Thank you for the opportunity to appear on this critical issue.
In the 1980s, the Ontario Pay Equity Commission asked me to study the health sector to see who would be missing from the legislation, a request that began my research into long-term residential care, or what are most commonly called nursing homes.
Most recently I've been the principal investigator on a 10-year interdisciplinary project, called “Re-imagining Long-Term Residential Care: An international study of promising practices”. This research took international interdisciplinary teams, made up of mainly senior scholars, into nursing homes in six countries: Germany, Norway, Sweden, the U.K., the U.S. and Canada. We observed, interviewed and reflected together on what we saw and heard over the week-long span we spent in each of these homes.
In this, and in a number of other related projects, we've confirmed our central assumptions, assumptions I want to set out here.
First, we need nursing homes now and in the future for those who require 24-hour care. Such care cannot be provided in private homes, not only because many people do not have homes or at least homes suitable for such care, but also because the care required is skilled and demanding. Your grandmother and mine never provided this kind of care, because few people lived into old age and even fewer lived with the kinds of conditions and technologies required today. Of course, it is primarily women, unpaid for the work, who provide care at home now, often to the detriment of their health now and in the future. We need to plan for more, and more accessible nursing homes where 24-hour care is provided.
Second, the conditions of work are the conditions of care. These conditions certainly include adequate staffing in terms of numbers, composition, training and continuity. These conditions also include pay and benefits, especially paid sick leave, and decent terms of employment, such as hours of work and shift length as well as choices about them. The conditions involve equipment that goes well beyond the personal protective equipment that has appropriately received so much attention today. It must include such things as lifts and carts, when we think about the health risk to the residents and staff.
However, the conditions for care include much more than that. Reasonable autonomy, the time to provide the care that training and experience have taught workers to provide, and support for teams are critical conditions. Union protections, especially the right to say no to on-site conditions and to the violence that is far too common, are also essential conditions. Similarly, the physical structure of the home, as we've just heard, and its location shape care.
This is not a complete list of conditions that are necessary for care. We have to take all of them into account in planning for care both during and after the pandemic. Otherwise, we will not have a labour force, as the OECD and the ILO recently made clear in their report in December.
Third, these conditions have to take into account all those who live in, provide paid and unpaid work in, and visit in long-term residential care. Our research clearly shows that it is not only direct nursing care that is critical. While there has been recent media attention on cleaning in pandemic times, there has been virtually no discussion of the laundry and dietary services that are also particularly important now but are always essential to care. Moreover, families do much more than provide the hugs that have received so much media attention. They also fill gaps in other care work, as do the privately paid companions many families provide. Volunteers, too, make critical contributions to the social activities and the physical environment, contributions that are essential to care in long-term residences.
In recent years, this unpaid work of families and volunteers, the paid work of non-staff and the unpaid work of paid staff have all expanded to fill the gaps in care, well before the pandemic. We need to address the gaps in care at the same time as we ensure that everyone who provides care has the training required.
Fourth, this is skilled, gendered work. We've heard a great deal about the heroism of these workers, which may end up like Mother's Day, a one-day recognition. Pay equity legislation grew out of research demonstrating that there is systemic discrimination in the labour force. This discrimination renders invisible and undervalues the skill, effort, responsibility and working conditions involved in women’s work.
This is definitely women’s work, whether carried out by staff, contractors, families or volunteers. More than four out of five of those employed in this sector are women, and a significant proportion are new to the county and/or are racialized. There is a faulty assumption that this is work any woman can do by virtue of being a woman. The value of and the skills involved in the labour may be further undermined by the fact that this is mainly women looking after older women.
I am reminded of an interview I did with a human resources manager of a large home in Norway. I asked her what surprised her when she went into the home after working in a major media corporation and she said, “I couldn't believe how hard these women worked.” When I asked what she would do if she was in charge of the country, she said, “I'd pay these women what we pay the men on the oil rigs, because these women work harder.”
We have to recognize this work. We have to support it as skilled, demanding work that carries considerable responsibility. We have to do so not just now but in the future.
Fifth is that context matters. We talk about promising practices in our research rather than best practices because there are often multiple ways of making care conditions as good as they can be. We can learn from other countries and jurisdictions as we recognize at the same time that what works well in Toronto may not work well in rural Nova Scotia. Nevertheless, we can establish broad principles for setting conditions, and we must do so to protect workers, residents, families and volunteers.
Sixth, the search for profit does not lead to better quality care, greater efficiency or more choice, nor do many of the practices taken from that sector. Indeed, such privatization can lead to the reverse. We have to ensure that our public money goes to care rather than to profit, and to democratic decision-making rather than shareholder decision-making. At the same time, we need standards for all homes and to make sure those standards are practised and enforced.
While there are many other lessons we have learned that would take me well over my 10 minutes, let me end by saying this all leads to the need for federal leadership, as many here have said today. I would argue that it should be through legislation that is similar and parallel to the Canada Health Act, legislation that provides conditional funding based on evidence that principles and criteria are followed.
We have a host of research and commissions that provide enough evidence and advice to move forward quickly. However, in doing so, we need to ensure that the voices of those who live in, provide paid and unpaid work in, and visit long-term residential care are heard. We must ensure that nursing homes are not only safe and accessible, but also organized, funded and designed to make life worth living for all of those who live in, work in and visit long-term residential care.
Thank you. I'd be happy to answer any questions.
