Ontario narrowly misses target of 4 hours direct care for long-term care residents

Ontario failed to meet its legislated target for getting long-term care residents an average of four hours a day of direct care by March of this year, the government concedes, though it came quite close.

The Progressive Conservative government set the target aimed at boosting both the amount of direct care residents receive from nurses and personal support workers, as well as other health professionals such as physiotherapists, in a 2021 law.

While the government met its interim targets in the following two years, starting at three hours of direct care, it did not reach the third-year or final targets, amid staffing challenges.

In the last year, the average direct hours of nursing and PSW care in long-term care homes across the province was three hours and 49 minutes, or 95.5 per cent of that four-hour target, according to a report recently published by the Ministry of Long-Term Care, led by Minister Natalia Kusendova-Bashta.

The province will continue trying to increase the amount of direct care residents receive, the government wrote in its report.

"This includes addressing the challenges that affect the government's ability to recruit and retain qualified care staff at a pace that keeps up with the need of the province's aging population," the report said.

"These challenges are further compounded by the construction of a record number of new and upgraded long-term care beds, an important government priority that will require even more staff to meet demand."

Ontario is aiming to get 30,000 net new long-term care beds built by 2028.

The head of the association representing Ontario's non-profit homes said ensuring an average of nearly four hours of daily direct care for residents is a great achievement.

"I think the fact that they almost reached the target is excellent news, because there's been a lot of challenges with health human resources in the health-care sector," said Lisa Levin, CEO of AdvantAge Ontario.

The programs the government has put in place to increase the numbers of nurses, PSWs and other health professionals — at a cost of $4.9 billion over four years, the government says — has been helping, Levin said.

Where more work needs to be done to close that gap is likely in northern and rural regions, she said.

"(It's) where we're hearing from our members that they're having the most difficulty and are more reliant on temporary staff," Levin said.

The government identifies "recruiting and retaining staff in some rural and remote communities" in the report as one of the challenges it needs to address to further increase direct hours of care. As well, it says another difficulty is "competition for existing and new staff from primary care, home care and hospitals."

AdvantAge Ontario and a coalition of eight other community health organizations have been urging the government to equalize pay within the sector so that health workers don't leave long-term care, for example, to get better pay doing the same work in hospitals.

Levin and others have also been pushing the government to raise wages for registered practical nurses in order to help recruit and retain them. Personal support workers were given a $3-per-hour wage increase during the pandemic, and while that was a good move, it has left the RPNs who supervise them paid the same or even less, Levin said.

Liberal long-term care critic Tyler Watt said it's great that the government is working on recruitment and retention strategies, but it should focus more on the retention side.

"I'm supportive and happy that the hours of direct care are going up, but there's still a lot that needs to be done to surpass that goal," he said.

"We see a lot coming from the health minister and Premier (Doug) Ford about all these investments they're making into recruitment and training, again I applaud all of that … but they are severely lacking on any investments or initiatives to retain the current staff and expertise that are there."

In the 2021 law, Ontario also set a target of 36 minutes per day of care for residents by allied health professionals, such as physiotherapists and social workers, and that target was exceeded in all four years, the government report said, including reaching 45 minutes in the last year.