Long-term care in Ontario is broken. People are dying. Residents of this province deserve and expect that the care they receive in their golden years will allow them to live with dignity and respect. We are seeing the opposite.
Many of the reoccurring issues facing both long-term care employees and the sector have been exacerbated by the COVID-19 pandemic. This pandemic has exposed shortcomings in the long-term care system that OPSEU/SEFPO has been fighting to fix for years. These include the lack of full-time, permanent jobs, insufficient pay, understaffing, recruitment issues, and health and safety concerns – specifically the lack of sufficient personal protective equipment (PPE) and training with regards to infection control.
The Ministry launched a study in February 2020 to provide strategic advice on staffing issues in the long-term care sector in Ontario. A range of long-term care partners, including labour unions and operator associations, were engaged during this process. This report noted that during the height of the pandemic, several long-term care homes reported critical staffing shortages – impacting the quality of resident care and employee safety. So as you can see we were in a crisis before the pandemic. The Ministry of Health and Long-Term Care knew about it all along.
But now, more than ever before, we are seeing the importance of keeping our healthcare services public – prioritizing people over profits. Sadly, the expansion of long-term care has largely been in for-profit homes. People are dying because money is seen as a higher priority than caring for people when they are at their most vulnerable. Where is the compassion and dedication to care? Absent in the private sector, that’s where! We know there are higher fatality rates in for-profit facilities as compared to non-profit or municipal facilities. Still, nothing is being done to make real change. On May 14, we sent a position paper to the Government recommending that long-term care and home care be publicly operated, along with 22 other recommendations aimed at preventing another tragedy like the deaths caused by the COVID-19 pandemic.
Do the right thing and not only read these recommendations, but do something with them! People are dying because of this broken system. To ensure more lives aren’t lost, and to honour those have paid the ultimate price for this negligence, changes must come now.
Staffing issues and shortages
Currently there is a massive shortage of people willing to work in long-term care. Some have immune-compromised family members living in their home and they can’t risk transmission. Others simply feel that the wages paid aren’t worth rolling the dice on their own health. In those cases of illness, employers are not allowing employees to access sick leave for periods of quarantine unless their collective agreement language or short-term disability plan specifies. As such, employees who should be at home quarantined are taking incredible health risks and going to work to protect their incomes and professional goals. LTC is often a stepping stone for Registered Practical Nurses (RPNs), Personal Support Workers (PSWs), etc. who are looking to get experience so they can move into better paid hospital environments.
These issues are creating incredible hardships on residents. In some cases, it has been reported that residents are only being bathed once a week or have missed baths, gone without personal care, not being changed positioned regularly (skin issues are on the rise), or/and a lack of toileting, among other basic care functions. This is directly correlated to there being too few staff to tend to the needs of a large, diverse group of residents.
Adequate staffing levels need to be mandated, and we must make sure there are punitive measures to ensure compliance. We don’t want to hear any more stories of companies cutting corners on staff to save a few dollars.
- We echo our recommendation made on September 29, 2020 for community colleges to increase access and waive tuition costs of people entering fields like personal support work.
- Ensure the compensation package is attractive to attract and retain dedicated staff to the healthcare field.
- A floor on wages must be established for all workers.
- Create a regulatory body. Licensing workers would ensure they have standardized training and better pay, address the workforce shortages, and help keep the public safe.
- Mandate staff-to-patient ratios in homes that allow for more interaction and care for residents.
- Guarantee part-time hours of work. With a fixed schedule, decent hours, and a living wage, there would be a drastic decrease in the number of people working in two, or more, homes at a time.
- Ensure a minimum daily average of four hours of direct care per resident in order to alleviate staffing pressures and support resident quality of life.
- Keep triage teams in place.
- Eliminate shifting staff across geographic regions and potentially spreading the virus across the province.
- Stop diluting the labour pool in LTC homes. Many homes are trying to replace PSWs with unregulated care aides.
- Cut down on agency staff, and bring jobs in-house. Make vacant jobs permanent, and ideally full-time.
- Improve staff ratios and skill-mix for PSWs, nursing staff, and other health professionals, with variance to address specific circumstances.
