Face to face with COVID-19: How do we care for care workers? 

In the midst of a global pandemic, are workers in long-term care (LTC) and home care in Ontario getting the support they need to do their jobs and get home safely? No, they’re not. Not by a long shot.

These workers are on the front lines of the battle against COVID-19 right now, risking their own health to care for those most at risk of dying from the virus—the sick, the elderly, people with disabilities, and the immunocompromised.

The failure of governments to ensure adequate supplies of personal protective equipment (PPE) for health care workers is making headlines right now. SEIU Healthcare union president Sharleen Stewart has likened it to “sending firefighters into the fire with no equipment.” Unfortunately, the lack of PPE—dangerous as it is—is not the only problem LTC  and home care workers face. The COVID-19 crisis has shone a bright light on the structural weaknesses in both systems. 

In Ontario, privatization and chronic underfunding are key drivers of precarious employment in care work. And leading health policy experts have described how precarious employment puts workers and the people they care for at greater risk of infection. 

About 58% of LTC homes in Ontario are for-profit facilities, and evidence shows that for-profit homes have poorer quality of care than not-for-profit homes. Private care providers must make profits, and to boost those profits they cut costs. Underfunding by governments, even in not-for-profit homes, has the same effect  with not-for-profit care managers feeling the pressure to cut costs, too.

In frontline care, cutting costs mostly means cutting staff costs.

A recent Ontario research report on personal support workers (PSWs) attributed the shortages of PSWs in LTC homes to low wages and poor working conditions. The onset of the pandemic has only made it worse

In home care, the province’s system of “managed competition,” where providers bid on contracts to provide home care services, has been an abysmal policy failure. Attempts to improve it have failed: the model itself is the problem.

Increased privatization of home care has been a by-product of managed competition. Statistics Canada data show that 85% of Ontario’s home healthcare providers’ operating revenues went to for-profit providers in 2017 (the most recent year available). Managed competition has also increased staff turnover rates. When wages are low and working conditions are dismal, workers don’t stick around. High turnover and low staff retention are major problems in this sector.

The current pandemic has the potential to make long-standing quality-of-care issues lethal, both to patients and to providers. Simply put, when the people caring for our most vulnerable are paid poorly and must rush from patient to patient under unsafe conditions, the likelihood of transmitting COVID-19 increases.

Workers, advocacy organizations, and even employers have sounded the alarm on the hazardous conditions that LTC and home care workers find themselves in. These conditions put workers’ health, and the health of their clients, at risk. 

Who is working in long-term care facilities and in home care?¹
We used 2016 Census data to look at how earnings in these essential occupations and industries compared to those across the labour force.

Nursing and residential care facilities include both assisted living and long-term care facilities. Home care, sometimes called community care, serves clients in their own homes. 

They both have an overwhelmingly female workforce: 86% of workers in nursing and residential care facilities are women, and 89% of workers in home health care services are women.

Racialized women work in long-term care and home care at about twice their share of the Ontario total workforce. They make up 13% of the total workforce, but 25% of workers in nursing and residential care facilities and 27% of workers in home health care services.

Earnings in long-term care and home care are, on the whole, far below average despite the essential services they provide. The average income in Ontario across all industries was $51,105. Workers in nursing and residential care facilities made 75% of that amount, while those in home health care services earned 77% of that average. 

The data on employment and earnings by occupation paint an even clearer picture.  They show that 89% of nurse aides, orderlies and patient service associates are women. And 91% of home support workers, housekeepers, and related occupations are women.  

Racialized women work in these occupations at nearly three times their share of the total labour force: they make up 33% of nurse aides, orderlies and patient service associates, and 38% of home support workers, housekeepers, and related occupations. 

Looking at earnings by occupation, the low wages are even more evident. Home support workers made 50% of the average income in Ontario ($51,105), while nurse aides and orderlies made 65% of that amount. 

What are their working conditions?
Labour force survey data gives a glimpse into the employment conditions facing these frontline healthcare workers. Workers in “assisting occupations in support of health services” includes a broader range of occupations than just nurse aides, orderlies, and other assisting occupations (although the latter accounts for 77% of the total). These workers are in different institutional settings including hospitals as well as LTC facilities. In 2019: 

  • 24% of these workers had a part-time job;
  • 12% were multiple job holders; 
  • 9% were temporary, term, contract, or casual employees; and
  • their average hourly wage was $21.40, or 76 per cent of the average Ontario wage rate.

What has Ontario done in response to the pandemic?
The impact of the pandemic on workers and residents in LTC are evident. Yet the  Ontario government’s response has been further deregulation of this critically important sector. Premier Ford’s emergency order eliminates training requirements for workers in LTC, allows homes to bring in volunteers, and eliminates the need for administrators to report some complaints to the Ministry of Long-Term Care. 

The provincial government’s announcement of $243 million for surge capacity in the LTC sector is welcome, but it does not address the aforementioned decade-long staffing shortages and issues around quality of care. A further $75 million announced for PPE for frontline staff is also critical, but money alone does not address the immediate need for supplies, especially for workers like PSWs, who are too often left out of the discussion about “frontline” workers.

What Ontario needs to do
The stark lack of PPE is of grave concern. LTC and home care workers need proper protections when caring for such at-risk populations. Ramping up production and funding for PPE is more important than ever. 

Thanks to British Columbia, we also have a clear, made-in-Canada solution to the deeper staffing problems plaguing long-term care and home care. The B.C. government recently implemented a policy ensuring that all workers in long-term care become provincial employees, are hired as full-time workers, are limited to work at one facility, and paid a standardized wage that is equal to the pay that workers in public-sector unionized facilities are paid. 

Ontario should implement this policy for long-term care workers, and bring in a similar policy to increase wages and improve working conditions in home care.

We need increased funding in these sectors, but we also need policy changes that return these essential services to the public sector and improve wages and working conditions. Better jobs mean better care for residents and clients, not only during this crisis, but also well into the future.


Footnotes

¹ The data available at this level of detail is for employment by occupation and industry in 2016, and 2015 annual employment income. We focus on occupations and industries that include workers in long-term care and home care.

We also used 2019 data from Statistics Canada’s Labour Force Survey (LFS) to understand the working conditions and employment circumstances of workers in these occupations. However, this data is available in broader occupational categories that include workers in other related occupations.


Sheila Block is a senior economist with the Canadian Centre for Policy Alternatives’ Ontario office. You can find her on twitter at @SheilaBlockTO.

Simran Dhunna is a CCPA placement student and MPH Epidemiology candidate at the University of Toronto. She is also an organizer with Climate Justice Toronto and Peel.