Human Resources Committee on March 21st, 2022

[Bonita Zarrillo, NDP, Port Moody—Coquitlam, BC]

Thank you, Mr. Chair.

Thank you to the speakers who came today. I appreciate the witnesses' shining a light on care work being gendered.

Traditional women's work has been undervalued for too long, and it is now moving into exploitation. That's no accident, based on long-standing gender discrimination, and it's even worse for intersectional women, immigrant women and women of colour.

With care work making up 8% of GDP and with an aging population, the care economy has the potential to grow exponentially. We know that we need the workforce behind it.

My questions for the witnesses are around privatization. There's been some move toward privatization in this area. I would like to hear from each of the witnesses on how privatization has impacted the quality of care and the working conditions for the workforce in the care economy.

[The Chair, Liberal, Bobby Morrissey]

Have you directed that question, Ms. Zarrillo?

[Bonita Zarrillo, NDP, Port Moody—Coquitlam, BC]

I would ask Madam Silas first, and then perhaps Mr. Bolduc and, if we have time, Ms. Stewart.

[Linda Silas]

For us right now, it's the crisis in our long-term care and home care sectors. There's a lack of transparency of where public dollars are going to in these private agencies. Ms. Stewart will be able to talk about the research they've done in the private sector and in home care and long-term care, but for our nurses, it's the agencies. We're seeing nursing agencies popping up across the country. They're paying double or triple the salaries. Nurses are not working in their communities anymore, because they're too tired of the awful working conditions within our long-term care and acute care sectors. They just go to an agency. I mentioned that in my introductory comments.

I commit myself to an employer. They cannot work with me to improve my working conditions, and then have my co-workers just leave for an agency. That is opening the door for more privatization of our acute care sector, and that's where we're talking about our critical care nurses, where the specialization is extreme. With our emergency nurses, again, the specialization is extreme. Honestly, they're paid by us, the taxpayers, and now they're going to agencies.

I'll keep it at that. We have many studies on the negative effects of privatization in health care, such as an education that we need to keep the five principles of the Canada Health Act solid. It's the role of the federal government to protect them.

[Denis Bolduc]

First, health care is a public service. I have a real issue with austerity measures, budget cuts and so on. Before the health crisis, the system had been struggling for years. When the crisis hit, the system couldn't respond properly. What was done? People turned to the private sector and then said that this approach worked. Yet it didn't.

In Quebec, people turned to employment agencies to find staff. These agencies [Technical difficulty—Editor] not provide a public service. It costs twice or three times as much. Every time, we enter a vicious cycle where the private sector seems like the rescuer. However, the reality is quite different. In reality, the public health sector is overlooked. When things go wrong, people turn to the private sector. They then claim that this approach works.

Increased reliance on the private sector further weakens the public sector. We must stop this vicious cycle and focus on the public health care system. It must be given the resources required to carry out the work and to provide these services to the community, to the public.

Clearly, both health care and education services must be provided as public services, not for profit.

[Sharleen Stewart]

I'm going to proceed until I'm told we don't have time.

I just want to remind people again of Pat Armstrong's words, “The conditions of work are the conditions of care.” As a reminder, compared to the OECD average over the last couple of years, Canadians had fewer care workers per 100 [Technical difficulty—Editor]. When you cut corners, when you put profits before people, and when you put your shareholders' money before the care that you provide to our senior residents, the outcomes are going to be exactly what we saw. We performed worse [Technical difficulty—Editor] put the respect and the dignity back into care. That starts with caring for the patients, residents and clients, but also for the people we rely on to care for our loved ones.

The conditions of care have to improve through improving the conditions of work and improving the wages.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Ms. Stewart.

Thank you, Madam Zarrillo. Your time is up.

Now we go to Madam Gladu for five minutes. You have the floor.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thank you, Mr. Chair, and thank you to our witnesses for being here today.

When I was on the health committee, we did a study on long-term care and some of the factors affecting it. Nurses and PSWs were part of that. I believe Ms. Silas gave testimony there.

With respect to the 50% turnover of nurses, it was true then, as well. I just want to see whether the factors that were contributing to that are the same. At the time, for nurses and PSWs, it was violence in the workplace, working conditions like mandatory overtime, and non-competitive compensations that were driving a brain drain to the U.S.

Ms. Silas, is that still the scenario with respect to the nurses?

[Linda Silas]

Thank you, Ms. Gladu. I hope your daughter is doing well in nursing.

Right now, it's the understaffing. Among our members, 83% are telling us they are working understaffed every day. That means every day they go into work unable to provide great care—they're not able to do their job properly. That is number one, followed by violence. Respect would be the third one, which I would put in with a competitive salary.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

It's really unfortunate, then, that we fired so many nurses and PSWs for being unvaccinated. That certainly made a bad situation even worse.