Personal Protective Equipment (PPE) and infection control:
It goes without saying that PPE needs to be readily available. In August of this year, the Governments of Ontario and Canada partnered with 3M Canada to ensure adequate quantities of N-95 masks. Unfortunately, too few workplaces were prepared for the onset of the COVID-19 pandemic, putting people at higher risk early on when the capabilities for increased production were obviously there all along. Workplaces had to scrounge for whatever PPE they could find and often relied on the good nature of the communities they are located in to fill the void. While Directive 5, which has been improved to enhance the level of PPE in use, there are still many cases of non-regulated healthcare workers relying on regulated point-of-care risk assessments to obtain the higher level of PPE.
Other issues include:
- Lack of PPE training. Some of our members, especially support services and resident care aides, didn’t understand the proper use of PPE.
- Lack of N95 masks and other PPE including gowns and face masks.
- N95 masks are only required during aerosol generating medical procedures.
- Poor quality of masks (straps breaking, mask materials irritating the skin, poor fitting of masks).
- The irresponsible use of ‘regular’ or ‘prep’ masks.
- It was reported to us that our members did not fully understand COVID-19. Too many people had their own versions of what it was and how contagious it really is.
- Ignoring irresponsible past examples for which PPE became a life or death issue during an outbreak.
Excerpt from Justice Archie Campbell’s 2006 report Spring of Fear that was released following SARS. Today’s leaders will do well to remember this:
“When it comes to worker safety in hospitals, we should not be driven by the scientific dogma of yesterday or even the scientific dogma of today. We should be driven by the precautionary principle that reasonable steps to reduce risk should not await scientific certainty.”
- The Ministry of Long-Term Care develops a province-wide pandemic protocol, with a clear chain of command that can be implemented quickly. Such a protocol must define what constitutes a pandemic, and when such protocols need to be implemented.
- Mandate that an adequate supply of PPE must be readily available at ALL times. We should not be waiting until an outbreak or pandemic to develop an adequate supply of PPE.
- Mandate that each home develop and implement a PPE training program that is given to staff when they are hired, and is reviewed on a regular basis.
- As information about a disease becomes available, employers should be sharing it with staff members. Members should not be filling in the blanks about various causes of illness by using contentious sources of information, such as Facebook or Instagram.
- As part of their inspection, each home should have to show Inspectors how much personal protective equipment they have on hand, and ensure that there is an adequate supply, at all times.
All Ontarians deserve the dignity of receiving a living wage and benefits for work completed. When it comes to our health care professionals, this reality takes on increased importance. Wages must be improved. If a fair, living wage isn’t paid to people working in long-term care, the staffing shortages will continue to proliferate. Turnover will remain an issue, and those leaving school and entering healthcare for the first time won’t choose long-term care as their first choice.
- Permanent wage enhancements and benefits for all front-line workers in long-term care.
- Ensure that new jobs in the sector are permanent in nature. Stop the proliferation of casual and temporary work in this sector.
- Ensure that along with wages, that other monetary benefits such as pensions, benefits, and paid time off for sick leave or vacation are available to all workers in this sector. Make long-term care an attractive place for people to work.
Residents and their families; social isolation; anxiety and depression
Ontario residents have had a difficult time seeing their families during periods of quarantine and the locking down of long-term care facilities during peak outbreaks. Residents went months without seeing their loved ones. During times of relative stability between outbreaks and waves of high community spread, a designated loved one, or care person, should be able to enter the home and visit with their family member. Further, given that staff are often the only human contact residents have during periods of lock-down, our members should be given extra time to tend to the social and emotional needs of residents. Without human connection during times of quarantine, there is arguably little difference between LTC and jail. Staff can help residents’ Facetime, write letters, or place phone calls with their loved ones outside of the home.
- Rapid testing technology is approved, and readily available; each home should have it on hand to test visitors and residents coming into the home.
- Bring iPads and other technologies into long-term care homes, and make them available to residents so they can video chat with their family members.
- Allow staff to spend time with residents. Schedule staff in a way that allows them to take an extra few minutes with each resident, and not jump from one to the next as quickly as possible to maximize efficiencies.
Background of OPSEU/SEFPO membership in LTC
OPSEU/SEFPO represents approximately 2,400 workers in 15 homes spread across the province of Ontario.
OPSEU?SEFPO represents a variety of classifications in this sector including: PSWs, RPNs, HCAs, Social Workers, Laundry Service Workers, Housekeeping Workers, Cooks, and Dietary Workers. There are three types of long-term care facilities in Ontario in which OPSEU/SEFPO members are employed: private homes that operate on a for-profit basis, homes that operate on a non-profit basis, and municipal homes which are public, non-profit homes that are owned and partly funded by municipal levels of government.