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Ontario elder care: fewer staff, more privatization, more private payment



Ontario LTC falls short of other provinces
New data  published by the Canadian Institute for Health Information (and based on a mandatory survey undertaken by Statistics Canada) indicates that staffing at Ontario long-term care facilities (LTC) falls short of other provinces. 

The Long-Term Care Facilities Survey indicates that Ontario has 0.598 health care full time equivalent staff (FTE) per LTC bed. Canada (excluding Quebec, which is not included in the survey) has 0.641 staff per bed.  

In other words, Canada as a whole has 7.2% more health care staff per resident compared to Ontario.

This despite the relatively low number of higher paid nursing staff in Ontario. RNs and especially RPNs are underrepresented among all health care staff in Ontario LTC facilities, with RNs comprising just 11.5% of health care FTEs and RPNs comprising just 19.3% of health care FTEs. Across Canada the corresponding figures are 13% and 25.6%.

Fewer RPNs to RNs: Ontario has a relatively low number of RPNs compared to RNs in LTC facilities. The Canada-wide ratio of RPN (or, in other provinces, LPN) FTEs to RN FTEs in LTC facilities is 1.96 to 1. But in Ontario, the ratio is only 1.67 to 1.

Fewer support staff: Administrative and support service staff are also more thin on the ground in Ontario, with only 0.225 FTE support staff per bed, while Canada has 0.248 (i.e. 10% more than Ontario).

Some of the under staffing in Ontario may be rationalized by the somewhat higher proportion of facilities classified as "Type II" in Ontario rather than Type III or higher.  (This report deals with Type II or higher facilities, excluding Type I facilities such as retirement homes in Ontario.  Type II facilities "require" 1.5 to 2.5 hours of care per resident per day, while Type III require 2.5 hours or more).  In Ontario 69% of facilities are rated as Type II, while across Canada 44% are rated Type II . However, given the very modest role hospitals play in Ontario, it is hard to believe that the residents in Ontario LTC are less in need of care than elsewhere.   Notably, 52% of residents in Ontario facilities are 85+, about the same as the cross-Canada percentage of 51.7%.

Higher private payment in Ontario: Residential “co-insurance” accounts for 24.7% of total revenue in Ontario, but 23.2% across Canada.  The extra for preferred accommodation accounts for 2.89% of revenue in Ontario, but only 1.92% across Canada. In total private payment accounts for 27.6% of revenue in Ontario but only 25.1% across Canada. Private payment for LTC is high in Ontario. 

More care in public facilities: Across Canada, public LTC facilities have 0.76 FTE health care staff per bed, compared with 0.566 in for-profit facilities and 0.632 in non-profit facilities. In other words public facilities have 34% more staff than for profit facilities. Unfortunately these figures are not broken down by province – and provincial differences could play a role in these reported differences (e.g. Ontario has both low staffing and a high number of for-profit beds).

For this study, 609 LTC facilities, with a total of 75,282 beds, reported in Ontario.   Unlike an older, now terminated survey done by Statistics Canada (the Residential Care Facility Survey), the new survey is based only on facilities that provide their residents with a minimum of professional nursing care or medical supervision (i.e. Type II or higher facilities, with at least 1.5 hours of care per resident per day). Also notable:
  • Just under 70% of residents are female in both Canada and Ontario. 
  • 61% of facilities in Ontario are for profit, but only 45% across Canada.  If Ontario is excluded from the Canada-wide percentage, only 30% of Canadian facilities are for-profit.  Indeed, most for-profit facilities are found in Ontario (370 of 591). 
  • A little over half of the total reported LTC beds were in Ontario, roughly equivalent to the population of Ontario compared to the rest of Canada excluding Quebec. Just under half of the total FTE staff were in Ontario (61,923 FTEs out of a total 126,389).
  • The mandatory survey covered April 1, 2013 through March 31 2014.
Photo: freeparking ;-| James E. Barna 1970

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