The shortage of doctors and nurses can be deeply felt by many Canadians. However another aspect of the health human resource crisis has gone under reported. With little mainstream attention, long-term care and home care in Manitoba has fallen deeper into crisis, according to a new report by the Canadian Centre for Policy Alternatives (CCPA) released on August 23.
Many may remember the devastating reports of patient deaths in long-term care facilities during the early months of the COVID-19 pandemic. In the Maples Personal Care Home in Winnipeg, eight residents died in 48 hours.
Further investigation into conditions at long-term care homes revealed that pre-existing staff shortages were exacerbated by the pandemic and left many patients vulnerable.
According to CCPA’s new report, staffing and labour condition issues persist despite the high risk to patients.
The report, written by Niall Harney, senior researcher at CCPA, details the results of a survey administered to unionized long-term care and home care workers in Manitoba.
Long-term care workers in Manitoba are employed in personal care homes across the province. These facilities provide ongoing patient care to its residents. Manitoba was a pioneer in introducing a provincial home care program. Home care workers provide personal care, nursing, occupational and physical therapy, household maintenance, meal preparation, laundry, and respite.
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Unionized workers on average enjoy better labour conditions due to their collective bargaining power. But despite any protections unions may provide, respondents to the survey painted a pretty bleak picture of conditions in care facilities and home care environments.
Many care workers tend to be precariously employed. The report found that 49 per cent of workers in long-term care facilities are employed on a part-time or casual basis. Meanwhile, a whopping 59 per cent of home care workers are part-time or casual.
Care workers are paid below the provincial median, according to the report. Hourly wages sit between $18.87 and $21.04 while the Manitoba median hourly wage is $24. At this rate of pay, only 15 per cent of long-term care workers and 10 per cent of home care workers feel their job allows them to save for their future.
“All continuing care workers in Manitoba received retroactive pay increases following the settlement of their contract negotiations in August 2022, which delivered a 9.75 percent increase over a seven year contract,” Harney wrote in the report. “However, with Manitoba’s annual inflation rate peaking at 9.4 percent in June 2022, the financial space for care workers to save for the future will likely be unchanged.”
Care workers are also facing high levels of burnout due to lack of benefits, lack of vacation time and insufficient sick leave. Harney found that less than 14 per cent of home care workers felt satisfied with the amount of paid sick leave available to them.
The result of these chronic issues lead to an exodus from care work, which pushes forward the health human resources crisis. With low staffing levels, there are simply not enough workers to be able to put in the hours needed for a high quality of care.
Harney pointed to research by the United States Centre for Medicare and Medicaid which found that facilities require 4.1 hours of care per patient per day for patient health and safety. Manitoba has set a goal for 3.8 hours of care per patient but this goal is not legislated, leaving many in the dark on whether it is being met.
Including care workers in the the Health Human Resources Plan
In response to the strain on the healthcare system, Manitoba launched its Health Human Resources Action Plan in November 2022. The plan is designed to recruit and retain healthcare employees. Harney called out, though, that this plan makes little mention of long-term care and home care workers.
While the lack of long-term care and home care solutions in Manitoba’s health human resource action plan may be discouraging, it does provide a blank page on which workers and allies can provide labour-informed policy recommendations.
After analyzing data from the survey, Harney’s report concludes with three primary recommendations. The first is to raise daily hours of care to 4.5 hours per patient. This figure goes beyond the minimum of 4.1 hours per patient in order to not only meet survival needs, but improve quality of life.
Harney also recommended the hiring of 800 more home care aides and home support workers and the improvement of working conditions and benefits. These two recommendations go hand in hand. Recruiting and retaining care staff will prove difficult if working conditions are poor.
The change to quality of care is possible, according to Harney. However, the province will need to move away from privatization models that value profit over patients and staff.
“Long term care and home care appear to be undergoing a tried and tested method of stealth privatization that has been applied to healthcare in Canada for the last 30 years,” Harney wrote. “The hallmark of this method is the chronic underfunding of public healthcare services and using the gaps created in the system to justify handing over public services to the private sector.”
When care is put above profit, lives can be saved. Cutting costs by cutting staff has proven deadly in some long term care facilities. While the crisis is persisting for care workers, the way out has become clear. A well-funded public long term care program will attract staff and combat the health human resources crisis.
“Well-supported care workers are critical to providing the high- quality service that Manitobans expect from their healthcare system.” Harney wrote. “Increasing staffing levels should be a priority to reduce workloads, reduce stress, and improve patient care. Improving working conditions, through improved benefits, better wages, improved immigration supports, and regularizing work encourage staff to remain in their positions, improving outcomes for clients.”
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