Author Archives: Jodi Gillis

Long-term care needs improvements but at what cost? One report states that the government would have to more than double spending in long term care to carry out a number of improvements exposed during the COVID-19 pandemic outbreak

Spending across the country to make these improvements would have to increase to $13.7 billion each year, yes you read that right $13.7 billion according to the newest released report, along with costs growing by 4.1% per year following that due to the aging population to get ready for the baby boomers when the care is needed.

In the 2019-20 year, the government in Canada spent $13.6 billion on long-term care facilities.

This report all came about at the request of the Green MP Paul Manly, who has proposed Motion 77 (M-77) which proposes a number of changes to long-term care in Canada. Some of the provisions proposed are to providing long term care for anyone who will need it, increasing pay and benefits for long term care workers, mandating that 4 hours at a minimum of direct care per resident per day and to increase spending on home care to 35% of the total spending on long term care to try and keep people in their homes longer.

“The number of residents in long-term care is expected to rise due to population growth, population aging, and changing socioeconomic circumstances of the elderly,” the report says.

The rise in demand for long-term care is expected to raise the cost of the proposed changes to $17.5 billion by the 2025-26 year.

There are 205,000 people in Canada that lived in long-term care in the 2019-20 year, with a growing number of 52,000 on waiting lists.

So who is going to pay for this needed increase in spending? The report says most of the cost of any increase in spending will be on the provinces.

“We assume the direct cost would be primarily borne by provincial and territorial governments, although federal transfers could be increased to cover a portion of the incremental costs,” it says.

Thousands of Canadians died in long-term care homes during the COVID-19 outbreak, leading to these calls for changes. Something different needs to happen to prevent anything like this from happening to our seniors again. During the first wave of the pandemic, March to August 2020, long-term care residents made up over 80 % of all COVID-19 pandemic deaths, according to the Canadian Institute for Health Information.

Earlier this year, the federal government announced that it would spend $3 billion over 5 years to create new standards for improvements in long-term care across Canada.

Of the $13.6 billion governments did spend in the 2019-20 year, $13.2 billion was provincial spending.

Do you agree with the spending needed and do you think it will help make the necessary changes needed in long-term care?

On Tuesday March 17th the Ontario government declared a state of emergency over the COVID-19 virus.  The government announced emergency funding that includes $50 million specifically for long-term care homes to support 24/7 screening, additional staffing in the support of infection control, and additional supplies that may be needed, as well as $50 million to increase the supply of personal protective equipment to protect workers and other critical supplies for health care workers, first responders, and patients.

OLTCA is continuing to advocate for additional funding, for more flexibility, and for relaxed regulatory oversight during this time to ensure long-term care homes can focus all their efforts on resident care and safety. 

“We are facing an unprecedented time in our history,” said Premier Ford. “This is a decision that was not made lightly. COVID-19 constitutes a danger of major proportions. We are taking this extraordinary measure because we must offer our full support and every power possible to help our health care sector fight the spread of COVID-19. The health and wellbeing of every Ontarian must be our number one priority.”

As a result of this decision and announcement, these establishments are legally required to close immediately:

  • All facilities providing indoor recreational programs
  • All public libraries
  • All private schools as defined in the Education Act
  • All licensed child care centres
  • All bars and restaurants, except to the extent that such facilities provide takeout food and delivery
  • All theatres including those offering live performances of music, dance, and other art forms, as well as cinemas that show movies
  • Concert venues.

To further this order of closures, all public events of over 50 people are also prohibited, including parades and events and communal services within places of worship. These orders were approved by the Lieutenant Governor in Council and will remain in place until March 31, 2020, at which point they will be reassessed and considered for extension, unless this order is dismissed earlier.

“We are acting on the best advice of our Chief Medical Officer of Health and other leading public health officials across the province,” said Christine Elliott, Deputy Premier and Minister of Health. “We know these measures will affect people’s every day lives, but they are necessary to ensure that we can slow the spread of COVID-19 and protect our people. We’re working with all partners across the system, from public health to hospitals and community care, to do everything we can to contain this virus and ensure that the system is prepared to respond to any scenario.”

“Our government is taking an important step to protect Ontarians by declaring a provincial emergency through the Emergency Management and Civil Protection Act, establishing Ontario’s ability to quickly implement and enforce orders in the public interest,” said Solicitor General Jones. “Our government will continue to respond to this outbreak by limiting the exposure of individuals to COVID-19 and ensure the health and well-being of all Ontarians.”

