RNAO releases list of 35 reports and recommendations dating back 20 years documenting the government’s failings of Ontario long-term care sector

June 5, 2020

If the Ontario government is serious about fixing the long-term care (LTC) system, it must adopt evidenced-based solutions documented in numerous reports that have examined the sector’s failings. 

RNAO today released a list detailing dozens and dozens of recommendations in the areas of staffing and funding made in 35 reports as well as a public inquiry and a coroner’s inquest looking into the problems in LTC over the past 20 years. The recommendations in these reports call for more staffing in LTC homes, the proper skill mix of regulated and unregulated staff to meet the increasing acuity, and a funding model that responds to growing needs. 

RNAO compiled Long-Term Care Systemic Failings: Two Decades of Staffing and Funding Recommendations because we are among those who have examined this issue for years. “We implore the Ministry of Long-Term care, the Ministry of Health and the premier to act NOW. It is disheartening, exhausting and expensive to continue to study problems that are known and understood and where the missing factor is the political will to act decisively rather than, once again, kick the can down the road with more commissions and more reports,” says Dr. Doris Grinspun, RNAO’s CEO. “Enough of over-studying and under-acting in this sector – we know and the government knows what needs to be done to improve and save the lives of LTC residents.”

“Premier Ford has vowed to fix the system. He says there will be accountability. However, as much as I want to believe him, I have heard heartfelt words from political leaders before. Accountability begins at the top and must be delivered with swift actions. Residents living in long-term care, along with their families, and staff can’t wait any longer for change. No study and no words will deliver better care for residents, only better funding and better staffing will,” Grinspun insists.

RNAO has proposed a staffing formula that builds on earlier reports and studies and addresses those needs. It wants each LTC home resident to receive at least four hours of direct nursing and personal care per day, based on a skill mix of regulated and unregulated care providers. Of those four hours, 0.8 hours (48 minutes per day) should be provided by a registered nurse (RN), 1 hour (60 minutes per day) by a registered practical nurse (RPN), and 2.2 hours (132 minutes per day) by an unregulated personal support worker (PSW). In addition, each home should have one nurse practitioner (NP) for every 120 residents as well as a nurse specializing in infection prevention and control.

RNAO explains such a formula is necessary because about 55 per cent of LTC residents are 85 years or older and 90 per cent of all residents have some form of cognitive impairment, including dementia. The majority of residents in LTC also have complex health needs including chronic conditions such as heart disease, diabetes or arthritis - needs that require the expert care and skill mix NPs, RNs, RPNs and PSWs provide.  

RNAO’s President Dr. Angela Cooper Brathwaite says a critical deadline is looming. “July 31, 2020 is an important date on the government’s calendar. It’s the deadline Justice Eileen Gillese gave the government to table in the legislature a detailed report on the adequacy of regulated staffing in LTC. It was a key recommendation in her report The Long-Term Care Homes Public Inquiry (2019).”

“The July 31 government report gives the opportunity to Premier Ford to demonstrate he means action. We need to address staffing and funding issues in LTC immediately. We don’t need more studies, as the list released by RNAO today demonstrates. Let us get on with improving the lives of people, in real ways. We owe residents in LTC a debt of gratitude for the contributions they have made during their lives. They should be able to live with dignity, comfort and love, and they and their staff should be better equipped and protected, especially when the second wave of the pandemic hits,” adds Dr. Cooper Brathwaite.

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)