{"id":28998,"date":"2022-02-03T15:19:23","date_gmt":"2022-02-03T20:19:23","guid":{"rendered":"https:\/\/blog.residences-quebec.ca\/ratios-de-personnel-soignant-en-rpa-et-en-chsld\/"},"modified":"2022-03-16T13:16:35","modified_gmt":"2022-03-16T17:16:35","slug":"staffing-ratios-in-retirement-homes-and-long-term-care-homes","status":"publish","type":"post","link":"https:\/\/residences-quebec.ca\/blog\/en\/staffing-ratios-in-retirement-homes-and-long-term-care-homes\/","title":{"rendered":"Staffing ratios in retirement homes and long-term care homes"},"content":{"rendered":"<p>\u201cIt\u2019s undeniable that the more nurses and care attendants there are, the better the quality of care will be in seniors\u2019 living environments,\u201d says Philippe Voyer, an expert in geriatric nursing care and professor in the Nursing Sciences Faculty of Laval University. \u201cStudies have very clearly demonstrated that a higher number of nurses is associated to residents preserving their autonomy and to a lower mortality rate.\u201d<\/p>\n<p>&nbsp;<\/p>\n<h2><strong>The minimum ratios in long-term care homes (CHSLDs)<\/strong><\/h2>\n<p>There is currently no legal requirement regarding staff-to-resident ratios in long-term care homes (known in Quebec under the French initials CHSLD). However, there is an established standard that varies according to the shift (day, evening, night).<\/p>\n<p>A nurse could, for instance, have the following patient loads:<\/p>\n<ul>\n<li>        Day: 32 residents<\/li>\n<li>        Evening: 75 to 96 residents<\/li>\n<li>        Night: up to 100 residents<\/li>\n<\/ul>\n<h2><strong>Desired minimum ratios <\/strong><\/h2>\n<p>Professor Voyer would like the maximum threshold for a head nurse to be lowered to 25\u201332 residents during the day shift, 50\u201364 in the evening and 75\u201396 overnight.<\/p>\n<p>He also suggests having ratios for nursing assistants and care attendants.<\/p>\n<table>\n<tbody>\n<tr>\n<td style=\"padding: 10px; color: #fff; text-align: center;\" colspan=\"4\" bgcolor=\"#007fc4\" width=\"575\"><strong style=\"text-align: center;\">Table <\/strong>1 \u2022 Proposed Ratios<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" bgcolor=\"#DEDEDE\" width=\"144\"><strong>Positionn<\/strong><\/td>\n<td style=\"text-align: center;\" bgcolor=\"#DEDEDE\" width=\"144\"><strong>Day<\/strong><\/td>\n<td style=\"text-align: center;\" bgcolor=\"#DEDEDE\" width=\"144\"><strong>Evening<\/strong><\/td>\n<td style=\"text-align: center;\" bgcolor=\"#DEDEDE\" width=\"144\"><strong>Night<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"144\">Head nurse<\/td>\n<td style=\"text-align: center;\" width=\"144\">1 per 25\u201332 residents<\/td>\n<td style=\"text-align: center;\" width=\"144\">1 per 50-64 residents<\/td>\n<td style=\"text-align: center;\" width=\"144\">1 per 75-96 residents<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"144\">Nursing assistant<\/td>\n<td style=\"text-align: center;\" width=\"144\">1 per 25-32 residents<\/td>\n<td style=\"text-align: center;\" width=\"144\">1 per 25-32 residents<\/td>\n<td style=\"text-align: center;\" width=\"144\">1 per 32-40 residents<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"144\">Care attendant<\/td>\n<td style=\"text-align: center;\" width=\"144\">1 per 6-7 residents<\/td>\n<td style=\"text-align: center;\" width=\"144\">1 per 10-15 residents<\/td>\n<td style=\"text-align: center;\" width=\"144\">1 per 32-50 residents<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Source : <\/strong><a href=\"https:\/\/www.msss.gouv.qc.ca\/professionnels\/documents\/forum-chsld\/Presentation_Philippe_Voyer.pptx\">https:\/\/www.msss.gouv.qc.ca\/professionnels\/documents\/forum-chsld\/Presentation_Philippe_Voyer.pptx<\/a><\/p>\n<h2><strong>Current situation of nurse-to-resident ratios in retirement homes<\/strong><\/h2>\n<p><strong> <\/strong><strong>Minimum staffing thresholds by category of retirement home:<\/strong><\/p>\n<p>The regulation respecting the certification of private seniors\u2019 residence requires minimum staff thresholds in the four following categories of private retirement homes (RH):<\/p>\n<ol>\n<li>RH with basic services<\/li>\n<li>RH with basic services and medication distribution<\/li>\n<li>RH with personal assistance services and the administration of medication<\/li>\n<li>RH with nursing care<\/li>\n<\/ol>\n<p>Depending on their size, the four RH categories are subject to different requirements:<\/p>\n<ul>\n<li>RHs offering basic services and those also offering medication distribution do not require any healthcare professionals, only supervisors, volunteers, supervising lessees or residents.