Ontario is investing up to $304 million to enhance the province’s response to COVID-19 by providing the following monetary breakdown:

  • $100 million for increased capacity in hospitals to assist with the effective treatment of COVID-19 patients both in critical care and medicine beds.
  • $50 million for more testing and screening through public health, including additional funding to support extraordinary costs incurred to monitor, detect and contain COVID-19 in the province. This includes contact tracing, increased laboratory testing capacity and home testing.
  • $50 million to further protect frontline workers, first responders and patients by increasing the supply of personal protective equipment and other critical supplies and equipment to protect them.
  • $25 million to support frontline workers working in COVID-19 assessment centres, including the creation of a new fund to provide respite care, child care services and other supports as they are needed.
  • $50 million for long-term care homes to support 24/7 screening, additional staffing to support infection control and additional supplies.
  • $20 million for residential facilities in developmental services, gender-based services and protective care for children and youth to support additional staffing, respite for caregivers impacted by school closures, personal protective equipment and supplies and transportation costs to minimize client exposure and to support social distancing, as well as additional cleaning costs.
  • $5 million to protect seniors in retirement homes through increased infection control and active screening procedures.
  • $4 million for Indigenous communities to support transportation costs for health care professionals and the distribution of critical supplies.

Some additional facts: 

  • This increased of funds include investments from Ontario’s previously-announced COVID-19 Contingency Fund, as well as funding from by the federal government.
  • Coronaviruses comes from a large family of viruses that can cause illnesses ranging from a simple common cold to more serious respiratory infections like bronchitis, pneumonia or severe acute respiratory syndrome.
  • At this time there is no vaccine available to protect against the COVID-19 virus, but there are steps you can take everyday that can help prevent the spread of germs that can cause respiratory illnesses.
    • Hand washing, avoid touching your face, wiping of common surfaces, self isolating if feeling unwell, staying hydrated, getting enough sleep, eating well, and keeping 1 meter away from others are just some of the steps you can take to keep yourself well! 

Mom might have been on to something with her homemade pot of chicken soup! 

Part 6: Why you need a menu management system

This is what was recommended from the Auditors: 

Recommendation 1

To provide residents with safe and appropriate food and nutrition services that are in accordance with their plans of care and reduce the risk of food-related harm to residents, we recommend that long-term-care homes develop ways to ensure that all direct-care staff have timely access to the most current plans of care of the residents for food and nutrition before serving food.

Recommendation 2

To remind long-term-care homes of the importance of providing residents with safe and appropriate food and nutrition services that are in accordance with their plans of care and reduce the risk of food-related harm to residents, we recommend that the Ministry of Long-Term Care confirm during its inspection process that all direct-care staff are able to know the residents’ plans of care for food and nutrition before serving food.

While the regulation requires homes to have a system to monitor food and fluid intake of residents, Ministry inspectors only look at food and fluid consumption records if the inspection was related to a resident at a nutrition or hydration risk. Ministry inspectors would only review completeness and accuracy of records related to the inspection they are doing and not for all residents. Reviewing the home’s system for monitoring resident food and fluid intake as a whole could help proactively minimize the nutrition and hydration risk posed to other residents.  A food and nutrition menu system like mitrition is exactly what homes need. 

Recommendation 3

To better meet the dietary needs of their residents, as assessed in their plans of care and proactively mitigate nutritional risks to residents, we recommend that long-term-care homes:

  • communicate to their staff the importance of complying with internal policies to refer residents for registered dietitian assessment and maintain complete and accurate food and fluid consumption records; and
  • allocate more time for the registered dietitians to proactively monitor the nutrition and hydration risk posed to all residents such as observing residents eating at mealtimes, attending resident-care conferences and providing education to residents, staff and family members.

Recommendation 4

To confirm that long-term-care homes are meeting the residents’ dietary needs as assessed in their plans of care and proactively mitigate nutritional risks to residents, we recommend that the Ministry of Long-Term Care:

  • monitor whether long-term-care homes’ staff are complying with internal policies to refer residents for registered dietitian assessment and maintain complete and accurate resident food and fluid consumption records;
  • establish protocols for registered dietitians to allocate more time for observing residents eating at mealtimes, attending resident-care conferences and providing education to residents, staff and family members; and
  • during their inspections, review long-term care homes system for monitoring resident food and fluid consumption as a whole to see how they proactively minimize the nutrition and hydration risk posed to other residents.

Our review of menus and recipes from a sample of long-term-care homes showed that residents were not provided with food that had adequate nutrients, fibre and energy based on the current Dietary Reference Intakes values. With the assistance of an independent registered dietitian, we found that food on the homes’ menus contained sufficient protein and energy as measured in calories, but excessive or insufficient nutrients as compared to recommendations made in the Dietary Reference Intakes such as:

  • too much sugar (40% to 93% above recommended amount), mainly in juice, fruit drinks and bakery items, which increases the risk of obesity and type 2 diabetes
  • too much sodium (32% to 59% above recommended amount), mainly in entrees and soups, which increases the risk of high blood pressure, stroke and heart failure;
  • too much saturated fat (19% to 69% above recommended amount), mainly in entrees, which increases the risk of heart disease;
  • not enough fibre (19% to 34% below recommended amount), which increases the risk of constipation;
  • not enough potassium (14% to 42% below recommended amount), usually found in fresh fruit and vegetables that help lower blood pressure; and
  • not enough magnesium (5% to 35% below recommended amount), usually found in fresh beans, nuts, seeds, fish and whole grains that promote healthy bones, muscles and nerves.

