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Long Term Care Staffing Background
The Staffing Crisis
The 2001 report from FAIRE1, the Background Brief in support of the 2003 Citizen Watch request to the
Auditor General for an audit of long term care facilities2, and the subsequent 2003 Creating Protections
for Better Lives of Vulnerable Seniors in Care3 both document the list of problems directly attributable
to inadequate staffing levels and staff competencies. In 2006, Citizen Watch reported the same
problems. 4
The staffing crisis is apparent in both home care5 and in assisted living facilities6 as well. The history of
home care through the 1990s is that as home care was made available to a larger number of people
(largely as a consequence of the closure of hospital beds and the reduced admissions to extended care
facilities), the range and level of services were reduced7, admission criteria were increased, and wait
lists developed. This issue got some attention in May 20068, when the province removed the $3,000
funding cap on services in response to a series of public complaints9 about services to young disabled
adults. Users of the maximum services reported that even when the increased care had been
approved, it wasn't available because there was no staff to provide the care ­ and there was no
additional funding provided by the province to the health regions to expand the home care programs.
In order to reduce the use of ambulance responses to seniors' falls in lodges and other supportive living
settings, Capital Health and EMS have initiated a pilot project which involves a "first response"
assessment team to determine if an emergency room visit is necessary.10 This reduces the need to
have these settings staffed sufficiently to prevent falls injuries, or to assess harm caused by falls.

Facility Staffing
Today, 80% of care is provided by personal care aides11, many of whom have no formal training.
Increasingly, the professional nursing staff is occupied with administrative duties and crisis response,
leaving little if any time for supervision or coaching of the unregulated care staff and ongoing
observation, monitoring, and unscheduled interventions for individual residents.
The shift of daily care responsibilities and "nursing care" to persons other than professional nursing staff
has not been supported by the training and certification necessary to provide the hands-on care staff
with the knowledge and skills necessary for effective monitoring or to identify intervention needs or care
­ and in any event, there aren't enough bodies available for individual care other than the basics.12
While the attending and consulting doctors and mental health professionals rely almost entirely on the
resident logs and other records, these too are often incomplete and inaccurate because staff do not
have sufficient skills or time for the necessary observation and recording of information which, taken
collectively, could identify significant emerging issues.
Both the care facility operators and the Alberta Senior Citizens Housing Association acknowledge
difficulties because of staffing shortages.13
Temporary bed closures in care centres because of staffing shortages and care concerns are a reality;
they simply are not publicly reported. Families report that Capital Health has assumed management of
the Rivercrest Lodge Care Centre in Ft. Saskatchewan, and that the Jubilee Lodge has frequent
"temporary closures" because of long-standing care concerns. (Both are owned by Qualicare Health
Service Corporation.14)
The oversight bodies, and in particular the Health Facilities Review Committee, do not do a competent job
of monitoring quality of care, or adequacy of staffing. In fact, they simply don't even try to do either.
Alberta has never done a review or study of the care services needed and available. A 2001 study by
PriceWaterhouseCoopers of the Ontario Long Term Care Facilities found that residents were receiving
inadequate nursing, aide and therapy care.15

Staffing requirements
There are no specific requirements for the staffing levels or the clinical quality of care services. The
Health Care Service Standards simply require health regions to develop policies about care, including
the skill levels of staffing. The Health Care Service Standards apply only to publicly funded care, and
not to care or supplemental services for which the resident pays privately.
The requirements to increase the "hours of care" were a Department of Health and Wellness directive;
there was $38.2 million extra funding provided in 2005 and 2006 for this purpose, and the Minister at
the time promised an accounting of the resulting staffing increases16. That has not yet been provided.
The Minister was not talking about the actual care time being provided to residents. "Hours of care", in
this context, means "paid hours of work"; it's an accounting number. It includes time spent on vacation,
sick leave, paid breaks, staff meetings, administrative work, housekeeping, planning, and a myriad of
other activities. Facilities are not even required to record time actually spent providing hands-on care
to a resident or residents, which residents and their families consider being "care time".
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