LTC staffing study highlights what RNAO has been saying for two decades: Government must immediately mandate hiring to avert second tragedy

Toronto
July 30, 2020

The Registered Nurses’ Association of Ontario (RNAO) says the long-term care (LTC) staffing study released by the government today highlights deficiencies known for decades, and underlines an LTC sector that has been neglected by government after government, resulting in severe underfunding and understaffing. 

The government’s Long-Term Care Staffing Study Report provides recommendations within five priority areas to improve staffing across the sector:

  1. The number of staff working in long-term care needs to increase and more funding will be required to achieve that goal
  2. The culture of long-term care needs to change – at both the system and individual home level
  3. Workload and working conditions must get better, to retain staff and improve the conditions for care
  4. Excellence in long-term care requires effective leadership and access to specialized expertise
  5. Attract and prepare the right people for employment in long-term care, and provide opportunities for learning and growth

“While these are, for the most part, sound recommendations within a comprehensive report, there is nothing here that we have not discussed before. Also not new is the government statement that ‘This study will inform the development of a comprehensive staffing strategy to be released later this year.’ What we needed to hear today was that Premier Doug Ford is ready to move swiftly to hire staff. This is foundational to the care residents in nursing homes will receive,” says Dr. Doris Grinspun, RNAO’s CEO. 

“We urge the minister of long-term care, Merrilee Fullerton, to immediately direct nursing homes to hire personal support workers, registered nurses, registered practical nurses and nurse practitioners ahead of the second wave of COVID-19, which will coincide with the coming Influenza season,” says Grinspun. “There is not a minute to wait if we are to prevent a second massive tragedy in Ontario’s nursing homes come the fall.” 

The need for immediate action is outlined in RNAO’s Nursing Home Basic Care Guarantee submission to the government’s Long-Term Care Staffing Study Advisory Group, which was struck by minister Fullerton in response to the public inquiry on LTC homes, which issued its recommendations on July 31, 2019. Justice Eileen Gillese led that inquiry and gave the government a deadline of July 31, 2020 to table in the legislature a staffing plan for regulated staffing in LTC.  

The government’s report, released this afternoon, highlights a minimum staffing complement to provide four (4) direct hours of nursing and personal care per resident, per day. However, the report fails to specify the skill-mix composition of those four hours, leaving residents, families and staff to the will of operators. 

RNAO will continue to call for the Nursing Home Basic Care Guarantee as the only way forward. It will also continue to urge that no nursing home – whether for-profit or not-for-profit – go below four hours of direct nursing and personal care per resident, per 24 hours. All homes must guarantee a proper skill mix as follows:

  • 0.8 hours (48 minutes) of RN care per resident, per 24 hours
  • 1 hour (60 minutes) of RPN care per resident, per 24 hours
  • 2.2 hours (132 minutes) of PSW care per resident, per 24 hours

RNAO is also calling on government to fund each LTC home for one NP per 120 residents, in the role of attending NP or director of clinical care; as well as one additional nursing full‐time equivalent (FTE) staff (preferably an RN) to support the functions of infection prevention and control and quality improvement.

RNAO and others have repeatedly sounded the alarm about inadequate staffing levels in the sector. In June, RNAO released a list of 35 reports that have been published over the last 21 years, each with recommendations on how to address ongoing systemic failings. That list included the Gillese inquiry report. A common theme in those reports was the need for more staff in nursing homes, as well as a proper mix of regulated staff, in particular RNs, RPNs and NPs, which are scarce in this sector and are central to improving the safety and quality of care needed to meet the complex care needs and rising acuity levels among residents. The government's own report states today that: "The Long-Term Care Staffing Study Advisory Group concludes that if barriers to optimal staffing are addressed, as recommended in this report, the sector could more consistently deliver safe, quality and resident-centred care, to better meet the needs of long-term care residents." Yet, once again, the government has failed to move into action.

RNAO says rising acuity levels demand urgent attention. Currently, 55 per cent of seniors in LTC homes are 85 years or older, and 90 per cent of all residents have some form of cognitive decline, including dementia and Alzheimer’s disease. Add to that, many residents have chronic health ailments, such as heart disease, diabetes or arthritis. These health conditions require the knowledge and expertise of nurse practitioners, clinical nurse specialists and registered nurses. PSWs cannot manage these complex areas of care without the support, direction and oversight of registered staff.   

“Improving the staffing and skill mix in nursing homes is the first and most fundamental change that is needed,” says RNAO President Morgan Hoffarth. “In addition, we need human resource policies that encourage staff to only work in one home by providing full-time work and offering compensation that is on par with compensation for those who work in other settings, such as hospitals. All of these measures are necessary to ensure continuity of care for residents, and to keep infection rates down and provide people with a satisfying work environment,” urges Hoffarth.  

It is also essential that nurses and personal support workers are not left scrambling to deal with the devastating consequences of outbreaks in nursing homes, which is why RNAO says each of Ontario’s 626 LTC homes must be equipped with a six-month supply of personal protective equipment (PPE). “One of the consequences of a lack of PPE during the first wave of COVID-19 was that it effectively let the virus spread freely amongst staff and residents, taking a toll on a sector already grappling with a shortage of workers trying desperately to care for residents. It was a tragedy of major proportions for residents, their loved ones and staff,” adds Hoffarth.

Hoffarth says residents and their families, as well as staff who work in nursing homes, have paid a heavy price during COVID-19. There have been too many preventable deaths and unbearable suffering. That’s why RNAO is steadfast in urging that the government allow family visits with residents, in all nursing homes – including those experiencing an outbreak. “Residents and staff don’t need the army and they also don’t need hospitals to come to their rescue. What they need is adequate staffing, PPE, and the help and love only family members can provide. Families are essential care partners who keep residents’ spirits up, and help them maintain their will to live. They also support residents with toileting, hydration and eating,” says Hoffarth.

Close to 2,000 nursing home residents died during the first wave of the COVID-19 pandemic in Ontario. “The government’s announcement demonstrates it is willing to learn from its past and recent mistakes, and make the necessary improvements that we desperately need to see in long-term care,” says Grinspun. That political will is extremely important, she adds: “However, to save residents’ lives and boost their well-being, we must immediately move from more reports to decisive actions.” 

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 our website at RNAO.ca or follow us on Facebook and Twitter. 

Contact info
Marion Zych
Director of Communications
Registered Nurses' Association of Ontario