In terms of recognizing credentials across provinces, is there adequate recognition of credentials for nurses, and are we graduating enough nurses to really meet the demand?

[Linda Silas]

I'll start with your last question, on whether we're graduating enough nurses. We honestly don't know. That's why we're asking the federal government to do something similar to what they did with the building trades. Do a BuildForce. Do an agency to see how many RNs we need. How many personal care workers do we need? How many doctors do we need, or how many respiratory technicians? The numbers go on. Right now we know that we have a shortage. Every vacant position in the province means they'll stay vacant for at least 90 days. That means 90 days of extra overtime. That increases the burnouts.

In regard to vaccinations, which was your first comment, I wouldn't worry that much. Not many got fired. Many got put on leave of absence, but the number was very, very small. We're talking similar to the population of Canada, around 8%, and that's about it. Our unions are working with the employers to provide alternate working arrangements. Some are still on leave of absence, but that's a public health crisis and a public health decision.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Bolduc, you spoke of the need for nurses. Would immigration be a way to meet this need?

[Denis Bolduc]

Immigration is one solution, but it isn't the only way to improve the situation.

In the immigration process, there should be a better way to process applications for permanent residence. We hear every day that processing times are extremely long. To improve the situation specifically in the health care field—and this is true for most professions as well—there should be better credentials and skills recognition for immigration applicants who want to settle here and help [Technical difficulty—Editor]. There should be a review of the conditions for the recruitment, intake and processing of foreign workers in the country.

Temporary foreign workers are in high demand in specific sectors. These workers are often tied to a single employer. We're asking that these people be allowed to have open work permits, so that they can change employers if the conditions aren't suitable. Sometimes, a worker may be in a workplace and the situation may be less than ideal for various reasons. Under the current system, these workers are—

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

I must interrupt you, because my time is up. Thank you.

[Denis Bolduc]

Okay, thank you.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Madam Gladu and Mr. Bolduc.

We'll now go to Mr. Collins for five minutes to conclude the first round.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thanks, Mr. Chairman.

My questions, first and foremost, are for Ms. Silas. They're related to the whole issue of recruitment.

You were very clear in your opening statement, when you identified both recruitment and retention issues. Many of the questions posed to you this morning have revolved around the retention issue, but I want to speak to recruitment. I know our government has made some substantial investments in that area. I was hoping to get your understanding in terms of what we can do to encourage more people to enter the profession.

Ms. Silas, the foreign credential recognition program is currently active in many provinces and territories. I think it's to everyone's benefit that we integrate internationally trained immigrants into the workforce. There are literally thousands of foreign-trained doctors and nurses who are waiting to provide their expertise and their training, and for it to be recognized here in Canada.

I've been wondering about that program. I know the minister recently made another very large announcement of $26 million for 11 programs related to the same. Do you see the foreign credential recognition program currently working? Is there more we can do in that area to bolster the numbers on the recruitment side of the labour shortage issue?

[Linda Silas]

First, we need to turn the dial on their working conditions and the stories that are coming out. That's the number one reason they're not staying. We've seen federal government programs and provincial government programs to educate more personal care workers, and the last statistics I heard were that only 30% of them stayed after they entered.

It goes back to what Ms. Stewart was saying: the conditions of work. The conditions of work will be the conditions of care and will be the conditions for retention. That's why I stress so much retention and recruitment first. If we don't change the retention aspect, we will never be able to recruit.

In regard to the internationally educated health professionals, you see doctors, nurses and respiratory technicians. Again, the list is long of those who need credentials, who need a licence to practice. We need to standardize that. As for the way to standardize that, Mr. Bolduc talked about it a bit. We need to make sure that before they enter the country they know what will be expected, and that we help them.

I was very pleased last Friday to hear that my home province of New Brunswick is looking at “earn to learn” programs. It's at its newest beginning. How can we integrate internationally educated health care workers into a program where they will be able to pay the bills, get their credentials and get a permanent job in our system, a permanent job they will stay in?

It's a lot of work, but I think it can be done.

[Chad Collins, Liberal, Hamilton East—Stoney Creek, ON]

Thank you for that. I have a subsequent question for you, Ms. Silas.

I've always felt it very important that all levels of government provide as much support to students as possible in order to help them complete their studies. I know the government has invested tens of millions of dollars for thousands of students who are currently enrolled in study here in Canada. I know those investments are made to give them a better chance to complete their studies.

On the whole issue of investing in our students, we have the programs. Could you comment on those that are in place and what you think we could do more of or where we could place more weighted investments in students in provinces across the country?

[Linda Silas]

Thank you.

