As the province has lifted long-term care staffing levels since the pandemic, some companies’ homes have lagged behind, records show
EDITOR’S NOTE: This article originally appeared on The Trillium, a Village Media website devoted exclusively to covering provincial politics at Queen’s Park.
After the Canadian military was dispatched to Ontario long-term care homes during the pandemic, the province learned a lesson: the homes that had more robust staffing before the crisis fared far better than those that didn’t.
The horror stories the Canadian Armed Forces described — the virus running rampant and seniors dying of neglect — occurred in homes where staffing had collapsed.
So, in late 2020, the long-term care minister of the day announced that the province had set a goal: by the end of 2024-25, each resident would receive an average of at least four hours of direct “hands-on care” from nurses and personal support workers (PSWs) each day.
The province passed legislation, set interim targets and began measuring progress by collecting detailed information on the cumulative hours worked by these staff, and the days residents lived in each home.
Since then, the government has been doing the math and publicly releasing figures for how many hours of hands-on care LTC residents in Ontario have received, on average, as the province works toward its goal.
While Ontario just missed its final target, recording an average of 3 hours and 49 minutes of hands-on care in the fourth quarter of the 2024-25 fiscal year, it exceeded it in the following quarter, Minister Natalia Kusendova-Bashta recently said at a legislative committee.
But data on individual homes’ performance has not been made public, until now. The Trillium requested it through the freedom of information system in the spring of 2024 and received it last week.
The data for the fiscal year ending March 31, 2024, shows a wide disparity between homes, with some recording barely an hour of care per resident per day and others well exceeding the year’s interim target of 3 hours and 42 minutes.
The difference between those numbers is quality of life.
At homes with low staffing levels, residents will have more complications and more visits to hospitals, said Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario.
“It means you’re not getting the care you need — that’s the bottom line,” said Grinspun. “What it means is more pressure injuries (known as bedsores), more falls, more use of restraints — physical restraints or chemical restraints, as in medications — because they don’t have the staffing to engage with residents.”
MPP Tyler Watt, the Ontario Liberal critic for long-term care who worked as a nurse in long-term care early in the pandemic, echoed that, saying low staffing leads to health issues being missed and long-term care residents being sent to emergency rooms.
Watt said he wants to see the province aim higher than four hours a day of hands-on care.
“Just getting someone up and out of bed, showered and dressed and getting them ready for breakfast could take one to two hours,” he said, adding that it depends on the resident’s individual needs.
“And it’s really not even giving an opportunity to dive into things like their mental health and spending quality, meaningful time with them.”
Kusendova-Bashta, who is also a nurse, didn’t respond directly to questions from The Trillium about this data, including about any steps the government has taken to enforce standards on homes with low staffing, and its decision to extend and expand LTC licences for homes that performed poorly during the pandemic and continue to show low staffing levels today.
A spokesperson for her ministry issued a statement saying that the government “is making record investments and taking historic action to connect more long-term care residents to the care they need when they need it.”
“Compared to 2021, long-term care residents are now receiving, on average, more than an hour of additional daily direct care from nurses and PSWs — a 36 per cent increase, equivalent to 15 days of additional care per resident, per year,” the ministry said.
Please note — some data is missing. The ministry said it excluded some information for data quality issues, including removing some outliers where the data indicated homes provided less than 1 hour or more than 7 hours of care per resident per day in some quarters.
Ownership models
The data shows another pattern: the homes with the lowest recorded staffing over that year are for-profit homes. Of the bottom 10, seven are owned by one company, Southbridge Care Homes.
Information on some quarters of the company’s homes is also missing from the ministry’s data set. The company said in a statement that it experienced “an internal reporting issue,” but would not say if the data it provided to the ministry was accurate or inaccurate.
“Beginning in October 2023, Southbridge transitioned from a third-party management company to in-house operations, including a full back-office system change. During this transition, some data was not captured in reports,” the company wrote.
It also indicated that it increased staffing in its homes the year following this data.
“During the 2024-25 12-month period, we delivered an average of 3.8 hours of direct care, with the last six months reaching 3.9 hours (3 hours and 54 minutes) on average,” the company said. “While we strive for four hours of care, unforeseen circumstances such as staff illness or personal emergencies can impact delivery.”
The company average in 2023-24, according to the ministry data, was 2.59 hours, or 2 hours and 35 minutes.
It’s clear there were issues in some of the company’s homes.
The home with the lowest reported hands-on care that year was Southbridge’s Chelsey Park, in London, Ont. Despite the home operating throughout the year, ministry records were blank for the first three quarters. In the fourth quarter, it reported to the ministry that it provided an average of just 1 hour and six minutes of hands-on care per day.
During that year, the ministry issued a series of compliance orders to the home for serious problems, including one that stated it “has failed to ensure that the resident was not neglected by the licensee or staff.”
The inspector’s report described a patient with worsening necrotic wounds with no documented treatments over a span of months, to whom pain medication was administered without proper documentation and procedure.
