Operational Direction: Fall/Winter Readiness and Response 2025-26

Thank you for your dedicated work over the spring and summer to advance key access and capacity measures, as outlined in May’s Operational Direction: Priorities for Spring/Summer 2025. We have seen progress in several priority areas, including a sustained reduction in the number of patients designated alternate level of care (ALC) in hospitals. We have also made progress reducing surgical waitlists and are seeing the positive impact of investments in primary care.

As expected, we saw a small seasonal increase in COVID activity and other pressure metrics in September-October with return to school. Peak acute bed occupancy is projected in early to mid-January, when COVID-19, influenza and RSV in seniors typically peak along with a surge in ALC open cases. We anticipate fewer RSV-related hospitalizations this year, thanks to the hard work of health service providers in administering immunizations to infants and seniors 75 and older. Our modelling draws on data from Ontario and the southern hemisphere and assumes viral hospitalization patterns will progress similarly to previous seasons. Updates and changes to this forecasting will be reported through our regional tables.

As always, we strive to work together as a unified system. Our joint focus this year is aimed at reducing overall system pressure. One central measure of success will be maintaining hospital occupancy (a surrogate marker for overall system performance and flow) at or below the levels seen in 2024-25. Priorities include:

• Supporting greater immunization uptake among health providers and eligible populations
• Continuing to improve transitions and flow between care settings
• Increasing attachment to primary care and advancing integrated care planning
• Continuing to advance surgical access, with a continued focus on reducing “long waiters” and increasing the percentage of patients receiving procedures within target wait times
• Continuing to build health human resources capacity

Please reach out to your Ontario Health regional and provincial teams with any questions. Thank you for all that you do to provide care for the people of Ontario.

All Sectors

• Implement strategies to promote, create access to, and maximize uptake of COVID-19, influenza, and RSV (if eligible) immunizations among health care providers, patients, residents, clients, and caregivers.
  • Collaborate with local partners including public health units to develop and amplify consistent messages promoting vaccines and where they can be assessed in communities.
• Prioritize collaborative efforts to achieve a reduction in ALC volumes to support fall/winter surge.
  • Continue adherence to the Home First Operational Direction and ALC Leading Practices.
  • Work with Ontario Health regions and Ontario Health atHome to actively manage and prioritize placement of patients designated ALC, to the most appropriate settings based on patient need and local or site-specific surge status.
• Establish and maintain communications and mitigation protocols that enable rapid information sharing and guidance during staffing challenges, including following established protocols related to risks of emergency department (ED) closure.
• Promote Health811 for non-urgent health inquiries and questions, including links to virtual urgent care clinics.
• Review Ontario Health’s new drug therapy pathway tool and resources on the treatment of COVID-19.
• Work with palliative care specialists and champions embedded in community and acute care services to develop plans of care for patients with high symptom burden/advanced illness that reduce avoidable acute care visits.
• Review December holiday staffing plans to support continued access to care over this period.
• Participate in collaborative regional tables (e.g., Situational Awareness Tables) to support optimization of patient flow and system resources.

Primary Care

• Actively support immunization delivery for all eligible populations by leveraging partners and supporting Ontario Health Teams (OHTs), primary care networks (PCNs), public health units, interprofessional primary care teams, pharmacies, wellness clinics, and other local partners. Specifically:
  • Continue to encourage regular immunizations across the lifespan per Ontario's routine immunization schedule.
  • Continue to focus on RSV prevention programs for infants and older adults, including providing information/guidance to pregnant patients.
• Continue to support the priorities outlined in Ontario’s Primary Care Action Plan. Specifically:
  • Work with OHTs and PCNs to coordinate attachment of patients from the Health Care Connect waitlist to primary care, in partnership with local clinicians and Ontario Health atHome Care Connectors.
  • Encourage unattached patients to register with Health Care Connect.
• Clearly communicate patient care options for after-hours, weekend, and holiday periods.
• Prepare for the season by utilizing existing navigation tools and local knowledge, such as:
  • Health811 resources for patient self-management as well as OHT navigation platforms describing local services.
  • The Centre for Effective Practice’s Seasonal Preparedness Resource.

Home Care

• Work with Ontario Health regions 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 prevent ED visits and increase discharge from hospital to home care to reduce open volume of ALC waiting for home and community care services, including via new and expanded programs such as Hospital-to-Home.
  • Regional and local plans to minimize wait times to five days or less for home care clients from hospital and community.
• Work with public health units and other health system partners to administer COVID-19, influenza, and RSV vaccines to clients in the home.
• Work with providers of hospice residence beds to ensure that available hospice bed capacity is communicated regionally and that there are no undue admission delays.
• Review December holiday staffing plans to support continued access to care over this period. Staffing plans should ensure supports in hospitals are available to maximize discharges over the holiday period.

Community Support Service Providers

• Ensure local partners, including hospitals and Ontario Health atHome, are aware of existing capacity through regional collaborative tables, including palliative care services and available grief and bereavement services.
• Work with your Ontario Health region and local partners, including Ontario Health atHome and public health units, to implement immunization strategies for congregate and group settings that will allow for convenient access to immunizations, reducing caregiver burden in managing appointments (e.g., immunization clinics at drop in or day programs).
• Work with your local partners to disseminate information about respiratory season immunization clinics and where to seek care to clients of your programming, for example, with Meals Delivery.
• For congregate living settings, connect with local Infection Prevention and Control (IPAC) Hubs to access expertise and support on developing and reviewing your respiratory season preparedness plans, including IPAC refresher training for staff (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.
• EDs and community providers implementing the Substance Use Disorders Integrated Care Pathway should continue to work to implement the pathway and to ensure that clients presenting to the ED transition to community-based services where appropriate.
• Providers implementing Homelessness and Addiction Recovery Treatment Hubs (HART Hubs) should ensure services, including but not limited to MHA supportive housing, are launched in accordance with identified timelines to reduce winter exposure.

