By Zaid Noorsumar
Protective equipment shortages in the midst of the COVID-19 crisis are causing panic among home and community care workers and placing them on the verge of quitting, says an Ontario nurse who works in the sector.
Janice Ackerman*, a registered practical nurse (RPN), says personal protective equipment (PPE) such as gloves, masks, gowns and goggles are being rationed, creating dangerous conditions for workers.
The shortage of PPE is already affecting health care professionals across Canada, but could be catastrophic as supplies are expected to run out within weeks. Multiple news reports have already documented infections (or suspected infections) among health care staff.
Ackerman argues that home and community care workers are feeling the crunch harder as they go into homes that are not sanitized, unlike hospital or clinical settings.
“When you’re going into someone’s home, you’re touching surfaces that you would never touch in a hospital room or a clinic room,” she says.
But workers, about 90 per cent of whom are women, don’t have enough hand sanitizer or disinfectant wipes.
“You’re carrying in gloves, your stethoscope and your blood pressure monitor, and your pen in your pocket, all of those types of things, and then having to put them somewhere,” she says.
In an emailed statement, Sue VanderBent, CEO of Home Care Ontario – the association that represents for-profit home care firms – says that she has raised workers’ concerns at the Provincial COVID-19 Collaboration Table.
“We are working closely with government to procure more PPE because ultimately the government controls the purchase and distribution of PPE for our health care system,” VanderBent writes.
Risk of transferring the virus
Ackerman says that even as supplies are short, nurses across the sector are beginning to notice a higher caseload as patients are discharged from hospitals to be taken care of by home care workers.
According to updated public health guidelines, care workers are not required to wear protective equipment when caring for patients who show no symptoms.
But Ackerman says that the guidelines don’t show adequate regard for professionals or their patients. As home care workers visit multiple clients a day, they may transfer infections as they travel around their communities.
“I’m going to immuno-compromised patients that are on chemotherapy, needing IV therapy and tube feeds and all kinds of things, but if they have no symptoms, I’m going in with nothing,” she says.
“If the patient before them had symptoms, I went in with my bare minimum PPE. I’m not even being provided with disinfectant wipes. And I’m expected to do a full assessment as a nurse.”
The risk of the unknown
Before visiting patients, home care workers screen them to ascertain if they have COVID-19 symptoms. But Ackerman says clients may downplay their symptoms in the fears that they may be abandoned.
“One of my patients the other day was hesitating when I was screening him,” she says.
“I was like, ‘Listen, I’m still coming to your house, regardless of what you tell me right now. But I need you to be honest so that you and I can protect ourselves.’ And then the response was, ‘Oh yeah, you better put on a mask and goggles.’”
The compounding fear of contracting the virus and spreading to other patients or their family members is terrifying nurses, according to Ackerman.
“I’ve been [speaking with] nurses all week that are hysterical, they’re beside themselves, they don’t know what to do,” she says. “And a lot of us are saying, ‘Okay, I think I’m gonna have to quit.’”
Ackerman says quitting may be the only option for nurses who can’t apply for leave of absences for fear that they may be accused of abandoning patients and have their licenses revoked.
“Workers [who are eligible] are taking leave of absences. They are dropping like flies,” she says.
How Ontario home care got this bad
Although nurses – as other home care workers – are highly qualified professionals, many are precariously employed and may be severely impacted financially if they fall sick.
Ackerman says her employer, who provides zero paid sick days, is not paying workers for self-isolation.
Fewer than 40 per cent of home and community care workers are unionized, a problem traceable to the competitive bidding process introduced in the mid-1990s.
The reforms introduced by Ontario’s Progressive Conservatives and continued by Liberals allowed for-profit firms to lower compensation for workers, strip them of unions and replace non-profit employers.
Ever since, “piece work” has been normalized in the sector. That means workers are only paid wages for time spent with clients but not for paperwork, travelling time or for providing additional care.
If a client is assigned one hour, but actually requires 85 minutes, workers are only paid for the hour.
“If you work out the hours that I put in, compared to the visits that I see, I’m usually making less than minimum wage,” Ackerman says.
The deterioration of working conditions in home and community care is part of a broader trend in Ontario’s underfunded health system over the past few decades, whereby the nursing profession has become increasingly precarious.
Just before COVID-19 took over the government’s agenda, the Conservatives were ramming their new home care legislation through the legislature.
According to the advocacy group Ontario Health Coalition, Bill 175 will create more opportunities for private companies to profit off government funding while reducing accountability.
“We’re the ones being directly impacted by that. But we don’t have time to organize right now,” Ackerman says, adding that it won’t surprise her if the government were to pass it even before the pandemic ends.
At the moment, she and her colleagues are focused on the issue at hand.
“[Right now] our workers are not being protected. And it’s the patients who are going to suffer by either front-line workers leaving, or workers spreading [the virus].”
*At her request, Rankandfile.ca is using a pseudonym to protect her from potential repercussions