Determinants of Quality in Ontario LTC Homes (2007-2010)

Walter P. Wodchis (PI), Tim Burns (Co-PI; MOHLTC)

 Team Members
 HPME  Whitney Berta, Katherine McGilton, Ann Tourangeau, Natalie Ceccato, Catherine Montgomery, Dina Franchi, Jane Weber, Chen Su
 OANHSS  Margaret Ringland
 OLTCA  Paula Neves
 SHRTN Larry Chambers

Facility-based Long-Term Care (LTC) is an important and growing component of the health care system. Residents in LTC Homes are a frail elderly population susceptible to multiple functional and cognitive impairments. Improving quality of care for these vulnerable residents is a concern for residents, providers, and health care policy makers.

The process of delivering quality care requires interaction between LTC Home staff and residents. Given that nursing staff comprise more than 70% of LTC resources, nursing staff-related factors are the most substantive determinant of LTC quality. But high quality of care requires more than ensuring adequate staffing levels. Enabling staff in the workplace with effective training, feedback, support and leadership may enhance staff outcomes which will in turn improve the quality of care provided to residents.

This study aims to integrate the knowledge needs of decision-makers with researchers’ expertise in LTC quality to inform policy and practices. To achieve this, a partnership between University of Toronto researchers (led by Dr. Wodchis), the Ministry of Health and Long-Term Care (MOHLTC), provider associations including the Ontario Long Term Care Association (OLTCA) and Ontario Association of Non-profit Homes and Services for Seniors (OANHSS), as well as the Seniors Health Research Transfer Network (SHRTN) was established. This project involves 2 phases: Phase 1) a survey of senior management regarding organizational supports in all LTC facilities in Ontario and Phase 2) a survey of all staff in a representative sample of facilities across the province. This research will provide a key understanding of what LTC facilities can and should do to improve staff and resident outcomes in their organizations.

The specific aims of this research are:

  1. To describe organization-level staff supports (staff levels, training opportunities and participation, HR practices and use of clinical practice guidelines) and turnover based on a survey of all Ontario LTC Homes.
  2. To describe staff perceptions of organizational supports (leadership, support, empowerment and participation in decision-making), and staff outcomes (burnout, satisfaction, intention to turnover) in a representative sample of 75 Ontario LTC Homes.
  3. To examine the relationship between organizational supports, staff outcomes and quality of care in LTC Homes, and translate these results into meaningful knowledge through active knowledge exchange activity.
  4. To test a conceptual model describing the relationships between organizational supports, staff outcomes and LTC quality of care.

The purpose of this website is to provide information and access to resources relating to the Determinants of Quality in LTC Homes project.  Materials provided as they relate to Phase 1 and 2 of this project are outlined below. If you have any questions or require more information, please e-mail:

Phase 1: Senior Management Survey

Oral Presentations

Poster Presentations

Phase 2: LTC Staff Survey


 Fundings and Partnerships