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Health human resources forecasting: Understanding the
current and future requirements of PSW’s and nurses in
Ontario’s LTC sector
Presented by:
Adrian Rohit Dass, MA
IHPME, University of Toronto
Canadian Centre for Health Economics
PI’s: Audrey Laporte, Ivy Bourgeault
Team: Raisa Deber, Andrea Baumann, Janet Lum, Amy Hsu, Christine Kelly
Preliminary - Please do not cite or quote without permission from the authors
Presenter Disclosure 2
• Speaker: Adrian Rohit Dass
• Relationships with commercial interests: – Grants/Research Support: N/A
– Speakers Bureau/Honoraria: N/A Consulting Fees: N/A Other: N/A
This project is supported with funding from the Government of Ontario through the Bruyère Centre for Learning, Research and Innovation in Long Term Care.
The views expressed in this publication are the views of the author(s)/presenter(s) and do not necessarily reflect those of the funder.
Disclosure of Commercial Support 3
• This program has received financial support
– CIHR Operating Grant
• This program has received in-kind support
– N/A
• Potential for Conflict of Interest:
– N/A
Acknowledgements 4
• We thank Peter Walker, Melissa Donskov, Tracy Luciani, and the team at the
Bruyère Centre for Learning, Research and Innovation in Long Term Care for
their input and support on the project.
• We also thank the Ontario Long Term Care Association (OLTCA), Ontario
Association of Non Profit Homes and Services for Seniors (OANHSS),
Ontario Home Care Association (OHCA), Ontario Community Support
Association (OCSA), Nursing Health Services Research Unit (NHSRU),
Ontario Personal Support Worker Association (OPSWA), Canadian Home
Care Association (CHCA), Toronto Central Community Care Access Centre
(TC-CCAC), Ontario Health Human Resources Research Network (OHHRN)
and Canadian Centre for Health Economics (CCHE) for providing their
expertise and facilitating connections with those in the policy realms.
• All errors/omissions are the responsibility of the research team.
Objective for today’s presentation 5
• Outline the main components of the model
• Show how we marshaled various datasets to
produce the data inputs for the forecasting model
• Present preliminary forecasts from the model
• Present policy scenarios that can be explored
with the model
Motivation 6
• PSWs are essential in providing care in Long Term Care.
Approximately three-quarters of direct care staff in
Ontario’s LTC sector are PSWs (MOHLTC, 2012).
• Despite their importance in administering care, relatively
little is known about them
• Need for PSW services expected to grow over the years
as proportion of population aged 65+ continues to grow
• From a policy point of view knowing how many PSWs
will be required is essential
Hours of Direct Care Per Resident Day 7
0
0.5
1
1.5
2
2.5H
o
u
r
s
p
e
r
R
e
d
i
s
e
n
t
D
a
y
Year
Registered Nurses
Registered Practical Nurses
Other Direct Care Staff
Source: Residential Care Facilities Survey for Ontario (1996-2009)
LTC PSW Forecasting Model
• Goal: To predict the need and supply of Personal Support Workers
(PSWs) accounting for the supply of Nurses (RPNs and RNs) in
Ontario’s LTC sector by LHIN
• Approach:
– Multi-professional (PSW, RPN, RN)
• Model RN labour force as well as RPNs which has largely
been neglected to date in Canada.
– Currently focusing on one sector-LTC but working to expand to
the community
– Forecast at the level of the LHIN, rather than provincially
– Improve upon existing forecasting models, which have focused
on one profession and have not accounted for the effects of
different skill mixes on output.
8
Diagram for Forecasting LTC PSW labour force 9
Provider Supply (Continued)
• To estimate the future stock of the Nurse and PSW
workforces, we take the current stock, subtract the
expected outflows, and add to it the expected inflows (all by
age), which is outlined by Birch et al. (2007):
• For Nurses, the College of Nurses of Ontario (CNO) has a
rich, longitudinal database of all nurses in Ontario
• For PSWs, we have the PSW registry, which is cross-
sectional and only (currently) mandatory for PSWs working
in Home and Community Care
10
Employment Categories of PSWs 11
Source: Lum (2013) – Ontario PSW Registry Data
Analysis
Age Distribution of PSWs 12
Source: Lum (2013) – Ontario PSW Registry Data
Analysis
How to measure RN/RPN outflows from the LTC sector by
LHIN?
