Status of Women Committee on Oct. 27th, 2020

[The Chair, Conservative, Marilyn Gladu]

I call this meeting to order.

This is my first time Zooming as well as chairing in person, so bear with me.

Welcome to the second meeting of the House of Commons Standing Committee on the Status of Women.

Today's meeting is in a hybrid format, pursuant to the House Order of September 23, 2020. The proceedings will be made available via the House of Commons website. Just so that you are aware, the webcast will always show the person speaking rather than the entire committee

To ensure an orderly meeting, I'd like to outline a few rules.

Members and witnesses may speak in the official language of their choice. Interpretation services are available and, at the bottom of your screen, you can choose the floor, English or French.

For members participating in person, proceed as you usually would when the whole committee is meeting in person in a committee room. Keep in mind the directives from the Board of Internal Economy regarding mask and health protocols.

Before speaking, please wait until I recognize you by name. If you are on video conference, please click on the microphone icon when I recognize you to unmute yourself. For those in the room, your microphone will be controlled as normal by the proceedings and verification officer.

This is a reminder that all comments by members and witnesses should be addressed through the chair. When you are not speaking, your mike should be on mute.

With regard to a speaking list, the committee clerk and I will do the best we can to maintain order, and I think it's much better now that I'm in the room and I can see people.

To begin, let's start first with committee business. You all received a copy of the subcommittee's report from last week—

[Jag Sahota, Conservative, Calgary Skyview, AB]

Madam Chair, I have a point of order. My staff is still in the waiting room and has not been allowed in.

[The Chair, Conservative, Marilyn Gladu]

Clerk, there's someone in the waiting room waiting to get into the meeting.

[The Clerk of the Committee, Ms. Stephanie Bond]

Normally in a public meeting the staff are asked to log into Parlvu and to watch the proceedings on ParlVU. That's the case with public meetings at this point.

Thomas is welcome to go onto ParlVU and watch—albeit there's a bit of a delay—or to use the phone lines.

[The Chair, Conservative, Marilyn Gladu]

For those of you who haven't had a chance to review the meeting of the steering committee, basically we approved all of the motions that were submitted. In short, we like all of those topics, and we consolidated the study on the impact of the pandemic on women and agreed that we would begin with that study.

I think I need a motion to approve the report. If the committee concurs with the recommendations in the report, then we will go ahead and commence our study.

[Some hon. members]

Agreed.

[The Chair, Conservative, Marilyn Gladu]

(Motion agreed to)

Very good.

I also have to ask for the committee's approval. We have a lot of witnesses who were submitted for the list. If we don't make our way through them before the schedule to make the report by the end of the year, we will be requesting briefs from them. Is that agreed?

[Some hon. members]

Agreed.

[The Chair, Conservative, Marilyn Gladu]

Very good.

Our first panel today is on long-term care. Our witnesses are Pat Armstrong, professor at York University; Carole Estabrooks, professor at the University of Alberta; and Jodi Hall, chair of the Canadian Association for Long Term Care.

Welcome to all of our witnesses. Each of you will have five minutes to give a summary, then we will begin our round of questions with six minutes for each party.

We'll start with Ms. Armstrong.

[Dr. Pat Armstrong, Distinguished Research Professor of Sociology, York University, As an Individual]

Thank you.

Thank you for inviting me here to talk about the long-term care labour force. Long-term care is primarily care for older women by women, many of whom are racialized and immigrant. These facts help explain why so little attention has been paid to this sector and so little value is attached to this work. These are care places called “homes”, in part to indicate that people live there for a significant period of time and their care needs are not exclusively medical. This too contributes to the limited attention paid to the sector and to the notion that, just like in the home, this is work any woman can do by virtue of being a woman.

It's taken the high death rates in long-term care during the pandemic, combined with the military reports, to draw attention to both the conditions in long-term care and the skilled nature of the work. The military reports make it clear that the required skills are both medical and social and that everyone working in these homes, including housekeepers and dietary and laundry workers, need specific skills to become part of the care team. Having tempting food appropriately prepared, having knowledgeable assistance in eating, having infectious laundry efficiently handled, and being decently dressed can be just as important as ensuring that medicine is swallowed.