Serving food that contains insufficient nutrients may contribute to poor health outcomes. At the time of our audit, in the five homes where we conducted detailed work, registered dietitians assessed that 39% of residents were at a “high nutritional risk.” Statistics Canada defines people with high nutritional risk as those who need further assessment and intervention to prevent or reverse the consequences of chronic under-nutrition. Regulation requires that the home’s registered dietitian approve the menu, which should be in accordance with Canada’s Food Guide and the Dietary Reference Intakes. Of the five homes where we conducted detailed work, two could not provide evidence that their registered dietitian analyzes the home’s menu, two performed minimal analysis and instead relied on the corporate dietitian to perform the analysis, and one performed analysis as required. Even though some registered dietitians have noted exceptions such as high sodium, they still approved the menus with certain nutrients being over or below the recommended values. For example, the registered dietitian at one home who had concerns with the menu’s sodium content did not change the current menu cycle but, instead, made recommendations to decrease the sodium in the next menu cycle. We could not verify whether the next menu had sodium adjusted because the menu was not finalized when we completed the audit. As well, two of the five homes did not even have data on the sugar content in their menus and were therefore unable to demonstrate they meet Dietary Reference Intakes recommendations for sugar. While Ministry inspectors have protocols to review nutrition levels of menus, the Ministry informed us that it would be unlikely an inspection would require a review of the entire menu cycle. An inspector would likely only review nutrition levels of a particular day if there were complaints about the nutrients provided or if the inspector observed unusual meals in the dining room. At the five homes where we conducted detailed work, registered dietitians and nutrition managers informed us that in the last three years Ministry inspectors never asked them for the nutrient analysis of the home’s menu.

Having a menu management system like mitrition will allow you to have nutritionals and totals at your finger tips.  All recipes have nutritionals attached to them even if you make changes and swap them in and out of menus. 

Recommendation 5

To increase the likelihood that residents receive food and fluids with adequate nutrients, fibre and energy, we recommend that long-term-care homes’:

  • registered dietitians make appropriate menu changes to achieve compliance with the current Canada’s Food Guide and Dietary Reference Intakes requirements; and
  • management monitor their menus for compliance with the current Canada’s Food Guide and Dietary Reference Intakes requirements.

A menu management system will help with menu changes and the proper calculation of total nutritionals to meet the requirements. 

Recommendation 6

To increase positive health outcomes and assist residents in receiving food and fluid with adequate nutrients, fibre and energy, we recommend that the Ministry of Long-Term Care:

  • support long-term-care homes to develop and implement a transition plan setting out when long-term-care homes need to fully adopt the 2019 Canada’s Food Guide; and
  • instruct its inspectors to regularly verify that long-term-care-home menus are meeting the current Canada’s Food Guide and Dietary Reference Intakes requirements as part of their inspection protocol and review the long-term-care home’s nutrient analysis of its menus.

Recommendation 7

To minimize the risk of residents consuming low-quality food, we recommend that long term-care homes require and monitor that their staff abide by the internal food storage policy, including not storing food beyond their best before date.

Recommendation 8

To minimize the risk of residents consuming low-quality food, we recommend that the Ministry of Long-Term Care require its inspectors to regularly verify that food items in refrigeration and storage in long-term-care homes are not beyond their best-before date.

Recommendation 9

To promote quality of life and provide timely assistance during mealtimes to residents, we recommend that long-term-care homes evaluate alternative staffing options to provide assistance to residents during peak demand times such as mealtimes; for example, volunteer or students trained in feeding residents with dementia.

Recommendation 10

To promote quality of life and provide timely assistance during mealtimes to residents, we recommend that the Ministry of Long-Term Care:

  • clarify to long-term-care homes that alternative staffing options exist that can be used to provide assistance to residents during peak demand times such as mealtimes; for example, part-time staff, volunteers or students trained in feeding residents with dementia; and
  • develop and implement an updated staffing strategy for the long-term-care home sector that considers the varying needs of residents throughout the day.

Recommendation 11

To allow more long-term-care home residents to eat in a safe and home-like environment, we recommend that the Ministry of Long-Term Care:

  • re-evaluate whether its home design requirements for homes constructed before 2009 continue to be reasonable given the increased use of mobility devices in long term-care homes today; and
  • determine what measures to put in place for homes that do not have dining spaces under the current design manual to increase the comfort of their residents during mealtimes.

Recommendation 12

To minimize the risk of gastroenteritis outbreaks in long-term-care homes, we recommend that long-term-care homes regularly assess compliance with the Ministry of Health’s policy on hand hygiene around mealtimes and correct on a timely basis any weaknesses that they identify through these reviews.

