CAHSPR 2023 Poster: Long-Term Care Staffing Policies Pre-COVID-19 and Pandemic Responses: A Case Comparison of Ontario and British Columbia
Patrick B. Patterson, Tessa Weinberg, Sarah McRae, Candice Pollack, Daniel Dutton
References Cited
1. Canadian Institute for Health Information. The Impact of COVID-19 on Long-Term Care in Canada: Focus on the First 6 Months. 2021. https://www.cihi.ca/sites/default/files/document/impact-covid-19-long-term-care-canada-first-6-months-report-en.pdf
2. WHO. Infection Prevention and Control guidance for Long-Term Care Facilities in the context of COVID-19: Interim guidance – 21 March 2020. World Health Organization. Accessed April 27, 2020, https://apps.who.int/iris/bitstream/handle/10665/331508/WHO-2019-nCoV-IPC_long_term_care-2020.1-eng.pdf
3. WHO. Operational considerations for case management of COVID-19 in health facility and community: Interim guidance – 19 March 2020. World Health Organization. Accessed April 20, 2020, https://apps.who.int/iris/bitstream/handle/10665/331492/WHO-2019-nCoV-HCF_operations-2020.1-eng.pdf
4. Armijo-Olivo S, Craig R, Corabian P, Guo B, Souri S, Tjosvold L. Nursing Staff Time and Care Quality in Long-Term Care Facilities: A Systematic Review. The Gerontologist. 2020;60(3):e200-e217. doi:10.1093/geront/gnz053
5. Boscart VM, Sidani S, Poss J, et al. The associations between staffing hours and quality of care indicators in long-term care. BMC Health Services Research. 2018/10/03 2018;18(1):750. doi:10.1186/s12913-018-3552-5
6. Harrington C, Kovner C, Mezey M, et al. Experts recommend minimum nurse staffing standards for nursing facilities in the United States. Gerontologist. Feb 2000;40(1):5-16. doi:10.1093/geront/40.1.5
7. WHO. Framework for countries to achieve an integrated continuum of long-term care. World Health Organization; 2021.
8. Damiano N, Turcotte L. Factors associated with COVID-19 outbreaks, transmission and poor outcomes in Ontario’s LTC Homes: Presentation to the Ontario Long-Term Care Commission. 2021. https://wayback.archive-it.org/17275/20210810151614/http://www.ltccommission-commissionsld.ca/presentations/pdf/Canadian_Institute_for_Health_Information_March_3_2021.pdf
9. B.C. Ministry of Health. Residential Care Staffing Review. 2017. https://www.health.gov.bc.ca/library/publications/year/2017/residential-care-staffing-review.pdf
10. Castle NG, Anderson RA. Caregiver Staffing in Nursing Homes and Their Influence on Quality of Care: Using Dynamic Panel Estimation Methods. Medical Care. 2011;49(6) doi:10.1097/mlr.0b013e31820fbca9
11. Harrington C, Dellefield ME, Halifax E, Fleming ML, Bakerjian D. Appropriate Nurse Staffing Levels for U.S. Nursing Homes. Health Services Insights. 2020/01/01 2020;13:1178632920934785. doi:10.1177/1178632920934785
12. Harrington C, Ross L, Chapman S, Halifax E, Spurlock B, Bakerjian D. Nurse Staffing and Coronavirus Infections in California Nursing Homes. Policy, Politics, & Nursing Practice. 2020/08/01 2020;21(3):174-186. doi:10.1177/1527154420938707
13. Schnelle JF, Schroyer LD, Saraf AA, Simmons SF. Determining Nurse Aide Staffing Requirements to Provide Care Based on Resident Workload: A Discrete Event Simulation Model. Journal of the American Medical Directors Association. 2016;17(11):970-977. doi:10.1016/j.jamda.2016.08.006
14. Castle NG. Nursing Home Caregiver Staffing Levels and Quality of Care: A Literature Review. Journal of Applied Gerontology. 2008/08/01 2008;27(4):375-405. doi:10.1177/0733464808321596
15. McGregor MJ, Cohen M, Stocks-Rankin C-R, et al. Complaints in for-profit, non-profit and public nursing homes in two Canadian provinces. Open medicine: a peer-reviewed, independent, open-access journal. 2011;5(4):e183-e192.
