Human Resources Committee on March 21st, 2022

[The Chair, Liberal, Bobby Morrissey]

Thank you, Madam Bisanz.

Now we go to Mr. DaSilva for five minutes.

[Ian DaSilva, Director of Operations, Canadian Support Workers Association]

Thank you.

I'm Ian DaSilva, director of operations for the Canadian Support Workers Association. We represent 50,000-plus to 60,000 PSWs right across Canada. I would like to thank you for having us here today.

Governments, health human resource strategists, labour leaders and advocacy groups have long held that the simple reason for significant staff shortages is low wages. The impact of the COVID-19 pandemic and the current staffing crisis must force us to reconsider our decades-long fixation on wages as the principal driver behind any health care shortages and challenges, as this is simply false and the reason that we are all here today.

The reason is simple: It is the absence of basic professional respect and, most importantly, dignity. PSWs and frontline health care workers deserve a guarantee that their title of personal support worker or other [Technical difficulty—Editor] cannot simply be stolen from them at any given time. In short, title protection provides the professional framework from which professional dignity arises.

Unfortunately, for many Canadian frontline health care workers, this is simply not the case. Sadly, their dedicated time in these roles is increasingly perceived as having been a bad investment, especially as governments and employers refer to them with several different titles. In other words, why hire a PSW when one can hire someone else, calling them something else, to do the job of a PSW for less money?

PSWs across Canada serve as the backbone of the entire Canadian health care system. Personal support workers spend more time with patients. The shortage in our numbers is felt many times over by senior members of the health care team. Consequently, Canada's health care workforce is completely exhausted, creating a vicious domino effect that our health care system may not survive. To reverse this exodus and ultimately stop the cycle, we ask this committee for what we have always asked for and what our members continue to demonstrate to Canada—respect.

Ending this title flexibility will establish the necessary foundation to end the perceived replaceability of these workers. Human resource leaders across Canada remain incorrectly convinced that the solution can be found by simply opening the floodgates to fill these vacancies, but what impact does this have on those who have already paid for their education? Who are these people? Most importantly, what about the patient? At the end of day, it must be remembered that the PSW and the patient are cut from the same cloth. They are the guardians and protectors, and they are the real face of the Canadian health care system.

Patients across Canada in both home and long-term care facilities need to become the focus of government policy in coming years. Governments and advocates regularly tout the need for patient-centred care. This is the concept that our system was originally built upon, but over time it has become hijacked to focus on the needs of the system and its players, effectively making patients the last priority of government and industry planning.

For the past decade, the Canadian Support Workers Association has fielded concerns from families and caregivers expressing dismay at the turnover rates in all settings. The exhaustion of having to explain a health condition in detail, often several times within a 24-hour period, to new PSWs or other workers with another title and less training, becomes an overwhelming experience on its own. This situation is often worse for the sizable population of those with dementia, whose needs for continuity of care are becoming unachievable.

Patients are further disadvantaged by the significant disconnect in policy planning, in that the decision-makers remain very far removed from frontline health care activities. The disconnect only serves to fuel feelings of dissatisfaction from PSWs and those performing the duties of PSWs.

Pursuant to Standing Order 108(2), the Canadian Support Workers Association and its provincial chapters formally recommend that the Minister of Health support the ending of unregulated health care provision in Canada and the recognition of the title of personal support worker. This would be an important first step in ending the constant devaluation of PSW education and in encouraging future Canadians to enter this field.

Most importantly, a professional framework will provide a permanent mechanism to conduit the concerns of patients to the health care system and, most importantly, vice versa. We ask that this government help us make the patient the priority again by making the PSW a profession of choice for Canadians.

Thank you. I'd be happy to answer any questions.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Mr. DaSilva.

We will begin our questioning with Madam Kusie for six minutes.

[Stephanie Kusie, Conservative, Calgary Midnapore, AB]

Thank you very much, Mr. Chair. I'd just like to start by welcoming Marilyn Gladu to the committee.

Marilyn, it's a pleasure to have you here. I know your years of experience will certainly benefit the committee. We're very happy to have you here.

Secondly, I'd like to thank all the witnesses here today, not only for appearing before the committee, but for your dedication to what has been a challenging last couple of years and for your commitment to the most vulnerable who need care. Along with the members of this committee, I am truly grateful for the dedication and sacrifices you and your members make for so many Canadians and their families. Thank you very much for that.