Recommendation 13

To minimize the risk of gastroenteritis outbreaks in long-term-care homes, we recommend that the Ministry of Long-Term Care monitor to ensure that long-term-care homes regularly assess compliance with the Ministry of Health’s policy on hand hygiene around mealtimes, and correct on a timely basis any weaknesses that they identify through these reviews.

Recommendation 14

To limit the impact of food waste on the environment, we recommend that the Ministry of Long Term Care:

  • work with the Ministry of the Environment, Conservation and Parks to establish a goal of diverting food and organic waste generated in long-term-care homes; and
  • work with the associations that represent the long-term-care home sector to develop guidelines to help long-term-care homes meet this goal.

Recommendation 15

To achieve further cost savings in purchasing food for the long-term-care-home sector, we recommend that Ministry of Long-Term Care, in conjunction with the Ministry of Health:

  • identify the organization(s) responsible for co-ordinating group purchasing for long term-care homes;
  • determine how best to group the long term-care homes, such as by region or by ownership type, in future food-buying arrangements, until the organization(s) responsible for co-ordinating group purchasing is identified; and
  • assist in the establishment of group buying contracts where needed, until the organization(s) responsible for co-ordinating group purchasing is identified.

Recommendation 16

To demonstrate that residents receive the best possible nutritional care, we recommend that the Ministry of Long-Term Care, in conjunction with long-term-care homes:

  • identify appropriate meaningful performance indicators that measure how effective a long-term-care home is at meeting residents’ food and nutrition needs;
  • set performance targets and regularly assess actual results against these targets; and
  • report publicly on the results.

Recommendation 17

To improve the well-being and safety of long term-care home residents, we recommend that long-term-care homes formally share best practices related to food and nutrition with each other.

Recommendation 18

To improve the well-being and safety of long term-care home residents, we recommend that the Ministry of Long-Term Care identify commonly occurring issues related to food and nutrition from data collected through critical incidents and inspections, and provide information and recommend best practices to long term-care homes.

Recommendation 19

To decrease long-term-care home residents’ harm or the risk of harm, we recommend that the Ministry of Long-Term Care respond to all critical incidents reported by long-term-care homes within prescribed timelines.

Part 5: Why you need a menu management system

What was the objective of the audit? 

The audit objective was to assess whether the Ministry of Long-Term Care, in conjunction with long-term-care homes and public health units, has effective systems and procedures in place to ensure that:

  • food and nutrition services are delivered to residents in long-term-care homes in accordance with relevant legislation, regulations and policies;
  • resources are appropriately managed to provide safe and nutritious meals to long term-care home residents; and
  • results on the efficiency and effectiveness of food and nutrition services provided to long term-care home residents are measured and publicly reported.

They visited 62 of the province’s 626 homes across 60 municipalities, with the majority of our work conducted at 59 homes. We conducted detailed audit procedures in five homes in Mississauga, Oshawa, Ottawa, Thunder Bay and Toronto. We selected these homes to visit based on a variety of factors such as geography, amount of funding provided, governance type of the home and number of residents. At these five homes, we conducted the following work:

  • interviewed senior management, residents and family councils;
  • interviewed and shadowed staff including registered dietitians, registered nurses and registered practical nurses (nurses), personal support workers, chefs and food service workers;
  • observed inventory control at the home’s kitchen, dining services and snack services;
  • reviewed client files, homes’ policies, records of gastroenteritis infections and outbreaks, inspection reports prepared by the Ministry and public health, complaints, resident council minutes, surveys and other relevant documents related to food and nutrition; and
  • obtained and analyzed relevant data.

They also conducted unannounced visits at another 54 homes to observe meal service at either breakfast, lunch, or dinner, with some visits conducted on the weekend or on a statutory holiday when staffing level may differ from the regular workday.

At another two homes, they observed dining and kitchen operations and interviewed senior management as well as selected food and nutrition services staff to better understand their perspectives on food and nutrition services for home residents and their day-to-day work.

Regarding the design and application of nutrition policy, they met with and reviewed documents prepared by Dietitians of Canada and its Ontario Long Term Care Action Group (Dietitians of Canada), a professional association representing dietitians at the local, provincial/territorial and national levels. As well, they met with Ontario Society of Nutrition Management. They spoke with the Office of Nutrition Policy and Promotion in Health Canada to understand the federal government’s efforts to support healthy eating. They also engaged an independent registered dietitian to provide advice on information on best practices and evaluate a sample of menus used in homes to determine whether they meet regulatory requirements.

Part 4: Why you need a menu management system

How are homes funded by the Ministry? 

Nursing and Personal Care

  • Includes wages, benefits, and training for direct-care staff, as well as any equipment or supplies used by direct-care staff to provide nursing and personal care to the residents.
  • Staff in this category include registered nurses, registered practical nurses, and personal support workers who, beyond clinical duties, provide eating assistance to residents.


Program and Support Services

  • Includes staff, equipment, and supplies used to provide services and programs to residents.
  • Staff in this category include Registered Dietitians, physiotherapists, occupational therapists, social workers, recreational staff and others that provide support services to the residents.


