RNAO calls for a “Nursing Home Basic Care Guarantee” and provides staffing formula to Minister Fullerton for her July 31 report to legislature

June 11, 2020

The Registered Nurses’ Association of Ontario’s (RNAO) board of directors calls on the Ontario government to ‘walk the talk’ and meet its obligation to residents living in long-term care (LTC) homes. RNAO’s board issued its report to LTC Minister Merrilee Fullerton, on the eve of its annual general meeting, with the unanimous declaration that: “It’s time to call for a “Nursing Home Basic Care Guarantee” and demand the government allocate proper staffing and funding.” 

For 21 years, one government after another has failed to protect LTC residents. We must begin a new era for seniors living in nursing homes by guaranteeing their basic care needs, shoring up staffing levels for regulated and personal support staff, and adjusting the staff mix, so residents in nursing homes can count on consistent, safe and quality care. “Nursing home residents deserve this basic care guarantee enabled by the required minimum staffing hours and the knowledge, competencies and skills demanded by the complexity and acuity of care needs in LTC,” says RNAO CEO Dr. Doris Grinspun. “And they need these guarantees today.”

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

RNAO’s submission provides detailed, evidence-based analysis supporting the basic care guarantee and staffing formula issued in RNAO’s May 28 media release. It calls for implementing and funding recommendations from past inquiries and commissions, rather than engaging in more study and deliberation. RNAO says such action must begin right away, with Minister Fullerton’s tabling of her staffing plan by July 31, 2020.

“RNAO’s submission is to honour the 1,963 residents in LTC who lost their lives over the past four months, in part, because of years of government neglect. While governments have been paying lip service to this sector, the acuity and dependency needs of persons living in nursing homes have increased exponentially and the shortfalls of nurse practitioners (NP), registered nurses (RN), registered practical nurses (RPN) and personal support workers (PSW), required to provide safe and quality care, have been given little consideration. Frankly, governments have relegated LTC to the backburner, treating residents as second-class citizens,” says Grinspun. 

RNAO calls on the government to adopt, fund and implement a nursing home basic care guarantee, and its related staffing formula, so residents of nursing homes can be assured safe care and quality of life, their families can sleep at peace, and staff will no longer need to struggle to meet the minimum care needs of their residents. It means that no home – whether for-profit or not-for-profit – will provide care below the guarantee. 

The guarantee is for a staffing formula that provides no less than four 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 0.8 hours (48 minutes) of RN care per resident, per day, 1.0 hours (60 minutes) of RPN care, and 2.2 hours of PSW care (132 minutes). Such an allocation would provide each resident with safe care and quality of life.

The acuity and vulnerability of LTC residents drives RNAO’s staffing formula and its urgent call for more RN and RPN staff, who are best equipped with the knowledge and the regulatory mandate to provide safe care. Each home should also have one NP for every 120 residents. The government should also fund each home to hire a nurse to focus on infection prevention and control, quality improvement, and staff orientation, training and professional development.   

RNAO says the recommended four hours of care, based on past studies of care need, is very conservative. In 2017, the government committed to providing these four hours of direct care. Shockingly, only 2.71 hours of direct care are currently provided to each resident on a daily basis. This means LTC residents in Ontario receive one third less nursing and care hours than the very conservative estimate government committed to, but hasn’t implemented since 2017. 

Equally alarming is that current legislation in Ontario does not specify skill mix ratios for RNs, RPNs and PSWs. It only assigns one RN on-site per shift, which is grossly deficient. We estimate the current skill mix at 0.30 hours of RN care per resident, per day, 0.49 hours of RPN care and 1.92 hours of PSW care. 

All three groups are below the recommended levels of nursing and care hours. For RNs, the shortfall is 63 per cent from the recommended level. For RPNs, there is a shortfall of 51 per cent. And for PSWs, the shortfall is 13 per cent. Added to these deficiencies is the reality that only a small number of nursing homes have NPs. Most homes must do without an NP. 

RNAO’s report also calls to ensure nursing home staff members are only permitted to work in one home. Offering full-time work and topping up salaries in this sector, so they are on par with those in hospitals, complete with benefits, will result in higher care continuity for residents, decreased infection rates, and higher recruitment and retention, which leads to happier staff and happier residents,” says RNAO President Dr. Angela Cooper Brathwaite.  

Premier Doug Ford is scheduled to address RNAO members at the association’s virtual annual general meeting on Friday (June 12). “Many of our members have worked flat-out during the pandemic, and we know they expect the premier to live up to his word when he says: ‘We’re going to do whatever it takes. We won’t hold back any funds’ when vowing to address issues in LTC,” adds Cooper Brathwaite. “Premier, too many lives have been lost and too many families are waiting for change that is long overdue. A nursing home basic care guarantee will help lead us where we need to go. We’re eager to work with government so we can finally take the right path to better serve residents in long-term care.” 

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 or follow us on Facebook  and Twitter.

Contact info

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