13
RNs and RPNs: Since we have longitudinal data for nurses, we can
calculate transitional probabilities to determine the proportion remaining
in LTC from year to year
•This measure is also known as “stickiness”, a term coined by
Alameddine, Laporte, Baumann, O’Brien-Pallas, Mildon, & Deber
(2006)
– Defined as the transition probability of a nurse working in a
given setting in year ‘‘t’’ remaining in the same setting in year
‘‘t+1’’ (sector)
– We have calculated transitional probabilities for RNs and RPNs
over the years 2005-2010 by age group and LHIN
RN Stickiness by LHIN 14
2005/2006 2006/2007 2007/2008 2008/2009 2009/2010 Average
Total Outflows 1284 1253 1205 1086 902 1146
Stickiness 82% 82% 83% 84% 87% 84%
% Outflows by LHIN
Central 8% 10% 9% 11% 8% 9%
Central East 11% 11% 12% 9% 9% 10%
Central West 4% 4% 4% 3% 4% 4%
Champlain 9% 12% 11% 11% 11% 11%
Erie St. Clair 7% 6% 5% 4% 6% 6%
Hamilton Niagara Haldimand Brant 9% 10% 10% 11% 12% 10%
Mississauga Halton 6% 5% 6% 5% 6% 6%
North East 5% 5% 5% 6% 7% 6%
North Simcoe Muskoka 4% 3% 5% 6% 5% 5%
North West 3% 2% 3% 2% 3% 2%
South East 5% 7% 5% 7% 7% 6%
South West 10% 8% 9% 9% 8% 9%
Toronto Central 14% 11% 13% 13% 11% 12%
Waterloo Wellington 5% 5% 4% 5% 4% 5%
Source: CNO Database
RPN Stickiness by LHIN 15
2005/2006 2006/2007 2007/2008 2008/2009 2009/2010 Average
Total Outflows 1188 1151 1324 1451 1317 1286
Stickiness 82% 83% 83% 82% 84% 83%
% Outflows by LHIN
Central 5% 6% 6% 7% 9% 6%
Central East 10% 8% 9% 12% 8% 10%
Central West 2% 3% 4% 3% 4% 3%
Champlain 12% 10% 11% 10% 13% 11%
Erie St. Clair 7% 5% 6% 5% 5% 6%
Hamilton Niagara Haldimand Brant 11% 13% 14% 12% 10% 12%
Mississauga Halton 3% 4% 3% 5% 4% 4%
North East 6% 10% 9% 7% 10% 8%
North Simcoe Muskoka 5% 3% 4% 5% 4% 4%
North West 5% 5% 5% 5% 5% 5%
South East 6% 6% 6% 5% 4% 5%
South West 11% 10% 10% 8% 9% 10%
Toronto Central 11% 11% 10% 11% 11% 11%
Waterloo Wellington 6% 6% 5% 5% 4% 5%
Source: CNO Database
How to measure outflows of PSWs from the LTC sector by
LHIN?
• Wodchis et al (2015) found the turnover rate of full-time PSW’s in
LTC to be 6.5%. We therefore assume that the LTC sector retains
93.5% of it’s FTE PSW workforce from year to year.
• In terms of outflows per LHIN, we use the same proportions as the
RPN labour force
• In terms of outflows by age, we calculate this based on the PSW
Registry Question: In the next 1-3 years, what do you plan on
doing?
– We obtained an age distribution of PSW’s intending to: retire,
seek employment outside of the PSW field, return to school for a
PSW Certificate, return to school for PSW professional
development or continuing education, or return to school for a
different career.
– We found intention to leave is not limited to the older ages, as a
high proportion of younger PSWs intend to leave as well.
16
How to measure Nurse (RN, RPN) inflows into the LTC
sector by LHIN?
• RNs and RPNs: Alameddine et al. (2006) also have an inflow
measure, defined as as the percentage of nurses that are working in
a particular setting in year ‘‘t’’, who were not working in that setting
in year ‘‘t-1’’, i.e., were fresh additions to that setting.
• This measure captures nurses who are new additions to the
workforce (new graduates, immigration), returning to the workforce,
and those switching sub-sectors.
• This was estimated using the CNO database for years 2005-2010.
17
Inflows of RN’s into LTC by LHIN 18
Source: CNO Database
Inflows of RPN’s into LTC by LHIN 19
Source: CNO Database
How to measure PSW inflows into the LTC sector by LHIN?
PSWs •Every year, over 7000 PSWs graduate from Ontario
programs (“PSW Educational Program Accreditation”
http://www.pswepa.ca/)
•According to the Ontario Ministry of Training, Colleges,
and Universities website, 54% of new PSW graduates go
into the “Nursing and residential care facilities” sector
– We therefore assume that 54% of 7000, or 3780 new
PSW graduates enter the LTC sector in each year.
•In the absence of data on inflows across LHINs for PSWs,
we apply the same proportions as the RPN labour force.
20
Demand for Providers
• Before we can estimate the number of required providers, we need
to estimate the number of services required, which can be done
using the following indicators:
21
(1) (2) (3)
This is the needs based approach for estimating the number of services
required by the population, originally created by Birch et al (2007), and
used by CNA (2009) and Murphy et al (2012) to estimate the number of
required services in each sector of Ontario (including Long Term Care).
Predicting Services Required 22
0
5000000
10000000
15000000
20000000
25000000
30000000
19961997199819992000200120022003200420052006200720082009
P
a
t
i
e
n
t
D
a
y
s
Year
Total Patient Days (Predicted)
Total Patient Days (Actual)
Source: Residential Care Facilities Survey for Ontario (1996-2009)
How does this translate to the number of staff
required? And what about productivity?
