By Zaid Noorsumar
The recent announcement by the Ford government to provide an additional $4 per hour for 16 weeks has been welcomed by home care workers, but they also say the sector needs fundamental transformation.
“It’s a nice little bonus, but it’s not going to come anywhere close to fixing home care,” says Tammy Ladouceur, a personal support worker (PSW) from Orillia who has been working in the sector for 14 years.
Even as they have been deemed essential amidst the pandemic, due to decades of underfunding and privatization, home care workers are poorly compensated, often employed part-time with meagre or poor benefits, may have few or no sick days, and are likely to have a mediocre pension plan – if they have one at all.
And then, there are safety concerns of working during a pandemic.
“Without proper protection”
Home care workers go from home to home visiting seniors and other people with disabilities to provide a range of services, most commonly falling under personal support or nursing care.
Unlike long-term care employees who have been mandated to work at one facility to prevent the spread of COVID-19, home care workers continue visiting multiple clients each day.
COVID-19 has already claimed the life of one home care worker – Arlene Reid, a 51-year old PSW who worked for Victorian Order of Nurses (VON). As of May 6, 2892 Ontario health care workers have been infected with COVID-19 and five have died.
“We are seeing a lot more infected members,” says Tali Zrehen, SEIU spokesperson. “And that’s because the government has not put in stronger regulations when it comes to PPE.”
Even though health care providers account for one in seven Ontarians infected by COVID-19, government policy around distribution and use of personal protective equipment (PPE) appears to based on supply concerns, not scientifically-determined health and safety practices.
Zrehen castigated employers for endangering lives by not providing essential equipment, questioning whether a construction worker would be asked to perform their job without a safety helmet.
“These members are sick and they are dying, and no one is taking responsibility,” she says. “These employers should be held accountable for allowing their workers to service dangerous areas without proper protection.”
Fear and anxiety: “We never know what’s behind the door”
While going into people’s homes carries inherent risks for workers – attacks by dogs, unruly family members, harassment and even sexual assault – COVID brings an additional source of anxiety.
“There is a lot of stress,” says Ladouceur, who is now working a reduced schedule due to lack of child care. “You don’t want to bring that home, but you really don’t want to bring that to seniors. So the distress was twofold because I didn’t want to be asymptomatic and pass it onto seniors.”
In conversations with Rankandfile.ca, multiple workers said they were being asked to use one surgical mask all day and carry it around in a brown paper bag, even as some employers claim they have adequate supplies.
Workers also express concerns that some of their clients and their family members’ lack of adherence to social distancing. In some cases, they have walked into people’s homes to find family members or friends lounging around.
“There’s fear that – ‘Do you have people coming in that I don’t know about that could have possibly contaminated or given you [COVID-19]?’” Ladouceur says. “Because a lot of people just don’t understand how very important it is to self-isolate.”
Linda Soper, a PSW with CarePartners and a chief union steward with SEIU, says some patients may also hide information during the pre-visit screening process due to fear of losing their services.
“We do trust our patients, but sometimes they’re afraid to tell us when we’re clarifying with them if they’ve been anywhere or if they’ve had any visitors,” she says.
“You know, it’s hard for them to say ‘yes,’ because they’re afraid we won’t come. We never know if somebody that has COVID or has been near COVID has been in their home. We never know what’s behind the door.”
The limited benefits of the wage enhancement
Care recipients themselves are afraid of contracting the virus from workers, which is why many have voluntarily asked for suspension of services. This has led to reduction in hours for workers.
Those earning less than $1,000 per month can apply for Canada Emergency Relief Benefit (CERB). However, many are earning far less than their regular income but are still ineligible for CERB.
Mary Johnson*, a nurse, says that workers’ schedules are so unpredictable that they often have little idea what their week looks like until the last minute.
“You’re never really going to know until after you’re paid [whether you were eligible for CERB],” she says. “So then you’re in the position of applying for that, receiving it and potentially having to pay it all back.”
For many workers, the government’s wage enhancement will merely offset the decline in revenues from reduction in working hours.