The overwhelming majority of these paid workers are variously called “personal support workers”, “care aides” or “orderlies”. There's no consistency in their formal training or in their access to continuing education necessary to keep up with the ever-increasing complexity of resident needs. Those who work as nurses, therapists, recreation directors and physicians have more formal and consistent education but often lack special training in long-term care. It's obvious that we need to recognize, appropriately value and educate for the specific skills required.

It should be equally obvious that this is demanding work too often carried out under poor working conditions. Compared with other industries, this labour force has the highest rates of absence due to illness and injuries, with back injuries particularly common. Work absence is just one indicator of the risks. Our research indicates that Canadian workers were almost six times as likely as those in Scandinavian countries to say they faced physical violence on a daily basis, even though resident needs are similar. The major differences were staffing levels. According to the Canadian Institute for Health Information, Canada has fewer health care workers per resident than other OECD countries “with a rate that was half as high as the rates in the Netherlands and Norway”. Study after study demonstrates that an absolute minimum staffing is four work hours of direct nursing care per resident per day. No Canadian jurisdiction has such a requirement.

The physical environments also create risks, with toilets jammed into corners, making assistance hazardous, with carpets making pushing a wheelchair back-injuring, and with malfunctioned lifts creating dangers for both residents and staff. The risks are also mental and social, and are also linked to staffing. Going home feeling you could not provide the care your education taught you to provide—that puts enormous stress on both the women and their families. Racism and sexual harassment are common. Death is a daily occurrence. It's frequently the death of someone they know well. They share the grief with the families they also know well.

These are just some of the excessive demands and poor conditions pre-pandemic, which the pandemic has worsened. As we've said for a long time in our research, the conditions of work are the conditions of care. Unions provide some protection for workers' pay, benefits, sick leave and job security, but unions have been less successful in their efforts to get minimum staffing levels, pay equity, more full-time employment and safe physical environments, and to prevent contracting out, often to non-union workers who move from place to place and fragment teams.

The pandemic also draws attention to some ways in which workers' precarity creates risks for residents, as do some government strategies. B.C. recognized that those seeking full pay by working in multiple homes could carry infections with them, raising wages to attract and keep workers. Some even attended to sick leave, day care and transport.

Quebec's offer to train and pay more for 10,000 additional care workers acknowledged the low staffing level.

However, too many of these measures are temporary. They fail to recognize that secure employment in one workplace, with benefits such as paid sick leave, can help not only reduce infections but also provide for the continuity of care and the support for teamwork that is essential to quality of work and—

[The Chair, Conservative, Marilyn Gladu]

I'm sorry, Ms. Armstrong, but that's your five minutes.

I'm going to have to move along to Ms. Estabrooks.

You have five minutes as well. When you have one minute left, I'll raise the good finger. You may begin.

Thank you.

[Dr. Carole Estabrooks, Professor, University of Alberta, As an Individual]

Thank you very much for the invitation.

Let me be very clear: The pandemic did not cause the problems in long-term care, deep-seated attitudes about sexism and ageism did. The pandemic was just the proverbial straw on top of long-term, long-standing neglect.

We have the highest death rate in long-term homes as a percentage of national COVID deaths in the world, over 80%, nearly double the hardest-hit countries. This is both a national tragedy and an international shame.

We've failed older adults who need this specialized care. They have died in excess numbers from both the virus itself and from the conditions it created. They have died alone, afraid, often in great suffering, and in the worst outbreaks, they died of dehydration and starvation in their own excrement. Tragically, disadvantaged women have borne and continue to bear the brunt of the impact of COVID in long-term care.

The residents, the older adults there, are extremely vulnerable: half of them are over 85, and are frail, with many co-existing conditions. About 80% of them have dementia, a progressive life-limiting neurological disease.

In the Canadian population at large, over two-thirds of older adults with dementia are women. In nursing homes, over two-thirds of residents are women, usually women of lower economic means.

However, the population of older adults in long-term care is not a homogeneous group of old white people. The population there is increasingly heterogeneous, as is our general population. These are people with not only dementia, who are not only overwhelmingly female, but also people with disabilities, of various religious and ethnic backgrounds, with and without family, members of the LGBTQ community and so on.

Over 90% of all long-term staff in this workforce, as Pat indicated, are women, with care aides, personal support workers, being by far the majority. They provide 90% of hands-on direct physical and emotional care. They are overwhelmingly female—90% to 95%—unregulated, middle-aged or older, and half are immigrants in urban settings.