Raw Food

  • Strictly for the purchase of raw food materials, including food supplements ordered by a physician, a nurse, or a Registered Dietitian.
  • Includes the resident portion of food for special events (like Christmas dinners), but does not include any non-resident guests like family.


Other Accommodations

  • Includes other eligible expenditures defined in the Ministry’s policy that are not included in the above categories, such as dietary services (i.e., food service workers, cooks), housekeeping services, property operations and maintenance, and general and administration services.


Do you know what your raw food cost is sitting at especially if you have made changes to your menu?  Is it an estimate or is it accurate to todays pricing?  We can help with getting your food costs in control and maybe even save you some money!

Part 3: Why you need a menu management system

Relevant Legislation and Regulations Governing Delivery of Food and Nutrition Services in Long-Term-Care Homes

Long-Term Care Homes Act, 2007 and Ontario Regulation 79/10

  • designed to provide residents with safe, consistent, high-quality, resident-centred care in accordance with their plans of care
  • regulates admissions, operations, funding, licensing, compliance and enforcement through inspections at long-term-care homes
  • governs residents’ rights, care, and service, specifically, every resident has the right to be properly fed through an organized program for dietary services, nutrition care, and hydration services controlled by a menu management system
  • outlines requirements such as menu planning, food production, dining and snack services, and proper qualifications of staff involved with food management. Menu planning, food production and snack services can all be managed by a menu system like mitriton
  • requires menus to be approved by the long-term-care home’s registered dietitian;
  • to provide for adequate nutrients, fibre and energy for residents based on the current Dietary Reference Intakes; and
  • to provide for a variety of foods, including fresh seasonal foods, each day, in keeping with Canada’s Food Guide
  • All of these tasks can be taken care of through a menu management system with these functions right at your finger tips
  • requires registered dietitians spend at least 30 minutes per resident per month to carry out clinical and nutrition care for residents
  • requires long-term-care homes to have a full breakfast available before 8:30 a.m. and serve dinner after 5:00 p.m.

Health Protection and Promotion Act and Ontario Regulation 493/17

  • aimed at preventing the spread of diseases and promoting and protecting the health of the people in Ontario
  • sets out the requirements for the operation of food premises, such as long-term-care homes, in Ontario to assist in the prevention and reduction of foodborne illnesses, and the enforcement of the regulation through public health inspections
  • sets out the requirements for operation and maintenance of the food premises, cleaning and sanitizing of equipment, and food handling

Part 2: Why you need a menu management system

Canada’s Food Guide

A regulation made under the Long-Term Care Homes Act, 2007, requires that long-term-care homes provide a variety of foods each day from Health Canada released a new version of the Food Guide, 12 years after the last update. Unlike the previous Food Guide, the current Food Guide no longer classifies food into different groups or provides serving counts for recommended intake. Instead, it provides guidelines and advice intended to help Canadians make healthy food choices and adopt healthy eating habits. Another significant change is that Health Canada recommends that fruit and vegetables make up half of the plate, with whole grains and protein foods each making up the remaining quarters.  See below:

Guideline 1

Nutritious foods are the foundation for healthy eating.

  • Vegetables, fruit, whole grains and protein foods should be consumed regularly. Among protein foods, consume plant-based more often.
  • Protein foods include legumes, nuts, seeds, tofu, fortified soy beverage, fish, shellfish, eggs, poultry, lean red meat including wild game, lower fat milk, lower fat yogurts, lower fat kefir, and cheeses lower in fat and sodium.
  • Foods that contain mostly unsaturated fat should replace foods that contain mostly saturated fat.
  • Water should be the beverage of choice.

Guideline 2

Processed or prepared foods and beverages that contribute to excess sodium, free sugars, or saturated fat undermine healthy eating and should not be consumed regularly.

  • For example, sugary drinks and confectioneries should not be consumed regularly.

Guideline 3

Food skills are needed to navigate the complex food environment and support healthy eating.

  • Cooking and food preparation using nutritious foods should be promoted as a practical way to support healthy eating.
  • Food labels should be promoted as a tool to help Canadians make informed food choices.

A regulation that was made under the Long-Term Care Homes Act in 2007, requires that long-term-care-home operators have to provide adequate nutrients, fibre and energy for residents based on the current Dietary Reference Intakes values established by a scientific body commissioned by both the Canadian and the US governments. These values specify the intake level required of healthy populations in specific sex and age groups. A standard from the Dietary Reference Intake is that people over the age of 70 years have a recommended dietary allowance of 1,200 mg of calcium per day as an example.

Health Canada recommends using these values for assessing and planning diets, and expects professionals such as registered dietitians in healthcare settings to tailor these values to accommodate health requirements of different individuals needs.