“I’ll probably break even,” says Soper. “I’m not gonna get any more pay – if I do it’s not gonna be very much.”
The government has also promised a $250 bonus for workers who clock more than 100 hours a month, but many workers are unsure if they will qualify for it.
Moreover, unions point out that even the rollout of the wage enhancement is uncertain, as few details have been provided.
Johnson says that it’s unclear if support staff will be given a wage bump as well. She says the administrative workers who schedule and coordinate with the front-lines should not be left out.
There is also a concern about the notoriously unreliable conduct of some home care employers.
Last month, the Ford government began providing an additional $5/hour to agencies who would deploy workers to long-term care homes affected by COVID-19.
However, those $5/hour were allocated differently by each employer. According to SEIU, some agencies passed along the whole $5/hour to workers while others, like a major for-profit firm, only redistributed $3 to workers.
One of the biggest challenges for most home care workers is that they only receive hourly wages when visiting clients, while also spending unpaid time between patients, extending their working days for little reward.
The travelling in between clients is paid at a very low rate. For instance, CarePartners compensates workers a minute’s pay for every three kilometers plus 38 cents a kilometer. That minute’s pay is 25 cents for a worker whose base wage is $15.44/hour.
When accounting for the extensive travelling, especially in rural communities, workers may effectively earn lower than minimum wage even if their hourly wage may be $17 to $19 an hour.
The travel compensation is onerous and unfair, say workers. It doesn’t reflect the cost of buying and maintaining cars, the time spent in traffic, or the cost of public transportation.
“If you get stuck in traffic, and it’s even if it’s like one kilometer away, but it takes 20 minutes to get there, you’re not getting paid for that at all,” Ladouceur says.
The sector is also already plagued by a shortage of workers but according to Johnson, the additional stress of this crisis will likely worsen the problem.
“We don’t get paid enough for this shit,” she says. “Many of us are talking about leaving the sector after all of this. Some of us are even considering quitting nursing.”
Lucy Morton, a nurse and president of OPSEU Local 269, says the mental health aspect of this crisis needs to be addressed. She suggests workers be provided additional vacation time to decompress when the pandemic is over.
More privatization on the horizon
The compensation model for home care is a reflection of the structural changes introduced by the Mike Harris government in the late 1990s. A mostly unionized and cooperative non-profit sector gave way to a competitive, market-driven model that had for-profits and non-profits competing to deliver services at lower costs.
The restructuring has had catastrophic consequences for workers who are left with low-wage, insecure and mostly non-union jobs.
Instead of addressing underfunding and privatization, the Ford government’s home care reforms found in Bill 175 – which were being rushed through the legislature days before the lockdown – will further reduce accountability and transparency.
Currently, home care is delivered by agencies with oversight by the government through Local Health Integration Networks (LHINs).
But as the Ontario Health Coalition has outlined, Bill 175 will outsource the coordination as well to Ontario Health Teams, which are being run by various for-profit and non-profit agencies.
“There is going to be a big struggle”
Natalie Mehra, the executive director of the Ontario Health Coalition, says that the current crisis has exposed the dangers of privatization and will likely place more scrutiny on such initiatives in the future.
“I believe that there will be more scrutiny of what the government is actually doing in terms of privatizing health care,” she says. “I believe that they will have to be a lot more cautious about it.”
But Mehra also points to the underfunding of health care as a critical problem, which the public has been misinformed about.
“At the beginning of this pandemic, home care growth nowhere matched the number of patients that were being offloaded onto the system,” she says, referring to service reductions failing both workers and patients.
Mehra says that while Ontario has the lowest social spending across Canada (even during the Liberal era), the public has instead been given the opposite impression.
“Ontarians are subject to endless propaganda saying that healthcare spending is out of control when in real dollar terms it has been declining,” she says.
She says that advocates for public health care will need to wage a struggle to ensure adequate funding.
“There is going to be a big struggle about how to pay for continued tax cuts that benefit the wealthy and corporations and funding to support the improvements that are so desperately needed in health care,” Mehra says.
“And that struggle is by no means over. It hasn’t even begun.”