As we begin this study, we are still emerging from the pandemic environment. One of my colleagues on the committee talked about the media stories that appeared at the commencement of the pandemic and the critical stress that put on long-term care facilities and long-term care workers.

My first question is for Ms. Hall.

I would like your opinion as to why we were so woefully unprepared for such a tragedy that hit us.

Thank you.

[Jodi Hall]

I think several factors feed into that. There's been chronic, long-standing underfunding of long-term care across the country, I'd say, at all levels. That certainly created a circumstance where we see an overall weakness.

At the very beginning of the pandemic, homes initially had very limited access to PPE. That was a key challenge at the start.

There was also a delay in receiving specific guidance from the Public Health Agency of Canada for long-term care home operations with the pandemic. A tremendous amount of information was moving from multiple sources. Having timely, scientific-based evidence and information was critical.

There are also the more big-picture questions about the age of the infrastructure we have in long-term care homes across the country. There are many examples of infrastructure that was built decades ago. They were designed for a different generation and a different time. Trying to implement modern infection control and prevention practices became an incredible challenge for some, with the size of hallways, shared dining spaces and even ventilation systems. A number of critical factors played into all of those circumstances.

Certainly the vaccine has been a tremendous advantage and a game-changer for many across the country. Homes are still experiencing outbreaks, but the severity is less. We certainly appreciate the government's efforts in getting vaccines to long-term care residents as quickly as possible.

[Stephanie Kusie, Conservative, Calgary Midnapore, AB]

Thank you very much, Ms. Hall.

Mr. DaSilva, you talked extensively about the ideas of respect and dignity being central, obviously not just for humanity, but for attracting and retaining support workers.

You mentioned both the importance of the title and the necessity of the framework. I was hoping you could perhaps provide more context as to what “respect and dignity” mean to you and your organization, and how they can be tied to the attraction and retention of support workers.

[Ian DaSilva]

That is a primary element of what we're trying to do as the Canadian Support Workers Association: It's to put essentially a fence around that title. Right now, in Canada, there are a number of different titles that can describe the work of the duties that a PSW or a community care aide or whoever perform across Canada.

Within each province, however, the provinces can simply create new titles to redefine that role at their leisure. Right now, we're dealing with.... This sounds like economics, but it's essentially an opportunity-and-cost question. If you have the opportunity to become a PSW and enter health care or not, [Technical difficulty—Editor] investment of time and money, why would you make it into a field like health care for PSWs when that title is not guaranteed? On your first day of work, your boss can say, “Well, I don't want to pay you that much money, so I'm going to pay a dollar an hour less to someone I found in the parking lot who I'm just going to give in-house training to.” That's happening again and again and has been happening for a decade, constantly eroding the value that these people feel on a day-to-day basis.

The senior members of their team and their directors of care can easily tell them, and tell them regularly, “You don't have to be listened to because you can be replaced on a thought.” This is not applied to nurses. This is not applied to doctors or to any other profession except frontline health care workers.

It is impossible to attract people. That's why it's no longer worth the opportunity cost to go into health care versus not going into health care. Until we can actually put a fence around it and guarantee any sort of investment around the title of “personal support worker” in Canada, we can keep dumping money into this and it will continually filter away, because it's a bottomless pit.

Like Ms. Silas and Ms. Stewart were saying, it's a question of what the conditions of employment are. Well, the conditions for a PSW are horrible. They're not allowed to have respect. Their unions may or may not speak for them, because they [Technical difficulty—Editor]. They have no professional association that they're mandated to join, and again, they can be terminated on a thought.

Once you can end that process, embed that title and create a baseline, that's what we need in this province and in this country for our patients and for everybody. We don't have that right now.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Mr. DaSilva and Madam Kusie.

Now we'll go to Mr. Long for six minutes.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Thank you, Chair.

Good afternoon to my colleagues and good afternoon to our witnesses.

My questions will be for Ms. Hall.

Ms. Hall, thank you so much for the work you've done in my home province of New Brunswick on behalf of seniors. It's very much noted and appreciated.

