Nearly 70 per cent of COVID-19 deaths in B.C. have been residents in long-term care homes. To put it in numbers, according to the Ministry of Health, that’s 115 out of 167.
“This has been an eye-opener for a lot of people,” said B.C.’s Seniors Advocate Isobel MacKenzie. “I think it has revealed some of the fault lines or cracks in the care system for seniors.”
MacKenzie highlights the three different operators for long-term care. There are publicly owned and operated facilities, non-profit facilities and for-profit facilities, and the wage discrepancy for care aides depending on what type of facility they work in can be as much as $7, according to the hospital employees union. The range is between $18 per hour in some privately run facilities to $25.30 in the publicly owned and operated ones.
“What this pandemic has revealed is that good resident care links to both staffing levels, also continuity of staffing, and to the level of training of the staff in the care homes,” said MacKenzie.
These are all issues the provincial government is working on, according to Health Minister Adrian Dix.
“We’re looking at steps to make the system better,” he said.
Province mandates care aides work at one home
In March, the province mandated that care aides must only work at one site.
CTV News Vancouver spoke with a care aide who asked not to be identified for fear of losing her job for talking to media.
“There are still some staff that after their shift in this facility they still have work in (another) facility to keep up with the living expenses,” she said.
Low wages are a large part of the reason for this, the care aide said, but she also cite critical staffing shortages and “excessive workload.”
Enforcing single-site work is a way to limit infection spread and Dix said the single-site order is likely going to be permanent.
“Long-term, I actually don’t see the single-site thing going away,” said Daniel Fontaine, CEO of BC Care Providers Association. “One of the legacies of this pandemic will be we will have a complete restructure of the labour force.”
For that to happen, said Jennifer Whiteside, of the hospital employees union, wages must increase.
“That’s the only way to implement the provincial health officer’s direction is to ensure that all workers are working the same wage,” she said.
Fontaine said if there’s funding from the government to level up the wages, “I don’t think you’re going to get any argument from care providers in this province that it will actually make the position more attractive and will actually get more people in.”
But, he said, simply paying higher wages is not going to solve the problem.
“We had a health human resource crisis before we entered this pandemic,” he said.
Dix said the government has already hired 1,000 new care aides “since the start of the pandemic,” and it has increased the number of care aide spaces in schools to educate a whole new generation of care aides.
MacKenzie said all care homes are already funded by government money. The province invests $2 billion each year in long-term care, with about $1.3 billion going to the private sector.
“To say the solution is not higher wages and that isn’t a part of solving that problem, that sort of defies the logic of supply and demand and labour economics,” MacKenzie said.
The province announced a $4 per hour top-up for frontline health-care workers during the pandemic.
But research associate Andrew Longhurst, of the Canadian Centre for Policy Alternatives, cautioned taxpayers “may be paying twice for staffing.”
Because billions of public dollars are already allocated to the long-term care sector, Longhurst questions whether additional funds should be used in this way.
“We’re talking about topping employers up further to increase wages,” he said. “We’re not provided any certainty that those obligations will be there.”
“It's an economic decision for some people": sick leave needs to change
Another aspect of the long-term care sector getting a second look during the pandemic is sick leave. In speaking with CTV News, the anonymous care aide said she and her colleagues get five paid sick days per year.
"A lot of us don't think about the fact that it's an economic decision for some people," said MacKenzie. “You’ve heard this message very clearly from public health and from the province that we have to support workers not to come into work if they are at all sick.”
MacKenzie said this is another way the pandemic could shape the future of long-term care in BC.
“We normally have influenza outbreaks,” she said. “I’m thinking, you know, if we responded to influenza outbreaks the way we responded to COVID, we might be able to reduce the number, the severity.”
Fontaine said he expects care providers will be open to making changes.
“The whole structure around wages and benefits and that discussion around sick time and making sure that if people are feeling sick – in particular if they’re working with vulnerable populations – they shouldn’t feel like they have to come into work, we never want them to feel that way,” he said.
“We have some collective agreements where private companies will really only provide five or seven days of sick leave,” Fontaine said. “Now, these are health-care workers who are very much at risk, who we’re hearing now of devastating consequences of workers not having adequate sick leave and having to report to work sick.”
Working in health care, in close proximity to so many people, all health-care workers are at a higher likelihood of getting sick, said Whiteside, the union representative.
Premier John Horgan is pushing for a national sick leave program. Details of the plan are unclear, but Prime Minister Justin Trudeau said workers across the country could soon get 10 days of paid sick leave.
The other “inequity,” said Whiteside, is around pensions. She said it makes “no sense” that care aides working at a public facility “can look forward to a dignified retirement,” but those doing the same work at a private facility don’t have comparable benefits or pension plans.
Does profit belong in long-term health care?
Underlying all of these discussions is a more existential question: Should private, for-profit care homes be a part of the long-term care system at all?
It’s a question that continues to be up for debate, but for Longhurst, profit doesn’t belong.
“We’re seeing across the board the vulnerabilities, the gaps, the shortcomings, and really I think shining a light on just how desperate the situation has become,” he said, arguing that the province should use only non-profit and public care homes.
Fontaine said private sector operators give “fantastic care” and – using wages as an example – explained that the homes are all individual enterprises.
“If you take that and extrapolate it, that would mean that every coffee shop would pay the same to all their workers at every coffee shop,” he said. “They’re run by non-profit boards, some are for-profit, some are government operations. They have a different complexity of clientele. It’s not a cookie cutter, everybody isn’t the same, so everybody does come at it a different way.”
MacKenzie doesn’t suggest getting rid of private care in its entirety either.
“First of all, I think that’s not feasible,” she said. “But, what is feasible and achievable is to align the funding and financial incentives that we provide to publicly funded but privately operated care homes to ensure that it’s focused on best care.”
But, it’s important to know where the money is coming from. Whiteside said there’s actually a “very small percentage” of homes that are purely privately funded and run, and more than 90 percent of the nursing home sector is funded – at least in part – with public money.
“We have many more private operators in the system, many more private operators who are needing to make a profit to run their businesses, all being funded by public dollars,” she said.
Longhurst said in all of this we are “on the right track,” but he wants British Columbians to reconsider the values behind seniors care.
“We need to move on bringing long-term care and seniors care more broadly under the Medicare umbrella,” he said.