Part 1: Why you need a menu management system

The Office of Ontario’s Auditor General released an audit about food and nutrition in long term care homes.  There are more than 77,000 adults that live in Ontario’s 626 long-term-care homes. The Ministry of Long-Term Care funds the homes to provide residents with the 24-hour nursing care and help with daily living activities that they need in a protective, safe and supportive environment.

At the time of the audit, the average age of a resident in Ontario’s long-term-care homes was 83. Compared with a 2009 report, the current population of residents are more cognitively impaired and require more assistance with daily living than in the past. The percentage of residents with a form of dementia has increased from 56% in 2009 to 64% in 2019.

People with dementia require more help with the basic daily activities, including eating and drinking. It was stated that in 2016, there were 228,000 people living with dementia and this number is expected to grow to over 430,000 by 2038. Providing food and nutrition services to residents will be more challenging for long-term-care homes with the anticipated increase in the number of people with dementia.

A daily activity in long-term-care homes is eating, with the dining experience being one of the most social times of day.  Families of the residents count on long-term-care homes to care for their vulnerable loved ones.  On the other hand, the residents themselves depend on nutritious delicious food to maintain their well-being in a pleasurable environment. The audit showed that residents rarely had family or friends join them during mealtimes and relied on personal support workers (PSW’s) to help provide their appropriate food and nutrition choices.

The Ministry will go in to inspect long-term-care homes on different aspects related to food, such as dining room observation for pleasurable dining environments, menu planning, and evaluating nutritional and hydration risks to residents. Also, Ontario’s 35 public health units, which are co-funded by the Ministry of Health and municipalities, inspect the homes for food-safety concerns such as food temperature controls such as HACCP, kitchen sanitation, pest control and food-preparation practices.

The consequences of improper food and nutrition care are quite significant. Between January 2018 and May 2019, long-term-care homes had reported over 660 incidents involving food and nutrition issues. These included residents choking, missed meals, staff feeding residents food with the wrong texture, and gastroenteritis outbreaks. These outbreaks could be caused by contaminated food or drink, or spread through contact with the infected persons or contaminated items for reasons like poor handwashing practices as an example. This works out to about 1.3 incidents a day and includes 27 cases of unexpected deaths for reasons such as choking or aspiration and about 100 cases of abuse, neglect or improper treatment of a resident by home staff related to food that resulted in harm or risk of harm to the resident. Choking will occur when a foreign object becomes obstructed in a person’s airway and aspiration will occur when a person has accidentally inhaled an object or fluid into their windpipe or lungs.

The audit found that some of the long-term-care homes were not consistently providing residents with sufficient high-quality food and nutrition care. Further, the Ministry could do more through its inspection program to help confirm that long-term care homes are providing a safe and comfortable eating environment and good quality food to help residents enjoy a more home-like pleasurable dining experience at the long-term-care homes. In some cases, residents were subject to unnecessary risks that made them ill, simply just by eating and drinking.

Some of the more significant audit findings included:

  • Mealtime service is affected when personal support workers tend to other responsibilities or do not report to work.
  • Residents in older long-term-care homes can be less likely to enjoy meals in a homelike environment.
  • Long-term-care staff do not consistently follow the residents’ plan of care, increasing the risk that residents may be eating the wrong food. A menu management system would minimize this.
  • Long-term-care homes’ registered dietitians do not spend sufficient time proactively monitoring residents.
  • Menus do not have recommended nutrients for residents compared to the recommendations in the Dietary Reference Intakes. A menu management system would minimize this.
  • Long-term-care homes are offering residents food and drinks high in sugar; high sugar intake can contribute to heart disease, stroke, obesity, diabetes, high blood cholesterol, cancer and poor dental health. A menu management system would minimize this by calculating nutritionals. 
  • In three of the five long-term-care homes where we conducted detailed work, some food used to make meals was past its best before date.
  • Only 19% of residents observed to have washed their hands to proactively prevent and control infections.
  • Group purchasing has not been fully explored to help long-term-care homes realize higher savings to allocate to potentially higher-quality food.
  • The Ministry does not require long-term care homes to report on performance indicators related to food and nutrition.

So, what did all conclude?  Well the audit concluded that the Ministry of Long-Term Care and the long-term-care homes do not have sufficient procedures in place to confirm that residents are receiving sufficient mealtime assistance and that they receive food and nutrition services in accordance with their individual plans of care.

Menus that long-term-care home registered dietitians approved did not always meet nutritional requirements in accordance with Canada’s Food Guide and the Dietary Reference Intakes.  A menu management system would minimize this by calculating nutritionals.

Some residents who require help to eat and drink are having to wait longer when personal support workers tend to other responsibilities. Staffing is not consistently allocated optimally to provide residents with the resident-centred care that meets their dietary and nutritional needs at meal time including feeding assistance requirements.

