Long-Term Care staffing plan welcomed, but lack of urgency and legislated action will continue to devastate residents, their loved ones, and staff for years to come

RNAO welcomes the release of the government’s long-term care (LTC) staffing plan, entitled A Better Place to Live, A Better Place to Work. With COVID-19 raging through Ontario’s LTC homes, the plan could not have come soon enough. And while RNAO is pleased to see the government move on its budget commitment to ensure a daily average of four hours of direct care for each LTC resident, the minister’s staffing plan falls short on immediate action and specifics.

The government pledges to commit up to $1.9 billion to enhance staffing in the battled LTC sector, but its plan only offers an additional 15 minutes of direct care per resident on average before the next provincial election. The remaining care it promises will take an additional three years. It will come after the next election, and thus is questionable. “Without a legislated commitment to four worked hours of direct nursing and support care, delivered with the appropriate skill mix of RNs, RPNs and PSWs to enable safe and dignified care, as RNAO has repeatedly called for, the LTC staffing roadmap is nothing more than an election promise,” says RNAO CEO Dr. Doris Grinspun.

RNAO is pleased to see the plan recognizes the increasing complexity of the health-care needs of residents and calls for a larger focus on nursing within the LTC staffing skill mix. However, the association is disappointed that Minister Merrilee Fullerton shied away from committing to a clear skill mix of regulated nursing staff (RNs and RPNs) and unregulated staff (PSWs) to deliver safe care. It is exactly that increased complexity that drove RNAO to release its 2016 Mind The Safety Gap report, calling for four worked hours of care and a skill mix of 20 per cent RNs, 25 per cent RPNs and 55 per cent PSWs; as well as one (1) NP for every 120 residents.

RNAO’s call has continued and will continue. In June 2020, the association submitted to Minister Fullerton its Nursing Home Basic Care Guarantee (NHBCG), providing the government with a ready-made plan and evidence-based minimum standards for protecting Ontario’s vulnerable LTC residents. RNAO’s guarantee is for a staffing formula that provides no less than four worked hours of direct nursing and personal care per resident, per day. The formula also calls to ensure the proper skill mix by allocating a minimum of 48 minutes of RN care per resident, per day, 60 minutes of RPN care and 132 minutes of PSW care. Such an allocation would provide each resident with safe care and quality of life. RNAO estimates that the current skill mix in nursing homes averages about 18 minutes of RN care per resident, per day, 29 minutes of RPN care and 115 minutes of PSW care.

Exacerbating these already damaging staffing deficiencies is the reality that only a small number of nursing homes – about 60 out of 626 – have NPs. Most homes do without this critical advanced nursing role. RNAO will continue to call for one (1) NP for every 120 residents. The government report released yesterday makes no clear commitment – except for 15 NPs, which had been promised and committed by the previous Liberal government as part of a funded plan for 75 NP positions. Minister Fullerton’s report also leaves out action on the need for a dedicated Infection Prevention and Control (IPAC) nurse, another demand from RNAO given the devastating shortfalls of infection prevention and control experienced in recent months.    

“There has been, and remains, no excuse for delay in the implementation of a basic care guarantee for nursing home residents. The delay is causing preventable deaths of residents, anguish of loved ones, and creating post-traumatic stress disorder among administrators and health-care workers,” says Grinspun, adding that “the association will re-double its efforts to call for and to build a brighter future for those living and working in nursing homes across the province.”

RNAO is gravely concerned that the government’s staffing plan does not pursue immediate hiring of staff. And while the association fully supports the commitment to training, education and a clearer career path from PSW to RPN, and from RPN to RN, there is an urgent need to bolster staffing immediately. “Nursing homes and their staff have been battling for more than 10 months – and continue to battle – to protect and save the lives of LTC residents. To date, Ontario has lost 2,526 residents to COVID-19. Many have succumbed, in part, due to inadequate staffing. Residents, their loved ones and staff do not have the luxury of time to wait for the government’s four-year plan to unfold,” says RNAO President Morgan Hoffarth, adding that RNAO estimates a pool of more than 2,500 RNs are seeking nursing employment and ready to join the workforce.

The province has indicated that it will engage with residents and families to develop a quality framework based on what quality of life and quality of care means to them. “This is critically important in good times and over the long term. In the midst of this pandemic, however, our residents, their loved ones and front-line staff are urgently seeking to receive and provide basic care. RNAO insists that staffing increases, based on the right skill mix, must be in place immediately to protect the lives of nursing home residents. There is no time to waste. Lives depend on it,” Hoffarth urges.

The Registered Nurses' Association of Ontario (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 system, and influenced decisions that affect nurses and the public they serve. For more information about RNAO, visit RNAO.ca or follow us on Facebook  and Twitter.

-30-