Under the traditional uni-professional approach, once the services
required have been estimated, the next step is usually to divide this
number by the rate at which FTE workers can perform them
(productivity) to yield the required number of health workers. The
conceptual framework is usually modeled as follows (adapted from
Murphy et al 2012):
23
Why might this approach be incomplete?
From Auditor General of Ontario (2013 report), as a recommendation to
the MOHLTC:
“…further refine its forecasting models and their capabilities to assess
the impact of various factors on service-provider productivity”
From Health Workforce Australia’s “National Health Workforce
Productivity Modelling – Final Report” (2012):
“Current workforce planning models examine labour productivity of
each health worker (e.g. number of visits per doctor), though in reality
the number of visits each doctor produces is also influenced by nurses,
equipment, and other resources... Models that estimate requirements
for a particular group of health professionals do so independently of
other groups of health professionals, leading to inaccurate results”
24
Predicting the Number of FTE RN’s in Ontario, 1996-2009 25
0
1000
2000
3000
4000
5000
6000
F
T
E
'
s
R
e
q
u
i
r
e
d
Year
FTE RN"s Required (Estimated)
FTE RN's Required (Actual)
Source: Residential Care Facilities Survey for Ontario (1996-2009)
Predicting the Number of FTE RPN’s in Ontario, 1996-2009 26
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
F
T
E
'
s
R
e
q
u
i
r
e
d
Year
FTE RPN"s Required(Estimated)
FTE RPN's Required (Actual)
Source: Residential Care Facilities Survey for Ontario (1996-2009)
Predicting the Number of FTE PSW’s in Ontario, 1996-
2009
27
0
5000
10000
15000
20000
25000
30000
F
T
E
'
s
R
e
q
u
i
r
e
d
Year
FTE PSW's Required (Estimated)(Silo)
FTE PSW's Required (Actual)
Source: Residential Care Facilities Survey for Ontario (1996-2009)
How to model workers together?
We need a way to relate services required (output) with the
factors that influence it (PSWs, RNs, RPNs, drug
expenditures, etc.). Conceptually, it would look like this for
the LTC sector:
28
This can be done by estimating a production function
Multi-professional Approach
• We estimate a translog production function, which allows for interactions of the
inputs, thereby allowing for the productivity of one input to depend on the level
of other inputs. It also has a history in the economics literature for use of
determining the complementarity/substitutability of inputs (Hsu et al, 2015).
– We find a statistically significant interaction effect of -0.016 between PSWs
and RPNs, This implies that a 1% increase in the number of RPN hours
leads to a 0.016% decrease in the productivity of a PSW, all else being
equal.
– We also found a positive (though not significant) interaction between RN’s
and PSW’s of 0.008, implying an increase in PSW productivity of 0.008% for
every 1% increase in RN hours.
• These results are supported by qualitative work performed by members of the
team (see Kelly 2015).
– PSWs feel their role is very similar, overlapping, or even identical to that of
RPNs
– The PSWs and key informants do not make comparisons of this nature with
RNs
29
Predicting the Number of FTE PSW’s in Ontario, 1996-
2010
30
0
5000
10000
15000
20000
25000
30000
F
T
E
'
s
R
e
q
u
i
r
e
d
Year
FTE PSW's Required (Estimated)(Silo)
FTE PSW's Required (Actual)
FTE PSW's Required (Estimated)(Concert) (RN's + RPN)
Source: Residential Care Facilities Survey for Ontario (1996-2009)
Results of Forecasts – Gap
(Surplus) of Workers by LHIN
31
Results of Forecasts – Gap of PSW Labour Force 32
-2500
-2000
-1500
-1000
-500
0
500
2010201120122013201420152016201720182019202020212022202320242025
Central
Central East
Central West
Champlain
Erie St. Clair
Hamilton Niagara HaldimandBrant
Mississauga Halton
North East
North Simcoe Muskoka
North West
South East
South West
Toronto Central
Waterloo Wellington
Results of Forecasts – Gap of RN Labour Force 33
-600
-500
-400
-300
-200
-100
0
100Central
Central East
Central West
Champlain
Erie St. Clair
Hamilton Niagara HaldimandBrant
Mississauga Halton
North East
North Simcoe Muskoka
North West
South East
South West
Toronto Central
Waterloo Wellington
Results of Forecasts – Gap of RPN Labour Force 34
-800
-600
-400
-200
0
200
400
Central
Central East
Central West
Champlain
Erie St. Clair
Hamilton Niagara Haldimand Brant
Mississauga Halton
North East
North Simcoe Muskoka
North West
South East
South West
Toronto Central
Waterloo Wellington
Policy Scenarios
35
Policy Scenario 1: Initial Gap
• In our base-case scenario, we assume supply is equal to demand in
the base period and do not allow for unmet need.