What was the response from the Ontario Long Term Care Association

“We agree with the Office of the Auditor General that more supports are needed to improve the food and nutrition care of those living in long term-care homes. The issues outlined in the report are a symptom of a systemic shortfall of funding and other supports that have contributed to a severe staffing shortage.  As the report recognizes, people who live in long-term care have increasingly complex needs. In the last decade, there has been a significant increase in acuity and the number of people who need support with daily activities such as eating and drinking. Yet funding and other supports have not kept pace. Improving the dining experience for residents is also dependent on a massive infrastructure program to rebuild and modernize Ontario’s long-term care homes.

Another important consideration for the findings in this report is resident choice. Long term-care homes are rapidly adopting the people-centred approach to care that honours personal preferences and habits, rather than an institutional model. Many people in long-term care prefer to eat a diet they find familiar, even if it is “less nutritious.” Many are also near the end of life when the desire to eat and drink naturally diminishes. The rights of seniors living in long-term-care homes, including those with dementia, to decide what they wish to eat or drink must be respected. The Long-Term Care Homes Act, 2007 and its dietary requirements are based on the old institutional model of care.

We recommend government work with the sector to move forward on the development of a health human resources strategy to address the staffing crisis and nutrition issues in long-term care homes”.

What was the response from the Ministry? 

“The fundamental principle of the Long-Term Care Homes Act, 2007(Act) is to provide a place for residents to live with dignity and in security, safety and comfort. Dietary services, nutritional care and hydration programs are central to maintaining the well-being of over 78,000 long term-care home residents in Ontario.

The government understands that nutritious food is critical to overall care and as such, the Ministry of Long-Term Care appreciates the comprehensive audit conducted by the Auditor General on Food and Nutrition in Long Term-Care Homes.

The Act and Ontario Regulation 79/10 require that every licensee of a long-term-care home ensures that there are organized programs of nutrition care and dietary services to meet the daily nutrition needs of the residents. Each day, there are over 234,000 meals served in long-term-care homes, which is over 85 million meals per year. Reported food related incidents represent less than 1% of these daily interactions.

The Auditor General made a recommendation to the Ministry in the 2015 audit of Long-Term-Care Home Quality Inspection Program to put the safety of residents first by focusing on high-risk areas. As a result, in fall of 2018, the Ministry shifted to a risk-based compliance program to prioritize inspections and resources for situations that put the residents at highest risk.

The Ministry has made a combination of investment and policy changes over the past few years to ensure that residents’ nutritional requirements are met. Since 2011/12, the Raw Food per diem has increased by more than 28%.

In 2019/20, the Ministry provided a global per diem increase of 1% to the Level of Care funding. We are investing $72 million more into long-term care this year. This is in addition to $1.75 billion invested to create 15,000 new long-term care beds and redevelop 15,000 older long-term care beds over five years.

We actively engage with partners to support innovation in the delivery of long-term-care services and infrastructure, including ensuring that proposed long-term-care home development and infrastructure projects serve the needs of their communities”.

The audit also observed that nutrition care and dietary services in long-term-care homes are among the key programs that enhance residents’ quality of life. Each day, homes provide residents with three meals, as well as two snacks and three drinks between meals.

Many residents consider dining times to be one of the most social times of the day.  A long-term-care-home resident can also use food and nutrition to restore health or prevent its deterioration. As an example, an increase in calcium and vitamin D intake can reduce serious risks of bone fractures from falls. For some residents, appropriate quantity and quality of food intake can help control diseases related to the heart, blood pressure, strokes, dementia and blood-sugar levels. In the opposite, inadequate or improper nutrition and dietary intake increases the risk of health consequences such as malnutrition, dehydration, delayed healing of wounds, and foodborne illnesses.


Access to all types of technology, control of it in all aspects, and the ability to create and shape it your own way, is a fundamental issue of women’s human rights. Global Fund for Women’s Technology Initiative aims to help end the gender technology gap that is conflicting our country to empower women and girls in creating innovative solutions to develop equality in their communities. As an example, with a cell phone, an expecting mother in a rural area can stay connected to her midwife. For some women and girls, Internet access and a cell phone can mean access to new experiences as a young adult, or a tool to help someone learn how to read and write.

Priority Issues

Worldwide, 200 million more men than women have access to the Internet, and 21% of woman are less likely to own a cell phone which can be a key resource in the global south where phones could provide access to safety, organizing networks, early severe weather warning systems, mobile health care and access to doctors, and banking activities. Global Fund for Women’s Technology Initiative is helping to close this gap and give women and girls the tools and access they want and need to these resources.

Global Fund for Women’s Technology Initiative is supporting efforts that is focusing on the production of new technologies or adapting technologies to adhere to women’s and girls’ contexts. They support women’s groups who use technology to address certain issues which can include violence against women, access to safe spaces, political movement, education, and health care. As an example, a current partner created a mapping tool to crowd-source reporting of sexual harassment in Egypt, and to use the same technologies to document and monitor it.

As part of this effort, Johnson & Johnson will help us support women-led organizations in Sub-Saharan Africa and Southeast Asia using technology to enhance health service delivery and outcomes.  Way to go Johnson & Johnson!

