Quality long-term care is crucial for older adults and is a top priority in Ontario. Insufficient staff in these facilities is a critical policy issue that requires quick attention and reform. The shortage of skilled nurses, personal support workers (PSWs), and other essential staff endangers the health and safety of elderly residents. It worsens neglect and abuse, creating a healthcare system with health inequities. The COVID-19 pandemic has highlighted long-term care system weaknesses and the dire effects of understaffing during a public health catastrophe. Tragic pandemic consequences highlight the need for substantial reforms to address structural concerns in Ontario’s long-term care institutions. This essay analyzes long-term care staffing, explains why legal reforms are needed, examines the legal framework, and proposes a comprehensive solution that meets accountability, standardization, recruitment and retention, neglect and abuse prevention, and transparency.
Ontario’s long-term care staffing issues are well known. Ageing populations increase the need for prolonged care beds in Ontario. In approximately the previous 15 years, residents’ medical complexity has increased by about 15%, necessitating more qualified people to offer care.[1]. Low staffing endangers residents and workers. A 2019 Ontario Health Coalition report on personal support workers (PSWs) highlighted the impact of understaffing on care. These effects included hasty care, missing bathing, and other negative results. PSWs faced lengthy shifts, several part-time jobs, little pay and benefits, a punishing work environment, and high injury and violence rates. Many residences reported empty shift lines during the coronavirus epidemic, indicating unfilled positions. Most claimed that sick staff were not replaced. Reports indicate staff turnover due to choosing between numerous part-time jobs and departing for higher-paying or more hourly homes.[2].
[3]Registered Nurses’ (RN) and personal support workers (PSWs) understaffing has afflicted Ontario for decades. The COVID-19 epidemic worsened the RN staffing shortage. Nurses survived extreme stress. During the pandemic, nurses had to adjust and seek support when needed. Nurses had limitations in terms of endurance and duration. Many RNs left their positions due to exceeding the limit. Some quit Ontario and the profession as well. Some left their career after the pandemic. The Registered Nurses Association of Ontario (RNAO) demanded immediate action from businesses and government in the health system.
The situation in Ontario shows that demand outweighs supply. Care quality needs to improve as overworked workers try to fulfil the different needs of an ageing population. Many long-term care residents need specialized care and medical support, making adequate staffing essential for their well-being. Understaffing in long-term care facilities lowers quality and increases neglect and abuse risk. Overworked and understaffed facilities fail to supervise vulnerable people. In addition, understaffing increases the risk of physical and emotional abuse, endangering residents’ safety and dignity.
Additionally, the demanding nature of the work and the increased duties put on an insufficient workforce have contributed to significant burnout rates among long-term care personnel.[4]. The COVID-19 epidemic worsened this situation, as frontline personnel confronted enormous challenges and strains. The loss of experienced staff perpetuates understaffing and makes long-term care harder. Over two-thirds of the sample (67.9%) reported burnout, with 5.8% indicating exhaustion and 12% reporting disengagement[5]. The Independent Review of Staffing and Care Standards for Long-Term Care Homes in Ontario recommends 3.5 hours of direct nursing care, with 2.5 PSW and one nurse hour. [6]. Despite these recommendations, personnel shortages persist, raising worries about the system’s resiliency and ability to fulfil the ageing population’s needs. The current situation highlights Ontario’s need for thorough, sustained long-term care staffing reforms.
Several reasons make legal reforms necessary to fix the current system. The main priorities are accountability, standardization, recruitment and retention, neglect and abuse prevention, and public confidence and openness. Clear accountability is a significant justification for long-term care legal revisions. Legal requirements for staff-to-patient ratios and training standards ensure that long-term care institutions have a qualified crew. The legislative framework measures a facility’s quality care commitment by establishing personnel levels. This promotes accountability by holding institutions accountable for satisfying standards and empowering regulatory bodies to act in noncompliance cases. Legal reforms are essential to long-term care standardization. Standardization includes staff qualifications, credentials, and training processes to ensure care consistency across facilities. This endeavour relies on the 2007 Ontario Long-Term Care Homes Act, which governs licensing, resident care, and reporting.[7]. Standardization ensures that all residents, regardless of location or institution, receive high-quality, standardized care. The Act fosters trust and reliability in long-term care services.
Legal reforms also help with long-term care personnel recruitment and retention. The legal structure reduces turnover and improves care by mandating competitive compensation and better working conditions. A supportive and well-compensated workplace attracts skilled professionals and encourages current workers to stay, producing a stable and experienced team needed to provide high-quality long-term care. Moreover, clear and enforceable laws deter long-term care negligence and abuse. Legal reforms that set criteria and penalties for noncompliance can protect vulnerable citizens. Clear sanctions for neglect or abuse encourage institutions to promote resident well-being. This legal deterrent protects older people and promotes respect and dignity in long-term care. In addition, Long-term care legal amendments boost public trust and openness. Clear regulations governing personnel numbers and training offer transparent reporting, helping families choose care for their loved ones. This community-wide transparency builds trust in long-term care facilities. Legal reforms make long-term care more transparent and trustworthy by aligning frameworks with openness and accountability.
