As an officer of the BC Care Providers Association (a provincial association representing both private and nonprofit facilities providing services to more than 10 000 residents in British Columbia), I read with interest the article by Margaret McGregor and associates about staffing levels at long-term care facilities.1
Unfortunately, the numbers of direct care hours of staff time per resident day reported in the article (e.g., in Table 1) appear suspect. The information on staffing levels was taken from essential service designations of the British Columbia Labour Relations Board, but in all cases the values appear unreasonably high. They are certainly higher than the levels of staffing possible through funding received from government or health authorities.2 For example, the time for direct care in intermediate and extended care not-for-profit facilities is reported as 3.41 hours per resident-day,1 but the funding model would provide only 2.83 hours of direct care. Furthermore, facilities are usually unable to staff to 100% of the funding formula. Although it is probably true that these long-term care facilities would like to be able to staff at the “essential staffing levels” on file with the Labour Relations Board, these values do not reflect actual staffing levels. One possible explanation for the discrepancy is that McGregor and associates used data for paid hours per resident-day rather than worked hours. Paid hours include vacation time, statutory holidays and sick leave and are therefore significantly higher than worked hours, which reflect hands-on care.
Given that the validity and accuracy of the hours of care being delivered are questionable, the resulting interpretation and conclusions of the article are similarly debatable. If valid conclusions are to be drawn regarding the overall impact of staffing, staffing levels must be tied directly to outcomes and to client and family satisfaction levels. The level of staffing is obviously a critical factor in quality of care, but other factors such as experience, training, productivity and innovation can be equally important.
We believe that the major determinant of differences in staffing levels in private and nonprofit facilities relates to inconsistencies in funding. Nonetheless, excellent services are provided in both sectors, and the provincial ministry of health and the regional health authorities have not identified any differences in quality of care between not-for-profit and for-profit facilities.
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Competing interests: None declared.