Ministry of Long-Term Care Releases Long-Term Care Homes Staffing Review Report

In February 2020, the Ministry of Long-Term Care launched a study, with support from an external Advisory Group, to help inform a comprehensive staffing strategy for the long-term care sector. Appropriate staffing levels in long-term care homes are essential to meeting the needs of residents and this issue was identified as a critical priority in the report of Justice Gillese’s Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System which was struck after the conviction of Elizabeth Wettlaufer, Canada's first known healthcare serial killer.

On July 30, 2020, Minister Merrilee Fullerton released both A Report Back on the Gilese Inquiry and the Long-Term Care Homes Staffing Study.

The Staffing Study Advisory Group made 5 key recommendations which they urge need immediate attention:

  1. The number of staff working in long-term care needs to increase and more funding will be required to achieve that goal
    • Staffing investment\
    • Minimum daily average of four hours of direct care per resident
    • Guidelines for improving staffing ratios and skill mix for PSWs, nursing staff, and allied health
      professionals, with variance to address specific circumstances

  2. The culture of long-term care needs to change – at both the system and individual home level
    • Regulatory modernization
    • A quality improvement approach to sector oversight
    • Renewed performance measurements
    • A strong coherent philosophy of care
    • Recognition of the critical role of PSWs
    • Respectful team environment

  3. Workload and working conditions must get better, to retain staff and improve the conditions for
    • Compensation
    • Full-time and part-time employment
    • Protection from physical, mental and emotional risk
    • Charting and documentation
    • Medication management

  4. Excellence in long-term care requires effective leadership and access to specialized expertise
    • Clarifying the role and accountability of the Medical Director
    • Expanding the use of Nurse Practitioners
    • Ensuring access to strong Infection Prevention and Control (IPAC) expertise

  5. Attract and prepare the right people for employment in long-term care, and provide opportunities or learning and growth 
View the Long-Term Care Homes Staffing Study Report, July 30, 2020.

Subsequent to the launch of the staffing study, the province has experienced the impact of the COVID-19 pandemic on Ontario's long-term care home system.  Tragically, the sector and its residents were extremely vulnerable.  That is why the province has launched an independent commission to review the impact of COVID-19 on long-term care homes in Ontario. The commission will prioritize transparency and will be able to hold public hearings. Additionally, the province is committed to making the report from the commission public. The independent commission into long-term care will provide an objective perspective on how the province can assist long-term care homes to better protect residents and staff by effectively managing any future outbreaks and contributing to the overall effort of improving the system across Ontario.  It is expected that this Commission's review may defer final attention to the staffing needs study.  OSOT will advocate for more immediate attention.
Implications for Occupational Therapists

Review of staffing in long-term care has been a longstanding advocacy message of OSOT.  Especially since 2013, when physiotherapy funding reform essentially withdrew OT services from LTC Homes (OT had been provided as a complimentary service by physiotherapy clinics that had contracts in LTCHs), OSOT has identified the critical shortage or absence of access to OT services for residents.  The Society made presentation to the Staffing Study Advisory Group in March and has looked forward to the results of their review.

While the report recommendations are all very supportable, OSOT met with MPP Effie Trian, Parliamentary Assistant to the Minister of Long-Term Care to share an OT response to the report.  The following key points were addressed;

  • Generalize support and congratulations for the thorough, fair, and well crafted recommendations of the report

  • Identification that the study did not address issues related to procurement of services through 3rd party providers (study only addressed employed staffing issues).  This is concerning to OTs who are primarily engaged through external contracts.

  • Support for the recommendation that a clearer knowledge/commitment to a philosophy of care in each home needs to be promoted.  OSOT advanced that consistent elements of a philosophy of care across the province should include commitments to the notion that a LTCH is a resident’s home and that they deserve the respect, dignity and quality of life that should be attached to one’s home and that the restorative care mandate of the LTCH Act, should be front and center of a philosophy of care.  This would give impetus to address resident function, quality of life and enablement approaches that requires occupational therapy intervention.

  • Supported recommendation that service requirements/allocations not be mandated by the Ministry but recommended that minimum service levels should be consistent across the province.  This would assure that services don’t get dropped when funding could be used elsewhere.   Reiterated OSOT’s recommendation that a minimum of 21 hours/200 bed home be considered for OT services

  • Supported recommendation that staffing levels should increase inclusion of allied health professionals and underlined the importance of a culture that embraces an interdisciplinary team approach to care. 

The Society will continue to monitor action on the report recommendations and has advocated to be engaged in the work of the new Commission.

OSOT's Long-Term Care Homes Sector Team, chaired by Joanne Kular can be contacted to provide input or to identify issues or concerns.