A personal support worker begins her shift, counting twenty-three residents she is responsible for today. The math is brutal - eight hours divided by twenty-three means twenty minutes per person if she does nothing else. But there are medications to help with, charting to complete, emergencies to manage. Some residents will get five minutes of her time. Others may wait. A registered nurse supervises multiple units, spread so thin that meaningful clinical oversight is impossible. A home advertises for staff continuously, the turnover constant, the wages insufficient to compete with other employers. A resident waits to be taken to the bathroom, no one available, the indignity of waiting adding to the indignity of needing help. A family notices different staff every visit, no one who knows their mother, no continuity of relationship. A government announces mandatory staffing standards; the industry warns there are not enough workers to meet them. Long-term care staffing, the workers who provide hands-on care to residents, determines whether vulnerable people receive adequate attention and dignity. How staffing is mandated, funded, and supported shapes the reality of daily care.
The Case for Mandatory Staffing Standards
Advocates argue that staffing standards must be mandated. From this view, voluntary approaches have failed.
Staffing determines quality. Research clearly shows that higher staffing produces better outcomes. More staff means more time for each resident, better care, fewer adverse events. Staffing is the key variable.
Markets won't provide adequate staffing. Without mandates, competitive pressure drives staffing down. Cost minimization trumps care quality. Only requirements can ensure adequate staffing.
Hours of care should be specified. Mandating four hours of direct care per resident per day - or similar standards - would ensure minimum staffing. Specific, measurable requirements are needed.
From this perspective, staffing standards should be mandatory, specific, funded, and enforced.
The Case for Workforce Development
Others argue that mandates without workforce are meaningless. From this view, staffing requires workers who don't currently exist.
Worker shortage is the constraint. Mandating staffing levels operators cannot meet is hollow. The workers needed to staff LTC adequately are not available. Workforce development must precede or accompany mandates.
Wages and conditions must improve. Workers leave LTC for better opportunities. Without improved compensation and working conditions, workers will not come or stay. Mandates require resources.
Training pipeline is inadequate. Not enough people are being trained for LTC work. Educational capacity must expand. Immigration pathways need attention.
From this perspective, workforce development - wages, conditions, training, recruitment - must accompany any staffing mandates.
The Wage Question
LTC workers are poorly compensated.
From one view, low wages are fundamental problem. Workers doing essential, demanding work earn poverty wages. Significant wage increases are necessary to recruit and retain staff.
From another view, wages must be funded. Operator revenues come from government. Wage increases require funding increases. Mandating wages without funding them forces cuts elsewhere.
How wages are addressed shapes workforce availability.
The Working Conditions
Beyond wages, working conditions affect retention.
From one perspective, LTC work conditions are often poor. Heavy workloads, violence exposure, inadequate equipment, and lack of respect drive workers away. Conditions must improve alongside wages.
From another perspective, working conditions improve when staffing improves. Many condition problems flow from understaffing. Adequate staffing is necessary for reasonable conditions.
How working conditions are addressed shapes worker experience.
The Skill Mix
LTC requires different types of staff.
From one view, more registered staff - RNs and RPNs - are needed. Complex resident needs require skilled assessment and intervention. Skill mix should include more nursing professionals.
From another view, PSWs provide most direct care. Investing in PSW numbers and training may improve care more than adding expensive nursing staff. Skill mix should match actual care needs.
How staff mix is determined shapes care capability.
The Agency Staff
Many homes rely on temporary agency workers.
From one perspective, agency dependence harms residents. Temporary staff don't know residents, lack continuity, and may not be invested in the home. Agency use should be minimized.
From another perspective, agency staff fill gaps. Without agency workers, shifts would go unfilled. Agency use is symptom of staffing crisis, not cause.
How agency use is addressed shapes staffing stability.
The Canadian Context
Canadian LTC staffing varies significantly. Some provinces have implemented or are implementing staffing standards. Wages have increased in some jurisdictions. Workforce shortages persist. Agency use has grown. Training programs have expanded but supply lags demand. Immigration has provided some workers. Turnover remains high. Post-pandemic attention to staffing has increased. Implementation of standards is ongoing. The gap between policy aspiration and staffing reality remains significant.
From one perspective, Canada must mandate and fund specific staffing standards.
From another perspective, workforce development must accompany any mandates.
How Canada addresses LTC staffing shapes care for residents.
The Question
If staffing determines quality, if workers are not available, if wages are too low, if conditions are poor - how do we staff long-term care? When a PSW has twenty minutes per resident for an eight-hour shift, what care is possible? When workers earn less caring for vulnerable elders than stocking store shelves, what message does that send? When staffing standards are mandated but workers don't exist, what is achieved? When turnover means residents never know their caregivers, what relationship is possible? When we speak of improving long-term care, how central is staffing? And when someone we love needs LTC, who will be there to care for them?