‘Pain crisis’: Inside the supply shortage that devastated Ontario’s home care system

Documents reveal how a cost-cutting merger led to palliative patients dying without medication or nutrition

EDITOR’S NOTE: This article originally appeared on The Trillium, a Village Media website devoted to covering provincial politics at Queen’s Park.

As Ontario’s home-care agency battled a severe supply shortage in 2024, officials logged in detail how a move that was supposed to save taxpayer money turned into a nightmare.

These internal memos, emails and notes, obtained by The Trillium through the freedom-of-information system, explain how health-care workers improvised medical supplies from everyday objects, “bartered” for necessities and cared for patients who died in pain, unable to access medication or nutrition.

They reveal not just chaos during the shortage, but also the red flags that were ignored before it began.

Created by the Ford government in June 2024, Ontario Health atHome (OHaH) manages long-term care placements and in-home support, from bathing to end-of-life palliative care. The agency also runs over 135 community nursing clinics.

The merger of several regional agencies to create OHaH was meant, in part, to “capture better value for health care dollars” by centralizing purchases of medical supplies, according to a mandate letter from Health Minister Sylvia Jones.

According to an internal OHaH memo, the move would save taxpayers an estimated $156 million over five years. The annual $31 million savings amounts to about one and a half times what the government spent on ads about how it was “building a better health care system” in 2022-23.

Desperate measures and a ‘pain crisis’

Ontario Health atHome completed its consolidations on Sept. 24, 2024, moving from 65 medical supply contracts to 15, including just two main purchasers.

Internal memos and health-care workers’ notes show the crisis began almost immediately.

By early October, an agency memo noted a “high volume of urgent orders” for antibiotics and symptom response kits (SRKs) — packs of medication to manage acute end-of-life symptoms like pain, nausea and anxiety.

Weeks later, the southwest region was seeing “late or only partial deliveries” of SRKs, according to a summary of health-care workers’ notes at the time.

“One resulted in a pain crisis for a palliative client,” the notes read.

Over the next month, the agency’s system logged 1,562 “incidents,” according to a memo OHaH prepared for the Ministry of Health.

“A key theme,” the memo read, “was incomplete supplies and missing doses causing distress prior to succumbing to illness.”

“In three known cases, palliative patients died without pain medications and one patient died without nutrition because supplies were delayed,” it said.

Palliative care is mainly about “keeping a person comfortable,” said Jane Meadus, a lawyer with the Advocacy Centre for the Elderly (ACE), in an interview with The Trillium.

Without medication, the end of one’s life can suddenly become filled with “a lot of pain,” and a loss of dignity, she said.

The crisis wasn’t limited to end-of-life care. As the supply chain fractured, standard medical equipment became scarce, then disappeared, driving nurses and patients to desperate measures, detailed in notes from health workers in every part of the province.

Soon after the transition, service providers had to raid their community clinics’ stockpiles of supplies, leaving them “[severely] depleted,” according to an OHaH briefing note.

With little to no supplies left, clinics sent patients to emergency rooms to get IV antibiotics. However, some refused “as they cannot afford [the] ambulance fee” of $45, another issues summary read.

As the shortage deepened, health-care workers detailed how they were forced to improvise.

In Toronto, “wreath hangers [were] sent to client homes as [a] substitute for IV poles.”

In Hamilton/Niagara, a nursing manager “went to [redacted] and bartered supplies” so the clinic didn’t have to turn patients away. It’s unclear what the nurse traded, and with whom.

Months after shortages began, patients were still being sent “incompatible” or “poor quality” substitutes that had to be thrown away, health workers wrote.

Nurses complained of leaky catheter bags and incontinence pads, poor-quality gauze, tape and injection kits, and “expired supplies,” like the anticoagulant used to flush intravenous lines and prevent blood clots.

Eventually, critical supplies ran out. Catheter bags and nephrostomy bags, which hold urine drained from the kidneys, were on backorder, and no amount of bartering or creativity could help.

