By Zaid Noorsumar
Part 3 of our Special Investigation into OPSWA
In November 2020, the Ontario Progressive Conservative government finally committed to restoring a minimum care standard in nursing homes. The government’s decision was a response to intense criticism and months of activism by healthcare workers, their unions, family members of nursing home residents, and other advocates.
It was the previous Ontario PC government of Premier Mike Harris which abolished minimum care standards in 1996.
Throughout the pandemic, advocates have been calling for a minimum four-hour care standard, so that residents can get better care and workers can get the support they need.
The Ontario Personal Support Workers Association (OPSWA) has been conspicuously silent on this issue.
In November 2019, when I interviewed Miranda Ferrier for Rabble.ca, I asked her if she supported the four-hour care legislation (NDP’s Time to Care Act), which has been championed by the Canadian Union of Public Employees (CUPE) and supported by many other healthcare unions. Ferrier responded:
We do support it. However, when we spoke with CUPE, there was not a lot of explanation around this four hours of care. So one of the questions that we posed was – where are those four hours going to go? Because it’s not stating that they need four hours of personal support worker care or four hours of nursing care. It just states that they need four hours of care. In long-term care, as you’re aware, there is an envelope system so it’s not clear where that money is going to go. So it was confusing because I said if you guys are really fighting for four hours of personal support worker care, then we are right behind you, boom! But my membership is saying, ‘I’m not understanding, Miranda, what this means because they are not getting enough personal support worker care on there.’
Ferrier says she would support the bill if it called for four hours of PSW care, but no one was demanding that. Long-term care residents, who have very complex needs, require a highly-skilled workforce to care for them. This means different workers provide care for every resident.
The four-hour care standard stems from a 2001 study by the U.S. Centres for Medicare and Medicaid. The study called for a minimum of 0.75 hours of registered nurse (RN) care, 0.55 hours of registered practical nursing (RPN) care, and 2.8 to 3.0 hours of certified nursing assistant (CNA) care. A PSW is the Ontario equivalent to a CNA.
The four-hours minimum care standard is thus based on evidence (although in recent years some researchers have even made the case for 4.6 hours or more). The NDP legislation, however, is flexible on how the care hours are allocated, presumably to not have strict regulations become a barrier to good care (or to passing legislation).
Long-term care workers in Ontario already face among the highest injury rates of any profession in Ontario due to understaffing.
On the matter of the funding “envelope,” it seems Ferrier doesn’t understand how the system works. There are four funding envelopes in long-term care, one of which is dedicated to Nursing and Personal Care (NPC). The Time to Care Act would require four hours of care by nurses and personal support workers, and that’s where the money would go.
OPSWA’s relationship with the business lobby
While Ferrier’s dubious arguments were part of a clash with unions over the care standards bill, OPSWA has established a relationship with the Ontario Long-Term Care Association. The lobby group mainly represents for-profit long-term care operators. It has always opposed a care standard in long-term care.
In April 2019, OPSWA was proudly displaying its booth at the OLTCA’s annual conference. That same month, the OLTCA annual report claimed that long-term care homes had “made great strides” improving quality over the past several years, even as understaffing was leading to alarming levels of violence.
In the same report, the OLTCA argued for further deregulation of the work done by PSWs. As unions and the Ontario Health Coalition pressed for care standards legislation, the OLTCA was lobbying to replace PSWs with lower-trained and lower-paid “resident care aides,” to help further reduce labour costs.
Four hours…by 2024
As mentioned, a strong chorus of voices has demanded a four-hour care standard during the pandemic, including the Ontario Health Coalition, unions, independent family councils and advocates. Neither the OPSWA or OLTCA have been advocates for the standard.
Only when the Ford government finally committed to a four-hour care standard in November did the OLTCA and OPSWA express support (however, the PC government won’t implement the four-hour care standard until 2024-25).
The OLTCA claimed it was a “transformational commitment”. The following month, OPSWA sang the praises of the long-term care minister Dr. Merrilee Fullerton in a government press release about its staffing plan, which only allocated an additional 15 minutes of care by April 2022. Meanwhile, residents were dying in the escalating second wave in understaffed long-term care homes as advocates demanded emergency staffing plans akin to measures taken in Quebec and British Columbia.
This article is Part 3 of our Special Investigation into OPSWA