The educational standards for this group are not standardized and vary from province to province and are the lowest of any required in the system. They are the most poorly remunerated workers in the system. As many as a third of them worked more than one job pre-pandemic to make ends meet. They work in homes that, pre-pandemic, were underfunded and high-stress environments, and are now facing serious mental health challenges because of the pandemic: anxiety, insomnia, depression, substance abuse, and in the most extreme cases PTSD, which will persist for years.

Our complacency and neglect, our attitudes toward the old and infirm, our attitudes toward women and the work of caregiving, our belief that anybody can care for an old person with dementia got us precisely where we are today—that and our baffling belief that we could manage the system without data.

The problems are solvable, but they are complex and wicked, tangled as they are with practical, readily solvable issues and the much harder to solve deep-seated values issue. However, if we do not solve them, this will assuredly happen again and again. We have thus far failed in our duty to care for our most vulnerable citizens, with particular savagery in some places in Canada. It is incumbent upon us to do better.

What needs to happen? We have to first fix the worst of the workforce conditions. We must help women workers whose children are out of school and whose own parents may need care. We must treat families like families, not visitors. We must have data. For heaven's sake, we need data.

What must not happen is another commission, inquiry, report. We can read the hundred, literally hundreds, that we have done over the years, and they all point to the same solution again and again. We must not favour acute care over long-term care. We mustn't be unrealistic. This is not easy, and it will take resources, and if we engage in endless acrimonious debates over federal issues versus provincial jurisdictional issues, we will not be able to progress.

We cannot solve the immediate or longer-term problems in Canada's care homes if we do not acknowledge and address the highly feminized environment of a long-term care home and what that means, if we do not value the work of caregiving, if we do not value lives that have been largely lived.

Thank you.

[The Chair, Conservative, Marilyn Gladu]

Thank you.

Now we'll go to Ms. Hall for five minutes.

[Jodi Hall, Chair, Canadian Association for Long Term Care]

Thank you, and I appreciate the invitation to appear before you today to discuss the impact of COVID-19 on women and, of course, the long-term care homes right across the country.

My name is Jodi Hall, and I'm here today as the chair of the Canadian Association for Long Term Care, also known as CALTC. We are the voice of quality long-term care in Canada, and our members deliver publicly funded health care services to seniors right across the country.

In addition to being here as a representative for CALTC, I did want to share with you that my roots are in long-term care. I started in high school, when I worked in food services in a long-term care home. Eventually I became a member of the care team and from there progressed to being an administrator of a long-term care home. For the last several years I've served as the executive director of the New Brunswick Association of Nursing Homes. I share that with you to show that my perspective is very operational, and I hope that it is helpful for the committee's perspective today.

There certainly are a number of areas of significant impact for women. As we have heard, this is a predominantly female workforce that we care for, and we commonly see issues related to child care and the many challenges around that, as well as the provision of care outside the homes to other vulnerable individuals, like aging parents. It does have a significant impact on the homes and their overall ability to manage.

I want to start the rest of my testimony by acknowledging the seniors who have lost their lives as a result of COVID-19, and we certainly extend our sincere condolences to families who have experienced a loss in that way.

I'd also like to pause and thank the front-line workers—again, many of whom are women—who continue to this day to provide very compassionate care to seniors in our homes across the country.

Some of these challenges that I'll be discussing have been exacerbated by COVID-19, but they represent many systemic issues that our members have been raising for several years. We believe that if the government had been proactive in supporting the sector, the impact of COVID-19 could have been mitigated.

This is an incredibly painful time for everyone involved in long-term care, including their families and front-line staff, and we fully acknowledge that and hope that our efforts as a nation become far more focused on stabilizing the situation in long-term care as we now face the second wave of COVID.

There have been differences in experiences with this virus among provinces and among individual homes, and that has been impacted by a range of factors—things like aging infrastructure, the staffing situation in individual homes, how rapidly homes were able to access PPE early on, and a host of other things, such as access to infection control specialists.

I'd like to focus the rest of my remarks today on the health and human resource needs. We are at a crisis point in Canada with respect to supply of health care workers in the senior care sector, and this is the critical issue that will make a significant difference for seniors as we respond to COVID-19 going forward. Between 65% and 70% of long-term care residents are women, many of whom have multiple, complex and chronic conditions, including different forms of dementia.

