National long-term care standards fall short of addressing staffing issues, says RNAO

Jan. 31, 2023

The Registered Nurses’ Association of Ontario (RNAO) welcomes news of national long-term care (LTC) standards, but says they fall short of addressing critical issues of the current inadequate staffing and skill mix levels in the majority of LTC homes. RNAO is also disappointed the federal government failed to make these standards mandatory, leaving in place patchwork approaches across and within provinces and territories. All LTC residents deserve safe, dignified care regardless of the place they call home. 

“RNAO has long advocated that national LTC standards be established and enforced, so today’s news is hopeful but does not go far enough,” says RNAO President Dr. Claudette Holloway. “On the eve of federal-provincial health talks next week, the federal government has an opportunity to make good on its promise to never repeat the devastation we saw in LTC homes during the early months of the pandemic. Enforceable standards of care backed by adequate staffing and skill mix should be conditions for future health transfers, as must be evidence-based practices,” adds Holloway.
While the national standards published Tuesday by the Health Standards Organization and the Canadian Standards Association refer to resident-centred care and meaningful quality of life, RNAO maintains these aspirations can only be realized with the right number of care providers and a guaranteed minimum four hours of direct nursing and personal care per LTC resident. 

Ontario has pledged through legislation to deliver four hours of direct care by 2025, a move RNAO applauds. However, the province has spoken in terms of “averages”, while “RNAO insists it be four hours per resident, per each single day,” says Holloway. “Ontario must also redouble its efforts to increase regulated staff, as we still have a gap of 3,400 RNs in our province’s nursing homes, compared to the rest of the country,” according to data released by the Canadian Institute for Health Information (CIHI). “To truly transform LTC in Ontario and meet the care standards we believe people need and deserve, it’s crucial that the government address the RN staffing shortage,” urges Holloway. 

The good news is that Ontario has taken steps to improve its LTC sector since more than 5,200 residents lost their lives due to COVID-19. “We can make the sector more responsive to residents by fulfilling a commitment to have one nurse practitioner (NP) for every 120 residents in every LTC home, ensuring evidence-based care though implementation of RNAO’s best practice guidelines, and embedding these in Clinical Pathways though electronic medical records,” says RNAO CEO Dr. Doris Grinspun. 

“We continue to work closely with Minister Paul Calandra to advise government on ways to strengthen the LTC sector and ensure residents, their families and staff are front and centre on all policies,” says Grinspun. Consistent with its position on national standards, “RNAO has urged the Ontario government to move with smaller, community-embedded LTC homes that feel more like homes – as outlined in our Enhancing Community Care for Ontarians 3.0 report – and to mandate accreditation for all Ontario LTC homes,” she adds. 

RNAO also urges the government to deliver on longstanding promises to enable RNs to assess, treat and prescribe medications to prevent unnecessary hospital visits and treatment delays for residents in LTC. “RN prescribing is long overdue and would immediately make a positive impact on the care LTC residents receive on a daily basis,” advises Grinspun.

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 we serve. For more information about RNAO, visit or follow us on TwitterFacebook and Instagram.

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Contact info

Madison Scaini
Communications Officer/Writer
Registered Nurses' Association of Ontario (RNAO)
Marion Zych
Director of Communications
Registered Nurses' Association of Ontario (RNAO)