We Need More “Than a Body On the Floor”
The Staffing Crisis in Long-Term Care: A Call for Change
In the realm of long-term care, a pressing crisis looms – severe understaffing that has reached alarming levels. It is a challenge many facilities face, making recruitment and the interview process feel like an uphill battle. Recently, I participated in a roundtable discussion with residents from various homes, and it shed light on a troubling reality about the quality of care provided.
One crucial takeaway from our conversations was the stark realization that having “a body on the floor” does not necessarily equate to effective care from a resident’s perspective. Many shared experiences of personal support workers (PSWs) whose competencies left us questioning how they ever made it through hiring processes. It has become clear that some homes prioritize filling positions over ensuring the quality of care, reflecting a concerning trend where the emphasis is placed on numbers rather than holistic well-being.
While reports in Ontario state that residents receive an average of 3.4 hours of care per day, our lived experiences tell a different story. The ideal, as we understand it, is a target of 4 hours daily care comprising 0.8 hours (48 minutes) of RN care, 1.0 hours (60 minutes) of RPN care, and 2.2 hours (132 minutes) of PSW care. However, when we analyzed the actual hours of care based on our varying levels of independence, it became glaringly obvious that these figures do not hold up. Whether needing less or more care, the promised hours felt more like a misleading statistic than a realistic portrayal of care received.
There were a few residents that addressed these concerns with their management, employing their own metrics to evaluate staffing levels. Yet, it soon became clear that the reported figures did not align with the reality on the ground. For instance, a home might claim four staff members are available, but in truth, only two are actively engaged with residents. This inconsistency raises critical questions about how staffing levels are calculated and reported.
Our discussions were heartfelt and impassioned, with a shared sentiment among residents that the current state of many long-term care settings is far from satisfactory. As more of us rally for meaningful change, it is evident that comprehensive research and assessment are vital to truly grasp the scale of the issue.
At this time, it is a bleak outlook in staffing.
Projected Shortages and Demand
- Ontario Crisis: By 2029, Ontario alone will require at least 25,400 more nurses and PSWs to meet increasing care needs and support new beds.
- Sector-Wide Shortfall: By 2035, a model for Ontario’s LTC sector suggests a need for an additional 11,632 full-time equivalent (FTE) PSWs, 6,031 FTE RNs, and 10,178 FTE RPNs.
- Rising Senior Population: The Canadian senior population is expected to exceed 11 million by 2043, significantly outpacing current care capacity and available workers.
Current Staffing Challenges
- High Turnover: Approximately 25% of personal support workers with two or more years of experience leave the sector annually.
- Unsafe Workload: Staffing levels have not kept pace with the rising complexity of care needs, resulting in high rates of worker injury and burnout.
- Vacancy Rates: In 2024, 80% of Ontario LTC homes reported difficulty filling Registered Practical Nurse (RPN) shifts, and 53% struggled to fill Registered Nurse (RN) positions.
- Overtime Strain: In 2023–2024, 8% of total hours worked by direct care staff in certain regions were overtime, equivalent to over 1,500 full-time positions.
Factors Impacting Future Supply
- Aggressive Care Targets: Government mandates such as Ontario’s goal of 4 hours of daily direct care per resident has increased the demand for staff, which is difficult to meet with current shortages.
- Workforce Competition: LTC homes are losing staff to other sectors and, increasingly, to private temporary nursing agencies.
- Leadership Turnover: 45% of Ontario LTC homes reported a change in their leadership (Director of Care, Administrator) in 2024.
Potential Solutions and Strategic Moves
- Accelerated Training: Implementing accelerated education programs and on-the-job training models to increase the supply of PSWs and nurses.
- Staffing Support Initiatives: Government investments aimed at increasing direct care hours and improving working conditions to aid retention.
- Increased Funding: Calls for, and implementation of, higher wages, better benefits, and improved working conditions to attract and retain staff.
More than anything, we seek quality care that genuinely enhances our quality of life. It is time to advocate for systems that prioritize residents’ well-being over mere statistics. Let’s shift the focus from quantity to quality in long-term care because we deserve far more than just “a body on the floor.”
Sources
The information in this article was compiled from publicly available reports and publications from the following organizations:
- Canadian Institute for Health Information (CIHI). Health Workforce in Canada and Long-Term Care workforce reports. https://www.cihi.ca
- Ontario Long Term Care Association (OLTCA). Workforce Reports, Sector Surveys and Long-Term Care Workforce Modelling. https://www.oltca.com
- Ontario Ministry of Long-Term Care. A Better Place to Live, A Better Place to Work: Ontario’s Long-Term Care Staffing Plan. https://www.ontario.ca/page/better-place-live-better-place-work-ontarios-long-term-care-staffing-plan
- Ontario Ministry of Long-Term Care. Long-Term Care Staffing Study. https://www.ontario.ca/page/long-term-care-staffing-study
- Ontario Newsroom. Ontario Growing Its Long-Term Care Workforce. https://news.ontario.ca
- Ontario Newsroom. Ontario Investing $26 Million to Train More Frontline Staff in Long-Term Care. https://news.ontario.ca
- Statistics Canada. Population Projections for Canada, Provinces and Territories. https://www.statcan.gc.ca
Statistics and projections cited throughout this article were current at the time of writing and are based on the most recent publicly available data from the above sources.
No Filters, No Excuses. Just Reality.
Now Living in Long-Term Care, I was a seasoned communications and marketing professional with a strong presence in the mining, media, and investor relations sectors.
ive been a paw for 25+ years both in LTC and home care. ive noticed a big difference in quality of care since we started streamlining the paw course and offering it online. Staff dont learn compassion online, they dont understand things through a computer. some homes have such a regular turn over of management its no wonder things are never changed. The ratios that are put in place by the government are not logical, 1 psi caring for 12 residents plus covering breaks, and whatever may come up in that shift is never going to allow for them to give each resident the amount of care outlined. Accidents happen and you could be sitting with an injured resident for long periods of time, family could send you on a wild goose chase to find their mothers black sock, a resident is in their last moments of life so you chose to sit with them when family aren’t there yet this takes away from your residents. there just simply isn’t enough staff on the floor. If there were more FT positions offered you would have staff but when you only offer 2 shifts a week your staff have to find multiple jobs and then there are outbreaks so the staff can only work at one facility. its a never ending battle. FUNDING is the issue and I dont know if people are getting a kick back on money not spent so they refuse to give it or what is happening but its not fair to residents and not fair to the staff who want to do their job well but feel like they failed every time they go home because they only had time to give the bare minimum during their shift.