Few Canadians have forgotten the devastating impact of the COVID-19 pandemic on residents and staff in the long-term care sector. With our aging population, significant pressures continue to mount on an already stressed system, where staffing shortages and outdated facilities persist, along with rising numbers of people requiring more complex care.

The Canadian Institute for Health Information (CIHI) reported there were about 2,076 long-term care homes with an estimated 198,000 beds across Canada in 2021. Specific to Ontario, the Ontario Long-Term Care Association reports there are currently about 609 licensed long-term care homes with about 77,000 beds. And of note, more than 50,000 people are on the waiting list in Ontario. [1]

The reality for many families is that long-term care is an important part of the continuum of care when a family member cannot be cared for safely at home or in a retirement home. As physical and/or cognitive needs increase and become more complex, families often struggle to get access to appropriate home care, family members are burnt out, and financial pressures can mount.

Last week, CIHI released its report on the safety, staffing, and well-being of residents in long-term care, highlighting important metrics and the challenges that need to be addressed.[2] The following are excerpts:

Safety

• The CIHI report indicates that in 2024-2025, about 1 in 4 LTC residents (24%) were given antipsychotic medication to manage behavioural and psychological symptoms without a diagnosis of psychosis. Antipsychotic drugs such as Haldol or Risperidone are designed to manage symptoms such as hallucinations in mental health conditions. However, in some cases, they have been used to treat aggressive behaviours in people with dementia. The report cautions that “inappropriate use of antipsychotics can carry serious risks including adverse reactions, cognitive decline, falls and even death”.
• Medical commentators note that the prescription of these drugs is a system-wide issue, as often the drugs are prescribed in the community or during a hospital stay before the person even gets to long-term care. Current data from the Ontario Long Term Care Home Association (OLTCA) indicate that 50% of long-term care admissions are coming directly from hospitals.
• There are various non-pharmacological strategies to address aggressive behaviours in dementia, including appropriate training and the availability of staff.

Well-being

• The CIHI report indicated that in 2024-2025, of the long-term care residents who were transferred to and died in hospital, 18% died within 24 hours. A quarter of those people had palliative care as the reason for their hospital stay. Families need to understand how end-of-life care is provided within the long-term care home or how it is coordinated with a hospital transfer. The provision of palliative care in long-term care is often not well understood.

Staffing Challenges

• The CIHI report noted that in 2023-2024, 8% of total hours worked by direct care staff in LTC units were overtime hours… High overtime rates signal staffing pressures that can affect both staff well-being and the quality of resident care.

However, in reviewing the Ontario-based data from the OLTCA, they specifically call out a more urgent staffing crisis in long-term care homes:

In 2024, 80% of long-term care homes reported difficulty filling shifts for registered practical nurses, and 53% for registered nurses. And more than 40% report having difficulty filling shifts for personal support workers and their dietary teams.

Ontario homes reported a significant turnover in leadership in 2024.

45% of homes saw a change in their Director of Care, Assistant Director of Care, or Administrator.

In Ontario, there was a recent funding announcement to increase access to dementia care and behavioural support units in long-term care. While these measures are welcomed in the industry, the health human resource crisis continues and resolving it is key to so many issues.

In closing, I can’t help but reflect on the recommendations of the Ontario Long-Term Care Covid-19 Commission.

“Long-standing human resources problems in long-term care complicated efforts to manage COVID-19 outbreaks in homes. These problems include staff shortages, insufficient skill mix, and a lack of training and education opportunities for staff. The following recommendations address the human resources issues that exacerbated the devastating effects of COVID-19 in long-term care homes.” [3]

[1] https://www.oltca.com/about-long-term-care/the-data/

[2] https://www.cihi.ca/en/aging-with-dignity-using-data-to-strengthen-long-term-care-for-canadians/insights-on-safety-well-being-and-staffing-in-long-term-care

[3] https://files.ontario.ca/mltc-ltcc-final-report-en-2021-04-30.pdf