When you're in a crisis, paid education programs and paid preceptor programs are very important. Those programs that exist are in pockets here and there. They are pockets that exist if an employer has applied for it or a sector [Technical difficulty—Editor] has applied for it. They're not generalized. I think your committee needs to look at what the federal government can do that is similar to the EI programs.

I always bring this up to the committee, and we've been bringing this up to the health committee and the human resource committee for over 20 years. When you're a plumber in this country, you can apply with your employer to get a higher level of credentials in your domain and be paid by EI. When you're a health care professional or a health care worker, you cannot do that. We need to look at those different rules to be able to bridge our population, to bring our workers a step up. I know a lot of personal care workers who want to become licensed practical nurses. Why can't they do it while they're working? For licensed practical nurses who want to become registered nurses, why can't they do it while they're working?

We looked at those programs in the early 2000s. It's time we looked at them again and that this time we implement and fund them.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Madam Silas and Mr. Collins.

That concludes the first round of witnesses.

On behalf of the committee, I want to thank Madam Silas, Mr. Bolduc and Madam Stewart for presenting to the committee this morning with your expert opinions. Thank you so much.

We will now suspend for a couple of minutes while we transition to the second group.

[The Chair, Liberal, Bobby Morrissey]

I call the meeting back to order.

I would like to make a few comments for the benefit of the witnesses.

You may speak in the language of your choice. Interpretation services are available for this meeting. You have the choice at the bottom of your screen of floor, English or French audio. Before speaking, please wait until I recognize you by name. If you are on the video conference, please click on the microphone icon to unmute yourself. When speaking, please speak slowly and clearly. When you're not speaking, your mike should be on mute.

I would like to welcome the witnesses to begin our discussion. Each of you will have five minutes for your opening remarks. I will ask the witnesses to honour the five minutes, because I will cut you off at five minutes for the benefit of the committee members.

We have Jodi Hall, chief executive officer of the Canadian Association for Long Term Care; Christina Bisanz, chief executive officer from CHATS, Community and Home Assistance to Seniors; and Mr. Ian DaSilva, director of operations from the Canadian Support Workers Association.

We'll start with the Canadian Association for Long Term Care for five minutes. Following the opening remarks from the witnesses, we'll open the floor to committee members for questioning.

Ms. Hall, you have the floor for five minutes, please.

[Jodi Hall, Chief Executive Officer, Canadian Association for Long Term Care]

Members of the committee, thank you for inviting me to appear before you today to discuss Canada's long-term care sector, the challenges with labour shortages and the opportunities for urgent action. My name is Jodi Hall. I am the CEO of the Canadian Association for Long Term Care, also known as CALTC. CALTC is committed to advocating for quality long-term care for all. We support the sharing of knowledge, insights and best practices to ensure that seniors can live and age with dignity.

I want to thank the frontline staff and long-term care leaders who have continued to provide care to long-term care residents throughout the pandemic. This has been a very difficult and painful experience for everyone in long-term care, and at the committee today I want to acknowledge their dedication to their work.

To begin, I'll provide an overview of current facts regarding the long-term care workforce and outline areas where we see opportunities. The most current data from StatCan indicates that in the third quarter of 2021, there were over 30,000 vacant jobs in nursing and residential care homes across Canada. To give a provincial picture of this, there are 3,400 vacant positions in care homes in British Columbia, a number that has nearly tripled in the last five years.

We know that as our population continues to age, this brings not only expectations for increasing demand for long-term care beds but also an expectation that the long-term care workforce itself will face an unprecedented number of retirements over the next decade. For example, in Ontario, 25% of the 50,000 PSWs who work in long-term care are in their mid-fifties. On average, over 90% of the long-term care workforce in Canada is female. In Nova Scotia, over the last 10 years, there's been a 38% decrease in the number of certified care assistants, also known as PSWs in other provinces.

Among OECD countries, it can be projected that the number of employees in the sector will need to increase by 13.5 million by 2040. This is an important consideration for Canada in terms of how we will attract skilled immigrants in the context of global competition.

There are many examples of long-term care homes across the country that have closed beds as they do not have the staff to operate them. Currently, 19% of the homes in the province of Nova Scotia have closed admissions due to the lack of staffing.

With the few examples I've offered from across the country and the many reports from CALTC members, it is clear that we are at a crisis point in long-term care staffing, which is raising questions with regard to how we will sustain long-term care in Canada. Staffing shortages in long-term care are not new to the sector, and this has been a long-standing priority. Over the last few years the situation has intensified. It has been difficult to tell the story of long-term care and our workforce, as the data that is available is limited and difficult to compare provincially, and there is no central collection to create a national picture.

We are seeing investments being made by both provincial and federal governments to support recruitment efforts. There are examples of innovations such as the work and learn program in Nova Scotia and tuition coverage for personal support worker training courses in many provinces. There is concern that as provincial efforts increase, competition will also increase and ultimately not result in an increase nationally.