16. Pue K, Westlake D, Jansen A. Does the Profit Motive Matter? COVID-19 Prevention and Management in Ontario Long-Term-Care Homes. Canadian Public Policy. 2021: e2020151. doi:10.3138/cpp.2020-151
17. OECD. Data from: Long-term care resources and utilisation (Edition 2020). 2021. Paris, FRA. doi:10.1787/24863ddb-en
18. National Institute on Ageing. Enabling the Future Provision of Long-Term Care in Canada. 2019. https://static1.squarespace.com/static/5c2fa7b03917eed9b5a436d8/t/5d9de15a38dca21e46009548/1570627931078/Enabling+the+Future+Provision+of+Long-Term+Care+in+Canada.pdf
19. Canadian Institute for Health Information. Dementia in long-term care. Canadian Institute for Health Information. Accessed May 16, 2020, https://www.cihi.ca/en/dementia-in-canada/dementia-care-across-the-health-system/dementia-in-long-term-care
20. Mofina AM, Guthrie DM. A comparison of home care quality indicator rates in two Canadian provinces. BMC Health Services Research. 2014/01/25 2014;14(1):37. doi:10.1186/1472-6963-14-37
21. Ontario Long Term Care Association. This is long-term care 2019. 2019. https://www.oltca.com/OLTCA/Documents/Reports/TILTC2019web.pdf
22. Romanow R. Building on Values: The Future of Health Care in Canada – Final Report. National Library of Canada; 2002.
23. Government of Nova Scotia. Minister’s Expert Advisory Panel on Long-Term Care: Recommendations. 2018. https://novascotia.ca/dhw/publications/Minister-Expert-Advisory-Panel-on-Long-Term-Care.pdf
24. B.C. Office of the Seniors Advocate. Every Voice Counts: Office of the Seniors Advocate Residential Care Survey Provincial Results. 2017. https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2017/09/Provincial-Results-Final-HQ.pdf
25. Ontario Ministry of Long-Term Care. Long-Term Care Staffing Study: Long-Term Care Staffing Study Advisory Group, July 30, 2020. 2020. https://files.ontario.ca/mltc-long-term-care-staffing-study-en-2020-07-31.pdf
26. B.C. Care Providers Association. The Perfect Storm: A Health Human Resources Crisis in Seniors Care. 2018. https://bccare.ca/wp-content/uploads/2018/04/The-Perfect-Storm_BCC3-2018-Report-FINAL.pdf
27. Canadian Life and Health Insurance Association. CLHIA Report on Long-Term Care Policy: Improving the Accessibility, Quality and Sustainability of Long-term Care in Canada. 2014. https://www.clhia.ca/web/clhia_lp4w_lnd_webstation.nsf/page/3C342451F891CF1D85257A240044F961/$file/LTC_Policy_Paper_1_EN.pdf
28. Berta W, Laporte A, Valdmanis V. Observations on Institutional Long-Term Care in Ontario: 1996–2002. Canadian Journal on Aging / La Revue canadienne du vieillissement. 2005;24(1):71-84. doi:10.1353/cja.2005.0002
29. Hsu AT, Berta W, Coyte PC, Laporte A. Staffing in Ontario’s Long-Term Care Homes: Differences by Profit Status and Chain Ownership. Canadian Journal on Aging / La Revue canadienne du vieillissement. 2016;35(2):175-189. doi:10.1017/S0714980816000192
30. McGregor MJ, Tate RB, Ronald LA, et al. Trends in long-term care staffing by facility ownership in British Columbia, 1996 to 2006. Health Rep. Dec 2010;21(4):27-33.
