As the province has lifted long-term care staffing levels since the pandemic, some companies\u2019 homes have lagged behind, records show<\/p>\n
EDITOR\u2019S NOTE: This article originally appeared on The Trillium<\/a>, a Village Media website devoted exclusively to covering provincial politics at Queen\u2019s Park.<\/p>\n After the Canadian military was dispatched to Ontario long-term care homes during the pandemic, the province learned a lesson: the homes that had\u00a0more robust staffing before the crisis fared far better than those that didn’t.<\/p>\n The horror stories the Canadian Armed Forces described \u2014 the virus running rampant and seniors dying of neglect \u2014\u00a0occurred in homes where staffing had collapsed.<\/p>\n So, in late 2020, the long-term care minister of the day announced<\/a> that the province had set a goal: by the end of 2024-25, each resident would receive\u00a0an\u00a0average of at least four hours of direct \u201chands-on care\u201d from nurses and personal support workers (PSWs) each day.<\/p>\n 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.<\/p>\n 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.<\/p>\n While Ontario just missed its final target<\/a>, 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.<\/p>\n But data on individual homes\u2019 performance<\/a> 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.<\/p>\n The data for the fiscal year ending March 31, 2024, shows a wide disparity between homes, with\u00a0some recording barely an hour of care per resident per day and others well exceeding the year\u2019s interim target of 3 hours and 42 minutes.<\/p>\n The difference between those numbers is quality of life.<\/p>\n At homes with low staffing levels, residents will have more complications and more visits to hospitals, said Doris Grinspun, CEO of the Registered Nurses\u2019 Association of Ontario.\u00a0<\/p>\n \u201cIt means you\u2019re not getting the care you need \u2014 that\u2019s the bottom line,\u201d said Grinspun. \u201cWhat it means is more pressure injuries (known as bedsores), more falls, more use of restraints \u2014 physical restraints or chemical restraints, as in medications \u2014 because they don\u2019t have the staffing to engage with residents.\u201d<\/p>\n 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.<\/p>\n Watt said he wants to see the province aim higher than four hours a day of hands-on care.\u00a0<\/p>\n \u201cJust getting someone up and out of bed, showered and dressed and getting them ready for breakfast could take one to two hours,\u201d he said, adding that it depends on the resident\u2019s individual needs.<\/p>\n \u201cAnd it\u2019s really not even giving an opportunity to dive into things like their mental health and spending quality, meaningful time with them.\u201d<\/p>\n Kusendova-Bashta, who is also a nurse, didn\u2019t 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\u00a0and continue to show low staffing levels today.<\/p>\n A spokesperson for her ministry issued a statement saying that the government \u201cis making record investments and taking historic action to connect more long-term care residents to the care they need when they need it.\u201d\u00a0<\/p>\n \u201cCompared to 2021, long-term care residents are now receiving, on average, more than an hour of additional daily direct care from nurses and PSWs \u2014 a 36 per cent increase, equivalent to 15 days of additional care per resident, per year,\u201d the ministry said.<\/p>\n Please note \u2014 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.<\/p>\n Ownership models<\/p>\n 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,\u00a0Southbridge Care Homes.<\/p>\n Information on some quarters of the company\u2019s homes is also missing from the ministry\u2019s data set. The company said in a statement that it experienced \u201can internal reporting issue,\u201d but would not say if the data it provided to the ministry was accurate or inaccurate.<\/p>\n \u201cBeginning 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,\u201d the company wrote.<\/p>\n It also indicated that it increased staffing in its homes the year following this data.\u00a0<\/p>\n \u201cDuring 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,\u201d the company said. \u201cWhile we strive for four hours of care, unforeseen circumstances such as staff illness or personal emergencies can impact delivery.\u201d<\/p>\n The company average in 2023-24, according to the ministry data, was 2.59 hours, or 2 hours and 35 minutes.<\/p>\n It\u2019s clear there were issues in some of the company\u2019s homes.<\/p>\n The home with the lowest reported hands-on care that year was Southbridge\u2019s Chelsey Park, in London, Ont. Despite\u00a0the home operating throughout the year, ministry records were blank for the first three quarters. In the fourth quarter, it reported to the ministry\u00a0that it provided an average of just 1 hour and six minutes of hands-on care per day.<\/p>\n During that year, the ministry issued a series of compliance orders to the home for serious problems<\/a>, including one that stated it \u201chas failed to ensure that the resident was not neglected by the licensee or staff.\u201d<\/p>\n The inspector’s\u00a0report 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.<\/p>\n 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 \u201crisk of harm to the health or well-being of residents of the home or persons who might be admitted as residents.\u201d<\/p>\n Southbridge told the media at the time<\/a> it was due to issues \u201ctied to the building’s opening\u201d 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 \u201cincontinent in their room with urine on the floor,\u201d and unable to get assistance, an inspector reported.<\/p>\n Most homes fared better.<\/p>\n The top 10\u00a0homes by staffing levels are a mix of non-profit, municipally owned, and independent for-profit homes.<\/p>\n 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.<\/p>\n