Who’s Caring for BC’s Home Care Workers?
As province takes over service delivery, long-time worker fears job problems will persist.
‘People can’t live on two or three hours of paid work a day,’ says Deborah Diduck, who’s worked in the home care sector for two decades. She’s tired of the insecurity. Photo by Jake Sherman for The Tyee.
Big changes are coming to the way home support services are delivered in British Columbia, but a woman who has worked in the sector for two decades says they won’t solve serious problems hurting employees and clients.
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What’s really needed are stronger laws to protect workers, said Deborah Diduck, who at 64 is approaching retirement age.
“I am frustrated,” she said. “I’m trying to do a good job for the seniors, and I’m trying to make it so they can be happy and live in their own home, and the company and labour legislation doesn’t allow me to do that.”
A low point for Diduck was getting called into work for a 90-minute shift on Boxing Day. It was typical of the company she worked for at the time, she said.
“I’ve been lucky to get one-hour or two-hour work days out of the company,” she said. “If you don’t take the work, then you might not get any more work. You’re stuck between a rock and a hard place.” Diduck said her pay rate has ranged from $14 to $22.
Diduck began doing home support work in 1996 on the Sunshine Coast. She has been in Victoria since 2013, where she worked several years for We Care, which is now a franchise of CBI Home Health. Most recently she has worked for Beacon Community Services.
While with We Care she was represented by the Christian Labour Association of Canada, which she found did little to standup for workers and in fact negotiated contract terms that she said made the job more difficult.
Beacon has been better than other employers in the sector, she said.
“They seem to be listening, because so many people quit,” she said. “They were having trouble finding workers. Well the main reason they’re having trouble finding workers is people can’t live on two or three hours of paid work a day.”
Issues extend across the sector, Diduck said, noting that the vast majority of the workers are female and tend to be treated worse than workers in male-dominated industries. “A lot of home support workers are finding out [that] even once you take that course for the residential care aide, a lot of companies will only give you two hours of work in a day and call it a job.”
In the 1990s employment standards laws required that workers be paid for at least four hours every time they were called in to work. After 2001, the BC Liberal government reduced the minimum pay to two hours.
At times workers are booked for full days but not given enough time to travel between clients’ homes, Diduck said. “A lot of times they would send me from one client to another, which would take me a half an hour to drive, and they would give me 15 minutes to get there.”
Diduck’s own health suffered. Her pre-diabetic condition became full-blown Type 2 diabetes, a development she blames on not being able to have a lunch break many days.
She had a heart attack. “They severely compromised my health,” she said.
The working conditions lead to poor care for the clients, mainly seniors, who use the services, Diduck said. “We weren’t even being allowed to do the job properly for the clients... We’re not given enough time to do the job properly.”
There were times she was scheduled to visit a person’s home for as little as 20 minutes. “What can you do in 20 minutes?”
She described homes with shelves that never got dusted and with room edges that never got vacuumed. “I’ve walked into apartments that were so filthy, and it was basically 22 years of legislated filth,” she said.
In one case she realized a client needed more help to get groceries. She notified the company, but nothing was done about it for weeks. When she returned, she said, “I walked in and this woman had absolutely no food in the cupboard. Then they finally listened.”
Staff told ‘do the best you can’
The time that a worker can spend in a client’s home is dictated by whoever is providing the funding, said Twyla Johnson, the director of operations in Victoria and Duncan for CBI Home Health, which was previously We Care.
Besides working for private clients, the company has been under contract to various public agencies, including WorkSafeBC, ICBC and the Public Guardian and Trustee. It has also done overflow work for Island Health.
“When we’re directed and there’s a care plan, we can only do what’s on the care plan,” Johnson said. “What we say to our staff is ‘do the best you can with the time you’re in there.’”
She acknowledged it could be hard for a worker to leave when they feel the client needs more help than they’ve had time to provide. “I get the worker wants to do more and that the client needs more. You can only do what you can do, right?”
Johnson said that many of the company’s registered care aides now end up working overtime, but that there have definitely been times where it was hard to give workers enough hours.
“The client base can go up and down, so it’s really difficult to give guaranteed hours,” she said. “If we guaranteed hours to our staff, then a couple large clients passed away, we’d pretty much have to shut our doors because it would run us into the ground. It’s a balance we try to maintain.”
Workers are able to set the hours when they are available and the flexibility really suits some people, she added. “A lot of people have said they love working for us.”
The company is unionized and everything about the work is negotiated with CLAC, Johnson said. “Our labour standards are quite in line with everyone else in the industry.”