Some patients were left with only one choice.

“Clients having to reuse supplies as there are not enough appropriate [nephrostomy] bags available,” read a note from early December 2024.

Health worker notes from different parts of the province also revealed a lack of co-ordination.

In the southwest, patients’ orders for nephrostomy supplies were “changed” to catheter supplies — while at the same time, in Hamilton/Niagara, orders for catheter supplies saw nephrostomy supplies delivered instead, according to health worker notes.

Multiple patients received orders meant for others, which “then cannot be returned,” according to several health worker notes.

Sometimes, clients received what they thought were supplies, but turned out to be IOUs.

“Clients are receiving empty boxes with notices indicating that their supplies are on backorder,” wrote Deborah Simon, then the Ontario Community Support Association’s CEO, in a letter to Cynthia Martineau, OHaH’s CEO at the time.

Other supplies were marked as delivered, but never showed up, Simon wrote — an issue noted multiple times by health workers.

One delivery arrived at 2 a.m., causing a patient to think “he was being robbed,” according to health worker notes in Hamilton/Niagara.

One regional summary describes the bureaucratic hell health workers had been wading through for weeks. Nurses had “no visibility” into what was in stock, read the November 2024 notes.

“If supplies are ordered by [a] nurse and they are out of stock, OHaH will just remove them from the nurse’s order with no notification to [the] nurse or client. The supplies are just not delivered and no substitute is provided,” the notes read.

The ordering system caused false hope for some patients, as supplies were sent to clinics with patients’ names on them, when they were meant for the clinic itself, the summary reads.

“Clients are being called to pick up their orders when it’s a nurse’s replenishment order,” the notes read.

An “escalation line” set up by OHaH the month after the crisis began was supposed to provide answers for patients and care providers. 

It was quickly overwhelmed.

Health workers wrote that there was “often no answer” from the line, and when someone did pick up, it could take 45 minutes or more to get through. When they did, those staffing the line sometimes evaded questions or refused to give out information without patients’ billing reference number, a bureaucratic signifier “which patients often don’t know,” the notes read.

Meadus said organizations and governments have to take a hard look at what they could lose when they change from small, “nimble” contracts to much larger ones.

“Health care isn’t just about the dollars we spend,” she said. “It’s about quality.”

Notes and memos can’t fully capture the human cost of the crisis, added Meadus.

“(You have) increased pain, you’re not getting wound care, so does that mean that the wound is getting infected? Is it staying longer?” she said.

“It just wears on the psyche of people,” she said. “You’re already sick, you already have issues, and now you’re having to try to battle a bureaucracy, and I think that many people just don’t have the wherewithal or the ability to do that.”

Children’s medical supplies missing

The crisis appears to have affected not just seniors but pediatric patients as well.

Several regional formularies, or approved lists of medical supplies, were combined into one under the new system — but evidently, important items for children were left off, forcing the agency to ask Toronto’s Hospital for Sick Children (SickKids) for help.

An OHaH memo written two weeks after the changeover said the agency was “working with our suppliers and vendors” to add supplies to its formulary.

“In the meantime,” OHaH asked SickKids to supply the missing items from its own stockpile “to avoid delays in discharge and support health system flow.”

The agency worked with SickKids and other pediatric hospitals “to review and identify gaps in the formulary for hospital-based pediatric supplies as well as create a pediatric urgent care kit,” according to an OHaH memo.

The formulary was finally updated on Dec. 17, 2024, nearly three months after the crisis began. A type of catheter, insulin syringes and blood thinners were added, the memo reads.

In a statement, SickKids said it “regularly collaborates with Ontario Health atHome on initiatives related to home care for children and youth being discharged home from the hospital.” It did not answer questions about how pediatric patients were affected by the shortages.

SickKids and OHaH did not say what was in the pediatric urgent care kit, or why the agency scrambled to create one.

