The Ontario Health Coalition (OHC) released a sobering report on Wednesday, Jul. 22 revealing systemic staffing shortages in Long Term Care (LTC) homes.
The survey took place during the week of Jul. 10 to 17, 2020 in every region in Ontario. Ninety-five percent of respondents indicated their LTC homes were short-staffed. Fifty-three percent said the shortages occurred daily. Staff reported often missing lunches and skipping breaks, working double-shifts and overtime to make up for the lack of staffing.
Of the 150 respondents, more than 100 indicated that bathing, emotional support and cleaning for residents were regularly missed. More than 50 staff surveyed said they didn’t have enough time for feeding, toileting or repositioning residents.
Sixty-three percent of respondents said staffing levels are worse now than they were before the start of the COVID-19 pandemic, and 28 per cent say staffing levels are the same. New regulations preventing Personal Support Workers (PSW) from working on more than one residence, as well as illness and fear of illness, are reportedly diminishing their numbers.
“There is barely any time for emotional support,” one survey respondent said. “Bathing often gets changed to a bed bath as we often do not have the manpower to have two staff to transfer for a full bath.”
“Resident does not have proper time to eat,” said another. “Providing any emotional support is out of the question. This is unacceptable. When they can’t see their family we are their family. Residents are unsure of what’s going on and to rush them through their day is just plain wrong.”
The Chair of the Provincial OHC board, South Frontenac Deputy Mayor Ross Sutherland, says the findings are not a surprise.
“You have to go back over basically the past 25 years of long term care in this province. We’ve had 20 reports or studies, commissions, etc, done by the provincial government. All of them consistently have said we don’t have enough staff,” he said. “Residents in long term care facilities do not get enough care. There are numerous reasons for that but central of them is: there’s just not enough staff.”
Sutherland said the Kingston region is not immune from the trends in the report. A retired registered nurse, Sutherland worked in emergency medicine, home care and community care in addictions work. “In terms of the staffing shortage, though I can’t give you any local results for the survey, I do know from my previous work, they’re the same here as everywhere else,” he said.
COVID-19 impact on Long Term Care
The COVID-19 pandemic has shone a spotlight on LTC facilities across the country. The first reported death from COVID-19, and subsequent outbreak, occurred in a LTC home in British Columbia on Monday, Mar. 9, 2020.
In the first week of April, a nurse and a doctor in Quebec made national headlines when they came forward describing extreme, horrific conditions of neglect in a facility near Montreal, where staff had abandoned patients in their beds. On April 15, The Canadian Armed Forces were mobilized to reinforce staffing levels in LTC in Ontario and Quebec, as part of Operation Laser.
According to the Canadian Institute for Health Information, by May 25, more than 840 COVID-19 outbreaks had been reported in LTC facilities and retirement homes, accounting for more than 80 percent of all COVID-19 deaths in Canada.
Sutherland said from a COVID-19 perspective, Kingston’s LTC homes have done exceptionally well.
“I think we took a very smart tactical approach which was somewhat unique in the province,” Sutherland said. “They pulled the inspectors out of restaurants and put them into LTC homes, and it made all the difference in terms of protecting residents in those homes. In the immediate sense right in our townships and the municipality of Kingston, we didn’t have that same COVID-19 impact. But you didn’t have to go very far before you hit it.”
Some of the biggest and worst outbreaks were in Lanark and Leeds and the Thousand Islands, he said. “It was right in the neighbourhood, and I think we were well-managed and a little bit lucky that we avoided that.”
Sutherland said individual staff do not bear the blame for the current situation.
“I know from my personal experience that the staff are doing the best they can,” he said. He described the role of PSWs, who bear the brunt of patient care in LTC, as emotionally taxing and generally not well-paid.
“Most people who do that work, they take it seriously, they get to know the residents,” he said. “There’s a fair amount of death. There’s a fair amount of seeing people who are starting to have a really difficult time in their life. They’re starting to hallucinate, they’re starting to lose their mobility, they’re depressed. Not everybody, but it’s a tough time. It’s hard work. And, it’s often physically demanding.”
He points instead to the allocation of resources at for-profit homes, which generate millions in profit per year and yet are chronically understaffed.
“There’s an article in this week’s Canadian Medical Association journal once again documenting the impact of having for-profit LTC homes,” he said. “The article reports three times the number of deaths in for-profit homes than in municipal facilities. That’s just a very consistent finding over the years that this has been studied.”
Another study from BC, he said, found that non-profit and municipal homes spent ten thousand dollars more per year per resident than for-profit facilities.
“Rather than only having money which is spent on resident care, for-profit homes also have to pay investors. Most people on the boards of these organizations, I think 90 percent is the figure I read recently, are not health care people. The biggest portion of people who are on boards of directors of LTC chains are in real estate. And the reason is they see this as a huge profit-making investment for their real estate holding.”
Calling for change
The OHC is renewing their call on the provincial government to mandate a minimum 4.1 hours of direct care per patient every twenty-four hours in response to the crisis in long-term care.
Sutherland said raising wages for LTC staff and increasing their job security will also help.
He pointed to the Quebec provincial government’s response to the COVID-19 crisis as an example. “The government said ‘We’re going to hire ten thousand more people in LTC the next three months, and we’re going to raise everyone’s wages to $25 per hour,'” he said.
More than ten thousand people have already applied. “At $25 per hour you’re starting to move into something which is a respectable job for the level of qualifications that they have,” he said.
“I think that’s not enough still, but it’s certainly better than seventeen or eighteen [dollar wage] which I think most people in Ontario get paid.”
Meanwhile in Ontario, the Provincial government announced construction of new LTC facilities on Jul. 21, which Sutherland said could in fact be a setback.
“They’re not addressing the problem of staffing. What they’re doing is saying they’re going to build more beds. They’ve got the capital funding in place, but then they never put any money into the operational side. You’ve still got the disconnect between building facilities and not being able to attract staff,” he said.
The OHC released an open letter to the provincial government on Wednesday, May 28 calling for immediate reform. Sutherland said now is a good time for constituents to raise their voices and ask for change. “We seem to be at a time of flux, which is great to see,” he said.
“We’ve had good success at the OHC at either stopping bad things or pushing good things,” he noted. “Things do change, especially on an issue like this where there is a lot of understanding that the current system is broken and it needs to be fixed.”
Sutherland suggested that Kingstonians support reforms in LTC by requesting investment in non-profit and municipal facilities, and rejecting new for-profit homes. “We should invest in making sure that the homes that currently exist are providing good care. Raise the minimum wage for health care workers. And I think if you start to put that pressure on the government, things do happen.”