Health authorities bringing work in-house
On Wednesday three health authorities — Vancouver Coastal Health, Fraser Health and Island Health — announced they would take over delivering home support services that had been contracted out for years. The change will bring them in line with Northern Health and Interior Health.
Victoria Lee, president and CEO of Fraser Health, was quoted in a press release saying the change “will result in better services for our clients and better experiences for our employees.”
A statement from Vancouver Coastal Health head Mary Ackenhusen said “This transition will create an excellent opportunity for our health authorities to form integrated teams to improve patient care, enhance service co-ordination and better align home support with the provincial vision of more team-based and connected community and primary care systems.”
The BC Care Providers Association, an organization that represents companies working in the sector, said it wasn’t consulted on the change and expressed “deep disappointment” with the decision.
CEO Daniel Fontaine said the change wouldn’t provide the increased services and longer visit times that seniors want.
“These changes only serve to drive up the cost of the support, and complicate the staffing shortage crisis the sector is facing, without addressing the needs of B.C. seniors. Furthermore, many of our members tell us that their staff do not want to work for government.”
The BC Liberal opposition put out a press release saying the government is “reducing choice and driving up costs for seniors by moving private home support services into health authorities.” It accused the government of catering to the unions that had donated to the NDP.
Diduck said she’s not convinced the change will make a difference. The directives on scheduling were already coming from Island Health, she said.
“The labour legislation has to be changed,” she said. “That’s the main thing. Otherwise the employers are going to keep doing what they’re doing, and it’s not right.”
“It’s not good enough that the government is taking over home support,” she said in an email. “Unless they improve the labour standards, all local and temporary foreign workers, primarily female, will still have to endure the same idiotic directives, low wages, no medical coverage etcetera, etcetera.”
Improving employment standards would have the added benefit of improving conditions for all workers, not just in one sector, she added.
Right decision, says Dix
Health Minister Adrian Dix said having the health authorities deliver home support directly makes sense for several reasons. Unionization didn’t factor in the decision, he said, noting the workers are unionized now and will remain unionized after the change.
Dix said the change would let health authorities improve scheduling and provide more stable hours for staff and seniors, making it easier to recruit employees.
Health Minister Adrian Dix says regardless of who manages the province’s home care health system, ‘the goal is to make it better.’ Photo: BC Government Flickr.
The existing contracts were coming up for renewal at the end of June for Island Health and a year from now for Fraser Health and Vancouver Coastal Health. While Beacon Community Services has been very good, there were a wide variety of contractors in the other two health authorities, he said.
“There were some issues with the way the contracts had been managed over time... that were certainly brought to my attention,” he said. Services were reviewed in each health authority and the recommendation was the same in all three.
Home support is essential for seniors and closely connected to the improvements the government is making to primary care, Dix said.
“Home support under the previous government, aside from the cuts and the lack of service, was sort of kept aside from everything else. We obviously need to integrate it. It’s a very important central health-care service for people. It helps them live at home a lot longer.”
The decision will directly affect the care that some 29,000 people receive and will be supported through an agreement with the federal government that’s going to be formally announced soon, Dix said.
The move may add some costs, but there will also be efficiencies, so there’s unlikely to be a big difference in cost to the government, he said.
“This is for the clients. They’re my biggest priority. They rely on the service. They are often frail or elderly seniors. They need the service. They need it to be part of a continuity of care, and it makes sense for the health authority to do it,” Dix said.
“Ultimately we had to do a better job organizing this service, especially if we’re going to increase our investment in it. I’m optimistic that we’ll do that. It’s going to take some time.”
The change will be good for workers in the sector as well, he said.
“My view is this isn’t about seeking out blame for the failures of the system now, but making them better in the future,” he said. “That means making the work less precarious and more consistent. It means providing better service to seniors and others.”
Dix acknowledged that bringing the services in-house wouldn’t on its own fix home support.
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“Regardless of who manages the system the goal is to make it better. So what I say is there’ll be more resources in home support services, that bringing the services together allows us to offer more and better options and more easily recruit people, and the test will be doing it.”
People like Diduck who are providing the service know that “if nothing changes but who the management is, then nothing will change,” Dix said.
Asked about Diduck’s point that strengthening labour laws could have a much bigger impact on working conditions, Dix said, “My colleague Harry Bains is working on stronger employment standards and that’s a real priority for the government.”
Those changes may be coming within months.
The labour ministry launched a month-long consultation on Feb. 28 seeking comments on improving the employment standards law.
“To reflect modern workplaces and to ensure that employment standards are evenly applied and enforced, the Ministry of Labour intends to make changes to the act as early as this spring,” the announcement said.