– This assumption is likely to be false in Ontario, as it does not
take into account clients in the community or hospital waiting for
an LTC bed
• According to a report by the MOHLTC, there was an average of
25,322 clients in the Community and in the Hospital on the waitlist
for LTC in the 2009/10 fiscal year (MOHLTC, 2012).
– Unfortunately, this was not broken down by LHIN, so we
approximated how many individuals per LHIN were on the wait-
list this year by the number of facilities in each of the LHINs.
36
Policy Scenario 2: Diversion of home-care clients on LTC
Wait-list to Community
• Williams et al conducted 11 Balance of Care
(BOC) projects across 10 of the 14 LHINs in
Ontario
• They found that individuals on the LTC wait-list
could be “diverted” safely and cost-effectively
cared for in the family home or in supported
housing. This generally ranged from 14-50%
• We simulate from the lower and upper ends to
explore the effects on the estimated gap in LTC.
37
Policy Scenario 3: Level of staffing and Quality of
Care
• One issue related to LTC Homes in Ontario is the level of staffing used by
homes.
• Data from RCFS suggests that residents were receiving 1.94 PSW hours,
0.91 nurse hours (RN and RPN), and 0.22 Therapist Hours per resident day
in 2009, totaling 3 hours of direct care per resident day.
– These figures are below the recommended 2.5, 1, and 0.5 hours for
PSWs, Nurses, and Other Staff recommended by Shirlee Sharkey’s
2008 report on LTC Homes in Ontario, which equates to 4 hours of care
per resident day.
– To date, these staffing levels have not been implemented (OANHSS,
2015).
• OANHSS’s 2015 report suggests implementing these ratios to improve the
quality of care in LTC homes in Ontario.
• We simulate the effects of these ratios on the projected gap of workers.
38
Summary of Forecasts: Gap of FTE Workers in
LTC by 2025 in Ontario
39
PSWs RNs RPNs
Scenario Gap % Change Gap % Change Gap % Change
Base Case - Silo 5698 - 3162 - 2754 -
Base Case - Multiprofessional 11475 101% 3162 - 2754 -
Policy Scenario 1-2 - Unmet Need (50% cared for in HCC) 17036 48% 4069 29% 4127 50%
Policy Scenario 1-2 - Unmet Need (14% cared for in HCC) 21043 24% 4723 16% 5115 24%
Policy Scenario 3 - Staffing Ratios 39609 88% 5836 24% 7003 37%
Limitations
Demand Side data
•Residential Care Facilities Survey (RCFS)
– Quality of care measures not available. This is not a limitation of the methodology, but rather, the data used
in the study.
• Although we used a volume based measure of care (patient days of care), we could have explored quality
outcomes as well. Such data was not available to use at the time of the study. Future work may look into
exploring this should such data become available
– Only reports total direct care hours (including casuals).
• Future work may explore variation in hours worked across class of works (Full-time, Part-time Casual, etc.)
Supply Side Data
•PSW Registry
– PSW labour force is unregulated, so we don’t have a robust, representative dataset.
– Is only currently mandatory for PSWs working for publicly funded employers in the home and community
sector, so may be unrepresentative (selection bias).
– In contrast to nursing registry, PSW registry is (at least for now) cross-sectional so that we cannot get a
sense of dynamics that are driven by changes in the age distribution.
– Had to source data from other sources (accreditation websites, survey research, Ontario Ministry of
Training, Colleges, and Universities, etc.) to obtain relevant data for forecasting model.
– Inflows from the Home and Community Care and Hospital sectors was assumed to be zero, since data on
these transitions do not currently exist
• Future work will allow for workers to inflow from other sectors (see Berta et al 2015).
40
Value of Forecasting
• Having the appropriate level of staffing available
in LTC will become essential in the upcoming
years as proportion of population aged 65+
continues to grow
• Knowing how may RNs, RPNs, and PSWs will
be required, as well as the projected supply, will
assist us as we plan for this
41
Conclusions
• Health Human Resource planning is a complex science
requiring detailed data
– Requires longitudinal data to get a sense of dynamics
of workers over time and across regions
• Need to model workforces simultaneously to take into
account interactive effects between workforces
• Vital for LTC with the expected increase in demand for
these services in the upcoming years.
42
Next Steps
• Funding leveraged through CIHR to expand model to
Home and Community care sector
– Survey data is currently being collected from PSWs
working in LTC and HCC
– With the data collected, we will be able to examine
the factors that affect hours of work and influence
intentions to leave the labour force, as well as
likelihood of working in a particular sector
– The results of the analysis will be used as inputs to
extend the current model to other sectors
43
References
• Alameddine M, Laporte A, Baumann A, O'Brien-Pallas L, Mildon B, Deber R (2006). 'Stickiness' and 'inflow' as proxy
measures of the relative attractiveness of various sub-sectors of nursing employment. Social Science & Medicine 63: 2310-
2319
• Birch, S. et al. (2007). Human resources planning and the production of health: A needs-based analytical framework.
Canadian Public Policy 33, supplement.
