From Funding to the Floor: Why Bedside Practice Determines Outcomes in Long-Term Care. A closer look at how funding supports care when education and practice align

In Ontario, increased funding has recently been directed toward the LTC sector. This is an important and welcome shift. After years of advocacy, it is encouraging to see governments paying closer attention to areas such as wound care, skin integrity, and resident safety.

At the same time, it is important to acknowledge a reality that Directors of Care (DOCs) know all too well: applying for and operationalizing these funds is not simple. The administrative burden often falls on already overextended leaders who are juggling staffing shortages, regulatory requirements, family concerns, and day-to-day clinical pressures.

Funding alone does not automatically translate into better care. How those dollars are used—and whether they meaningfully support frontline teams—matters just as much.

The Bedside Perspective

Nurses and PSWs are the ones who see skin breakdown as it happens.

They notice the early redness, the fragile skin, the subtle changes that signal risk long before a wound becomes complex. Yet many bedside providers describe feeling powerless in these moments—not because they don’t care, but because they lack practical, context-relevant education and the authority to intervene early. Waiting for “someone” to provide direction for skin/woundcare assessment and management, has often been complicated by the limited number of expert clinicians available.

Where Wound Champions Fit In — and Where the Gaps Remain

Wound Champions play an important role in today’s LTC landscape. Government-funded Champion programs are designed to build internal expertise, support complex wound management, and strengthen leadership capacity within homes. This investment matters.

Champions can be powerful advocates for best practice, policy change, and quality improvement. They often serve as a key resource for complex cases and help guide organizational decision-making.

But Champions alone cannot carry the day-to-day work of prevention and management of simple chronic wounds.

Sustainable improvement in wound outcomes depends on the people who are at the bedside every shift: RNs, RPNs/LPNs, and PSWs. These providers are the ones who see skin breakdown as it begins, who reposition residents, manage moisture, deal with dressings, notice changes, and respond in real time.

When bedside staff lack practical, up-to-date education—or when organizational policies and procedures have not kept pace with current scopes of practice—hesitation replaces action. Care providers may know something isn’t right, but feel unsure, unsupported, or unable to intervene appropriately.

Confident, informed bedside teams are the backbone for effective Wound Champions to function at their optimal capacity. This collaborative team approach is supportive: reinforcing shared knowledge, and helping align practice with current evidence and scope.

Families Are Watching

Family engagement in LTC has changed since COVID-19. Families are more informed, more involved, and understandably more concerned about safety, quality, and outcomes. This is not a negative trend—but it does require clearer communication and consistent education across care teams.

When staff are confident in their knowledge and supported by Champions and leadership, conversations with families become more transparent, collaborative, and grounded in prevention rather than crisis response.

Education That Matches Reality

If we want funding investments to translate into better outcomes, education must be designed for the realities of LTC:

·      Staffing mix and time constraints

·      The essential role of PSWs

·      Early identification and prevention

·      Practical, bedside-applicable decision-making

·      Collaboration across roles, not silos

At CHEN, we believe education should reduce pressure—not add to it. Programs must support DOCs, empower Champions, and equip bedside providers with the confidence to act early, advocate effectively, and partner with families.

The reality of LTC is complex—but the solution doesn’t have to be.

If funding is to make a real difference, it must reach beyond programs and policies and translate into practical, bedside-ready knowledge for the full care team.

DOCs need education options that respect the workload, Champions need partners at the bedside, and nurses and PSWs need the confidence to act early, within scope, and without hesitation.

That’s where sustainable change happens: not just in who holds the title, but in how every member of the care team is supported to protect skin, prevent wounds, and improve quality of life—one resident, one shift at a time.

Rosemary

Rosemary Kohr, RN, BA(Arts Plastiques), BScN, MScN, PhD

Tertiary Care Nurse Practitioner Certificate (University of Western Ontario, 1998)

San'yas Indigenous Cultural Competency Certificate (British Columbia, 2015)