Lastly, Provincial and territorial governments oversee long-term care in Canada, including Ontario. Ontario’s 2007 Long-Term Care Homes Act is vital for long-term care staffing and maintenance. Ontario professional colleges determine staff standards, scope, and qualifications for nurses. Ontario healthcare professionals are also covered by the Occupational Health and Safety Act, which emphasizes workplace safety. This legislative framework allows for and enforces long-term care reforms. Legal reforms can be carefully applied to promote accountability, uniformity, recruitment and retention, neglect and abuse prevention, and public trust and openness in Ontario’s long-term care services.
To address Ontario’s long-term care staffing shortages, several recommendations need to be actualized, including managing staff ratios, offering training to staff, paying a competitive salary, and having a transparent reporting tool. Defined and evidence-based staff-to-patient ratios are essential. The legislation mandates one Registered Nurse (RN) for every 20 residents throughout the day and one for every 30 at night. Moreover, directing one Personal Support Worker (PSW) for every eight residents during the day and one for every 15 residents at night will help solve staff-patient ratios. The Independent Review of Staffing and Care Standards for Long-Term Care Homes in Ontario emphasize the relevance of evidence-based staffing ratios in improving care. Enshrining these standards in law ensures that they become part of the regulatory environment, providing long-term care facilities with clear guidance and laying the groundwork for continued evaluation and improvement.
Secondly, standardizing staff credentials and training is essential to improve healthcare professionals’ proficiency throughout Ontario’s long-term care facilities. Legal reforms that require uniform qualifications and certifications can provide a unified framework ensuring minimum workforce knowledge and expertise. A legally mandated standardization of training encourages healthcare workers to grow throughout their careers.[8]. A more resilient and flexible healthcare workforce can better respond to long-term care sector difficulties, helping residents who rely on their knowledge. To address the issue of standardization, all nurses working in long-term care facilities must hold a Bachelor of Science in Nursing (BSN) degree. PSWs, on the other hand, should complete a standardized training program of at least 500 hours, covering technical care skills and interpersonal communication. Additionally, there is a need to boost enrolment and financing for four-year BScN, second entry, and RPN-to-RN bridging courses by 10% yearly for eight years.[9]. Such changes in staff standardization will ensure that residents receive high-quality care.
Additionally, laws to assure competitive remuneration and improved working conditions for long-term care personnel should be implemented to tackle recruitment and retention issues. Competitive pay helps recruit and retain qualified workers. Healthcare staff need better working conditions to avoid burnout and boost job satisfaction.[10]. Long-term care can be physically and emotionally demanding. Legislation should set a minimum hourly wage for PSWs at $25, with provisions for annual cost-of-living adjustments. Additionally, long-term care staff, including nurses and PSWs, must not work more than 40 hours per week. Mandatory breaks and overtime compensation should be a priority.
Moreover, transparent reporting requirements should be implemented. Implementing acceptable reporting requirements for long-term care facilities fosters accountability, empowers families, and boosts sector confidence. Transparent reporting requirements allow external examination, which encourages sector accountability. Public disclosure of personnel numbers, training standards, and other data offers a system of checks and balances that pushes long-term care facilities to meet criteria. Based on these indicators, families, advocacy groups, and regulatory agencies can actively monitor and review facility performance, holding institutions accountable for providing the promised quality of care. Legislation should be changed such that long-term care facilities must report staffing levels quarterly, including the number of RNs, PSWs, and other staff categories. Additionally, facilities should report incidents of neglect or abuse within 24 hours, with a standardized format for writing to regulatory bodies and families.
Furthermore, Legal reforms should improve caregiver training and support, including family members, to meet the holistic requirements of long-term care residents. Legislation improves caregiver training, creating a more professional and compassionate caregiving environment that benefits residents. Family carers can cope with caring issues using legal systems that provide resources, guidance, and emotional support.[11]. Legislation should mandate a standardized training program for family caregivers, covering basic care skills, communication strategies, and resources for emotional support. Additionally, legislation should propose laws ensuring that family caregivers have access to counselling, education, and support networks, with a minimum of 20 hours of respite care per month provided by the facility.
In addition, legal requirements that require public participation and inclusive policy creation for major long-term care reforms are essential to developing a more democratic and responsive healthcare system. Policies constitutionally requiring public consultation guarantee that individuals immediately affected by reforms are heard, promoting transparency and accountability in decision-making.[12]. Inclusive policy development creates well-informed, culturally sensitive policies that meet the different requirements of long-term care patients. Legislation should foresee the establishment of a Long-Term Care Advisory Committee with at least 50% representation from residents, family members, and frontline staff.
In conclusion, fundamental legal improvements in Ontario’s long-term care market are essential. Staffing shortages, exhaustion, and increased risks of neglect and abuse necessitate a quick and revolutionary response. Apparent staff-to-patient ratios, standardization of personnel qualifications and training, competitive pay, improved working conditions, transparent reporting requirements, periodic review of standards, enhanced caregiver training and support, and inclusive policy development through public consultation provide a practical framework for addressing existing shortcomings and building a resilient long-term care system.