• Canada. Office of the Auditor General of Ontario. 2013 Annual Report of the Office of the Auditor General of Ontario. 2013.
Web. April 7th, 2014.
• CNA (2009). Tested Solutions for Eliminating Canada's Registered Nurse Shortage, report prepared by Tomblin Murphy, G.
et al., Canadian Nurses Association, Ottawa
• Hamilton, Lynelle. “PSW Educational Program Accreditation”. Web. April 7th, 2014.
<http://www.pswepa.ca>
• HWA (2012). National Health Workforce Productivity Modelling - Final Report, Health Workforce Australia, Adelaide.
• Lum, Janet. (2013) Ontario PSW Registry Data Analysis Results. Canadian Research Network for Care in the Community.
April 7th, 2014.
<http://www.ryerson.ca/crncc/knowledge/events/pdf/PSW%20Registry%20Data%20Analysis%20Results%20Final.pdf>
• Ministry of Health and Long-Term Care (2012). Long-term Care in Ontario: Sector Overview. Health Analytics Branch.
• Murphy et al (2012). Eliminating the shortage of registered nurses in Canada: An exercise in applied needs-based planning.
Health Policy 105: 192-202
• OANHSS (2015). The Need Is Now: Addressing Understaffing in Long Term Care.
• Singh, D. et al. (2010), Ontario Population Needs-Based Physician Simulation Model, Ministry of Health and Long-Term
Care and the Ontario Medical Association, Toronto.
• Wodchis et al (2015). Factors Associated with Personal Support Worker Turnover in Ontario LTC Homes. Accessed online
August 19, 2015 http://ihpme.utoronto.ca/wp-content/uploads/2015/05/psw-poster.pdf
44
Extra Slides
45
Base Case – Gap of PSW’s 46
PSW's (Concert)
FTE's by LHIN (Predicted)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Central 116 150 182 209 233 253 265 266 264 257 245
Central East -247 -254 -265 -282 -299 -323 -358 -410 -468 -534 -609
Central West -71 -81 -95 -119 -146 -177 -212 -254 -301 -357 -418
Champlain -654 -710 -782 -864 -949 -1041 -1156 -1298 -1453 -1621 -1792
Erie St. Clair -84 -103 -119 -139 -158 -188 -225 -271 -323 -379 -443
Hamilton Niagara Haldimand Brant
-931 -1014 -1102 -1192 -1284 -1386 -1497 -1640 -1801 -1975 -2156
Mississauga Halton -283 -304 -326 -351 -376 -415 -461 -510 -569 -631 -709
North East -94 -119 -147 -170 -191 -220 -258 -300 -348 -405 -462
North Simcoe Muskoka -471 -507 -548 -592 -636 -684 -736 -796 -868 -938 -1013
North West -143 -151 -163 -177 -192 -211 -234 -255 -281 -310 -339
South East -267 -314 -365 -415 -469 -525 -586 -655 -730 -811 -891
South West -547 -609 -673 -749 -825 -909 -1004 -1120 -1246 -1381 -1516
Toronto Central -652 -645 -634 -629 -614 -604 -604 -622 -649 -686 -738
Waterloo Wellington -157 -180 -211 -241 -275 -314 -361 -419 -483 -554 -631
Base Case – Gap of RN’s 47
RN’s
FTE's by LHIN (Predicted)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Central -49 -53 -57 -61 -65 -69 -74 -81 -88 -95 -103
Central East -94 -110 -126 -142 -157 -173 -189 -208 -228 -249 -270
Central West -39 -49 -60 -72 -84 -96 -109 -123 -138 -154 -170
Champlain -190 -217 -246 -276 -305 -335 -367 -404 -442 -482 -522
Erie St. Clair -1 -10 -18 -26 -34 -43 -53 -64 -76 -88 -101
Hamilton Niagara Haldimand Brant
-148 -162 -176 -190 -203 -216 -230 -249 -271 -294 -317
Mississauga Halton -80 -96 -111 -127 -142 -160 -178 -196 -216 -237 -260
North East -72 -83 -94 -104 -112 -122 -132 -142 -154 -166 -179
North Simcoe Muskoka -76 -86 -97 -108 -119 -130 -141 -154 -168 -182 -196
North West 12 8 4 0 -4 -8 -13 -18 -24 -30 -36
South East -33 -43 -52 -61 -70 -79 -88 -98 -110 -122 -133
South West -141 -163 -184 -207 -229 -251 -275 -301 -329 -358 -387
Toronto Central -81 -99 -116 -132 -146 -160 -175 -193 -211 -231 -253
Waterloo Wellington -87 -99 -112 -125 -138 -151 -166 -181 -198 -216 -234
Base Case – Gap of RPN’s 48
