I received a great question regarding the content of our mobile apps, and wanted to share the response so others would have the same information.
The question queried why the Elder Pilot Long-Term care mobile app Checklist did not address staffing levels in Long-Term care homes?
The writer wondered if this would be a valid question during a LTC tour?
Although asking about staffing levels is an insightful and informative question, the number of staff may vary, based on the length of time from your home tour to actual admission. Staffing numbers also vary, relevant to the time (days or evenings) of the tour, and the tour area. That is why we didn't add this question to the app checklist.
How does a LTC home receive funds for Nursing and Personal care?
The funding transfer payments provided by the Ministry of Health and Long-Term Care to homes for Nursing and Personal care, is assessed annually, and reconfigured based on submitted data (to the government) by each home.
There is actually an assigned nursing staff member in each home, charged with the responsibility of data entering and monitoring, to support funding. (Wish we could get them back to the bedside where they belong!)
What does this mean?
Imagine that the entire funding envelope for Nursing and Personal care for Ontario LTC homes, was a giant pie. Each home would receive a piece of the pie, based on the outcomes of collected data about Residents living at that location.
There are factors relating to personal care needs, and resident wellness that factor into this equation. At the end of the day, when the funding pie is served each year, it is redivided so every one gets a piece. The funds sent to a home, may or may not be the same size as the year before. This fluctuation causes staffing numbers to vary somewhat, depending on whether more or less funding was received.
Another variance that may impact staff numbers...
Sometimes homes will divide staffing based on Resident's needs in Resident home areas (RHAs).
For example: Imagine there are four separate units; A, B, C, D, in a LTC home. Over time, it becomes apparent that the Residents living in unit B, require far more personal care than those in other units. Staff may be reallocated from the other units to this RHA. The outcome is a higher number of staff per resident, in one area over another.
The problem remains that the numbers quoted for the area toured, may not reflect the actual number of staff per each unit.
Staffing numbers also vary by shift. Numbers decline as the afternoon progresses into the night shift, as residents are settled for the evening.
What about Registered vs Personal Support staff?
There are specific rules about Registered Staff being "in charge" of a building, but the number of RNs and RPNs (Registered Practical Nurses) versus PSWs (Personal Support Workers) varies, depending on how the home management organized their funding.
Here is part of what the MOHLTC Homes Act Legislation (Ontario) states about staffing https://www.ontario.ca/laws/regulation/r10079#BK37
"The staffing plan must,
(a) provide for a staffing mix that is consistent with residents’ assessed care and safety needs and that meets the requirements set out in the Act and this Regulation;
(b) set out the organization and scheduling of staff shifts;
(c) promote continuity of care by minimizing the number of different staff members who provide nursing and personal support services to each resident;
(d) include a back-up plan for nursing and personal care staffing that addresses situations when staff, including the staff who must provide the nursing coverage required under subsection 8 (3) of the Act, cannot come to work; and
(e) be evaluated and updated at least annually in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices."
Why are there questions regarding staffing on the Retirement app Checklist?
With the Retirement App, there are direct staffing questions in this checklist. These were added as the homes are not receiving staffing funds from the Ontario Government.
In Retirement homes; the business model of the home's owner and the type of care provided, is reflective of staffing qualifications and number of staff.
So the bottom line is...
There are several other factors that affect staffing levels, but I think we can all agree that there needs to be an over view of staffing in Long-Term care homes. I have yet to hear that any home is overstaffed, it is quite the opposite.
Your tour guide may be able to give a current answer to the number of staff in the home, but the most comprehensive response regarding staff division/per shift will be from the Director/Assistant Director of Care... if you can get the face time.
Thanks for the great question! Further submissions of questions may be made through our web site.