Improving quality in Canada’s nursing homes requires “more staff, more training”

Categories: Care.

Many residents and families are quite happy with the care provided in nursing homes. However, news reports from home and abroad remind us that not all nursing home residents receive the same quality of care.

Ontario has launched several quality initiatives for long term care in recent years, and the Ministry of Health and Long Term Care has recently announced that it will be hiring 100 additional inspectors to monitor the long term care sector.

However, while more inspectors can help ensure minimum standards are being met, they do not address some of the root causes of low quality, which include low staffing levels, inadequate training and a failure to engage all front-line staff in quality improvement.

Staffing levels in Ontario nursing homes lower than Alberta, Canadian average
“There is no doubt that we don’t have enough staff;” says Gail Donner, who chaired Ontario’s Long Term Care Task Force on Resident Care and Safety, “It’s past even talking about – you just have to go to a long term care facility to see that.”

“There’s good evidence that staffing level is a prerequisite for quality care in nursing homes,” says Margaret McGregor, a family doctor and research scientist at the University of British Columbia. Below a certain threshold, she explains, care staff just don’t have time to complete all the routine activities – dressing, feeding, grooming, repositioning, toileting, changing wet clothes, etc. – required for quality care.

According to data from Statistics Canada, staffing levels in Ontario’s nursing homes have historically been below the national average (behind only British Columbia for the lowest staffing levels in the country).

While Ontario legislation requires there to be a nurse on duty at all times in nursing homes, Ontario has not legislated a minimum staffing ratio – the ratio between the number of nursing home staff (nurses and non-nurses) compared to the number of patients they care for.

Statistics Canada data shows the average staffing ratio in Ontario nursing homes was 4 hours per resident day in 2010 (the last year for which data is available). This was 25% less than in Alberta, where nursing homes averaged 5.3 hours per resident day. (This is only a measure of the hours paid to all staff in nursing homes, not of the actual time care staff spend providing care ‘at the bedside.’)

“Many nursing homes don’t have enough Personal Support Workers (PSWs),” says Miranda Ferrier, President of the Ontario Personal Support Worker Association. “Even when facilities aren’t short-staffed [due to illness or injury], staff are stretched too thin to provide quality care to all residents. When they are short-staffed, it’s even worse.”

Candace Chartier of the Ontario Long Term Care Association agrees, saying “there is simply not enough funding to staff appropriately for the kinds of patients who are now residing in long term care.”

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