RPN's
FTE's by LHIN (Predicted)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Central 58 77 96 114 133 150 166 179 192 203 213
Central East 3 3 0 -5 -5 -7 -10 -18 -27 -38 -52
Central West 72 74 76 75 73 70 66 61 53 44 34
Champlain 130 100 66 28 -10 -51 -90 -134 -182 -233 -285
Erie St. Clair 19 8 -1 -12 -23 -37 -50 -64 -80 -96 -114
Hamilton Niagara Haldimand Brant
-221 -261 -304 -348 -393 -441 -491 -549 -611 -671 -728
Mississauga Halton 27 30 33 35 37 35 32 28 21 14 3
North East -8 -21 -34 -45 -56 -69 -85 -101 -119 -139 -154
North Simcoe Muskoka -112 -127 -142 -159 -175 -190 -205 -223 -244 -263 -282
North West -23 -33 -43 -55 -66 -78 -87 -95 -104 -114 -123
South East -132 -155 -180 -204 -226 -248 -271 -293 -316 -341 -365
South West -248 -282 -317 -356 -395 -437 -478 -519 -563 -610 -656
Toronto Central -24 -24 -25 -27 -28 -30 -34 -43 -54 -67 -84
Waterloo Wellington -29 -38 -47 -55 -65 -76 -89 -105 -122 -141 -162
50% cared for in HCC – PSW’s 49
PSW's (Concert)
FTE's by LHIN (Predicted)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Central -298 -265 -233 -206 -182 -162 -151 -150 -152 -159 -171
Central East -850 -857 -868 -886 -903 -927 -962 -1014 -1073 -1139 -1214
Central West -264 -275 -289 -312 -340 -371 -406 -448 -496 -551 -612
Champlain -1187 -1244 -1315 -1397 -1483 -1575 -1690 -1832 -1987 -2155 -2327
Erie St. Clair -411 -431 -447 -466 -486 -516 -553 -598 -651 -707 -771
Hamilton Niagara Haldimand Brant
-1698 -1780 -1868 -1959 -2051 -2153 -2265 -2408 -2569 -2743 -2924
Mississauga Halton -531 -551 -573 -599 -624 -663 -708 -758 -817 -879 -958
North East -510 -534 -563 -586 -607 -636 -674 -716 -765 -822 -879
North Simcoe Muskoka -709 -745 -786 -831 -874 -922 -974 -1035 -1106 -1177 -1252
North West -319 -326 -338 -353 -367 -386 -410 -431 -457 -486 -515
South East -602 -650 -700 -750 -805 -861 -922 -991 -1066 -1147 -1228
South West -1214 -1275 -1340 -1416 -1491 -1575 -1671 -1787 -1913 -2049 -2184
Toronto Central -974 -966 -956 -951 -935 -926 -925 -944 -971 -1008 -1060
Waterloo Wellington -466 -489 -520 -550 -584 -624 -671 -729 -792 -864 -941
50% cared for in HCC – RN’s 50
RN's
FTE's by LHIN (Predicted)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Central -117 -121 -125 -129 -133 -138 -143 -149 -156 -163 -171
Central East -192 -208 -224 -240 -255 -271 -288 -307 -327 -347 -369
Central West -71 -81 -92 -103 -116 -128 -141 -155 -170 -186 -202
Champlain -277 -304 -333 -363 -392 -422 -454 -491 -529 -569 -609
Erie St. Clair -55 -64 -72 -80 -88 -97 -107 -117 -129 -142 -155
Hamilton Niagara Haldimand Brant
-273 -287 -301 -314 -327 -341 -355 -374 -395 -418 -442
Mississauga Halton -121 -136 -152 -167 -183 -200 -218 -237 -257 -277 -300
North East -140 -151 -162 -172 -180 -190 -200 -211 -222 -235 -247
North Simcoe Muskoka -115 -126 -136 -147 -158 -169 -180 -193 -207 -221 -235
North West -17 -21 -25 -29 -33 -37 -42 -47 -53 -59 -65
South East -89 -98 -107 -116 -125 -134 -143 -153 -165 -177 -188
South West -250 -272 -293 -316 -337 -360 -383 -410 -438 -467 -495
Toronto Central -133 -152 -168 -185 -198 -213 -228 -245 -264 -283 -305
Waterloo Wellington -137 -150 -163 -176 -189 -202 -216 -232 -249 -267 -285
50% cared for in HCC – RPN’s 51
RPN's
FTE's by LHIN (Predicted)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Central -45 -26 -7 11 30 47 63 76 89 100 110
Central East -146 -147 -149 -154 -155 -156 -159 -167 -176 -188 -201
Central West 23 26 28 27 25 22 18 12 5 -4 -14
Champlain -1 -31 -66 -103 -142 -183 -221 -266 -314 -364 -416
Erie St. Clair -62 -73 -82 -93 -104 -118 -131 -145 -161 -177 -195
Hamilton Niagara Haldimand Brant
-409 -450 -493 -537 -582 -630 -680 -738 -800 -859 -917