Attracting and retaining individuals who can provide the type and level of care that's needed has become increasingly challenging. Structured education and continued training are required to support health care aides, continuing care assistants and personal support workers—again, most of whom are women—in providing the highest quality of care. It requires a structured governance model to affirm the credentials, the conduct and the competency of these individuals.

To harness this opportunity, the long-term care sector does require the federal government to support policy changes aimed at solving the chronic labour shortage and aimed at supporting individuals to make the choice to have a career in long-term care.

Additionally, specific to COVID-19, the federal government has a role it can play in long-term care, including a dedicated focus on funding for homes across the country. We have been calling for predictable and stable funding for long-term care homes across the country. In our recent budget submission, we asked for $2.1 billion over two years to go to support PPE, staffing and other associated costs related to COVID-19 to ensure the health and safety of residents and our workforce.

We're also asking for additional support for recruitment and retention of infection control experts. We've also—

[The Chair, Conservative, Marilyn Gladu]

Thank you very much. I'm sorry, but that's your five minutes.

We're going to start our first round of questioning, so people can follow up on your comments.

We're going to begin with Ms. Wong, who is splitting her time with Ms. Shin. Alice, go ahead for three minutes.

[Alice Wong, Conservative, Richmond Centre, BC]

Good morning, everybody.

First of all, I would like to thank all the witnesses who spent their valuable time, at this very challenging time, to share their experiences and their views on the very important topic of the impact of COVID on women.

I would like to say that I also come from the perspective of somebody who has visited many long-term care homes before COVID, in a good number of years. Also, even during COVID, I was able to deliver masks to staffers at different seniors homes in the Lower Mainland. I heard them. I saw them. I will definitely appreciate all the good work they've been doing, and all the challenges as well.

Now, with respect to CALTC, Ms. Jodi Hall, I believe your association has written a letter to the Prime Minister stating that long-term care should be included in any statement of shared principals, and that long-term care homes be a top priority in a shared health system planning on moving forward. That is something you wanted the Prime Minister to ensure.

I just want to know whether you received any response from him.

[Jodi Hall]

A response was received just recently, kind of acknowledging the requests and creating an opportunity for us to have an exchange with the employees of the office going forward.

[Alice Wong, Conservative, Richmond Centre, BC]

Thank you.

My next question is on the importance of an holistic approach, like the one you've outlined in your letter.

How important is it not to look at one facet only, but holistically?

[Jodi Hall]

Yes, we completely agree with that, especially when we consider the needs of our workforce, which again is predominantly female. Their needs often extend outside of the home itself, as they continue to provide care to children, to aging parents and to other vulnerable individuals. Considering things like how we support them in these areas is critically important.

[Alice Wong, Conservative, Richmond Centre, BC]

Thank you.

Caring for the carers, in other words, means we don't only care for those who need care, but those who are giving care. We call them “carers” using the British term. We do need to care about them as well, and also about the families that have been affected, definitely. Thank you for restating that.

Now, with respect to federal money, I know that you also have specific concerns regarding federal dollars being invested in long-term care to help seniors. Do you think the federal government has already committed to increased funding?

[Jodi Hall]

Well, certainly we acknowledge the assistance that's been given with the safe restart agreement money. That hasn't always translated...or it has translated differently in each province, if I can express it that way. The homes in each province have not all necessarily received the funding that was given. We're still working towards achieving that. We are forecasting that in the next few years, the needs will be much greater. Although we appreciate the safe restart money as a start, we know that much more support is needed as we face COVID-19 in particular, but also the systemic challenges that existed long before we were faced with a pandemic.

[The Chair, Conservative, Marilyn Gladu]

Very good.

Now we will go to Ms. Sahota for the other three minutes.

Thank you.

[Jag Sahota, Conservative, Calgary Skyview, AB]

Good morning, everyone.

Thank you for your time, for being here and for everything you guys are doing.

I have a question for you, Ms. Hall. On your website, your organization has listed several priorities, one of them being “three critical areas where federal policy changes and investments will make the largest impact on the quality of life for seniors living in long-term care”, those being “health and human resources...infrastructure, and digital solutions”.

Could you please expand on those?

[An hon. member]

Madam Chair, we can't hear the witness.

[The Chair, Conservative, Marilyn Gladu]

You're on mute, Ms. Hall.