Girls’ STEM and IT Education and Digital Literacy

Part of closing the gender technology gap will mean helping girls access training and educational opportunities in STEM (science, technology, engineering, and math) and IT (information technology). STEM programs have been introduced this year in elementary schools across Canada which allows technology to be accessible to all starting at a very young age!

A partner of Global Fund for Women the Feminist Approach to Technology in India is creating a pioneering movement of tech savvy young women and girls by training and empowering young women between the ages of 12-18. They offer confidence in skill-building courses along with computer classes and trainings. In Sub-Saharan Africa, “we have supported for Women Educationalists in Malawi and Mozambique to develop a science, math, and technology model that includes both in-school and extra-curricular activities to increase girls’ interest and participation in STEM”.

Making the Internet Safe

The UN estimates that 95% of harassment, abusive language, and derogatory imagery in online spaces is aimed toward women. Global Fund for Women’s Technology Initiative is investing in projects and advocacy for safe online spaces for all, and in raising awareness hoping to end cyber bullying and online violence against women.

There is a project run by Si Jeunesse Savait that uses information technology to denounce the high rates of sexual violence in the Democratic Republic of Congo. Si Jeunesse Savait trains women’s groups and survivors of violence on online security, online advocacy, how to write blogs, and accessing online services.

Building Capacity and Driving Women’s Movements

Digital technology is an important tool for movement building, allowing organizations and networks to exchange information quickly, and to organize programs across geographical locations. It also creates a diverse group of voices to be heard and shared which is an important feature of strong social movements.

What the Technology Initiative Will Achieve

  • Improving access to and the control of technology for women and girls, especially in remote and areas
  • Creative technology-based solutions to gender issues like violence, health, and economic and political movement
  • Increased safe online spaces for women and girls, and women’s rights organizations
  • Encourage more women and girls into leadership roles in designing and shaping technology, especially in the advancement of women’s rights
  • Stronger, more inclusive national and global women’s movements, collaborating regularly to share resources and ideas, and develop common advocacy strategies

Canada’s New Food Guide – Whole Grains 25%

We all know that whole grains are good for us.  Well it is now part of the plate visual for the new Food Guide to include 25% of your plate to be whole grains. 

Whole grain foods have important nutrients such as:

  • fibre
  • vitamins
  • minerals

Whole grain foods are a healthier choice than refined grains because whole grain foods include all parts of the grain. Refined grains have some parts of the grain removed during processing that strips most of the nutrition away.

Whole grain foods have more fibre than refined grains.

Eating foods higher in fibre can help lower your risk of:

  • stroke
  • colon cancer
  • heart disease
  • type 2 diabetes

Choosing and preparing healthy whole grain foods

Enjoy a variety of whole grain foods such as:

  • quinoa
  • whole grain pasta
  • whole grain bread
  • whole oats or oatmeal
  • whole grain brown or wild rice

Some grain foods can have a lot of added sodium, sugars or saturated fat.

These include foods like:

  • breads
  • muffins
  • crackers
  • pasta dishes

Make sure your choices are actually whole grain

Whole wheat and multi-grain foods may not be whole grain. Some foods may look like they are whole grain because of their colour, but they may not be.

It is always important to read the ingredient list and choose foods that have the word “whole grain” followed by the name of the grain as one of the first ingredients like:

  • whole grain oats
  • whole grain wheat

Whole wheat foods are not whole grain, but can still be a healthy choice as they contain fibre. Read the fibre content on labels and chose higher fibre options. 

Use the nutrition facts table to compare the amount of fibre between products. Look at the % daily value to choose those with more fibre.

Preparing whole grain foods

Whole grain foods are tasty and nutritious without having to add highly processed sauces and spreads.

Try healthier ways to prepare your whole grain foods by:

  • leaving out or reducing the amount of salt added during preparation
  • limiting the amount of sauce or spreads you add
  • adding vegetables, vegetable oils, spices and herbs to enhance flavours

Snack ideas

Whole grain foods make quick and healthy snacks.

So many ways to enjoy them:

  • whole grain cereals
  • whole grain crackers
  • whole grain baked pita “chips”

How to include whole grain foods

There are some easy ways to get more whole grain foods on to your plate.

Try a new whole grain:

  • farro
  • freekah
  • amaranth
  • buckwheat

Some other ideas: 

  • Mix different whole grain cereals in your bowl and enjoy with lower fat white milk or unsweetened plant-based beverages.
  • Start your day with a bowl of oatmeal, whole grain cereal or whole grain toast.

Keep a variety of whole grain foods in your pantry.


  • oats
  • quinoa
  • brown rice
  • whole grain pasta
  • whole grain bread

You can also increase the amount of whole grain foods in your recipes by adding:

  • barley, bulgur and quinoa to soups, salads and stir-fries
  • brown or wild rice to white rice for more fibre and a nutty flavour

Whole grains are good for your digestive health and your heart.  It is easy to incorporate more whole grains into your diet.