The predominantly female and often racialized workforce of Ontario’s personal support workers (PSWs) is bearing the brunt of a chronically underfunded long-term care system, according to a new report released on December 9 by Unifor and the Ontario Health Coalition.
The report is based on eight roundtable discussions the organizations organized mainly in May and June 2019 across eight cities. More than 350 people participated in the forums including long-term care home directors, owners, administrators, PSWs, union reps, advocates and municipal councillors.
The understaffing of homes has been a longstanding problem that has led to a severe shortage of PSWs and in the process further undermined the safety and care of vulnerable residents.
The work in nursing homes is physically and emotionally tough — personal support workers are responsible for a wide range of duties including clothing, bathing and toileting residents.
The labour of taking care of an aging population is becoming ever more difficult. Seniors entering nursing homes are older with increasingly complex conditions — they often have multiple ailments, require more medication and need closer care.
However, according to government data, staffing levels have been declining over the past decade.
“[As a worker] you can’t watch people every single second when you’re split between so many residents. The ratios are just extreme. And the reality now is that almost every shift, they’re working short-staffed,” says Katha Fortier, spokesperson for Unifor.
Fortier points out that alongside elderly patients are younger residents with mental health problems, creating an even more challenging work environment for staff as they have to deal with stronger, more mobile residents.
The shortage of workers results in rushed and low-quality care, increasing staff errors, neglect of residents, conflicts and aggressive behaviors, according to the report.
A survey of 1,200 PSWs released in March this year showed alarming levels of violence in long-term care due to persistent understaffing. The study echoed findings of a 2008 York University study that also blamed inadequate staffing, but showed that the rates of violence including sexual assaults had intensified
Understaffing and PSW shortages
The OHC-Unifor report highlights that PSWs are leaving the industry due to demanding working conditions, poor compensation, high rates of injury and abuse, and lack of full-time work.
But the exodus of PSWs is creating an even more acute shortage of staff, creating a spiralling effect without an easy fix.
Precarity in work is a serious concern as full-time work is scarce, with workers having to negotiate multiple jobs, and balancing the scheduling needs of multiple employers.
The report notes that some workers in Chatham, Ontario, said they were still awaiting full-time jobs a decade into their careers.
Since hourly wages often hover around the $20 mark, it makes sense for workers to seek other low-wage jobs that don’t involve a stressful and volatile environment.
The report recommends increased government funding to hire more full-time staff with benefits, which would also address better resident care. It also calls for government subsidies for students to enroll in college PSW programs, to address the barriers of high tuition fees and child care costs.
One of the other recommendations is to build a provincial human resource strategy to ensure a sustainable solution to the problem.
In an emailed statement, Merrilee Fullerton, the minister of long-term care, said that the government was working on a comprehensive staffing strategy for nursing homes.
The statement acknowledged that “proper staffing plays a significant role in ensuring that the needs of all long-term care residents are being met.”
She said that her government was working with its partners in the sector to address the issue.
Thus far the government has increased funding below the rate of inflation.
“Ford’s $34-million cut to the long-term care sector is making things worse, and makes clear that his government has no intention of fixing the problems plaguing the sector,” says Teresa Armstrong, the NDP critic for long-term care.
The minimum care standard
Unions, the Ontario Health Coalition and patient advocates have long called for a minimum care standard that would guarantee residents four hours of direct care every single day. The current level of direct care in Ontario hovers around the 2.7 mark.
While nursing homes have to abide by onerous regulations around documentation, they face no consequence for being understaffed.
In October 2016, the NDP introduced the Time to Care Act bill, which proposed legislating a minimum care standard of four hours. The bill was enthusiastically received in the legislature, with endorsement from all three major parties. In November 2017, it passed second reading with consensus.
However, the Liberals didn’t pass the bill before the end of their term in June 2018. And the Conservatives have ignored the NDP’s re-introduction of the bill since last year.
“Last summer, I re-introduced the Time to Care Act,” Armstrong says. “The Ford government needs to come to the table and support this bill.”
Fortier says that Unifor raised the issue of passing the bill with Conservative MPPs at Queen’s Park on the day the report was released.
“The Conservatives’ question was, ‘How will we pay for this when we got this debt?’ I think the question should be, ‘How can we not pay for it?'” Fortier says.
“There’s a compliance report from Walkerton, in a home called Bruce Lee Haven, and it says that short-staffing may have contributed to the deaths of two residents. We’ve got people dying from short-staffing — what’s the price on that?”
The systemic issues
The current crisis of long-term care homes can be understood in the context of the privatization of care, according to Albert Banerjee, health research chair in community health and aging at St. Thomas University in New Brunswick.
In Ontario, 58 per cent of long-term care homes are for-profit, while the rest are not-for-profit and government-owned.
While all homes receive the same level of base funding from the government, academic research shows that for-profit homes tend to have a lower quality of care.
That trend is attributed to the fact that while municipal and non-profits tend to channel surplus funds back into hiring more workers, the for-profits divert money towards revenue.
“The research tends to show that the profit is coming from labour. That’s your biggest expense,” Banerjee says.
“Staffing tends to be better in the municipal homes [and non-profit homes] than the for-profit homes.”
The for-profit domination of the industry began during the previous Conservative government of premier Mike Harris from 1995-2002.
“We changed the model where most [nursing home care] was delivered by not-for-profit, hospitals, municipalities or charitable and religious organizations to a situation where most [beds have been contracted] to for-profit operators,” Fortier says.
In 2003, Harris became a director of Chartwell, one of the biggest for-profit corporations in the long-term care and retirement homes sector. He is currently chair of the firm’s board.
Zaid Noorsumar is rabble’s labour beat reporter for 2019, and is a journalist who has previously contributed to CBC, The Canadian Press, the Toronto Star and Rankandfile.ca. To contact Zaid with story leads, email zaid[at]rabble.ca.