31. McGregor MJ, Cohen M, McGrail K, et al. Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter? Canadian Medical Association Journal. 2005;172(5):645. doi:10.1503/cmaj.1040131
32. B.C. Office of the Seniors Advocate. A billion reasons to care: a funding review of contracted long-term care in B.C. 2020. https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2020/02/ABillionReasonsToCare.pdf
33. Marrocco F, Coke A, Kitts J. Ontario’s Long-Term Care COVID-19 Commission: Final Report. 2021. 978-1-7776961-2-2. https://files.ontario.ca/mltc-ltcc-final-report-en-2021-04-30.pdf
34. Wyonch R, Maqbool S. Public Health and Emergency Measures Working Group, Summary Discussion: Lessons from the First Wave of COVID-19 2020. https://www.cdhowe.org/sites/default/files/attachments/communiques/mixed/CWGR_2020_1028.pdf
35. Duan Y, Iaconi A, Song Y, et al. Care Aides Working Multiple Jobs: Considerations for Staffing Policies in Long-Term Care Homes During and After the COVID-19 Pandemic. Journal of the American Medical Directors Association. 2020;21(10):1390-1391. doi:10.1016/j.jamda.2020.07.036
36. Estabrooks CA, Straus S, Flood CM, et al. Restoring trust: COVID-19 and the future of long-term care. 2020. https://rsc-src.ca/sites/default/files/LTC%20PB%20%2B%20ES_EN_0.pdf
37. Holroyd-Leduc JM, Laupacis A. Continuing care and COVID-19: a Canadian tragedy that must not be allowed to happen again. Canadian Medical Association Journal. 2020;192(23):E632. doi:10.1503/cmaj.201017
38. Stall NM, Brown KA, Maltsev A, et al. COVID-19 and Ontario’s Long-Term Care Homes. Science Briefs of the Ontario COVID19 Science Advisory Table. 2021;2(7) doi:10.47326/ocsat.2021.02.07.1.0
39. Armstrong P, Cohen M. A Higher Standard: Setting Federal Standards in Long-Term Care and Continuing Care. 2020. https://www.policyalternatives.ca/sites/default/files/uploads/publications/National%20Office/2020/11/A%20higher%20standard.pdf
40. Chamberlain SA, Gruneir A, Hoben M, Squires JE, Cummings GG, Estabrooks CA. Influence of organizational context on nursing home staff burnout: A cross-sectional survey of care aides in Western Canada. International Journal of Nursing Studies. 2017/06/01/ 2017; 71:60-69. doi:10.1016/j.ijnurstu.2017.02.024
41. Chamberlain SA, Hoben M, Squires JE, Estabrooks CA. Individual and organizational predictors of health care aide job satisfaction in long term care. BMC Health Serv Res. Oct 13 2016;16(1):577. doi:10.1186/s12913-016-1815-6
42. Banerjee A, Armstrong P. Centring Care: Explaining Regulatory Tensions in Residential Care for Older Persons. Studies in Political Economy. 2015/03/01 2015;95(1):7-28. doi:10.1080/19187033.2015.11674944
43. Bowers BJ, Esmond S, Jacobson N. Turnover reinterpreted CNAs talk about why they leave. J Gerontol Nurs. Mar 2003;29(3):36-43. doi:10.3928/0098-9134-20030301-09
44. Castle NG. State Differences and Facility Differences in Nursing Home Staff Turnover. Journal of Applied Gerontology. 2008/11/01 2008;27(5):609-630. doi:10.1177/0733464808319711
45. Mittal V, Rosen J, Leana C. A Dual-Driver Model of Retention and Turnover in the Direct Care Workforce. The Gerontologist. 2009;49(5):623-634. doi:10.1093/geront/gnp054
46. Government of Canada. Canada Health Act (R.S.C., 1985, c. C-6). Canada1985.
47. Armstrong P. Regulating care: lessons from Canada. In: Meagher G, Szebehely M, eds. Marketisation in Nordic eldercare: a research report on legislation, oversight, extent and consequences. Stockholm University; 2013:217-227: Chapter 7. Stockholm Studies in Social Work; vol. 30.