<\/li>\n<li>RHs with 10 to 99 units that offer personal assistance services and the administration of medication require that a care attendant be present.<\/li>\n<\/ul>\n<ul>\n<li>RHs of 200 units or more that offer nursing care require four care attendants, but are not required to have a nurse.<\/li>\n<\/ul>\n<p><strong> <\/strong><\/p>\n<h2>Table 2. Minimum Thresholds for Care Attendants, According to Current RH Categories<\/h2>\n<table summary=\"Services Offered, According to Current RH Categories\">\n<caption><strong><strong>Services Offered, According to Current RH Categories<\/strong><\/strong><\/caption>\n<tbody>\n<tr class=\"\" style=\"padding: 10px; color: #fff; text-align: center;\">\n<th width=\"415\" bgcolor=\"#007fc4\" scope=\"col\">RH Category<\/th>\n<th width=\"359\" bgcolor=\"#007fc4\" scope=\"col\">Number of Units<\/th>\n<th width=\"353\" bgcolor=\"#007fc4\" scope=\"col\">Requirements at the RH<\/th>\n<\/tr>\n<tr>\n<td rowspan=\"4\">Category 1<br \/>\nRH with basic services<\/td>\n<td>49 units or less<\/td>\n<td>1 supervisor, volunteer, supervising lessee or resident*<\/td>\n<\/tr>\n<tr>\n<td>50\u201399 units<\/td>\n<td>1 supervisor, volunteer, supervising lessee or resident*<\/td>\n<\/tr>\n<tr>\n<td>100\u2013199 units<\/td>\n<td>1 supervisor or 2 volunteers, supervising lessees or residents*<\/td>\n<\/tr>\n<tr>\n<td>200 units or more<\/td>\n<td>2 supervisors or 3 volunteers, supervising lessees or residents*<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"3\">Category 2<br \/>\nRH with basic services and medication distribution<\/td>\n<td>9 units or less<\/td>\n<td>1 supervisor*<\/td>\n<\/tr>\n<tr>\n<td>10\u2013199 units<\/td>\n<td>1 supervisor*<\/td>\n<\/tr>\n<tr>\n<td>200 units or more<\/td>\n<td>2 supervisors*<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"4\">Category 3<br \/>\nRH with personal assistance services and administration of medication<\/td>\n<td>9 units or less<\/td>\n<td>1 supervisor*<\/td>\n<\/tr>\n<tr>\n<td>10\u201399 units<\/td>\n<td>1 care attendant<\/td>\n<\/tr>\n<tr>\n<td>100\u2013199 units<\/td>\n<td>1 supervisor* and 1 care attendant<\/td>\n<\/tr>\n<tr>\n<td>200 units or more<\/td>\n<td>2 supervisors* and 1 care attendant<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"4\">Category 4<br \/>\nRH with nursing care<\/td>\n<td>49 units or less<\/td>\n<td>1 care attendant<\/td>\n<\/tr>\n<tr>\n<td>50\u201399 units<\/td>\n<td>2 care attendants<\/td>\n<\/tr>\n<tr>\n<td>100\u2013199 units<\/td>\n<td>3 care attendants<\/td>\n<\/tr>\n<tr>\n<td>200 units or more<\/td>\n<td>4 care attendants<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Source : <a href=\"https:\/\/www.msss.gouv.qc.ca\/ministere\/salle-de-presse\/communique-1535\/\">https:\/\/www.msss.gouv.qc.ca\/ministere\/salle-de-presse\/communique-1535\/<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>In RHs, it is not required to have a night nurse on site in any of the four RH categories<\/strong><\/p>\n<p>\u201cThere is no requirement to hire a certified nurse, but if we don\u2019t, there is a reputational risk,\u201d explains the nursing care manager of a large RH.<\/p>\n<p>In the <strong>daytime<\/strong>, for a Category 4 RH with nursing care, there obviously needs to be a graduate nurse to provide the nursing care. If the RH doesn\u2019t have a nurse, a nursing assistant can dispense some of the care, but only within the limits set out by professional ethics.<\/p>\n<p>&nbsp;<\/p>\n<h2><strong>Who can do what in the event of an accident or incident in an RH?<\/strong><\/h2>\n<p>It\u2019s important to know that a care attendant cannot assess a situation, for instance, a fall. If an incident or accident occurs, attendants have no choice but to call 811, where a trained nurse can tell them what to do.<\/p>\n<p>Nursing assistants can assess a situation, but it must then be reassessed as soon as possible by a graduate nurse.