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Ontario may fail to meet direct LTC care target due to staffing shortage: document

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Difficulties hiring and retaining enough nurses and personal support workers in long-term care homes could mean the Ontario government may not meet its number target of practical care that residents receive, warned the minister responsible for the sector.

There is a “systemic shortage of nurses” across all sectors, according to a briefing paper prepared for Long-Term Care Minister Stan Cho when he took charge of the file in September.

As of this year, there is a need for 13,200 additional nurses and 37,700 PSWs in Ontario, says the document, obtained by The Canadian Press through an access to information request.

Long-term care shortages will become even more acute under the government’s efforts to dramatically increase the number of homes and as it attempts to increase the amount of direct care residents receive, the document says.

“The anticipated growth in LTC services, that is, the increase in the average daily duration of direct care in the system and the creation of 30,000 new beds, will create a need for thousands of new positions for nurses and personal support workers (and other LTC staff) over the next decade. ” says the briefing.

“This is in addition to existing shortages.”

The Progressive Conservative government has set a 2021 goal of ensuring that long-term care residents receive an average of four hours of direct care from nurses and PSWs per day by 2025 , compared to less than three hours in 2018. He enshrined this objective in the law.

The government met its first and second interim targets, documents show, with residents receiving an average of three hours and 15 minutes of hands-on care by March 31, 2023.

Cho’s office was not yet able to say whether the three-hour, 42-minute March 31, 2024, goal had been met, but briefings he received after taking over the case in September paint a difficult picture .

“Ongoing staffing challenges (e.g. supply shortages, cross-industry competition, etc.) as well as the continued impact of the pandemic and higher occupancy rates (…) present risks to the achievement of the objectives,” the document states.

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

“Every time the government announces that it is going to create thousands of new beds, we stand on the sidelines and ask, ‘Who is going to staff these homes?’ “, said Sharleen Stewart.

Shortages are affecting care, Stewart said, as staff such as personal support workers take on increasingly unmanageable workloads – caring for more residents at a time than they can handle. should and complete tasks that should be done alone in pairs – and then burns out.

“Some of them don’t last six weeks,” she said.

“Many of them say the workload is just too heavy, the conditions aren’t safe and they’re leaving. So we’ve reported that almost 50 percent of new hires leave within the first six month and certainly after a year. So it’s a continuous revolving door.

A spokesperson for Cho said the government was working with the long-term care sector to ensure funding was spent on quality care for residents, but acknowledged the staffing situation was difficult.

“Our government recognizes the current pressures facing Canada, such as inflation and global health and human resource shortages, which are harming our ability to continue progress toward our ambitious goals,” Daniel Strauss wrote in a communicated.

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

The government is funding a variety of programs to address these issues, including a $3 per hour wage increase for PSWs working in long-term care facilities, stipends during clinical rotations, and $10,000 for recent PSW graduates in exchange for a 12-month commitment to work in a long-term care center. temporary care home, and even more if it is in a rural or northern region.

Yet according to Cho’s transition filing, PSW attrition is as high as 25 percent, meaning up to a quarter of the profession leaves the profession each year. Low wages and working conditions are cited as key problems.

Lisa Levin, CEO of AdvantAge Ontario, representing non-profit homes, said after the government enacted the wage increase for PSWs during the COVID-19 pandemic, it left licensed practical nurses, who supervise PSWs, earn the same salary or less.

“What we are saying to the government is that we appreciate the efforts they have made, which is quite considerable, to provide funding and put in place health human resources programs, but it must be done globally, not globally. ” she said.

There is also a pay disparity between nurses in different parts of the health-care system, said Erin Ariss, president of the Ontario Nurses’ Association. The union is preparing to negotiate on behalf of 3,000 members in for-profit homes and wants staffing ratios to improve care for residents and salaries to be equal to their nursing counterparts in hospitals.

“These nurses working in long-term care have the same grocery bills, the same gas bills, the same mortgage rates as the rest of Canadians…and their salaries haven’t really changed significantly for almost a decade.” she says.

“Added to this is the fact that, in some cases, they care for hundreds of residents with just one nurse. »

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

“We are starting to see these initiatives bear fruit,” she said.

“It’s getting a lot easier to recruit PSWs…We continue to have difficulty with nurses and LPNs, probably more so with RPNs than RNs right now.”

In 2022-23, long-term care homes spent approximately $418 million on external nurses to temporarily fill vacant positions, an increase of 46% from the previous year. Homes have spent hundreds of millions more hiring temporary PSW workers, government documents suggest.

Other “allied health professionals” who work in long-term care homes, such as physiotherapists, dietitians and recreation staff, are also in short supply, Levin and Stewart said, although the briefing paper shows that the government has reached its target of 36 minutes per resident. of direct daily care from these professionals.


This report by The Canadian Press was first published April 16, 2024.

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