The home with the second-lowest staff levels was Southbridge Owen Sound, which opened in December 2022. The following August, the ministry ordered it to cease admissions, citing a “risk of harm to the health or well-being of residents of the home or persons who might be admitted as residents.”
Southbridge told the media at the time it was due to issues “tied to the building’s opening” that were later resolved. Inspection reports indicated problems with the systems that residents use to call for staff help, which, in one case, left a resident “incontinent in their room with urine on the floor,” and unable to get assistance, an inspector reported.
Most homes fared better.
The top 10 homes by staffing levels are a mix of non-profit, municipally owned, and independent for-profit homes.
The homes with the highest staffing levels include two each run by York Region and Simcoe County, which subsidize the homes with local tax dollars, allowing them to exceed the provincial funding for staffing. Non-profit homes also tend to augment their staffing budgets with donations.
That’s why most long-term care advocates and opposition MPPs oppose the for-profit model in long-term care. During the pandemic, academic research found that municipal and non-profit homes outperformed for-profit homes in keeping COVID-19’s spread under control.
On average, the differences in staffing between the models in the ministry’s data are present, but not extreme: municipal homes provided 3 hours and 40 minutes of care by nurses and PSWs per resident per day, non-profit homes provided 3 hours and 37 minutes of care, and for-profit homes provided 3 hours 26 minutes of care.
“I’ve been saying all along that for-profit homes only care about making a profit and not about care,” said Wayne Gates, who has been the NDP’s long-term care critic for eight years.
He said he wants to see the province pull the licences of homes that consistently fail to meet staffing targets.
“I think they should stop handing out licences and public dollars for-profit chains with chronic understaffing — that would help alleviate some of the problem,” Gates said.
“I don’t know how some of these get their licence anyways, particularly ones that had terrible results during COVID,” he added.
Advocates launched protests and a court action to stop the province from giving a new licence to Southbridge’s Orchard Villa long-term care home in Pickering, one of the homes the military had to assist in 2020. The advocates’ efforts failed. The province decided to allow the home to be rebuilt larger, and construction has recently begun. The 2023-24 data showed the home had below-target staffing that year, at 2 hours and 51 minutes for the three quarters for which there is recorded information for the home.
Nearly all of the homes of another chain, Caressant Care, fell below the provincial target in the data set, with one in the bottom 10.
A spokesperson for the company said the data is “a valuable snapshot of one measure of the care we deliver” and that the company is continuously working to enhance its care model.
“It is important to provide context regarding our operational funding: The specific funding envelopes allocated for nursing and personal care are mandated by the province to be spent exclusively within those domains, with no flexibility for reallocation or potential ‘profit,’” said Kayla Ritz, director of operations. “Our homes are managed and audited rigorously to fully utilize this provincial budget.”
The company has increased its homes’ staffing levels since then, with some reaching as high as four-and-a-half hours of care per day, she said.
Some long-term care chains had some homes that met or exceeded the province’s target in 2023-24 and others that fell below.
For instance, one of Sienna Senior Living’s homes — Muskoka Shores Care Community — was among the 10 lowest-staffed homes in the ministry’s data set, at 2 hours and 24 minutes of hands-on care, but most of the chain’s homes were close to the target.
“Muskoka Shores Community has faced unique staffing challenges, in particular because of its rural location,” said the company’s director of public affairs, Nadia Daniell-Colarossi.
“For this home, we use a range of strategies to create a full complement of stable staffing in the region to provide consistent, high-quality care,” she continued. “This includes offering relocation assistance and temporary housing, participating in programs for internationally educated nurses, and supporting the federal Ukrainian refugee program. These initiatives have contributed to stronger staffing levels.”
The home augments care with resident aides and student placements, she said.
The home’s staffing has improved, but is still below the provincial target, with 3 hours and 18 minutes of direct care per day last quarter, “an increase of nearly 40 per cent compared to last year.”
“This improvement reflects our ongoing commitment to meeting the provincial average and ensuring residents receive the support they need to thrive,” she said.
The public’s right to know
The NDP has been calling on the province to make this data public so that prospective residents and their loved ones can look at staffing levels when choosing a home, said Gates.
“They should be made to make all this public, and it should be done immediately, and then after that, it should be done every single year,” he said.
The data in this story was obtained from a freedom of information request filed in April 2024 for the most recent data, which, at the time, was for the fiscal year ending on March 31, 2024. The province agreed to grant access to the data in July 2024 but did not release it until November 2025. During that time, the file was transferred from the Ministry of Health to a new unit within the Ministry of Long-Term Care, which also agreed to release the data.
In August, The Trillium was informed that third parties had appealed the government’s decision to release the records, so the matter was brought to the Information and Privacy Commissioner of Ontario for resolution. During the mediation process, the third parties dropped their appeal, and the data was released.
The Trillium has since requested updated data on long-term care staffing levels.