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Source:<\/strong><a href=\"https:\/\/www.oiiaq.org\/questions\/divers-aspects-de-la-pratique-professionnelle\/residence-privee-pour-ainees-rpa\"> Ordre des infirmiers et infirmi\u00e8res du Qu\u00e9bec<\/a><\/p>\n<p>&nbsp;<\/p>\n<h2><strong>In conclusion<\/strong><\/h2>\n<h3><strong>Establishing clear standards for nurse-resident ratios <\/strong><\/h3>\n<p>A law on the minimum allowable thresholds would help ensure the safety of vulnerable older people and standardize the management of health establishments\u2014both public and private.<\/p>\n<h3><strong>Lack of staff is the main issue <\/strong><\/h3>\n<p>With the current staff shortage, managers of private RHs and other public establishments have considerable difficulty maintaining minimum ratios, as explained in this article (French only): <a href=\"https:\/\/lenord-cotier.com\/2021\/03\/24\/de-nouveaux-malgaches-pour-la-residence-des-batisseurs\/\">https:\/\/lenord-cotier.com\/2021\/03\/24\/de-nouveaux-malgaches-pour-la-residence-des-batisseurs\/<\/a><\/p>\n<p>NB: Information on care staff ratios in RHs and CHSLDs is very hard to find on the Quebec ministry of health website and seems to be unclear to everyone.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u201cIt\u2019s undeniable that the more nurses and care attendants there are, the better the quality of care will be in&#8230;<\/p>\n","protected":false},"author":27,"featured_media":29009,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[103,118,122],"tags":[],"class_list":["post-28998","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-consulting-services-on-private-residences","category-private-seniors-residences","category-statistics-on-residences"],"better_featured_image":{"id":29009,"alt_text":"ratio-infirmi\u00e8res-RPA-CHSLD","caption":"","description":"","media_type":"image","media_details":{"width":2500,"height":1640,"file":"2022\/02\/img-article.jpg","sizes":{"medium":{"file":"img-article-600x394.jpg","width":600,"height":394,"mime-type":"image\/jpeg","source_url":"https:\/\/residences-quebec.ca\/blog\/wp-content\/uploads\/2022\/02\/img-article-600x394.jpg"},"large":{"file":"img-article-1024x672.jpg","width":1024,"height":672,"mime-type":"image\/jpeg","source_url":"https:\/\/residences-quebec.ca\/blog\/wp-content\/uploads\/2022\/02\/img-article-1024x672.jpg"},"thumbnail":{"file":"img-article-300x300.jpg","width":300,"height":300,"mime-type":"image\/jpeg","source_url":"https:\/\/residences-quebec.ca\/blog\/wp-content\/uploads\/2022\/02\/img-article-300x300.jpg"},"medium_large":{"file":"img-article-768x504.jpg","width":768,"height":504,"mime-type":"image\/jpeg","source_url":"https:\/\/residences-quebec.ca\/blog\/wp-content\/uploads\/2022\/02\/img-article-768x504.jpg"},"1536x1536":{"file":"img-article-1536x1008.jpg","width":1536,"height":1008,"mime-type":"image\/jpeg","source_url":"https:\/\/residences-quebec.ca\/blog\/wp-content\/uploads\/2022\/02\/img-article-1536x1008.jpg"},"2048x2048":{"file":"img-article-2048x1343.jpg","width":2048,"height":1343,"mime-type":"image\/jpeg","source_url":"https:\/\/residences-quebec.ca\/blog\/wp-content\/uploads\/2022\/02\/img-article-2048x1343.jpg"},"kutak-blog":{"file":"img-article-760x428.jpg","width":760,"height":428,"mime-type":"image\/jpeg","source_url":"https:\/\/residences-quebec.ca\/blog\/wp-content\/uploads\/2022\/02\/img-article-760x428.jpg"},"kutak-blog-1520":{"file":"img-article-1520x856.jpg","width":1520,"height":856,"mime-type":"image\/jpeg","source_url":"https:\/\/residences-quebec.ca\/blog\/wp-content\/uploads\/2022\/02\/img-article-1520x856.jpg"},"kutak-blog-1248":{"file":"img-article-1248x703.jpg","width":1248,"height":703,"mime-type":"image\/jpeg","source_url":"https:\/\/residences-quebec.ca\/blog\/wp-content\/uploads\/2022\/02\/img-article-1248x703.jpg"},"kutak-blog-990":{"file":"img-article-990x558.jpg","width":990,"height":558,"mime-type":"image\/jpeg","source_url":"https:\/\/residences-quebec.ca\/blog\/wp-content\/uploads\/2022\/02\/img-article-990x558.jpg"},"kutak-blog-480":{"file":"img-article-480x270.jpg","width":480,"height":270,"mime-type":"image\/jpeg","source_url":"https:\/\/residences-quebec.ca\/blog\/wp-content\/uploads\/2022\/02\/img-article-480x270.jpg"},"kutak-blog-360":{"file":"img-article-360x203.jpg","width":360,"height":203,"mime-type":"image\/jpeg","source_url":"https:\/\/residences-quebec.ca\/blog\/wp-content\/uploads\/2022\/02\/img-article-360x203.jpg"}},"image_meta":{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"Copyright (c) 2020 Rigucci\/Shutterstock.  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