Ontario’s nursing homes continue to face critical staffing challenges

By Zaid Noorsumar

Robin Nelson’s 79-year old mother has endured more than four months of isolation during the pandemic in a long-term care home in Lakefield, Ontario. 

Ann Nelson, who has suffered three strokes, has intensive care needs. Even before the pandemic, Robin says the resident-to-staff ratio wasn’t sufficient to provide the level of care that her mother needed since her third stroke in November. 

Robin and her sister would spend 10 hours a day, seven days a week to supplement the basic care provided by paid staff at the home. 

For instance, her mother intakes food through a feeding tube because she can’t swallow. She also has a suction machine by her bedside as she is at high risk for choking. But personal support workers (PSWs), who do the bulk of resident-care at nursing homes, are not certified to operate the machines.

“My sister and I were using the machines. We’re not certified nurses [but] we learned how to do that stuff,” Robin says. “We learned how to hook up and disconnect her feed because a nurse wasn’t always readily available.”

In March, the government banned all visitors from entering the homes to prevent the spread of the virus. It partially lifted the restrictions earlier this month but still considers family members as “visitors” who are now allowed to enter the homes and see their loved ones while being socially-distanced.

But Robin argues that like many other family members, she isn’t a mere visitor. She is an essential caregiver and must be allowed to provide care, particularly as nursing homes face an unprecedented shortage of workers due to COVID-19.

According to the Ontario Health Coalition, there was a staffing crisis in long-term care homes before the pandemic. Now, it is an emergency. 

“We’re hearing from frontline workers that they’re working even shorter than ever,” says Natalie Mehra, OHC’s executive director. “We’ve already seen the deaths of a number of residents from dehydration and just terrible circumstances of inadequate care.”

The government’s inaction

On May 28, the Ontario Health Coalition and other organizations representing over two million Ontarians, sent an open letter to the Ford government to take concrete action on long-term care homes. Among the demands were ensuring full-time work for staff and legislating a minimum care standard. 

In April, the Ford government mandated workers had to choose one nursing home for work to prevent viral spread, but it didn’t require long-term care homes to ensure full-time hours. This has been financially detrimental to staff who were working at multiple nursing homes, but are now forced into a reduced schedule at one home. 

Lack of full-time work also created problems for homes that pay less, as workers chose homes with better compensation and/or more hours. In some cases, where eligible, workers also chose to not risk their lives for precarious work and instead collected the CERB (Canada Emergency Response Benefit).

“Leaving it to the providers to forge voluntary arrangements among themselves is not sufficient. Staff need a permanent improvement to their wages and access to full-time hours. This cannot be voluntary and there is no path to stability without the provincial government undertaking these measures,” read the OHC’s open letter.

There has been no response from the government, which has also been criticized for loosening regulations around staffing since the start of the pandemic through emergency orders, allowing homes to bring in untrained workers and volunteers. 

The government now plans to give itself extraordinary powers to extend the emergency order through its new legislation, Bill 195, Reopening Ontario (A Flexible Response to COVID-19) Act, 2020.

As with previous emergency orders that had to be extended through parliamentary approval, workers’ rights can be swiftly dismantled. Employers can refuse vacation time, disregard seniority, and bring in volunteers for work that was previously done by unionized staff. 

“The government must immediately legislate a care standard”

Sharleen Stewart, president of the SEIU Healthcare union, says the government must immediately legislate a minimum standard of care. SEIU Healthcare along with other unions and advocacy groups support the NDP legislation, Time to Care Act, which would mandate a minimum of 4.1 hours of daily care per resident in line with expert recommendations. 

The Ontario PCs supported the legislation when the bill passed second reading in November 2017, but haven’t taken action on it since coming to power. 

Stewart acknowledges that the staffing shortage won’t be solved by legislation alone, but she says the province must aim to reach a minimum standard within a stipulated period. 

Stewart says legislation must be complemented by a staffing strategy that includes standardized wages, full-time work and good benefits in order to attract new workers and old ones who have left the sector. 

The Ontario Health Coalition points out the British Columbia and Quebec governments’ efforts to address the staffing shortage provide a model for the Ontario. At the start of the pandemic, the B.C. government took over as employer for long-term care workers, standardized wages, and provided them full-time employment.

In Quebec, the government has embarked on an ambitious program to recruit 10,000 PSWs, raising wages to $26 an hour and providing $21 an hour for training.

In February, the Ontario government created a staffing panel that will deliver a report by the end of July.

While the government awaits the report before taking decisive action, the OHC is giving the Ford administration a failing grade on its efforts to address the staffing crisis.

“Staff are working double-shifts”

Anna* is a member of management at a non-profit Toronto nursing home. The home never faced an outbreak because management enacted infection control measures in January, such as limiting staff from working in multiple homes, long before the government’s directives in April.

Even though her home has been doing relatively better and has even been able to provide much needed vacation time in recent weeks, recruiting staff has been a challenge. One reason for the challenge is part-time staff have opted to work for municipal homes or hospitals that compensate much better. In some cases, PSWs are paid up to $10 an hour more in municipal homes and hospitals and even more for nurses. 

The burden has been borne by workers doing double-shifts or picking up extra hours in order to ensure residents’ needs are met, says Anna. 

“And they’re not only doing that because they are so compassionate but because [for some of them] their husbands are not working and they needed to pay their bills too,” she says.

She says one of the issues with recruitment is that all homes have been painted with a broad brush in negative media coverage, when in fact the problems with nursing homes are systemic and they need adequate support from the government.

“Government policies cost lives”

As Rankandfile.ca has previously reported, the structural problems in Ontario’s long-term care sector – chronic underfunding paired with privatization – have profoundly hurt residents, staff and family members. 

Over 1,836 residents have died and the current restriction on family members is heightening isolation and mental anguish and straining workers’ capacities. And yet, there is little action from the government – a running theme for two decades.

“[We can’t forget] the implications of the decisions that were made on people who were at risk in long-term care, and the loss [of life] and the families that are grieving,” says Teresa Armstrong, the NDP’s critic for long-term care. 

“Yes, it’s about funding. It’s also about structural change. But ultimately people die because of government policies.”

*Her name has been changed to protect her identity