With an aging population, provinces in Canada will be experiencing a demand for increased in home and hospital care facilities. In 2016, those 65 years and older made up 16.4% of the population. By 2014 those 65 years and older are projected to be 25% of the population totally 4.6 million (Ministry of Ontario, 2018). Long term care (LTC) homes are under scrutiny for the shortage of staff to provide proper care. With an aging population and a retiring workforce, it is becoming difficult to adequately fill health care positions to provide appropriate care. Seniors are vulnerable when it comes to the care they receive, both in their own home and in long-term care.
Provincial Funding
Ontario
The new Ontario Conservative Government is proposing a new governance structure to how health care will be delivered – Bill 74 The People’s Health Care Act. (2019) (still under review). A new agency – Ontario Health – will be responsible for all performance and accountability of funding dollars. Ontario Health will replace the current provincial funding agency the LIHN. Five governing bodies will span Ontario wide – North, South, East, West and the general Toronto area. The government has largely focused on three branches of funding – mental health and addictions, supportive housing and LTC homes in an attempt to decrease hallway medicine. This model is moving in the direction of how British Columbia currently manages and funds health sectors. This model may provide more funds and accountability; however, this does not solve recruitment issues. Ontario overall may need to look at reviewing the remuneration that personal support workers receive in order to increase demand.
British Columbia
Based on one British Columbia’s health authority report, it cost $190, 000 to create one new bed within a residential care facility. From 2016 to 2017, five hundred new residential beds were created for seniors under the five regional health authority of British Columbia (British Columbia Ministry of Health, 2017). In 2018, government of British Columbia (BC) had invested $548 million for the next three years expense in primary care, home and community care, residential care and assisted living. In addition, the Ministry of Health had assigned another $221 million specifically for senior care (Government of British Columbia, 2018).
Since 1997, the BC government had adopted a new method of distributing the funding from Ministry of Health and other resources; the funds no longer go directly to a facility but are distributed annually through the five regional health sectors which the facilities are under (British Columbia Ministry of Health, 2017). The amount of funds each regional authority receives is based on the regions’ “population growth and demographics, expected use of services, complexity, remoteness and the inter-regional patient flows” (BC Ministry of Health, 2017, p.24). From regional authorities, the funds will then be distributed to their facilities using the same distributing methodology (British Columbia Ministry of Health, 2017).
Staffing
Ontario
It is difficult for family members and seniors to be living through this everyday where basic hygiene is a struggle to meet. Feelings of guilt are felt from all involved. Seniors are extremely vulnerable to poor care due to physical inability to complete care themselves coupled cognitive issues such as dementia that decrease their ability to speak up for their rights. Vogel (2019) discusses the catch 22 that LTC homes and administrators face. It is noted that many of the issues within LTC is staffing, however when care statistics improve funding is decreased. As long as LTC homes continue to struggle to adequately fill positions seniors care will ultimately suffer.
Addressing the issues above need to be addressed at macro and mezzo levels. Hospital leadership teams’ hands are tied as they must be compliant with Ontario’s Long-Term Care Homes Act, 2007 or face noncompliance orders. For instance, the Long-Term Care Act holds a 24/7 RN staffing order across Ontario. Policy makers, government and stakeholders should focus on where should care be delivered, staffing requirements (e.g., RN vs RPN), inefficiencies in the system, burnout and funding. It is not an easy fix but reviewing current care delivery policies, processes and funding allocation could be a step in the right direction.
British Columbia
Number of hours spent on direct care was never enough within BC. The average direct care hours in 2016 was 3.11; the ideal is 3.26 and only 15% of the three hundred BC facilities met this goal in 2016. With the new funding in 2018, the hours will increase gradually within the next three years by hiring more staff and increasing more full time and part time positions. The plan for BC is to increase 3.24 direct care hours in 2019 and reach 3.36 direct care hours by 2021 (Government of British Columbia, 2018). The staffing target increased from 2018 to 2021 by 1500 new full-time positions as follow:
900 health-care aides;
165 registered nurses;
300 licensed practical nurses;
50 allied health-care professionals (physiotherapists, occupational therapists, social workers);
100 other health-care workers, including rehabilitation assistants, activity aides and other allied health-care workers.
Performance Indicators
Ontario
Health Quality Ontario is a database that tracks statistics across Ontario within LTC homes. Ontario has the longest running and largest LTC database in Canada. On average LTC homes experience the following rates:
Wait time from community: 163 days
Wait time from Hospital 109 days
Living with Psychosis: 19.6%
Residents who Fell: 16.4%
Physically restrained: 4.5%
Pressure ulcers: 2.7%
Residents in pain: 2.3%
Depression rates: 23.5%
British Columbia
British Columbia places residents based on the first available bed policy. This means that a patient must accept the available bed once it is offered or the patient will be removed from the subsidized long-term care list. If a patient is transferred to long-term care directly from the hospital, the wait time should be within one to three weeks. Hospital patients are always priority due to bed shortages. If a patient is from the community, wait time may vary as it is based on the urgency of care for that patient (Government of BC, 2019). Below are some indicators for LTC homes within BC:
Average Wait time for LTC within BC in 2017 – 45 days
Falls in 2017 – 2806 incidents
Missing or Wandering in 2016 – 23 cases
Serious incidents in 2016 – 419 cases (Office of the Senior Advocate, 2017)
Staff shortages within long-term care facilities is a major cause of inadequate care, however recruiting staff can be a challenge due to limited funds and unattractive work. Funding is vital in addressing this concern as it is a large contributing factor in funding more care worker positions and a way to increase incentives to attract care workers. As per above facts, British Columbia’s government seems to understand the urgency of this matter and has delegated extra funding for the next three years. Although extra funding has been provided by the BC government, there is still a required time frame of three years to achieve the desired hours of care. As for Ontario, the plan is only recently being developed to increase funding and appears to be a step behind British Columbia. Hopefully Ontario will see the importance of this matter before more incidents arises due to shortage of staffs. In conclusion, both provinces are aware of the problems that exist with LTC however there is still no immediate resolution to addressing staff shortages, recruitment and a retiring workforce. Although BC appears to be ahead of Ontario in planning and funding, the expected level of care cannot be achieved until three years later. Dollars will have to be put towards increasing incentives for care workers in order to fill the current vacant and upcoming vacancies that exist within LTC, in order to provide proper care to seniors.
References
BC Ministry of Health. (2017). Residential Care Staffing Review. Retrieved from: https://www.health.gov.bc.ca/library/publications/year/2017/residential-care-staffing-review.pdf
Bill 74, The People’s Health Care Act. (2019). Current status as of March 21 2019: order referred to standing committee. Retrieved from: https://www.ola.org/en/legislative-business/bills/parliament-42/session-1/bill-74
Government of BC. (2019). Long-Term Residential Care. Retrieved from: https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/long-term-residential-care
Government of British Columbia. (2018). B.C. seniors to get the hours of care they need as funding and staffing increased. Retrieved from: https://news.gov.bc.ca/releases/2018PREM0072-001861
Government of Ontario. Long Term Care Homes Act (2007). Retrieved from: https://www.ontario.ca/laws/statute/07l08
Health Quality Ontario. Retrieved from: https://www.hqontario.ca/System-Performance/Long-Term-Care-Home-Performance
Office of the Senior Advocate. (2017). Monitoring Senior Services’ 2017. Retrieved from: http://www.seniorsadvocatebc.ca/app/uploads/sites/4/2017/12/MonitoringReport2017.pdf
Vogel, L. (2018). New fines pose financial catch-22 for Ontario long-term care. Canadian Medical Association. Journal, 190(20), E630-E631.
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