Bibliography
Dass, Adrian Rohit, Raisa Deber, and Audrey Laporte. “Forecasting Staffing Needs for Ontario’s Long-Term Care Sector.” Healthcare Policy 17, no. SP (2022): 91.
Greg Shaw. Long-Term Care Staffing Study by the Ministry of Long Term Care, Ontario Long-Term Care Staffing Study Advisory Group – ontario.ca/longtermcare July 30, 2020https://geriatricsontario.ca/wp-content/uploads/2020/09/Shaw-Toronto-Friday-Presentation.pdf
Lee, DonHee. “Impact of organizational culture and capabilities on employee commitment to ethical behavior in the healthcare sector.” Service Business 14, no. 1 (2020): 47-72.
Ontario Health Coalition Long-Term Care Staffing Survey Report July 22, 2020https://www.ontariohealthcoalition.ca/wp-content/uploads/LTC-staffing-survey-report.pdf
Ontario’s Long-Term Care Staffing Plan. A Better Place to Live, a Better Place to Work. (2020)https://files.ontario.ca/mltc-ontario-long-term-care-staffing-plan-2021-2025-en-2020-12-17.pdf
Rahimi, Tahereh, Neda Dastyar, and Foozieh Rafati. “Experiences of family caregivers of patients with COVID-19.” BMC Family Practice 22 (2021): 1-10.
Rijal, Syamsu. “The Importance of Community Involvement in Public Management Planning and Decision-Making Processes.” Journal of Contemporary Administration and Management (ADMAN) 1, no. 2 (2023): 84-92.
Roblin, Blair, Raisa Deber, Kerry Kuluski, and Michelle Pannor Silver. “Ontario’s retirement and long-term care homes: a comparison of care services and funding regimes.” Canadian Journal on Aging/La Revue canadienne du vieillissement 38, no. 2 (2019): 155-167.
[1]Ontario’s Long-Term Care Staffing Plan. A Better Place to Live, a Better Place to Work. https://files.ontario.ca/mltc-ontario-long-term-care-staffing-plan-2021-2025-en-2020-12-17.pdf (2020)
[2] Ontario Health Coalition Long-Term Care Staffing Survey Report https://www.ontariohealthcoalition.ca/wp-content/uploads/LTC-staffing-survey-report.pdf July 22, 2020
[3] RNAO Ontario’s RN Understaffing Crisis: Impact and Solution. https://rnao.ca/sites/default/files/2021-11/Ontarios%20RN%20understaffing%20Crisis%20Impact%20and%20Solution%20PAB%202021.pdf (2021)
[4] Dass, Adrian Rohit, Raisa Deber, and Audrey Laporte. “Forecasting Staffing Needs for Ontario’s Long-Term Care Sector.” Healthcare Policy 17, no. SP (2022): 91.
[5] RNAO Ontario’s RN Understaffing Crisis: Impact and Solution. https://rnao.ca/sites/default/files/2021-11/Ontarios%20RN%20understaffing%20Crisis%20Impact%20and%20Solution%20PAB%202021.pdf (2021)
[6] Dass, Adrian Rohit, Raisa Deber, and Audrey Laporte. “Forecasting Staffing Needs for Ontario’s Long-Term Care Sector.” Healthcare Policy 17, no. SP (2022): 91.
[7] Roblin, Blair, Raisa Deber, Kerry Kuluski, and Michelle Pannor Silver. “Ontario’s retirement and long-term care homes: a comparison of care services and funding regimes.” Canadian Journal on Aging/La Revue canadienne du vieillissement 38, no. 2 (2019): 155-167.
[8]Lee, DonHee. “Impact of organizational culture and capabilities on employee commitment to ethical behavior in the healthcare sector.” Service Business 14, no. 1 (2020): 47-72.
[9] RNAO Ontario’s RN Understaffing Crisis: Impact and Solution. https://rnao.ca/sites/default/files/2021-11/Ontarios%20RN%20understaffing%20Crisis%20Impact%20and%20Solution%20PAB%202021.pdf (2021)
[10] Greg Shaw. Long-Term Care Staffing Study by the Ministry of Long Term Care, Ontario Long-Term Care Staffing Study Advisory Group – ontario.ca/longtermcare https://geriatricsontario.ca/wp-content/uploads/2020/09/Shaw-Toronto-Friday-Presentation.pdf July 30, 2020
[11]Rahimi, Tahereh, Neda Dastyar, and Foozieh Rafati. “Experiences of family caregivers of patients with COVID-19.” BMC Family Practice 22 (2021): 1-10.
[12]Rijal, Syamsu. “The Importance of Community Involvement in Public Management Planning and Decision-Making Processes.” Journal of Contemporary Administration and Management (ADMAN) 1, no. 2 (2023): 84-92.
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