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Can the US Implement the Same LTC Staffing Prohibitions as Ontario, Canada?

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June 02, 2021

ilene warner-maron, phdIn the March 2021 issue of The Journal of Post-Acute and Long-Term Care Medicine1, Aaron Jones and his colleagues examined the impact of an order imposed by the government in Ontario, Canada. On April 22, 2020, the Canadian government began prohibiting nursing home staff from working at more than one facility in an attempt to slow down the pandemic.  Agency staff were not limited in their ability to work at multiple in an attempt to avoid critical shortages of nursing home staff, although there was no attempt to curtail the number of long-term care facilities one agency staff were allowed to provide services.

GPS location data retrieved from mobile devices was used to track the movement of staff among the 623 facilities in the province. The authors found that prior to the prohibition order, 42.7% of the employees had connections with at least one other nursing home, however after restrictions were in place, only 12.7% of the staff were traced to more than one facility, a decrease of 80.3%.

Although the purpose of the study was to identify the impact of the order on the mobility of nursing home staff, the authors did briefly identify that part-time or casual employees frequently are compelled to work at multiple facilities to earn a living wage. My questions are:

  • What other industry has employees that are forced to work at multiple sites, including our competitors?
  • Would 12-hours shifts allow staff to work in one facility?
  • Would creative human resource policies provide more flexible scheduling of core staff members?

It is unlikely that the US would incorporate a formal prohibition that prevents the freedom of movement of staff from one nursing home to another despite our knowledge of the transmission of COVID-19.  We should be able to use this opportunity to rethink how to get the most of our staff and to maximize their ability to earn an appropriate wage. 

We know that the quality of care is enhanced by having permanent assignments performed by staff who have a deep knowledge of the individuality of the resident.  We also know that part-time staff who work at multiple long-term care facilities increase the risk of COVID-19 transmission to both residents and staff.  We do not need to be compelled by the government to find solutions to our employment issues.

Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, is an assistant professor in the Department of Geriatrics and Palliative Medicine at the Philadelphia College of Osteopathic Medicine. Dr Warner-Maron is also the executive director of the Eastern Pennsylvania Geriatric Society. 

Disclaimer: The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of Population Health Learning Network. Any content provided by our bloggers or authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.


Jones A, Watts AG, Khan SU, et al. Impact of a Public Policy Restricting Staff Mobility Between Nursing Homes in Ontario, Canada During the COVID-19 Pandemic. J Am Med Dir Assoc. 2021;22(3):494-497. doi:10.1016/j.jamda.2021.01.068

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