No turning back

Signs of trouble appeared months before the new system launched.

It was supposed to go live in June of 2024, not September. But the date was pushed back after vendors requested “additional time to get ready,” according to a November 2024 memo from Martineau, the then-OHaH CEO. 

Medical supply providers (MSPs) — the vendors that buy items directly from manufacturers — got a two-month extension, to Aug. 12, 2024.

Fulfillment and infusion service providers, which buy the medical supplies from the MSPs and deliver them to patients’ homes, were given until Sept. 24, 2024.

Vendors were told the date was “firm and there would be no further extensions,” Martineau wrote.

But by then, it was too late to change course.

“Making a go/no-go implementation decision immediately prior to implementation was not feasible,” Martineau wrote.

The previous suppliers had a 30-day termination clause and had already “prepared to stand-down,” she wrote, leaving the province with no safety net.

Adding to the issues were “deficiencies in the initial forecasts” — ordering patterns “far exceeded forecasted demand” shortly after the new system launched, Ontario Health atHome wrote in an internal memo.

Meadus wondered how OHaH failed to anticipate the demand for medical supplies.

“I don’t understand how the demand changed between the change of vendors,” she said.

Ontario’s patient ombudsman’s report on the shortages found that OHaH was “surprised” by the transition issues and “had no contingency plans in place.”

He wrote that he “observed an attitude of complacency” as previous, much smaller contract changes had “gone smoothly.”

“There was not enough time to properly implement a model of this scale,” he added, with several of those he spoke to estimating an appropriate timeline of 18 months, instead of the eight initially allotted.

“The timing was largely outside of Ontario Health atHome’s control given the funding parameters of the Ontario government and the dates on which the [request for proposals] process was completed,” the patient’s ombudsman wrote.

What the partially redacted documents don’t reveal is whether there was any “political pressure” on Ontario Health atHome to move quickly, Meadus said.

“There seemed to be some issues that arose, and then there seemed to be a time when it was like, ‘No, we’ve got to go ahead now,’” she said.

“Because I don’t think it was Ontario Health atHome that came up with this idea,” she said. “It was the government.”

Government, OHaH point fingers

Martineau, the Ontario Health atHome CEO during the shortage, was fired in January 2025, four months after the crisis began.

After the patient ombudsman’s report came out in September 2025, Ontario Health atHome offered “a heartfelt apology to the patients, families and caregivers who were impacted by these changes.”

The agency said at the time that it had improved its oversight and streamlined processes to “build a more responsive and resilient medical equipment and supply system that prioritizes patient care.”

Ontario Health atHome has implemented all of the patient ombudsman’s recommendations, and the ombudsman “is satisfied with this response,” spokesperson Amber Lepage-Monette said in a statement.

The agency also reimbursed patients and caregivers who had to purchase supplies out of pocket. As of Feb. 11, 2025, it paid out 932 reimbursement claims totalling $590,125, according to the ombudsman.

Ontario Health atHome and Jones’ office did not address several detailed questions about the documents. Both parties pointed to someone else as the root cause of the crisis.

Jones’ spokesperson, Ema Popovic, said OHaH “failed in its basic responsibility to patients, caregivers, and families.”

OHaH said the “issue with the vendor that led to the disruption” was “unacceptable.”

In addition to its escalation line, OHaH spokesperson Faadia Ghani said the agency spoke to clinicians to help revise its formulary, worked with vendors and Supply Ontario to address the shortages, updated service providers, physicians, palliative care, hospitals and vendors throughout the crisis, and has since placed more of an emphasis on “patient and family engagement.”

“Many of these actions were closely aligned with the Patient Ombudsman’s recommendations, and the steps we took to resolve the challenges were recognized in the Ombudsman report,” Ghani said.

“While the issue has been resolved for over a year, we continue to apply lessons learned to strengthen the delivery of medical and equipment supplies, ensuring this sort of disruption never happens again,” she said.