November 3, 2020

The Cyclical Issue Faced By Long Term Care Homes


Author: Katelynn Drake

The global population is living longer, presumably as a result of scientific and medical advances. However, while we may be living longer, we are not necessarily living healthier for longer; more and more, our older population requires care in later life. As a result, it is probable that the Ontario long-term care homes (LTCHs), which provide care for this population, will experience an increasing shortage of rooms, resources, and staff. These predicted shortages are concerning because research indicates that LTCHs are already regularly understaffed and under-resourced. Often cited as adding to the problem is the invasive issue of absenteeism, and an associated lack of funding.

Complicating matters is the fact that the LTCH workplace is highly regulated. Workers are required to complete tasks set out by the legislature in the Long-Term Care Homes Act as well as the specific LTCH management team. Workers in LTCHs report feeling that compliance with the statute-based requirements is the biggest part of their job (i.e., the tasks become their primary work goals). Unfortunately, when a facility is short-staffed, workers ability to perform their job is limited resulting in an inability to achieve their work goals and, thereby, experience “goal frustration”.

This can be a cyclical problem as stress causes absenteeism, absenteeism results in staff shortages, staff shortages cause goal frustration, and goal frustration results in stress – round and around we go.

As we have seen recently in the news, improper care related to staffing issues has a devastating effect on resident quality of life, and specifically on infection control. Lack of funding causes not only a deficiency in human resources, but also of the tools that workers rely on when providing care, such as bowel and continence care, mobility assistance, or wound management.  The unavailability of these resources and tools adds to poor resident outcomes, and thereby adds to workers’ stress and goal frustration.

It is possible that aggressive behaviours that result in abuse or neglect of residents are, in part, the result of the stress that is caused by goal frustration. This is a situation known as the ‘frustration-aggression hypothesis’, which suggests that when an individual’s efforts are frustrated and they are unable to achieve a goal, they are more likely to exhibit aggressive behaviours.

In a LTCH, the fear is not only that intentional abuse or neglect may occur, but also that feelings of aggression may result in ‘rapid care’. Rapid care could be defined as the rough or thoughtless care of a resident that has the potential to cause an injury. For example, a worker may pull or push a resident to increase the speed at which the resident is walking, rather than taking time to walk with the resident at their natural pace. There is no malicious intent in rapid care, but the result on the resident is the same – skin tears, bruising, and emotional impacts.

Importantly for lawyers and the families of residents affected by LTCH injuries, confirming the existence of a link between under-resourced homes and a lack of infection control, neglect, abuse and resident injuries of unknown origin, is highly important to LTCH litigation.  If a link exists, and LTCHs fail to remedy the resource deficit, the LTCH could be liable for the injuries.  In today’s climate of a global pandemic, one wonders how these issues will impact litigation for neglect or injuries at LTCHs.

As a former nurse myself, I have insight into the issues facing Canadian residents of LTCHs, as well as the nurses and support workers who care for them. Through research conducted for the purpose of litigation, we sometimes uncover issues that relate to abuse and neglect in LTCHs, or that form part of the barrier to care that is faced by the LTCH system. I have outlined some of those issues here. In a series of short articles that will follow, I will be exploring these and other issues in more depth.

The Ontario government recently revealed their goal for residents to receive four hours of direct care per day while in long-term care. Although the way in which this goal will be realized is not known, it is likely that with the promise of more workers comes the reality of more workplace regulation. It remains to be seen whether or to what extent the efforts undertaken by the Government going forward will have a remedial effect on the issues outlined in this and subsequent articles.

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Long-Term Care Homes Act, 2007, S.O. 2007, c. 8 at ss. 8-18, and accompanying regulations.

Fengsong Gao, Peter Newcombe, Cheryl Tilse, Jill Wilson and Anthony Tuckett, “Challenge-related stress and felt challenge: Predictors of turnover and psychological health in aged care nurses”, online: (2016) J Collegian.

Lynette Chenoweth, Yun-Hee Jeon, Teri, Merlyn, and Henry Brodaty, “A systematic review of what factors attract and retain nurses in aged and dementia care” (2010) 19 Journal of Clinical Nursing at 156–167

Ryan DeForge, Paula van Wyk, Jodi Hall & Alan Salmoni, “Afraid to care; unable to care: A critical ethnography within a long-term care home” (2011) 25(4) Journal of Aging Studies at 415-426.

Tamara Daly et al., “Lifting the ‘Violence Veil’: Examining Working Conditions in Long-term Care Facilities Using Iterative Mixed Methods” 30:2 (2011) Canadian Journal on Aging at 271-84.

 Jayna M. Holroyd-Leduc & Andreas Laupacis, “Continuing care and COVID-19: a Canadian tragedy that must not be allowed to happen again” 192:23 (2020) Canadian Medical Association Journal at E632-E633.