Ontario LTC may not meet direct care goal: doc

Difficulties recruiting and retaining enough nurses and personal aides for long-term care homes could keep the Ontario government from meeting its goals for hands-on care for residents, the minister responsible for the sector has warned.

There is a “systematic shortage of nurses” across all sectors, according to a briefing document prepared for Long-Term Care Minister Stan Cho when the file was received in September.

As of this year, Ontario needs 13,200 additional nurses and 37,700 PSWs, according to a document obtained by The Canadian Press through a Freedom of Information request.

Shortages in long-term care will be exacerbated by the government's efforts to significantly increase the number of homes and increase the amount of direct care provided to residents, the document says.

“Expected growth in LTC services, which means an increase in the system's average daily direct care hours and 30,000 new beds, will create the need for thousands more new positions for nurses and personal support staff (as well as other LTC staff) over the next decade,” the briefing said.

“It will exceed the current deficit.”

The Progressive Conservative government has set a target for long-term care residents to receive an average of four hours of direct care by nurses and PSWs per day by 2021 by 2025, down from three hours in 2018. He set this goal in the legislation.

As of March 31, 2023, the government has achieved the first and second interim goals outlined in the documents, with an average of three hours and 15 minutes of practical assistance for residents.

Cho's office has yet to say whether the March 31, 2024, three-hour, 42-minute target has been met, but briefings received since receiving the file in September paint a grim picture.

“Persistent staffing challenges (such as supply shortages, cross-sector competition, etc.), as well as the ongoing pandemic impact and high overcrowding … threaten the achievement of targets,” the document said.

The warning comes as no surprise to many in long-term care, including the president of SEIU Healthcare, the largest union representing long-term care workers.

“Every time the government announces they're going to have thousands of new beds, we're like, 'Who's going to provide these homes?' “We will sit on the sidelines,” said Charlene Stewart.

Shortages affect care, Stewart said, as staff like personal support workers take on increasingly unmanageable workloads — caring for more residents than necessary at one time and doing the tasks they're supposed to do in pairs — and then burn out.

“Some of them don't last six weeks,” he said.

“Most of them come in and say the workload is too heavy, the conditions are dangerous, and they move on. That's why we've reported that nearly 50 percent of new hires leave within the first six months and inevitably after. one year. So it's a continuous revolving door.”

Cho's spokesman said the government was working with the long-term care sector to ensure funding was used to provide quality services to residents, but admitted staffing was a challenge.

“Our government recognizes Canada's current pressures such as inflation, global health and human resource shortages affect our ability to continue to meet our ambitious goals,” Daniel Strauss wrote in a statement.

“That's why our government continues to make historic investments in Ontario's long-term care sector.”

The government funds a variety of programs to address the issues, including a $3-an-hour wage increase for PSWs in long-term care, stipends during clinical placements, and $10,000 for recent PSW graduates in exchange for a 12-month commitment to work longer hours. a long-term care home and more if it is in a rural or northern area.

However, according to Cho's transition liaison, PSW attrition is as high as 25 percent, meaning a quarter of the profession leaves each year. The main problem is low wages and working conditions.

Lisa Levin, CEO of AdvantAge Ontario, a non-profit representing homes, said after the government decided to raise wages for PSWs during the COVID-19 pandemic, it left registered practical nurses supervising PSWs who are making the same or less.

“What we are saying to the government is that we appreciate their efforts to fund and implement health workforce programs, but it needs to be done comprehensively, not one-off. on a piecemeal basis, because otherwise, you end up with situations like the RPN pay squeeze, where you can make things better for one group but make it worse for another group,” he said.

There are also pay disparities among nurses in different parts of the health care system, said Erin Aris, president of the Ontario Nurses Association. The union is negotiating on behalf of 3,000 members at for-profit homes and wants to see a staffing ratio to improve care for residents and equal pay with nursing colleagues in hospitals.

“These long-term care nurses have the same grocery bills, the same gas bills, the same mortgage rates as other Canadians … and their wages haven't changed much in a decade,” he said.

“This is due to the fact that in some cases they are caring for one nurse for hundreds of residents.”

Long-Term Care Association of Ontario CEO Donna Duncan said the health care workforce shortage is a global problem and the province has done a lot on the issue, but there is still more to do.

“We can see that these initiatives are starting to bear fruit,” he said.

“PSWs are getting a lot easier to recruit … We still have challenges with nurses and RPNs, probably more RPNs than RNs right now.”

In 2022-23, long-term care homes will spend an estimated $418 million on outside agency nurses to temporarily fill vacancies, a 46 percent increase over the previous year. Houses spent hundreds of millions more to hire PSW agency workers, according to state documents.

Other “allied health professionals” who work in long-term care homes, such as physiotherapists, dieticians and recreation workers, are also understaffed, Levin and Stewart said, but the briefing document shows the government has met the target of 36 minutes per resident. daily direct care of those professionals.

This Canadian Press report was first published on April 16, 2024