I think it's important, before I ask you some questions, for me to briefly talk about what our government has done on behalf of seniors. Certainly, in going door to door in the past three elections now, we have heard from seniors about their needs. Our government has stepped up, whether it's the increase of 10% for the GIS that financially helped almost 900,000 seniors.... We enhanced the New Horizons for Seniors program by offering a lot of different programs to different non-profits, if you will, around New Brunswick, and across Canada.

Moving forward, we now are going to increase the OAS by 10% for seniors who are over 74 years of age. We issued a one-time payment of $500 in August to OAS pensioners. We rolled back the age of eligibility from 67 to 65, and we're committed as a government to increasing the GIS by $500 for single seniors and $750 for couples. Last but not least, one that's certainly very meaningful to me and to my mom was the increase in the exemption that allowed seniors to earn up to $5,000 with no reduction of benefits, and then a partial exemption for the next $10,000. Those things are extremely relevant to helping seniors.

With respect to long-term care, Ms. Hall, you touched on it in your answer to Ms. Kusie, but I wanted to [Technical difficulty—Editor]. I mean, look, we all recognize as the federal government that jurisdiction is a major issue when it comes to the federal government's involvement in health care matters.

I know you hear that often. How do you think the federal government can help provinces and territories [Technical difficulty—Editor] infection prevention in long-term care facilities and with staffing shortages in the labour market?

Thank you.

[Jodi Hall]

Thank you, Mr. Long, for your comments and for your question.

There are a number of examples, as you've outlined, where this government has made investments for seniors. I know you are continuing to do work to better define abuse. That has some very important legal implications. The funding that was offered for long-term care homes through the safe long-term care fund was absolutely needed and appreciated through the last few years of the pandemic.

Specifically to how the federal and provincial governments work together, it's imperative that this jurisdictional question not become a barrier that stops action, but becomes one that opens engagement. When I talk about a pan-Canadian health human resources strategy, and we see the work that the provinces are doing to recruit.... It's critically important work, but it becomes a situation of too many chefs in the kitchen; we're all bumping into each other and, perhaps unintentionally, recruiting care providers and health human resources experts from various provinces, as opposed to helping to develop the workforce.

There's a great opportunity to develop the domestic workforce capacity that we have. There are many opportunities, whether it is marketing the profession and working on that together or, specifically, working to recruit men to the profession. I've noted that 90% of our workforce are women. There are some really interesting examples that were launched by the government in the U.K. to recruit men into care, which had great success.

As we look to the example of how the safe long-term care fund was structured, and perhaps even to the example of how child care funding is being offered across the country, there are ways in which the federal and provincial governments can collaborate to address some of those key challenges. Of course, the long-term care sector would be very pleased to be part of those discussions and support as well.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Thanks for that answer.

I want to drill a down a bit on staffing shortages. We saw, through the COVID-19 pandemic, the desperate [Technical difficulty—Editor] long-term care facilities found themselves in. It was deplorable.

We've all heard about the role that staffing shortages played in the tragedy, but can you explain to us the direct impact that understaffing has on seniors in these homes?

[Jodi Hall]

We've had long-standing issues with staffing shortages across the country. That's not new. However, it became exacerbated during the pandemic, when we saw examples.... One of the strategies used in the provinces was that staff could not be shared across different employers. That is something that impacted workforce numbers. The emotional impact took its toll on some individuals through the pandemic outbreaks and resulted in some who had to leave and others who were assigned to work from home because of exposure concerns.

When we think about the impact on residents, there were other services and a lot of the elements that we might add for activities that enhance quality of life. We use volunteers for support in many ways, and they were not able to enter the home. [Technical difficulty—Editor] designated support person or essential caregiver role was very important in shoring up those efforts.

The impact of social isolation was something we were all gravely concerned about. We used technology as a way to connect residents with families to the best of our ability, but it was an incredibly challenging situation and there were outstanding implications.

[The Chair, Liberal, Bobby Morrissey]

Mr. Long, your time has gone by.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Ms. Hall, thank you very much for what you do.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Ms. Hall.

Ms. Chabot, you have six minutes.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Thank you, Mr. Chair.

I want to thank all the witnesses.

Ms. Hall, I'd like you to briefly tell us about yourself and your association's role in long‑term care.

My question will focus on two of your recommendations. The first recommendation concerns immigration. According to your recommendations, thousands of qualified health care professionals would be willing to come to Canada if given the opportunity.

