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—