Determinants of Quality in Ontario LTC Homes (2011-2015)

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

 Team Members – 2015
U of T  Whitney Berta, Katherine McGilton, Kevin Walker, Sara Shearkhani
 HQO  Gail Dobell
 MOHLTC  Under review
 OANHSS  Dan Buchanan
 OLTCA  Nancy Cooper
 SHKN  Under review
 OARC  Donna Fairley
 Concerned Friends  Phyllis Hymmen

What is being done to improve quality in Ontario LTC Homes?

Ontario is active in both regulatory and Quality Improvement (QI) approaches to improving quality of LTC:

  • The provincial government enacted the Long-Term Care Homes Act, 2007 (LTCHA) that came into full force July 1, 2010.
  • Health Quality Ontario (HQO) has initiated a QI initiative called Residents First. They have also started Public Reporting of LTC quality outcomes.

Will these new initiatives improve quality in Ontario LTC Homes?

It is predicted that Homes will make changes in response to these three initiatives, an impact first felt by staff and resulting in improved resident outcomes. A research partnership, among the Seniors Health Knowledge Network (SHKN), the Ontario Association for Non-Profit Homes and Services for Seniors (OANHSS), the Ontario Long Term Care Association (OLTCA), the Ontario Association of Residents’ Councils (OARC), Concerned Friends of Ontario Citizens in Care Facilities, HQO and researchers at the University of Toronto, has embarked on a province-wide research project to explore the impacts of these new initiatives. Our study will measure changes in LTC Home leadership, support to staff and staff involvement in quality improvement and then evaluate the impact on resident clinical outcomes.

What does the research project involve?

The project is called “The Determinants of Quality in Ontario LTC Homes”. All homes will be asked to outline how they are dealing with the new initiatives. Data collection took place between November 2011 and December 2012. Analysis of the incremental change in resident-level outcomes attributable to the LTCHA, Residents First and Public Reporting is ongoing.

  • Staff surveys were used to measure leadership practices, supervisory support, involvement in QI initiatives and the staff work experience. More than 15,000 staff members from 418 LTC Homes across the province returned surveys. Administrators and Directors of Care from all of Ontario’s LTC Homes were asked to contribute by responding to an online survey about their Home’s QI activities, the availability of supports for QI activities and their need for additional supports. We will also be interviewing LTC Home leaders to understand how they are changing the way that they operate Homes.
  • The change in resident-level outcomes (e.g. restraint use, falls, and pressure ulcers) attributable the LTCHA, Residents First and Public Reporting is being examined using RAI-MDS data held at ICES. A copy of some of these analyses presented are available here.

Why is this study important?

  • This project will provide new information on the impact of regulation and QI affecting over 80,000 residents in Ontario LTC. Decision makers in Ontario will use this new information for public reporting and program evaluation purposes.
  • Participating homes have received their aggregate score from the staff survey compared to provincial and market benchmarks along with an interpretive commentary.

For more information

The purpose of this website is to provide information and access to resources relating to the Determinants of Quality in LTC Homes project.  Materials related to this project are outlined below. If you have any questions or require additional information, please contact our research team at:

Presentations Other Documents
Poster Presentation:


Funding and Partnerships