Mississauga Halton -35 -31 -28 -26 -24 -26 -29 -34 -40 -48 -59
North East -111 -124 -137 -148 -159 -172 -188 -204 -222 -242 -257
North Simcoe Muskoka -172 -186 -201 -218 -234 -249 -265 -283 -303 -322 -341
North West -67 -77 -87 -98 -110 -122 -131 -139 -148 -158 -167
South East -215 -239 -263 -287 -309 -331 -354 -376 -399 -424 -448
South West -412 -446 -482 -521 -560 -601 -642 -684 -728 -774 -820
Toronto Central -103 -103 -104 -106 -106 -108 -113 -122 -133 -146 -163
Waterloo Wellington -106 -115 -124 -132 -142 -153 -166 -182 -199 -218 -238
14% cared for in HCC – PSW’s 52
PSW's (Concert)
FTE's by LHIN (Predicted)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Central -598 -564 -532 -506 -481 -462 -450 -449 -451 -459 -471
Central East -1285 -1292 -1303 -1321 -1338 -1363 -1398 -1449 -1508 -1574 -1650
Central West -404 -414 -429 -452 -480 -511 -546 -588 -636 -691 -752
Champlain -1572 -1628 -1700 -1782 -1867 -1960 -2075 -2217 -2372 -2540 -2712
Erie St. Clair -647 -666 -682 -702 -721 -752 -789 -835 -887 -943 -1008
Hamilton Niagara Haldimand Brant
-2250 -2333 -2421 -2511 -2604 -2706 -2818 -2961 -3122 -3296 -3478
Mississauga Halton -709 -729 -752 -777 -803 -842 -887 -937 -995 -1058 -1137
North East -810 -834 -863 -886 -907 -936 -974 -1017 -1065 -1122 -1180
North Simcoe Muskoka -881 -917 -957 -1002 -1046 -1094 -1146 -1207 -1278 -1349 -1424
North West -445 -453 -465 -479 -494 -513 -536 -558 -583 -612 -641
South East -844 -892 -942 -992 -1047 -1103 -1164 -1233 -1308 -1390 -1470
South West -1694 -1755 -1820 -1896 -1972 -2056 -2152 -2267 -2394 -2530 -2665
Toronto Central -1205 -1198 -1187 -1182 -1167 -1157 -1157 -1176 -1202 -1239 -1292
Waterloo Wellington -689 -712 -743 -773 -807 -847 -894 -952 -1016 -1087 -1164
14% cared for in HCC – RN’s 53
RN's
FTE's by LHIN (Predicted)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Central -166 -170 -174 -178 -182 -187 -192 -198 -205 -212 -220
Central East -263 -279 -295 -311 -326 -342 -359 -378 -398 -418 -440
Central West -94 -104 -115 -126 -139 -151 -164 -178 -193 -209 -225
Champlain -339 -367 -396 -425 -455 -484 -517 -553 -592 -632 -672
Erie St. Clair -93 -102 -110 -119 -126 -135 -145 -156 -168 -180 -194
Hamilton Niagara Haldimand Brant
-363 -377 -391 -404 -417 -430 -445 -463 -485 -508 -532
Mississauga Halton -150 -165 -181 -197 -212 -229 -248 -266 -286 -307 -329
North East -189 -200 -211 -221 -229 -239 -249 -260 -271 -284 -296
North Simcoe Muskoka -143 -154 -164 -176 -186 -197 -208 -221 -235 -249 -263
North West -38 -42 -46 -50 -54 -58 -63 -68 -74 -80 -86
South East -128 -137 -147 -155 -165 -173 -183 -193 -204 -216 -228
South West -328 -350 -371 -394 -416 -438 -462 -488 -516 -545 -574
Toronto Central -171 -189 -206 -222 -236 -250 -265 -283 -301 -321 -343
Waterloo Wellington -174 -186 -200 -212 -225 -239 -253 -269 -285 -303 -321
14% cared for in HCC – RPN’s 54
RPN's
FTE's by LHIN (Predicted)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Central -119 -100 -82 -63 -44 -27 -11 2 14 26 36
Central East -253 -254 -257 -261 -262 -263 -267 -274 -284 -295 -308
Central West -11 -9 -7 -8 -10 -13 -17 -22 -29 -39 -49
Champlain -96 -126 -160 -198 -237 -278 -316 -361 -408 -459 -511
Erie St. Clair -121 -131 -141 -152 -163 -177 -190 -204 -219 -235 -254
Hamilton Niagara Haldimand Brant
-545 -586 -629 -673 -718 -765 -816 -873 -936 -995 -1053
Mississauga Halton -79 -75 -72 -70 -69 -70 -73 -78 -84 -92 -103
North East -186 -198 -211 -222 -233 -246 -262 -278 -296 -316 -331
North Simcoe Muskoka -214 -228 -244 -261 -277 -292 -307 -325 -346 -365 -383
North West -99 -108 -119 -130 -142 -154 -162 -170 -180 -189 -199
South East -275 -299 -323 -347 -369 -391 -414 -436 -459 -484 -508
South West -531 -565 -600 -639 -678 -720 -761 -802 -846 -892 -938
