Registered nurse Claire Wilkinson working in the intensive care unit at the Humber River Hospital in Toronto on April 13, 2021.Nathan Denette/The Canadian Press
The number of health care providers choosing to work in long-term care in Canada is shrinking, according to a new report that highlights a growing reliance on private nursing agencies and use of overtime to fill gaps.
The analysis, released on Thursday by the Canadian Institute for Health Information (CIHI), shows there were fewer health care workers in long-term care in 2023, when compared with pre-pandemic levels. This includes decreases in two of the largest professions working in the sector – registered nurses and licensed practical nurses.
Meanwhile, there was also a “substantial increase” from pre-pandemic levels in overtime, sick and purchased hours, or work by providers hired from private agencies. CIHI noted that long-term-care homes were already facing staffing and quality challenges before the COVID-19 pandemic.
University of Ottawa professor Ivy Bourgeault, director of the Canadian Health Workforce Network, said long-term care has always been a difficult sector to staff because of issues such as poor working conditions, long hours and lower wages. The care itself is also devalued, she said, because the population is older and disproportionately women.
Dr. Bourgeault said the new data highlights how the country has failed to improve the long-term-care system despite the pandemic revealing the dire conditions in facilities across Canada, where countless COVID cases and deaths occurred.
“It’s really frustrating and disappointing to see that there wasn’t sort of a seismic shift,” she said. “It’s inexcusable, five years after a pandemic, where so many people died in long-term care and so many long-term-care staff were afflicted with COVID – and many of them long COVID – that we have data showing it getting worse.”
She said there is no single entity to blame for the worsening situation but stressed that all levels of government have a role to play in improving the long-term-care sector. This includes adequate funding from the federal government to provinces and territories, in addition to the adoption of quality standards and accountability measures across the country.
Ultimately, Dr. Bourgeault said the report indicates that long-term-care residents are not getting the care they need – “and, truly, that they deserve.”
Data in the report show that licensed practical nurses employed primarily in long-term care dipped to 33,459 in 2023 from 35,644 in 2021, a decrease of 6.1 per cent. During the same time period, the number of registered nurses declined by 2.1 per cent and registered psychiatric nurses by 8.2 per cent. However, the number of nurse practitioners increased.
During a similar time period, from 2020-21 to 2023-24, the median number of purchased hours per organization increased by 238 per cent, overtime hours by 74.1 per cent and sick hours by 14.9 per cent. Regular worked hours increased by less than one per cent.
Purchased and overtime hours only represent a small portion of all worked hours – roughly 7.6 per cent in 2024 – but indicate a continued reliance from the pandemic on alternative staffing arrangements.
“Overtime and purchased hours can help fill staffing gaps. But they are costly and may increase pressure on already overworked employees, depend on individuals who lack the same training as regular staff, and impact continuity of care,” states the report.
Also in 2023, more than half of health care job vacancies in Canada were reported for professions commonly employed in long-term care, according to the analysis.
Natalie Damiano, director of health work force information at CIHI, said the continuing dependency on overtime and agency staffing signals a longer-term change in how health care providers want to work. She said sustaining this work force may require employers to allow staff greater flexibility in shaping their own schedules.
Ms. Damiano said she hopes that the new report provides health system leaders and policy-makers with the information needed to make quality investments and changes, especially as Canada’s population is aging rapidly.
“Clearly a co-ordinated effort will be needed and will take time to ensure that the system can meet the anticipated demands,” she said.