48. Banerjee A. The regulatory trap: Reflections on the vicious cycle of regulation in Canadian residential care In: Meagher G, Szebehely M, eds. Marketisation in Nordic eldercare: a research report on legislation, oversight, extent and consequences. Stockholm University; 2013:203-215: Chapter 6. Stockholm Studies in Social Work; vol. 30.
49. Canadian Institute for Health Information. Long-term care homes in Canada: How many and who owns them? Canadian Institute for Health Information. Accessed June 14, 2022, 2022. https://www.cihi.ca/en/long-term-care-homes-in-canada-how-many-and-who-owns-them
50. Hart C. Doing a Literature Review: Releasing the Social Science Research Imagination. SAGE Publications; 1998.
51. University of Southern California. The Literature Review. University of Southern California. Accessed September 20, 2021, https://libguides.usc.edu/c.php?g=235034&p=1559822
52. Goodrick D. Comparative Case Studies. Vol. Impact Evaluation No. 9. 2014. Methodological Briefs. https://www.unicef-irc.org/publications/754-comparative-case-studies-methodological-briefs-impact-evaluation-no-9.html
53. Bazeley P. Qualitative Data Analysis: Practical Strategies. SAGE Publications; 2020.
54. Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health services research. 2007;42(4):1758-1772. doi:10.1111/j.1475-6773.2006.00684.x
55. Corbin J, Strauss A. Basics of Qualitative Research (3rd ed.): Techniques and Procedures for Developing Grounded Theory. 3rd ed. SAGE Publications; 2008.
56. Ontario Ministry of Finance. 2008 Ontario Budget: Growing a Stronger Ontario (Queen’s Printer for Ontario) (2008).
57. Government of Ontario. Improving Care For Long-Term Care Home Residents. Queen’s Printer for Ontario; 2009. Accessed September 24, 2021. https://news.ontario.ca/en/backgrounder/8935/improving-care-for-long-term-care-home-residents
58. Ontario Ministry of Health and Long-Term Care. Increasing Direct Daily Care In Long-Term Care Homes. Queen’s Printer for Ontario; 2008. Accessed September 24, 2021. https://news.ontario.ca/en/release/1036/increasing-direct-daily-care-in-long-term-care-homes
59. Ontario Ministry of Long-Term Care, Ontario Ministry of Health. People Caring for People: A Report of the Independent Review of Staffing and Care Standards for Long-Term Care Homes in Ontario. 2008. https://www.health.gov.on.ca/en/common/ministry/publications/reports/staff_care_standards/staff_care_standards.aspx
60. Government of Ontario. General, O Reg 79/10 (Long-Term Care Homes Act) (Queen’s Printer for Ontario) (2010).
61. Ontario Ministry of Finance. 2019 Ontario Budget: Protecting What Matters Most (Queen’s Printer for Ontario) (2019).
62. Ontario Ministry of Long-Term Care. Ontario Extends Long-Term Care Funding to Ensure Quality Care for Patients. Queen’s Printer for Ontario; 2019. Accessed September 27, 2021. https://news.ontario.ca/en/release/53829/ontario-extends-long-term-care-funding-to-ensure-quality-care-for-patients
63. Government of British Columbia. Health Sector Partnerships Agreement Act, SBC 2003, c 93 (Queen’s Printer) (2003).
64. Government of British Columbia. Community Care and Assisted Living Regulation, BC Reg 217/2004 (Queen’s Printer) (2004).
65. Government of British Columbia. Residential Care Regulation, B.C. Reg. 96/2009 (Queen’s Printer) (2009).
66. Government of British Columbia. Improving Care for B.C. Seniors: An Action Plan (Government of British Columbia) (2011).