Toronto Central -160 -160 -161 -163 -163 -165 -170 -179 -190 -203 -220
Waterloo Wellington -161 -170 -179 -187 -197 -208 -221 -237 -254 -273 -294
Wait List + Staffing Ratios – PSW’s 55
PSW's (Concert)
FTE's by LHIN (Predicted)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Central -1269 -1256 -1243 -1237 -1232 -1233 -1244 -1268 -1296 -1330 -1370
Central East -2419 -2456 -2497 -2545 -2591 -2646 -2713 -2801 -2899 -3004 -3121
Central West -874 -902 -934 -978 -1027 -1080 -1138 -1204 -1277 -1361 -1451
Champlain -2889 -2976 -3082 -3199 -3320 -3448 -3605 -3796 -4003 -4225 -4452
Erie St. Clair -1414 -1450 -1479 -1513 -1546 -1593 -1647 -1712 -1786 -1864 -1952
Hamilton Niagara Haldimand Brant
-4074 -4193 -4317 -4443 -4570 -4708 -4858 -5047 -5259 -5486 -5722
Mississauga Halton -1404 -1450 -1497 -1549 -1600 -1668 -1744 -1825 -1917 -2015 -2132
North East -1660 -1704 -1752 -1792 -1829 -1875 -1932 -1993 -2062 -2142 -2222
North Simcoe Muskoka -1423 -1476 -1534 -1597 -1658 -1725 -1796 -1877 -1973 -2068 -2167
North West -751 -763 -780 -799 -819 -843 -873 -901 -935 -973 -1010
South East -1518 -1582 -1649 -1715 -1787 -1859 -1937 -2026 -2122 -2225 -2327
South West -2993 -3079 -3169 -3272 -3373 -3484 -3610 -3759 -3923 -4098 -4272
Toronto Central -3147 -3165 -3177 -3195 -3198 -3208 -3229 -3273 -3328 -3395 -3481
Waterloo Wellington -1381 -1422 -1471 -1519 -1572 -1631 -1699 -1781 -1870 -1968 -2074
Wait List + Staffing Ratios – RN’s 56
RN's
FTE's by LHIN (Predicted)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Central -200 -205 -210 -215 -220 -225 -232 -239 -247 -256 -265
Central East -320 -338 -355 -373 -389 -406 -425 -445 -467 -490 -514
Central West -118 -129 -140 -153 -166 -180 -194 -209 -225 -242 -260
Champlain -405 -434 -465 -496 -527 -559 -593 -632 -673 -716 -759
Erie St. Clair -132 -142 -151 -159 -168 -178 -188 -200 -213 -227 -241
Hamilton Niagara Haldimand Brant
-454 -470 -486 -501 -515 -530 -547 -567 -592 -617 -644
Mississauga Halton -185 -202 -219 -236 -252 -271 -291 -311 -332 -355 -379
North East -232 -244 -256 -266 -276 -286 -297 -309 -321 -335 -348
North Simcoe Muskoka -171 -182 -194 -206 -217 -229 -241 -255 -270 -285 -301
North West -53 -57 -62 -66 -70 -75 -80 -86 -92 -98 -105
South East -162 -172 -182 -192 -202 -211 -222 -233 -245 -258 -271
South West -393 -416 -439 -463 -486 -509 -535 -563 -593 -624 -654
Toronto Central -268 -287 -305 -323 -337 -353 -369 -387 -407 -428 -452
Waterloo Wellington -209 -222 -236 -250 -264 -278 -293 -310 -328 -347 -367
Wait List + Staffing Ratios – RPN’s 57
RPN's
FTE's by LHIN (Predicted)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Central -179 -161 -144 -128 -111 -95 -81 -70 -60 -51 -43
Central East -353 -356 -361 -369 -372 -375 -382 -393 -406 -420 -437
Central West -53 -52 -52 -54 -58 -63 -69 -77 -86 -98 -110
Champlain -211 -244 -281 -322 -364 -408 -450 -499 -551 -607 -663
Erie St. Clair -188 -200 -211 -223 -235 -251 -265 -281 -298 -316 -337
Hamilton Niagara Haldimand Brant
-705 -748 -794 -842 -890 -940 -994 -1055 -1122 -1186 -1248
Mississauga Halton -140 -139 -138 -138 -139 -143 -149 -156 -165 -176 -191
North East -260 -275 -289 -302 -314 -329 -346 -364 -384 -405 -423
North Simcoe Muskoka -262 -278 -295 -313 -331 -347 -365 -384 -407 -428 -449
North West -126 -136 -147 -158 -170 -183 -192 -201 -211 -221 -231
South East -334 -359 -385 -411 -434 -458 -482 -506 -531 -558 -584
South West -645 -681 -719 -760 -801 -845 -888 -933 -980 -1030 -1079
Toronto Central -329 -332 -334 -339 -341 -344 -350 -362 -375 -391 -411
Waterloo Wellington -222 -233 -243 -253 -265 -277 -292 -310 -329 -351 -373
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