Long-Term Care Homes

• Work closely with public health, IPAC Hubs and other health system partners as appropriate to ensure preparedness for the upcoming respiratory season.
  • Conduct IPAC audits and refresher trainings.
  • Order PPEs and testing kits and identify antiviral treatment supply in the community.
  • Review and validate outbreak management response with public health.
  • Pre-assess residents and receive consent for antiviral treatment in advance.
  • Speak with public health and with residents and their families in advance about repatriation to home in outbreak and document consent.
• Communicate the importance of vaccines in the home to prevent severe illness during the respiratory season and promote uptake.
  • Work closely with public health units and local health system partners so that homes can offer on-site vaccine clinics for the staff, residents and, where possible, caregivers.
• Review and respond to LTC applications within five business days of receiving application, aiming to expedite responses within peak surge periods where possible.
• Communicate with Ontario Health regional teams, the Ministry of Long-Term Care and Ontario Health atHome regarding occupancy and any changes in bed capacity within 24 hours.
• Leverage partnerships, including with IPAC Hubs, nurse-led outreach teams, Behavioural Supports Ontario, Community Paramedicine Programs, Palliative Pain and Symptom Management Consultants, etc. to limit resident transfers to the ED and support repatriation after hospital admissions. Utilize supports and resources provided by the Ontario Caregiver Organization (the Essential Care Partner Support Hub) to ensure caregivers are identified, included and supported as essential care partners.

Hospitals

• Ensure hospital-to-home programming is operating at full capacity and regularly performance managed to reduce ALC open volume and medical and surgical bed occupancy.
• Prepare surge plans to accommodate increased inpatient capacity and ED volumes. Surge plans should first focus on close management of admission and discharge rates, length of stay, and surgical activity before opening beds. Hospitals should contact their Ontario Health region as soon as possible if they are anticipating opening beds beyond 2024-25 levels.
• Outline potential changes to beds/services/programs (e.g., closures) to your Ontario Health region before they occur.
• Continue to follow a person-centred admission process aligned with organizational consent policy that includes early conversations about potential transfer to another hospital as appropriate.
• 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.

Surgeries

• Be prepared to actively manage surgical volumes in response to hospital capacity and potential region-wide hospital capacity pressures, in collaboration with your Ontario Health region. Pediatric surgeries, cancer surgeries, cardiac surgeries and “long waiters” (i.e., patients waiting beyond clinical access targets) should be prioritized, with a goal of 85-90% of patients receiving procedures within target wait times.
• Follow direction from your Ontario Health region regarding regional surgical networks/partnerships to optimize access, equity, and throughput and minimize cancellations and ramp-downs.

Medical imaging

• Optimize medical imaging capacity (including CT and MRI) to facilitate access and flow through and between hospitals. This includes ensuring patients receive all appropriate diagnostic workups at the hospital where they first present before transfers to other centres are initiated.
• Expedite imaging for patients in the ED to reduce length of stay, and enhance access for semi-urgent patients (e.g., priority level 3) to enable timely treatment decisions for cancer diagnosis and staging.

Hospitals with EDs

• Leverage the actions and practices from the ED Leading Practices Toolkit Action Plans.
• Leverage the ED Peer-to-Peer Program to access highly skilled emergency medicine physicians 24/7 by video or phone.
• Utilize the training opportunities and grants available through the ED Nursing Education, Retention and Workforce Program to support nurses working in EDs.
• Employ Pay-for-Results (P4R) Program funded initiatives to maximize ED performance, quality and patient experience.
• Continue to collaborate with Ontario Health to support performance monitoring.
• Continue to provide ongoing ED Shift Closures monitoring, mitigation and tracking.
• Review December holiday staffing plans, clinical and community resources to prevent need for patients to rely on the ED as the only available option for care.

Hospitals with obstetrics programs/birthing centres

• Support the uptake of the Infant RSV Prevention Program, with a goal of 90% uptake for in-season births. 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.

Ontario Health Teams

• Support collaboration and mobilization of OHT partners to respond to local, regional, and provincial priorities, including primary care and developing care pathways that promote equitable access for priority populations. As outlined in the 2025-2026 OHT TPA amendment, provincial priorities include:
  • Primary care enablement:
    • Coordinating the matching and referral of patients from the Health Care Connect waitlist to primary care, in partnership with Ontario Health atHome Care Connectors.
    • Working through PCNs with local clinicians to coordinate and support the submission of proposals for new and expanded IPCTs.
    • Continuing to advance the OHT’s PCN to support participation in OHT decision-making and local and regional PCN leadership tables, advance OHT/PCN clinical initiatives, and participate in fall/winter surge planning (e.g., coordinating the provision of immunizations for eligible populations and the availability of after-hours and weekend care, where possible).
  • Integrated clinical priorities:
    • Continuing to implement Integrated Clinical Pathways, chronic disease prevention and management models, and Home Care Leading Projects (for OHTs already involved in these initiatives).
    • Work to develop and implement an ALC action plan aligned to Ontario Health regional ALC planning.