Increase staffing, minimum care hours in long-term, expert panel recommends

An expert panel appointed by Ontario’s Conservative government is echoing what advocates have long called for: Increased staffing in long-term care homes to provide a minimum average of four-hours of care a day for residents.

The long-awaited long-term care staffing study underscores that more funding will be needed to achieve the goal. One estimate from the organization that represents not-for profit longterm care homes puts the cost at around $550 million to hire more personal support workers and nurses.

The study also calls for improved working conditions and compensation, a change in the culture of long-term care homes and better leadership and training.

Written in response to a recommendation from the public inquiry examining the case of Elizabeth Wettlaufer, a serial-killer nurse who preyed on long-term care residents, the report found that staffing in long-term care homes is in crisis and needs to be urgently addressed, something advocates have been saying for years. That pre-existing issue was exacerbated during the pandemic when some homes lost 50 per cent of their staff due to illness, fear and the requirement that staff work at only one home.

“Quality of care and quality of life for long-term care residents are significantly impacted by the long-term care labour force, which is currently spread far too thin. Staffing has not kept pace with the medical needs of increasingly frail and elderly residents, neither in number of staff or in specialized expertise,” according to the report.

Staffing negatively impacts the quality of life of residents and staff, according to the report.

“The current level of care cannot consistently support a high quality of life or care for all residents. Staff are frustrated because they cannot provide the care needed by residents and are often rushed. This can also lead to a higher prevalence of workplace incidents and injuries, and create unmanageable workloads for staff, which leads to burnout and high turnover.

“Long-term care cannot become a better place to work, nor a better place to live, without increases to staffing levels.”

The panel recommends one personal support worker for eight residents during the day and evening. Over time, it said, the government should work toward a ratio of one PSW for six residents.

Ratios for night coverage are as high as one personal support worker for up to 32 residents, something that puts residents and staff at risk, the report states.

It also recommend that the current requirement for at least one registered nurse on duty at all times should be maintained but should be increased in larger homes. Sufficient levels of registered nursing staff are needed to provide greater clinical oversight and expertise to the care team.

The report’s recommendations of significant spending to improve long-term care come as the provincial government announced more than $300 million in funding to help safely open schools during the pandemic. Many critics say the government is not doing enough to keep students safe.

In a statement, Long-Term Care Minister Dr. Merrilee Fullerton said the report will “inform the development of a comprehensive staffing strategy to be released later this year.”

But advocates say there is no time to lose in acting on the recommendations.

“We needed to start the hiring yesterday, three months ago or five months ago,” said Doris Grinspun, CEO of the Registered Nurses Association of Ontario. “We have been calling for it.”

The need to increase staff in long-term care is more important than ever, say advocates, with the possibility of a second wave of COVID-19 in the fall looming. Long-term care homes were the epicentres of the pandemic during the spring with more than 1,800 resident deaths.

Advocates and long-term care home officials said increasing staffing could make a difference in many homes during a second wave. There is evidence additional staffing did make a difference in the early months of the pandemic. Those homes with more staff — mainly municipal or notfor-profit homes — generally had fewer deaths due to COVID-19.

Grinspun said the focus should be on the deadly cost of not acting and not the price tag.

“Is there a price tag on the 1,800 people or more we have lost? Is there a price tag on the fact that we are really decimating that sector?”

Candace Rennick, secretary-treasurer at CUPE Ontario and a former personal support worker, said the report highlights many of the problems and challenges that front-line workers have been talking about for years.

“We can’t continue to talk about the problems. The time for action is long overdue. We have seen too many reports and recommendations shelved to collect dust.”

Rennick said the government should demonstrate it is serious about improving staffing and care conditions in long-term care homes by enacting a law guaranteeing residents a minimum average of four hours of care a day.

In response to the pandemic, Quebec has announced it will hire 10,000 full time workers at a starting wage of $26 an hour with pension, benefits and training.

“Yet here we have seen nothing but announcements of new buildings without any plan or strategy to address the staffing and care crisis,” Rennick said.

Lisa Levin, CEO of AdvantAge Ontario, which represents not-forprofit long-term care homes, said her organization is among those that has long asked for an average minimum of four hours of care.

“I think this is something that should have been in place in 2018. We didn’t need to have 1,800 people die (to tell us what was needed in long-term care). We already knew we needed these measures.” epayne@postmedia.com