The sentence that should set something off
You visit and she says: "I don't know any of them." You think about it and realise it is true for you too — six or seven different personal support workers in two months, and none of them seemed to know that your mother takes her tea without sugar, that she startles if you approach from the left, that she taught school for thirty years.
It looks like a question of warmth. It is a clinical question, and it is probably the single best predictor of the quality of everything else.
The number to ask for: hours of direct care per resident per day
This is the figure that has driven long-term care policy in this country for the past several years, and most families have never asked for it. It is expressed as hours of direct care per resident per day — the total nursing and personal support time available, divided by residents. Ontario legislated a four-hour daily average as a target, and other provinces have set their own expectations and reporting.
Ask it in two parts, because the second is where the information is:
- "What is your average hours of direct care per resident per day, and how is it broken down between registered staff and personal support workers?"
- "And what is that figure on this unit, for the last three months?"
A building-wide average is the number a home will offer you. It is also the number that hides the most, because the heaviest unit — usually memory care — is where the gap between the average and the reality is widest. If you get one figure and not the other, you have learned something.
Two more questions nobody volunteers
Turnover. "How many of the personal support workers who worked here a year ago still work here?" There is no magic threshold, but the difference between a home that answers with a number and one that says "you know how it is in this sector" is the whole of the information you need. The first measures itself. The second is on the receiving end.
Agency use. "How many shifts a month are filled by agency staff?" This is not a hostile question and it is not a judgment about people: someone working through an agency does the same job with the same qualifications. But they arrive on a unit they do not know, with residents whose history they do not have, and then they leave. That is precisely the continuity that goes missing.
The named worker, and why it costs the home nothing
Even in a home with high turnover there is something concrete to ask for: who is your mother's named worker? Not "the team", not "the unit" — a person, by name, who knows her, who takes part in her care conference, and whom you can ask to speak to.
If there is no such person, ask that one be designated and written into her plan of care. It is a reasonable request, it does not cost an additional position, and it transforms the quality of the information you get. It also gives the home somebody who owns the answer when you ask why she has stopped coming to the dining room.
What you can see on a visit without asking anything
- Is she addressed by name? And by which name — the one she uses, or "sweetie"?
- Does anyone know anything about her? Ask whoever is on shift what your mother did for a living. If nobody knows after six months, the life history in her file is not being read, or does not exist.
- Where does handover happen? Two minutes in a corridor, or a structured process?
- How many different people care for her in a week? If you visit often, write it down for a fortnight — then you have the number yourself, and it is the one number nobody can dispute.
Six questions to ask
- What are your hours of direct care per resident per day, broken down by staff type?
- What is that figure on this unit, over the last three months?
- How many staff from a year ago are still here?
- How many shifts a month are filled by agency?
- Who is my mother's named worker?
- How is information about her passed on when the staff change?
If the answers do not come
Put the first two questions in writing to the director of care, together — that pair is hard to answer vaguely. The home's family council is a real lever here and an underused one, because staffing is never one family's problem. Beyond that, every province runs a complaints and inspection line for long-term care, and staffing levels and care hours are standard inspection territory; several provinces also publish home-level data you can look up before you ask.
Where to start
If you are still choosing, ask the first two questions during the tour and watch the reaction. That pair separates the homes that measure themselves from the homes that improvise, in about two minutes, and it tells you more than any brochure.
If your mother is already there, start with the named worker. It is the smallest request in this article and the one most likely to be granted.
If you would rather not run it alone, we can. For CA$99 we take down your mother's situation, look for the homes in your area that answer these questions properly, and report back what they told us, with names and dates. Start here
This article is for information. Care-hour targets, staffing rules and public reporting are set provincially and change over time: check what applies where your mother lives. Curalune does not allocate beds and does not guarantee availability.