Policy and Political Action

Policy & Political Action

Disincentive to improve resident outcomes embedded in LTC funding model

Hon. Merrilee Fullerton
Minister of Long-Term Care

Minister Fullerton,

On behalf of the 42,000-plus members of the Registered Nurses’ Association of Ontario (RNAO), congratulations on your appointment as Minister of Long-Term Care. We look forward to working with you to improve access to, and resident outcomes in, Ontario’s long-term care sector. We are hopeful that through you and your new Ministry this sector of our healthcare system will get the focus and attention required to address a number of systemic issues.

Most immediately, I would like to direct your attention to the pending release of the report of the Public Inquiry into the Safety and Security of Residents in Long-Term Care (LTC) led by Justice Eileen Gillese. The circumstances that led to the inquiry were tragic and RNAO insists that meaningful and lasting change come as a result of the inquiry’s findings. As Minister of Long-Term Care, we call on you to honour the eight murdered residents by making the long-overdue changes to the LTC funding model.

RNAO was the first nursing organization to call for an inquiry and was an active participant. There are many systemic issues in the LTC sector that need to be addressed. Critical amongst them is the financial disincentive to improve resident outcomes at the core of the LTC funding model. Currently, when evidence-based practices are implemented and resident problems are prevented or resolved, resident acuity decreases. While this is good for residents, the home’s case-mix index (CMI) correspondingly falls and funding in future years is decreased. In other words, the perverse consequence of improving resident outcomes is a financial penalty. This must urgently change if we are to advance the quality of life and safety of nursing home residents.

We have raised this issue previously with your predecessor, Minister Elliott, and her Parliamentary Assistant, Effie Triantafilopoulos, and we have recently enjoyed constructive conversations on this issue with ADM (Long-Term Care Homes) Brian Pollard.

The release of the Gillese report is the right time to announce a change to this archaic funding model. It will also be timely because it coincides with your government’s broader project of designing a funding model for healthcare that will both incent improved health outcomes and sustain Ontario’s publicly funded health-care system. RNAO applauds your government’s commitment to redirect all savings generated by Ontario Health Teams (OHT) to frontline care. We believe that the funding model governing all component parts of OHTs – including LTC homes – must be fully aligned for our health system transformation to deliver success for Ontarians.

The funding disincentive to improve resident outcomes is a key shortfall in the LTC sector that needs addressing. Other systemic issues, including detrimental staffing in the LTC sector are included in RNAO’s document: Transforming Long-Term Care to Keep Residents Healthy and Safe.

RNAO and its 42,000 RNs, NPs and nursing students look forward to you announcing on July 31, 2019 –the day Justice Gillese releases her report – vital changes to the LTC funding model. Consistent with your government’s commitment to redirect OHT savings to frontline care, any savings generated through the provision of quality, compassionate and evidence-based care in our LTC sector must be reinvested into front line RNs, NPs and RPNs. We are confident this policy imperative will advance the safety, dignity and quality of life of LTC residents, and forever honour the memories of those lost in these tragic events.



Doris Grinspun, RN, MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT

Chief Executive Officer, RNAO



Hon. Christine Elliott, Minister of Health

Effie Triantafilopoulos, MPP and Parliamentary Assistant to Minister of Long-Term Care

RNAO LTC funding model.pdf212.05 KB
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