67. B.C. Ministry of Health. Lean in British Columbia’s Health Sector: Annual Report 2010–11 2011. Accessed September 23, 2021. https://www.health.gov.bc.ca/library/publications/year/2011/Lean-in-BCs-health-sector.pdf
68. B.C. Ministry of Health. Setting Priorities for the B.C. Health System: Supporting the health and well-being of B.C. citizens; Delivering a system of responsive and effective health care services for patients across British Columbia; Ensuring value for money. (Queen’s Printer) (2014).
69. B.C. Ministry of Health. Health Authority Investment of Revised Residential Care Client Rate Revenue: 2010/2011 – Year 1 Analyses Report Summary. 2011. Accessed September 23, 2021. https://www.health.gov.bc.ca/library/publications/year/2012/HA-residential-care-rate-revenue-investment-2010-2011.pdf
70. B.C. Ministry of Finance. Budget 2018: Working for You, Budget and Fiscal Plan 2018/19-2020-21 (Queen’s Printer) (2018).
71. B.C. Office of the Premier. B.C. seniors to get the hours of care they need as funding and staffing increased. British Columbia Office of the Premier; 2018. https://news.gov.bc.ca/releases/2018PREM0072-001861
72. Government of British Columbia. Assisted Living Regulation, BC Reg 189/2019 (Queen’s Printer) (2019).
73. B.C. Ministry of Health. Faster pathway helps increase trained health care assistants in British Columbia. Ministry of Health; 2019. Accessed September 23, 2021. https://news.gov.bc.ca/releases/2019HLTH0150-002178
74. Ontario Health Coalition. Situation Critical: Planning, Access, Levels of Care and Violence in Ontario’s Long-Term Care. 2019. http://www.ontariohealthcoalition.ca/wp-content/uploads/FINAL-LTC-REPORT.pdf
75. B.C. Office of the Seniors Advocate. British Columbia Residential Care Facilities Quick Facts Directory. 2018. https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2018/01/QuickFacts2018-Summary.pdf
76. B.C. Office of the Seniors Advocate. British Columbia Long-Term Care Facilities Quick Facts Directory. 2020. https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2020/12/QuickFacts2020-Summary.pdf
77. Liu M, Maxwell CJ, Armstrong P, et al. COVID-19 in long-term care homes in Ontario and British Columbia. Canadian Medical Association Journal. 2020;192(47):E1540. doi:10.1503/cmaj.201860
78. B.C. Office of the Seniors Advocate. Review of COVID-19 Outbreaks in Care Homes in British Columbia. 2021. https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2021/10/Outbreak-Review-Report.pdf
79. Ontario Chief Medical Officer of Health. March 22, 2020 Directive #3 for Long-Term Care Homes under the Long-Term Care Homes Act, 2007 (March 22, 2020) (Queen’s Printer for Ontario) (2020).
80. B.C. Ministry of Health. Information Collection to Allocate Staff Working in Facilities (Ministry of Health) (2020).
81. B.C. Ministry of Health. Long Term Care Facility Staff Movement Limitation (Ministry of Health) (2020).
82. Government of Ontario. Ontario Regulation 77/20: Order under Subsection 7.0.2 (4) of the Act – Work Deployment Measures in Long-Term Care Homes; Emergency Management and Civil Protection Act, R.S.O. 1990, c. E.9 (Queen’s Printer for Ontario) (2020).
83. Ontario Ministry of Finance. Ontario’s Action Plan 2020: Responding to COVID-19 (Queen’s Printer for Ontario) (2020).
84. Ontario Chief Medical Officer of Health. Directive #3 for Long-Term Care Homes under the Long-Term Care Homes Act, 2007 (April 15, 2020) (Queen’s Printer for Ontario) (2020).
85. Ontario Chief Medical Officer of Health. March 30, 2020 Directive #3 for Long-Term Care Homes under the Long-Term Care Homes Act, 2007 (March 30, 2020) (Queen’s Printer for Ontario) (2020).
