations.