Long-term care staffing study

The Registered Nurses’ Association of Ontario (RNAO) says the long-term care (LTC) staffing study released by the government highlights deficiencies known for decades. The government’s Long-Term Care Staffing Study Report provides recommendations within five priority areas to improve staffing across the sector:

  1. The number of staff working in long-term care needs to increase and more funding will be required to achieve that goal
  2. The culture of long-term care needs to change – at both the system and individual home level
  3. Workload and working conditions must get better, to retain staff and improve the conditions for care
  4. Excellence in long-term care requires effective leadership and access to specialized expertise
  5. Attract and prepare the right people for employment in long-term care, and provide opportunities for learning and growth

The need for immediate action is outlined in RNAO’s Nursing Home Basic Care Guarantee submission to the government’s Long-Term Care Staffing Study Advisory Group, which was struck by minister Fullerton in response to the public inquiry on LTC homes, which issued its recommendations on July 31, 2019. Justice Eileen Gillese led that inquiry and gave the government a deadline of July 31, 2020 to table in the legislature a staffing plan for regulated staffing in LTC.

The government’s report highlights a minimum staffing complement to provide four (4) direct hours of nursing and personal care per resident, per day. However, the report fails to specify the skill-mix composition of those four hours, leaving residents, families and staff to the will of operators.


RNAO will continue to call for the Nursing Home Basic Care Guarantee as the only way forward. It will also continue to urge that no nursing home – whether for-profit or not-for-profit – go below four hours of direct nursing and personal care per resident, per 24 hours. All homes must guarantee a proper skill mix as follows:

  • 0.8 hours (48 minutes) of RN care per resident, per 24 hours
  • 1 hour (60 minutes) of RPN care per resident, per 24 hours
  • 2.2 hours (132 minutes) of PSW care per resident, per 24 hours

RNAO is also calling on government to fund each LTC home for one NP per 120 residents, in the role of attending NP or director of clinical care; as well as one additional nursing full–time equivalent (FTE) staff (preferably an RN) to support the functions of infection prevention and control and quality improvement.