86. Ontario Ministry of Health. COVID-19 Quick Reference Public Health Guidance on Testing and Clearance (Queen’s Printer for Ontario) (2020).
87. Government of Canada. Military response to COVID-19. Government of Canada. Accessed September 10, 2021, https://www.canada.ca/en/department-national-defence/campaigns/covid-19-military-response.html
88. B.C. Ministry of Public Safety. Health Care Labour Adjustment (COVID-19) Order: Emergency Program Act; Ministerial Order No. M105 (Queen’s Printer) (2020).
89. Ontario Office of the Premier. Ontario Calls on all Health Care Workers to Help Fight COVID-19: Province Launches Online Portal to Match Available Health Care Workers with Employers. Queen’s Printer for Ontario. Accessed May 16, 2020, https://news.ontario.ca/en/release/56598/ontario-calls-on-all-health-care-workers-to-help-fight-covid-19
90. Ontario Ministry of Long-Term Care. COVID-19: Long-term care preparedness (Queen’s Printer for Ontario) (2020).
91. Ontario Ministry of Long-Term Care. Province Launching Recruitment Program to Support Long-Term Care Sector. Queen’s Printer for Ontario. Accessed September 10, 2021, https://news.ontario.ca/en/release/59108/province-launching-recruitment-program-to-support-long-term-care-sector
92. Ontario Ministry of Long-Term Care. A better place to live, a better place to work: Ontario’s Long-Term Care Staffing Plan (2021-2025). 2020. https://files.ontario.ca/mltc-ontario-long-term-care-staffing-plan-2021-2025-en-2020-12-17.pdf
93. B.C. Ministry of Health. Investments mean safer visits at long-term care, seniors’ facilities. Ministry of Health. Accessed September 10, 2021, https://news.gov.bc.ca/releases/2020HLTH0211-001207
94. B.C. Office of the Premier. Investment brings new support to those most vulnerable to COVID-19 and communities where they live. Office of the Premier. Accessed September 10, 2021, https://news.gov.bc.ca/releases/2020PREM0050-001694
95. B.C. Office of the Seniors Advocate. British Columbia Long-Term Care Facilities Quick Facts Directory. 2019. https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2019/09/QuickFacts2019-Summary.pdf
96. Ontario Ministry of Health and Long-Term Care. Ontario Enhancing Care and Services for Long-Term Care Home Residents. Queen’s Printer for Ontario; 2013. Accessed September 27, 2021. https://news.ontario.ca/en/backgrounder/25913/ontario-enhancing-care-and-services-for-long-term-care-home-residents
97. OECD & International Labour Organization. New job opportunities in an ageing society. 2019. https://www.oecd.org/g20/summits/osaka/ILO-OECD-G20-Paper-1-3-New-job-opportunities-in-an-ageing-society.pdf
98. Armstrong P, Armstrong H, Choiniere J, Lowndes R, Struthers J. Re-imagining Long-term Residential Care in the COVID-19 Crisis. 2020. https://www.policyalternatives.ca/sites/default/files/uploads/publications/National%20Office/2020/04/Reimagining%20residential%20care%20COVID%20crisis.pdf
99. OECD. Who Cares? Attracting and Retaining Care Workers for the Elderly. OECD Publications; 2020.
100. Gahwi L, Wolton-Roberts M. Migrant Care Labour and the COVID-19 Long-Term Care Crisis: How Did We Get Here? 2020. https://www.balsillieschool.ca/wp-content/uploads/2020/06/Balsillie-Paper-Gahwi-and-Walton-Roberts-3.pdf
101. Health Standards Organization. National Long-Term Care Services Standard. Health Standards Organization. Accessed Nov. 8, 2021, 2021. https://healthstandards.org/uncategorized/national-long-term-care-services-standard/
102. Government of Canada. A Recovery Plan for Jobs, Growth, and Resilience: Budget 2021 (Her Majesty the Queen in Right of Canada) (2021).
