A high quality of nursing home care requires adequate levels of nurse staffing, and nurse staffing standards have been shown to improve staffing levels.

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How was long-term care different in Ontario and British Columbia before COVID-19? Characteristics of residents Before the pandemic, the age and sex distribution of residents in LTC were similar in the 2 provinces (Table 2). 9,10 Although residents living in Ontario LTC homes appear to be more medically and functionally complex, it is unclear whether these are true differences or reflect differing documentation practices, which may arise as a consequence of different funding formulas. 15-17 Funding, staffing and direct care hours In 2018-2019, the average combined funding per resident per diem was higher in British Columbia ($222) than in Ontario ($203). 10,11 Most of this funding is used to pay staff in both provinces. 11,14 Some estimates suggest that, before the pandemic, residents in British Columbia received more daily hours of direct care (3.25) than residents in Ontario (2.71). 10,12 There are ANALYSIS HEALTH SERVICES

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Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality.

The higher adjusted hospitalization rates in FP versus NP facilities is consistent with previous research from U.S. authors. However, the superior performance by the NP sector is driven by NP-owned facilities connected to a hospital or health authority, or that had more than one site of operation.

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ResearchRecherche N nursing homes provide long-term housing, support and direct care to members of the community who are unable to function independently because of medical, physical and cognitive disabilities. Although only a small proportion of older Canadians reside in nursing homes (18% of those ≥ 80 years), the majority (81%) of long-term care residents are frail elderly people over the age of 65.1 Government-funded long-term care in Canada has been provided for many years by a mix of not-for-profit (nonproprietary) and for-profit (proprietary) facilities. The ratio of this mix varies greatly by province. For example, in Ontario 52% of publicly funded nursing homes are for-profit, as compared with 15% in Manitoba. 2Previous studies from the United States have shown that having more direct-care personnel is associated with better care in nursing homes.3-7 Specifically, higher numbers of registered-nurse hours per resident-day have been associated with fewer violations of care standards 4 and improved functional ability of residents.7 Schnelle and colleagues examined 21 nursing homes in California and found that the homes with the highest number of nurse aides performed significantly better in 13 of 16 quality-of-care measures than the homes with fewer nurse aides. 6 Although there has been little research on staffing levels and nursing home care in other countries, health policy-makers in the United Kingdom 8 and Australia 9 have begun to call for greater accountability for public resources spent in this area.The American literature has also shown that, compared with for-profit nursing homes, not-for-profit facilities have higher direct-care staffing levels 4 and lower staff turnover rates.10,11 However, the majority of nursing home care in the United States is delivered by the for-profit sector, whereas in Canada the not-for-profit sector constitutes the majority. This may result in a difference in the informal benchmarks for staffing levels between the 2 countries. There also may be a wider variation in wages and working conditions among nursing homes in the United States, which potentially confounds the comparison between for-profit and not-for-profit facilities.We compared staffing levels of nursing and support staff in publicly funded long-term care facilities by ownership type (not-for-profit v. for-profit) in British Columbia at a time when the majority of publicly funded not-for-profit and for-profit facilities employed a unionized labour force with standardized wages and benefits set by a master collective agreement.In British Columbia, approximately 70% of publicly funded nursing homes are nonproprietary (not-for-profit) Currently there is a lot of debate about the advantages and disadvantages of for-profit health care delivery. We examined staffing ratios for direct-care and support staff in publicly funded not-for-profit and for-profit nursing homes in British Columbia. Methods: We obtained staffing data for 167 long-term care facilities and linked these to the type of facility and ownership of t...