We would suggest that there's an important role that the federal government can play in bringing provinces and the long-term care sector together to create a coordinated team Canada approach. The creation of a pan-Canadian health human resources strategy that allows multiple stakeholders to work together in a coordinated way would be a significant step forward.

Despite these challenges, there are opportunities to better understand and make targeted investments. We need to improve data so that we understand our challenges and how to address them. Domestic workforce development needs to address barriers to HHR education—health human resources education—and promote long-term care careers. We need to support the current workforce to improve retention, with targeted funding for mental health supports, and to address workload through increases in hours of care.

As for immigration, we know that there are thousands of qualified health care professionals who'd be willing to come to Canada should avenues be available to them. We must also provide better support to those who contribute to the care economy in long-term care homes, such as family and community volunteers. I'd be happy to speak further to these specific examples.

In closing, we strongly urge the federal government to consider the opportunities that we have noted and to act with urgency, in recognition of the emergency situation that we are facing once again in long-term care.

Thank you for your time. I'll be pleased to address any questions.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Madam Hall.

Now we go to Madam Bisanz for five minutes.

[Christina Bisanz, Chief Executive Officer, Community and Home Assistance to Seniors]

Thank you very much, Mr. Chairman and honoured members of the committee.

I'm Christina Bisanz. I am the CEO of CHATS, Community and Home Assistance to Seniors. I want to thank you for the invitation to be here, and especially to thank Mr. Van Bynen for his encouragement and requesting this opportunity for me to speak with you today.

Your study of labour shortages, working conditions and the care economy couldn't be more timely, and we sincerely thank you for making this matter a priority.

CHATS supports approximately 8,500 seniors and their caregivers across York Region and South Simcoe by providing a full continuum of home care and community services. Our mandate is to advocate for and deliver high-quality home and community supports to enable our clients to have the dignity and choice to age at home. We believe that older adults live best at home and in their communities.

There is an abundance of evidence to demonstrate that this goal is entirely possible with the right supports in place. Keeping people at home significantly alleviates pressure on hospitals and long-term care, but our ability to recruit and retain the necessary frontline workers is severely threatened, and we are facing a crisis in care that has only been made worse by the pandemic and the public policy response to it.

The staffing crisis in home and community care is not new news. For years our sector has been sounding the alarm with the low labour supply of personal support workers and other staff. We're seeing increased retirements due [Technical difficulty—Editor] workforce that is not being replaced through new enrolments in PSW programs. Half of new graduates leave the sector entirely due to working conditions and low pay. The lack of guaranteed hours and the part-time, shift and weekend work make it challenging to earn a decent income. A vehicle is required to drive long distances to serve multiple clients, especially in rural areas, and mileage reimbursement has not kept pace with fuel costs, especially now. Frontline staff in home and community care are the lowest paid in the entire health care system.

Recently the Ontario Community Support Association, which represents CHATS and over 200 other non-profit organizations, conducted a member survey that showed that staff vacancy rates for 2021 had nearly tripled. PSWs and nurses are leaving the community sector in droves, many to other sectors where there are incentivized opportunities to shore up their income.

It makes little sense that workers in a sector that has shown an incredible ability to support people to stay in their own homes are barely considered in health human resource planning or funding.

Public policy decision-making continues to disregard and overlook the value, efficiency and effectiveness that home and community support services deliver to the health system and to the quality of life of the persons served.

For example, the Ontario government recently announced additional hands-on training opportunities and further incentives for more PSWs and nurses in the long-term care sector. We all agree that our health care system is in dire need of many more well-trained staff to help address the tremendous resource challenges, but by announcing these incentives for PSWs and nurses in long-term care only, the provincial government is amplifying the very staffing issue that is eroding the health care safety net of home and community services.

What does that say about the value we attach to the frontline heroes who enable people to live in their own homes rather than in more costly long-term care institutions and hospitals? In Ontario, billions of dollars are being pumped into building more and more long-term care beds, with little investment being considered to reduce the need for some of those beds in the first place.

By ignoring the impact of such decisions on equitable workforce resource allocation, the home and community sector is hit dramatically on the recruitment front, placing greater demand on burnt-out health care workers, overwhelming family caregivers, exacerbating wait-lists for services in the community, and increasing risks and costs to the most vulnerable in our society.

This committee can demonstrate the leadership we need for a comprehensive health human resource strategy that builds capacity across all sectors, so we can meet the growing demand for services that keep people living well at home and in their communities. However, getting there will require collaboration among the sectors and all levels of government to address [Technical difficulty—Editor] as one comprehensive continuum, rather than looking at our health human resources in silos.

I thank you and look forward to your questions.