A public inquiry called by RNAO delivers recommendations that can improve safety and care for nursing home residents

July 31, 2019

A public inquiry called for by RNAO to honour the lives lost, and  address the horrific killings by former nurse Elizabeth Wettlaufer, nearly all of them residents in nursing homes between 2007 and 2016, has provided a detailed plan of improvements needed to overhaul the long-term care sector.

Justice Eileen Gillese issued her report Wednesday listing 91 recommendations that cover measures the Ministry of Health and Long-Term Care (MOHLTC), Home Care Service Providers, the College of Nurses of Ontario and the Office of the Chief Coroner and the Ontario Forensic Pathology Service should adopt.

Key among the recommendations (85) is that the MOHLTC increase the number of registered nursing staff in long-term homes by undertaking a study and tabling results in the legislature by July 31, 2020.  RNAO is eager to partner with the government and our colleagues at the Ontario Nurses’ Association, the Registered Practical Nurses Association of Ontario and the College of Nurses of Ontario, to bring this study to fruition by the deadline. “We have long urged that regulated staff must be increased in long-term care. RNAO will continue to insist that at least one NP for every 120 residents, 20 per cent RNs, 25 per cent RPNs, and no more than 55 per cent PSWs be funded for nursing homes,” says RNAO CEO, Dr. Doris Grinspun. “This is essential if we want to ensure safe and quality care and reduce costs related to avoidable complications.” 

Grinspun says any changes to the funding parameters of the nursing and personal care envelope, outlined in recommendation 19 must be based on the evidence presented in the staffing study.  This is why the government should not act on this recommendation until this study is completed.  “We have to get this right,” adds Grinspun.

Other key recommendations in the inquiry report include:

•    LTC homes should adopt more robust hiring and screening practices, including background checks
•    LTC homes must enact measures that will improve training with respect to hiring, management of staff and discipline
•    Homes should require directors of care to conduct spot checks on evening and weekend shifts
•    Homes should maintain complete discipline histories for each employee  

The recommendations expose systemic vulnerabilities that made it possible for Wettlaufer to get hired by an LTC home without management knowing she had been fired years earlier from her first nursing job after stealing narcotics during a shift at a hospital and using them to try to kill herself. 

RNAO was also pleased to see a recommendation (20) that the Ministry of Health and Long-Term Care “encourage, recognize, and financially reward long-term care homes that have demonstrated improvements in the wellness and quality of life of their residents.” This addresses a major concern of nurses and nursing home operators. The Ontario government must immediately stop cutting funding to long-term care facilities that implement best practices that improve residents’ outcomes. As RNAO has repeatedly advised, LTC homes whose care improves the health of residents must retain all funding to reinvest in additional staffing for residents rather than have some of that funding stripped because the government wrongly tethers funding to acuity says Angela Cooper Brathwaite, RNAO’s president. We are urging Minister Fullerton to exempt Best Practice Spotlight Organizations (BPSO) from any clawbacks on funding resulting from their improved residents’ health outcomes. 

RNAO says change must happen quickly. A grey tsunami will double the number of seniors aged 75 and older in the next 20 years, experts say. That growth will further strain a LTC system whose resources badly lag the needs of residents who typically suffer from multiple chronic conditions that leave them cognitively compromised as a result of aging, and at times dangerously aggressive. 

“While we can’t undo the unimaginable terror Wettlaufer inflicted, we can honour the memory of the victims and the loss of their families by acting now to fix endemic problems in long-term care,” says Cooper Brathwaite. “Every resident deserves to live with dignity and support, and as a society we owe it to residents to take the steps recommended by Justice Gillese.”

“The tools are within reach: We have excellent nurses, proven best practice guidelines and, thanks to the inquiry, even more knowledge about where our system falls short,” Cooper Brathwaite says. “We urge the Ford government to quickly adopt the recommendations of the inquiry by working collaboratively with nursing associations and other stakeholders because residents in long-term care and their loved ones deserve no less.”

The commission granted RNAO standing at the inquiry, which allowed the association to submit recommendations and question witnesses. RNAO was represented by Christine Mainville, Lauren Binhammer, and Gabriel Edelson of Henein Hutchison LLP.

RNAO is the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the health-care system, and influenced decisions that affect nurses and the public they serve. For more information about RNAO, visit or follow us on Facebook and Twitter.

RNAO’s Best Practice Guidelines Program is funded by the Ministry of Health and Long-Term Care. It was conceived in 1998 and launched in 1999 to provide the best available evidence for patient care across a wide range of health settings. The 54 guidelines developed to date represent a substantial contribution towards building excellence in Ontario’s health system. Health-care facilities that successfully implement multiple guidelines receive special recognition from RNAO as Best Practice Spotlight Organizations (BPSO).  

Contact info

Marion Zych
Director of Communications
Registered Nurses' Association of Ontario (RNAO)