Support workers warn Ontario's long-term care staffing efforts will do more harm than good

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COVID-19 has put Canada's long-term care homes in a state of recurring crisis. Now, personal support workers and health-care advocates say Ontario's new initiative to recruit long-term care staff will put residents and staff in new danger.

On November 9, the Ontario government announced it will be recruiting a new class of workers to help fill the staffing shortage felt by so many long-term care homes across the province. The hiring program is called the Ontario Workforce Reserve for Senior Support, and is hiring what it calls resident support aides (RSAs).

The government appeared to be aiming to solve two problems at once, as it specifically called for "those who are unemployed or have been displaced from the retail and hospitality industries or administrative roles as well as students in education programs."

Unions, advocacy groups, and personal support workers themselves have roundly panned the hiring initiative, warning that long-term care homes already have disproportionate rates of violence, and require staff who are adequately trained in working with higher risk residents with dementia and other cognitive impairments.

A spokesperson for the Ontario Ministry of Health and Long-Term Care said in a statement that the program is short-term, and those who are hired will be undertaking 15 hours worth of online learning modules with the Michener Institute of Education before they are placed in homes.

"We are looking to recruit as many RSAs as possible that can be quickly trained and deployed to long-term care homes experiencing staffing shortages," read the statement. The workforce is intended to be a temporary one.

The potential for workers or residents to be hurt is a real concern. Almost 70 per cent of the seniors living in long-term care homes are dementia patients, and nearly 90 per cent have some form of cognitive impairment, such as that resulting from a stroke. Many of these patients are at-risk for violence, falls or otherwise unpredictable behaviour.

According to a January 2019 report from the Ontario Health Coalition (OHC), incidents of violence between residents increased from 2011. With data from the Ontario coroner, the report found that from 2014 to 2019, 27 homicides occurred in Ontario's long-term care homes.

The homes are also one of the most common settings for workplace injury in health care, second only to hospitals. (Many of these injuries result from the physical lifting required of PSWs when attending to some residents' needs).

Knowing how to reduce harm in interactions with patients, to recognize the signs of increasing frustration or confusion, and to de-escalate tenuous situations are all skills that PSWs are trained in.

According to one PSW who wanted to remain anonymous for fear of reprisals from their current employer, approaching a resident with dementia or Alzheimer's in the wrong way can very quickly cause the person to become stressed, scared and to lash out as a result.

"Even nurses aren't fully qualified sometimes to handle people that are high risk behaviour," said the worker who, until April of this year, worked at a long-term care home in Haileybury, Ontario.

This worker decided to leave the long-term care home and find work elsewhere after losing 11 people in one month to an upper respiratory infection that circulated through the home. The stress of constantly working short staffed through one health crisis on top of another left her completely burnt out, she said.

Amy Ayers is a PSW still working in a long-term care home in eastern Ontario. Initially, she said she welcomed the announcement that there would be more people coming into homes to help out. It would provide those working in areas with high risk of COVID-19 to recover from the stress and burnout of the last several months, she said.

"It would give them a little bit of a sense of relief, knowing that these individuals are able to hydrate and feed [the residents]," she said.

On the other hand, Ayers said staff without adequate training or dedication to the role could pose a safety risk both in terms of violence and infection control.

"What is going to be left on our shoulders if something happens? What really needs to be done is taking those funds ... and putting it into giving these people proper training within an education system," she said.

Andrea Potter, another PSW who left long-term care homes out of fear for her own safety when the pandemic began, said she too worries about bringing a workforce into long-term care homes who are there because they're out of employment options, not necessarily because they felt a calling to go into the field.

"You can't force people to do [this work]. You either have it in you, or you do not. There's no middle ground," she said. Even some PSWs who are newly trained don't last very long in the homes, she said, because they don't know what it all entails.

The high pressure environment of long-term care homes during the pandemic, and the widely reported stresses of the job pose a challenge to recruitment.

Natalie Mehra, the executive director of the OHC, said that over time, the complexity of residents' needs have increased, while staff training standards have decreased, leading to the rise in violence and subsequent staff burnout, resulting in huge challenges with staff retention.

Ayers said that staff burnout and retention was a major problem even before the pandemic.

"We were working exhausted, burned out. Endlessly, tirelessly working short all the time, and then you throw COVID into the mix of things, and it definitely does a number on a lot of PSWs," she said.

Doris Grinspun, CEO and founder of the Registered Nurses Association of Ontario, said at a Friday press conference that this staff recruitment initiative was a "band aid solution," and one that the RNAO could not support.

If sufficient nurses, PSWs and other trained health-care professionals are not hired immediately to provide a basic care guarantee of four hours care per day per resident, Grinspun said the government may as well admit to not caring about seniors.

Mehra worries that the latest recruitment program will threaten the working conditions and "already paltry wages" of PSWs by introducing cheaper labour and inexperienced workers.

"It's dangerous for the residents. It's dangerous for the people that they're sending into the homes. But it's also dangerous in terms of its impact on the workforce," she said, expressing concern that the new positions could overtake the roles of some PSWs as a cost-cutting measure -- a pattern she has repeatedly borne witness to.

According to the government, the aides will assist with meal times, the coordination of family visits, and recreational activities for residents.

Mehra doubts that duties will be able to be so clearly demarcated when the staffing shortage has created such a chaotic and intensive work environment.

"In reality, they're going to be thrown into it," she said.

If wages were increased to reflect the work involved, staff recruitment, burnout and retention would not be such an issue, said Mehra.

"The wages are too low for the kind of work. It is because the workloads are crushing. Because the level of injury and the care needs are so high and it's overwhelming to them," she said.

It's not lost on the Mehra nor the PSWs that a big factor in the deterioration of their wages and working conditions is due to the fact that the workforce is made up of mostly women, and older women at that.

"I just don't think we're as valued anymore," said the anonymous PSW.  

When asked what they need to be able to improve not only their own working conditions, but resident care, each of the PSWs said they require the option of full-time employment, higher wages and benefits.

"Everyone who understands long-term care, and, you know, has been advocating for all these years is livid" over the staffing crisis in Ontario, Mehra said.

"We do not understand why Ontario [did] not … recruit and start training PSWs by the thousands," in the summer months when they had the chance, she added.

The government said this particular staffing initiative is part of a broader strategy to recruit and retain front-line staff in homes, including PSWs, nurse practitioners, registered practical nurses and registered nurses.

"Our comprehensive staffing strategy will be released in December," read the government's statement.

Chelsea Nash is rabble's labour beat reporter for 2020. To contact her with story leads, email chelsea[at]rabble.ca.

Image: Elien Dumon​/Unsplash

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