As the numbers are updated with frightening regularity, it’s becoming clearer that Canada’s long-term care facilities will be on the front lines in the battle against COVID-19 until we develop and distribute a vaccine.
Even as jurisdictions slowly lift restrictions in a bid to open up their pandemic-battered economies, moms, dads, aunts, uncles, sisters and brothers in nursing homes will remain cloistered, hostages to this deadly foe.
What remains unclear is whether there will be a meaningful discussion about ways to improve the level of care delivered at homes that for years have been hampered by staff shortages, inadequate funding and a lack of attention from policy-makers and politicians.
Public records tell a large part of the story that should have been evident and concerning.
In 2005, an inspection at a Calgary facility cited comments from the spouse of a resident who said “…the care staff are so very busy that I know that if it wasn’t for my being here every day, my husband would not still be walking, and he would be much thinner. The staff just do not have time to spend with him. I help out with other residents as well. Something should be done about increasing the staffing.”
Then, on January 8, 2020, 15 years later in another part of the country, this excerpt from an Ontario nursing home inspection report:
“During the interview with the acting (director of care), they indicated there were a number of vacancies for (personal support workers) that had not been filled…The acting (director of care) also indicated they also used a number of agencies… to replace the PSW shortages…The acting DOC confirmed awareness of several dates when the home was working short staffed of (personal support workers) and resulted in bathing not being provided as a result.”
In the lead-up to my previous investigations into long-term care when I was at the CBC, I read countless reports that recount similar problems.
None of this comes as a surprise to Lindsay Couture, who, after three years as a personal support worker at an Ontario nursing home, burned out from working too many double-shifts.
It's unclear whether there will be a meaningful discussion about ways to improve the level of care delivered at nursing homes as COVID-19 continues its deadly path.
“None of (the residents) were cared for the way they deserved to be cared for,” she said in an interview with National Observer.
“You had so many residents and so few personal support workers.”
Couture made sure to emphasize that safety always came first. But sticking to that priority list came at a cost.
“To be honest, the people who are the most sick and confused got forgotten because they weren’t the ones who were able to voice their concerns. It breaks your heart.”
Couture says more staff would help, evidenced by Quebec and Ontario calling in the military for reinforcements in the most acutely affected long-term care homes.
To be sure, many personal support workers are being hailed as heroes for their continued dedication, even as they recently mourned the passing of one of their own, Christine Bacalocos Mandegarian, the personal support worker who died from COVID-19 on April 15.
Governments under fire for their neglect
During his April 15 daily briefing, Ontario Premier Doug Ford called the situation a “wake-up” call. Minister of Long-Term Care Merrilee Fullerton, a medical doctor, said they would “spare no expense.”
On the same day, Nova Scotia Premier Stephen McNeil vowed to “look at new protocols” after the crisis is over, acknowledging the dangers of putting too many residents in one room.
On April 16, Prime Minister Justin Trudeau said we need to do “better,” signalling that the federal government would help to subsidize temporary wage increases for nursing-home staff.
On April 17, Quebec Premier François Legault vowed to shift into “problem-solving mode,” as he told reporters about the need to increase wages for personal support workers.
On April 25, Ontario announced a salary top-up.
While governments are receiving credit for their short-term response in the court of public opinion, legal battles loom.
‘Defendants breached their duties of care’
Last Friday, a proposed class-action lawsuit was filed against Responsive Group Inc., a company that owns several nursing homes in Ontario. Among other things, the suit alleges that the “defendants breached their duties of care… by failing to ensure adequate staffing within the Homes to care for elderly residents.”
None of the allegations have been proven in court, and Response Group Inc. must still file a statement of defence.
However, in a statement to National Observer, a company representative wrote that in the meantime, “We continue to work closely with government(s), public health units and our other health-care partners to accelerate testing, initiate outbreak protocols, and comply with directives.”
Even though it is not named in the lawsuit, critics have blasted governments such as Ontario for dropping the ball well before the pandemic struck.
Though it neglected to comment on a matter before the courts, as governments usually do, the Ontario Ministry of Long-Term Care said that it is giving long-term care homes the tools they need to fight back.
“We have taken significant actions that include our aggressive COVID-19 Action Plan for Protecting Long-Term Care Homes, four emergency orders, two packages of amended regulations, and $243 million in emergency funding,” wrote spokesperson Macey Aramburo in a statement to National Observer.
“These measures ensure all long-term care homes have the flexibility and funds to rapidly hire and retain nurses, personal support workers, and other front-line staff they need, when they need them.”
As far as Ian Da Silva is concerned, the fact that personal support workers, who comprise the bulk of the staff at long-term care homes, are overworked, under-paid and under-valued has been known to successive provincial governments for many, many years.
As director of human resources for the Canadian Support Workers Association, he has seen the problems play out the same across the country.
In Ontario, occupying the same position with the Ontario Personal Support Workers Association, he has been demanding action.
A regulatory college for personal support workers, he argues, would address issues such as working conditions, qualifications and pay.
“We need to establish protection for this group of workers,” Da Silva said in an interview with National Observer.
“What we’re essentially asking (PSWs) for the last ten years is, ‘Please come to work for us. We’re not going to pay you a lot. We’re not going to treat you very well. You’re not going to have a lot of rights.’ And then that conversation ends. That’s what (employers) have been advertising.”
The pandemic’s legacy
Still, advocates such as Da Silva see an opportunity while governments are scrambling to keep residents in long-term care homes alive.
He’s encouraged when he hears Fullerton, Ontario’s minister of long-term care, who he says has been a strong ally, vow to “spare no expense.”
But the proof will be in the quality and depth of the political discussions that take place once the first wave — and perhaps a possible second wave — of the pandemic have passed, and scientists develop the hoped-for vaccine.
It will be interesting to see if the various lessons-learned exercises will take heed of the overwhelming evidence buried in all those public records: the inspection reports; auditors general reports; work-loss data due to illnesses and injuries; and Statistics Canada’s table that tracks deaths among the elderly in care facilities due to communicable diseases.
For Couture, the personal support worker, anecdotal evidence was enough to prompt her decision. She quit her job at the Ontario nursing home where she worked for three years, took a much-needed break, and then decided she still wanted to be a personal support worker after all, but under different conditions.
Now, she runs her own company that delivers services to seniors and other clients in their homes. And, as fate would have it, she’s also helping out in long-term care homes.
Her message to the lawmakers and bureaucrats who have promised to make changes?
“It should have never gotten to this point. We should not have been this low on personal protective equipment. We would never send a firefighter into a burning house with no oxygen mask or hose. We would never send a cop into a gun battle without a gun or a bullet-proof vest. So why are we sending health-care workers into their (workplaces) unprotected?”