The Association of Registered Nurses of BC

Care Hours within Residential Care
Residential care (frequently known as nursing homes or long-term care) provides 24 hour professional supervision and care for individuals who have complex care needs and can no longer be cared for in their own homes or in assisted living.


Seniors residing in residential care have some of the most complex care needs, requiring a significant level of care. However, earlier this year, the Office of the Seniors Advocate highlighted that many publicly funded residential care facilities with complex residents (i.e.: psychiatric illness, dementia and aggressive behaviours) fall below the minimum provincial guideline of an average of 3.36 care hours per resident per day . Specifically, the Seniors Advocate indicates that between 2014-2015, 232 out of 292 government-funded facilities did not meet care hour guidelines, which prompted an order by the Minister of Health for the review of staffing guidelines in government-funded long-term care homes. Through ARNBC's interactions with nurses and patients across the province, and submissions through the Issues Report Form, inadequate care hours within residential care facilities continues to be one of the most frequently reported issues impacting seniors' health and well-being.

Anecdotes from patients and providers as well as investigations and evaluations of residential care facilities across the province all suggest that there has been a decline in quality of care. The consequences of inadequate staffing levels of both care aides and nurses within residential care have significant implications on residents' health and well-being. Many residents are not provided with adequate support to mobilize, stay hydrated, be toileted and interact with each other. Specifically, residential care facilities with inadequate staffing levels and low care hours have also seen high incidences of resident-to-resident aggression along with the over-prescription of antipsychotic drugs to manage changes in behaviours in residents with conditions such as dementia.

Inadequate staffing levels have been attributed to the lack of funding dedicated to residential care within health authorities. Nurses and other care providers understand the importance of ensuring residents receive adequate care hours, yet they are continuously being understaffed with limited resources, further impacting their ability to fully meet the physical, social, psychological and spiritual needs of residents. Nurses practicing in residential care know that their ability to provide holistic, high quality and safe patient care strongly depends on adequate staffing levels. Addressing this issue will require better collaboration between all care providers, professional associations and unions, government and leadership within residential care.

Key messages

  • B.C. is reaching a crisis in the residential care sector, which will only worsen as baby boomers move into the final stage of life.
  • Without immediate action to address the challenges facing the residential care sector, the outcomes of this vulnerable sector will only continue to worsen.
  • The majority of publicly funded residential care facilities are not meeting the provincial guideline of 3.36 hours of care per residents per day.
  • Low staffing levels are contributing to less direct care hours, impacting nurses' ability to fully meet the physical, social, psychological and spiritual needs of residents.
  • Inadequate direct care hours within residential care facilities have implications on the high incidence rate of resident-to-resident aggression and overuse of antipsychotic drugs for behaviours related to conditions such as dementia.
  • Collaboration between care providers, professional associations and unions, government and residential care leadership is required to ensure seniors living within these environments are receiving the highest and safest level of care.

Questions for Nurses

(Answer any or all and hit Submit)
For nurses practicing in residential care, what other barriers impact your ability to release time to care?

What solutions exist at the organizational and systems level?

What advocacy initiatives should ARNBC champion to improve the level of care within residential care?

* Please note, all of the information will be kept private and will not be shared on ARNBC's website.