Hire more staff.
Understaffed homes, overworked staff and rising rates of dementia and clinical complexity are putting a strain on today’s long-term care workers.
The need for more staff.
Over the past decade, the profile of residents has changed to one of a population in need of more direct care. But funding has not kept pace. The investments that long-term care has been receiving have done little more than keep pace with inflation so that year-over-year increasing staffing costs have absorbed any annual funding increases. As a result, we have not been able to add more staff to care for these residents who need more daily support than ever before. Government must make a commitment to grow funding that will allow for the hiring of more personal support workers (PSWs) and more skilled staff like registered nurses (RNs), registered practical nurses (RPNs) and nurse practitioners (NPs).
Increasing dementia and mental health concerns.
Dementia and chronic mental health conditions in Ontario’s senior population have increased noticeably in the past decade. More than 90% of the residents in our long-term care homes have some form of cognitive impairment. Almost half demonstrate some degree of aggressive behaviour and 40% have a psychiatric or mood disorder. And almost all of Ontario’s long-term care homes have reported behavioural incidents serious enough to require police intervention.
Another trend is the growing number of residents with dementia who also have a mental health disorder. Long-term care operators are reporting high ratios of residents with mental health disorders in homes where staff have not been adequately trained in the management of these conditions.
Mental health support on site.
The last government’s Behavioural Supports Ontario (BSO) program only partially addressed the need for help with people living with dementia. But the program had its limitations. Chief among them was that most BSO teams were not in long-term care homes. Instead, mobile BSO teams formed the core component of the province’s dementia strategy, supporting both long-term care residents and the community.
But research has shown that having a specialized dementia support team on site in a long-term care home outperforms the mobile or remote support teams currently in use, by two to four times. An in-home team can not only help to develop preventative strategies and improve resident quality of life, it can reduce transfers to hospitals.
Still, many long-term care residents struggle every day, unable to have these supports to enhance their quality of life. Homes wait anywhere from days to weeks for assistance under this inconsistent model of mobile mental health teams, which are reactive and do not support residents’ quality of living in real-time as required.
Residents with dementia and mental health conditions need consistent and timely support. That’s why we are recommending that every home have a specialized dementia support team and that the Local Health Integration Networks (LHINs) should no longer be involved with its administration.
Homes unable to fill shifts and use flexible approaches to staffing.
Current staff-to-resident ratios vary depending on time of day so that resident-centred care – the type of care families want for their loved ones and the type of care staff want to provide – is inconsistent. Less staff means some locations are unable to fill PSW or RN shifts, which can impact a home’s ability to meet legislative requirements. It significantly affects staff morale and increases workplace stress.
But homes could better meet staffing needs if they were allowed to be flexible in their approaches to using RNs, RPNs, PSWs, porters, personal help workers and other care professionals. The province needs to move to a resident-centered staffing approach, offering the flexibility to commit to care in each and every home while maintaining a safe and secure environment.
In Ontario, the Long-Term Care Homes Act requires that an RN be in the home 24/7. This can be a real challenge for homes, particularly those in rural areas and small communities, where the supply of registered nurses is limited to begin with. The scope of practice of RPNs has expanded significantly over the last 15 years and they should be given the opportunity to work these shifts without their long-term care homes being found in non-compliance with outdated regulations.
The scope of the HR challenge.
The entire provincial health system is being affected by a significant health human resource challenge, but the effect of this challenge is compounded in long-term care as workplace stress mounts. In a survey of Ontario Long Term Care Association members, 80% of homes surveyed reported difficulty filling shifts and 90% experienced challenges recruiting staff. Of these positions, PSWs were the hardest positions to fill, followed closely by RNs.
This staffing gap can have a detrimental impact on a home’s ability to be compliant with the Long-Term Care Homes Act. Resident profiles across the province vary greatly – some require more care than others, and some homes have limited access to staff depending on where they are in the province and what human resources are available to them. While homes and resident populations can differ widely, the mandated 24/7 RN staffing level remains the same across Ontario. We need flexibility to care for residents and not a cookie-cutter approach to staffing.
Despite there being a human resource crisis, homes are performing and providing a high quality of care. With the right funding and the right staffing approaches for a very diverse population spread across the province, we can do even better.
|Recommendation||Estimated Annual Cost|
|1.||Adding $100 million every year for the next four years to fund more nursing and professional care staff means that by the fourth year, homes will have added two more personal support workers for every 32 beds.||$100 million in 2019/2020 to a total of $400 million by 2022/2023.|
|2.||An annual rate increase equal to the previous year’s Consumer Price Index (CPI) plus acuity to increase the nursing and personal care (NPC) and program and support services (PSS) envelopes so that any new funding in recommendation 1 results in net new staffing.||A 2.6% increase in CPI and acuity would cost $86 million.|
|3.||Homes should be allowed to use their NPC funding for the type of care staff they need. Work that is not considered a direct care function, such as transporting residents to meals and activities, helping residents at mealtimes, and making beds could be completed by personal help workers. Homes should be allowed to hire personal help workers to enhance care.||No additional cost.|
|4.||Specialized dementia support teams for all homes at $3.00 per resident, per day.||$11 million of new funding to the existing $74.5 million.|
|5.||Change the requirement for 24/7 RN coverage to 24/7 registered staff coverage.||No additional cost.|
|6.||Small homes with 65 to 96 beds need to be made eligible for FTE RPN funding so that they can have a similar ratio of nursing and professional care staff to residents as do larger homes.||$7.4 million.|
|7.||Create a long-term care health human resources plan that outlines what kind of capacity we need in our workforce, by when, and for what types of residents. It should also recognize the need to attract and retain health care professionals presenting long-term care as a viable place to build skills.||Unknown.|