Assessing the state of long-term care
Excerpt from Chapter 5 in “A Physician in the Political Arena”
One year has passed since I released my book “A Physician in the Political Arena” as a record of the events in health care and long-term care through the early pandemic years in Ontario, and as a commitment to continue advocating for improvements in the health care system including long-term care. As I wrote then, I feel a commitment to ensure what was gained is not lost, what has been started is completed, and what is better understood is acted upon.
No other virus, or coronavirus specifically, has impacted the modern world like SARS-CoV-2. The COVID-19 pandemic continues to cause deaths five years in. It has contributed to disease and disabilities associated with long COVID and has affected the availability and productivity of the workforce, including the health workforce resulting in shortages in care and growing wait times.
Long-term care is a keystone for the efficient functioning of the health care system. It is in this context that the review of Chapter 5, section 2, “Assessing the state of long-term care” must be applied both to the infrastructure required and to the staffing required to meet demand. COVID-19 and long COVID cannot remain unmentioned in relation to workforce planning or to ongoing efforts to build necessary infrastructure.
The unfortunate reality is that long-term care home construction is lagging despite ongoing efforts to create additional capacity through improved funding models and attempts to reduce red tape. Municipal approval processes and reduction in capital lender confidence are logistical hurdles contributing to the slow pace. An inadequate pool of skilled workers is an ongoing challenge as Ontario’s population ages and infrastructure demands, both for new and replacement, increase.
Despite the investments made in Ontario--up to $4.9 billion by 2024-25 to hire over 27,000 new staff—the shortage of nurses and personal support workers in long-term care continues to hinder full implementation of the four hours of care commitment as the March 31, 2025, deadline looms. While recruitment is ongoing, the health human resources crisis exacerbated by competition with hospitals is contributing to the shortage of staff in long-term care.
According to the Ontario Long-Term Care Association, OLTCA, by 2029 it is estimated that at least 58,600 more nurses and PSWs will be needed in long-term care to meet increased hours of care and support residents in new long-term care spaces—"more than double the current long-term care workforce”.
Again, long-term care is a keystone to the proper functioning of both community care and hospital care. Ultimately, it is foundational for the productivity of the workforce because without it, neither hospital care or community care will function as necessary, impacting the overall workforce.
If Ontario is to grow its economy, it needs a healthy and available workforce. Government must redouble its efforts to address long-term care needs in parallel with addressing COVID-19 and long COVID.
Below is an excerpt from Chapter 5, section 2 from my book “A Physician in the Political Arena”:
“During the pandemic years through to today, the Ontario government has been making historic investments in the long-term care sector. Much was accomplished in 2020 and 2021 to overcome the pre-existing shortcomings in Ontario’s long-term care sector. However, the changes required with infrastructure and staffing have only begun.
These investments are being made after decades of neglect. It is impossible to bridge in a few years the gaps that have been permitted to widen over decades. There are currently far too many people waiting for care and there is a serious shortage of health care workers. Added to this, are the mounting pressures of an aging population, increasing population, rising costs of pharmaceuticals, and the greater numbers of people requiring complex care – including rising numbers of people with dementia.
With the steep increase in need for elder care in the coming years, along with the overall growing health care needs, Canadians must understand the limitations of government driven solutions. How can the care needed for a growing segment of our aging population be provided for with a relatively shrinking pool of younger workers?
Further to this question, we will need to account for an old age dependency ratio that will be near 2:1 in just a few decades -- that is, in 2056, there will be two working-aged persons for every one elder over the age of 65. In 2006, the ratio was 5:1 and today it is approximately 3:1. This is a dramatic shift and it is expected to occur in Canada despite the rising levels of immigration. FOOTNOTE: https://www150.statcan.gc.ca/n1/pub/82-229-x/2009001/demo/dep-eng.htm
The greatest challenges for long-term care in the short and medium term are infrastructure capacity and human resources. To meet these challenges, we will need to continue to increase capacity and find new efficiencies in the care for elders. The Ontario government will need to:
follow through on delivering the planned 30,000 new beds in short order. Then more will need to be built, perhaps as much as another 30,000
invest more in human resources to increase staffing in long-term care – in fact, accelerate that projected growth to meet the increases in demand
continue to look at new, innovative ways of delivering care: expanded home care services, mobile and e-health monitoring, and improved connections to the community and palliative care.
The provincial government needs to look for ways to transition our long-term care system to one where long-term care homes will care for elders with complex care and help address the need for palliative care. For those who can manage in the community and wait for long-term care access, they will require an appropriate aging-at-home strategy integrated with community care, paramedicine, seniors’ centres, and long-term care at-home programs.”
The excerpt from Chapter 5, section 3, “Improving Long-Term Care” will be covered in the next Substack column.
Dr. Merrilee Fullerton’s book “A Physician in the Political Arena” can be read here.
References
“Ontario missed interim target for providing hands-on care to long-term care residents”, Canadian Press, November 25, 2024
https://www.cbc.ca/news/canada/toronto/long-term-care-hands-on-care-target-ontario-1.7392310
“The Data: Long-Term Care in Ontario”, OLTCA,
https://www.oltca.com/about-long-term-care/the-data/
“Growing the long-term care workforce”, OLTCA,
https://www.oltca.com/advocacy/staffing-crisis/
“Ontario could allow long-term care homes to skip planning rules to boost bed count”, Global News, January 8, 2025
https://globalnews.ca/news/10946684/ontario-long-term-care-homes-skip-planning-rules/
“Long-Term Care Staffing Study”, Ontario Long-Term Care Staffing Study Advisory Group, July 30, 2020
https://files.ontario.ca/mltc-long-term-care-staffing-study-en-2020-07-31.pdf
“Targeting the SARS-CoV-2 reservoir in long COVID”, The Lancet, Infectious Diseases, February 10, 2025
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00769-2/abstract
“Analysis of risk factors for long COVID after mild COVID-19 during the Omicron wave in Japan”, Science Direct, Respiratory Investigation, March 2025
https://www.sciencedirect.com/science/article/abs/pii/S221253452500019X
“Mortality during the COVID-19 Pandemic in Australia”, Burnet Institute, Australia, March 11, 2025
“Neuroimaging findings in children with COVID-19 infection: a systemic review and meta-analysis”, Nature, Scientific Reports, February 27, 2024
https://www.nature.com/articles/s41598-024-55597-2
“SPECT Perfusion Defects and Impaired Strain in Mild COVID-19: A Multimodal Imaging Study with a Female-Predominant Cohort”, Healthcare 2025, March 4, 2025