Could you elaborate on this?

[Jodi Hall]

The Canadian Association for Long Term Care is an organization that began as almost a networking group in 2002. Since that time we have grown and evolved to become an organization that represents a range of long-term care homes across the country.

We have a mixed membership base of many different types of long-term [Technical difficulty—Editor], and we're pleased to be able to share best practices, create knowledge translation and really do extensive support and engagement among those audiences. As well, of course, advocacy with the federal government is a key focus for the Canadian Association for Long Term Care.

I'm sorry. Could you repeat the second half of your question again, please?

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Could you elaborate on your recommendation regarding immigration?

[Jodi Hall]

Thank you very much.

We have met with the Minister of Immigration and his team. We've looked at the EMPP program—the economic mobility pathways project—which targets skilled refugees to enable them to come to Canada. We believe there is a tremendous opportunity for expansion under that program to connect these skilled refugees with long-term care employers.

We've had conversations with Talent Beyond Boundaries and RefugePoint, and both of these humanitarian organizations do this assessment to identify these individuals who could be and are interested in coming to Canada. That's one example of where we feel there is a great opportunity.

I believe it's already been noted for the committee today, however, that there is more work to be done when it comes to recognizing the credentials of internationally educated nurses. We certainly understand the diligence that's taken to ensure that they are safe practitioners, but we would very much like to see those who are responsible for licensing and regulating the various levels of health care providers reconsider how we ensure that, as much as possible, the processes in Canada are as efficient and as much along the same timelines as are the processes in other countries. As I noted, this is a global competition. It's not just Canada that's trying to recruit these individuals, and it's critical that we look at this situation through this lens.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Thank you.

I have another question for you, Ms. Hall.

According to one of your recommendations, there must be better support for families and community volunteers, in particular. There's also the contribution of family caregivers or informal caregivers.

What have you seen? Are there ways to strengthen the role of these family caregivers?

[Jodi Hall]

The role of volunteers and essential caregivers—or natural caregivers—is so important. We've come to see them as key partners for us in long-term care homes.

I'll use an example from my own province, in which, just prior to the pandemic, it was documented that long-term care homes received 30,000 hours a month of volunteer time. The significance of this contribution to supporting the quality of life for residents is very noteworthy.

I would suggest that equipping employers to strengthen their engagement with the volunteers and essential caregivers is very important. It is sort of left to the homes to find a lot of resources and to offer them specific training and opportunities for engagement and community-based activities that really create a strong link between the residents and their local community, so looking at funding for activities that strengthen and educate these audiences is critical.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Madam Chabot.

We now go to Madam Zarrillo for six minutes.

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

Thank you, Mr. Chair.

I'm going to ask some questions around data and data collection, but I want to start by saying thank you so much to the witnesses, and to express my gratitude to your members and also the workers. I've heard “respect and dignity” over and over again today, and I just want to share some respect and dignity to the workers and members.

I'm going to ask Madam Hall, Mr. DaSilva and then Madam Bisanz to respond.

On the respect and dignity aspect, traditional women's work, paid and unpaid, has long been undervalued, devalued and moving to exploitation, and I appreciate the fact that the witness testimony today will help change that. Going back to the data, around retention specifically, what kind of data should the federal government collect to highlight the reality of working conditions and gaps in compensation for PSWs and long-term care workers?

[Jodi Hall]

The absence of data in long-term care has been a key area of advocacy for the CALTC for some time. It's not only about resident clinical data. There are tools to collect that, but about 32% of long-term care homes do not have access to those tools. When it comes to workforce data, that is where there are really no consistent tools available. We can see in the draft national standards that have been brought forward that this is a key area of focus, but it puts the obligation on the employer to collect the data with tools that we don't have today. There would be a significant investment that would be required.

One thing we have noted is that there could be an opportunity through Statistics Canada to expand the current labour workforce survey that they do now, but in a way that would more specifically target the long-term care sector and bring the data to a disaggregate level so that it could be very specific. Right now, even if data was collected at the home level regarding the workforce, there is no body to report the data to in order to create a national analysis. Making sure that we have tools to collect the data, but also that we have a way to analyze and use it once it's done, are essential next steps.

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

Thank you, and Mr. DaSilva.