Registed Nurses' Association of Ontario

A message to Premier Ford and Minister Fullerton RE: Jan. 8, 2021 directives

A message to Premier Ford and Minister Fullerton RE: Jan. 8, 2021 directives

Feb. 3, 2021

Hon. Doug Ford, Premier
Hon. Merrilee Fullerton, Minister of Long-Term Care
Legislative Building, Queen’s Park
Toronto, ON M7A 1A1

Dear Premier Ford and Minister Fullerton,

We are writing to express our grave concern regarding the Jan. 8, 2021 directives, outlined in a Jan. 27, 2021
memorandum to long-term care (LTC) home licensees across Ontario. While RNAO, along with NPs and all
nursing staff in LTC always adhere diligently to all government directives, these particular directives are cause for
serious concern.

We know that you join all nurses in our collective understanding of the importance of relating to nursing home
residents. This means always remembering first and foremost that LTC homes are the primary residence for our
vulnerable seniors. These are the places that residents call “home.” We also know that you understand that the
most crucial shortfall in our LTC homes is the dire shortage of nursing and support staff.

RNAO has received numerous calls of serious concern from LTC NPs, RNs, RPNs, PSWs and essential care
partners regarding the presence of “third party oversight” – in the form of guards – at the entrances to LTC
homes. To summarize these concerns – which RNAO shares – having a guard at the entrance to a LTC home is
flawed from at least two perspectives.

First, this is akin to having a guard at the entrance of one’s personal residence. Unless there are serious and active
threats, this approach should not be utilized at the “homes” of LTC residents. Nursing staff question why security
for this purpose is needed at all. Instead, we suggest the funds needed for this purpose should be funneled into
more staffing for LTC homes. This funding could enable homes to hire more caregiving and screening personnel.
The best security for LTC residents and staff is adequate staffing. This is something RNAO has been actively
advocating for well over a decade, including in meetings and consultations with Minister Fullerton and
throughout the entire COVID-19 pandemic.

The second area of deep concern is the directive regarding the rapid antigen testing requirement to be carried out
on LTC staff multiple times per week, and on essential caregivers on each visit. While there may be some
advantage to the rapid antigen testing (i.e. the rapidity of results), this directive will tax LTC staff even further. LTC homes will be so busy fulfilling these testing directives, there will be little time left to provide the most basic
care to residents. This rapid testing requires at least 25 minutes per test for documentation of consent,
performance of the testing, waiting for results and documenting those results for each staff member multiple times
per week. Staff will need to be in a “holding pattern” as they wait on a negative result to start their shift.8 This,
coupled with the number of false positives experienced with this rapid antigen test, requiring more staff to be
absent unnecessarily from work, reduces the staff compliment even more. As we are all keenly aware, LTC homes
at present are operating on skeleton staffing schedules, and the required antigen testing, with its impact on staff
availability, makes the vital goal of providing safe, basic care unattainable. Furthermore, when the test produces a
false negative, this can inadvertently contribute to the introduction of the virus to homes.

There is absolutely a place for rapid antigen testing in certain situations. However, this directive as it stands now
has extreme implications for the availability of staff to provide the care LTC residents need and deserve. We
assert that if adequate additional funding were provided directly to LTC homes to support staffing for such
testing, as well as to bolster the nursing and support hours per resident, per day to four worked hours of direct
care, this could be a useful directive. Unless that happens, our LTC homes predict there will be further crises for
resident care, staffing and the budget (given the overtime needed to carry out these tests). Of course, if inspections
occur in the midst of these crises, there will be even more fallout for staff and residents. While these directives
may be well-intended, their implementation puts more pressure on an already strained and broken system, and
unfortunately the facilities and staff are often blamed when there are shortfalls. Alternative options include
increasing laboratory testing capacity or dedicating labs for the LTC sector with rapid turnaround time, similar to
the hospital sector.

Premier and Minister Fullerton, we are one year into a pandemic that has had a devastating impact on LTC and
the entire health system.

We are gravely concerned that despite reports and expressed commitments by both of
you, there has been no obvious progress made to address immediately the urgent staffing crisis in LTC. The
proposed budgeted staffing plan over the next four years 12 is too far out to alleviate the emotional and physical
stress of staff, and improve care for residents and their loved ones.
RNAO calls on the government to:

  1. Withdraw the directive related to the presence of “third party oversight” at the entrance to LTC homes, and instead allocate this substantive funding ($42 million) to be used directly by the homes to support their clinical staffing and COVID-19-related needs.
  2. Provide leeway to LTC homes to utilize NPs and nurse managers to make decisions about which type of regular testing to use in their home, and in which specific situations. This should come with the proviso that ongoing, regular testing of staff, volunteers, students and essential family caregivers be carried out for surveillance, prevention of outbreaks and overall safety.

We look forward to discussing these issues with you and contributing to workable solutions for LTC residents,
staff, students and essential family caregivers.

Warm regards,
Doris Grinspun, RN, MSN, PhD,
LLD(hon), Dr(hc), FAAN, O.ONT
Chief Executive Officer
Registered Nurses' Association of Ontario
(RNAO)

CC. Hon. Christine Elliott, Deputy Premier and Minister of Health

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