tag:theconversation.com,2011:/us/topics/personal-support-workers-87440/articlespersonal support workers – The Conversation2023-02-21T18:46:42Ztag:theconversation.com,2011:article/1992402023-02-21T18:46:42Z2023-02-21T18:46:42ZWorking more and making less: Canada needs to protect immigrant women care workers as they age<figure><img src="https://images.theconversation.com/files/510403/original/file-20230215-28-28mmto.JPG?ixlib=rb-1.1.0&rect=44%2C152%2C5946%2C3835&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Immigrant women working in the care sector do the essential work many Canadians rely on, but low wages mean many need to work past retirement age.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/working-more-and-making-less--canada-needs-to-protect-immigrant-women-care-workers-as-they-age" width="100%" height="400"></iframe>
<p>The pandemic has heightened Canadians’ awareness of the 3D jobs — <a href="https://calgaryherald.com/news/local-news/immigrant-women-face-dangerous-working-conditions-in-long-term-care-u-of-c-researcher">dirty, difficult and dangerous</a> — done by many migrant workers in our communities.</p>
<p>When the pandemic first struck, many of these workers were on the front line working in essential services. Engaged in low-wage work in health and child care, immigrant care workers had <a href="https://globalnews.ca/news/8123521/covid-cases-death-healthcare-workers-canada/">high rates of COVID-19 infections</a>, while also experiencing <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/210312/dq210312a-eng.htm">widespread job losses</a> and continuing <a href="https://www.parklandinstitute.ca/more_than_just_a_health_care_aide">financial struggles to make ends meet</a>. </p>
<p><a href="https://doi.org/10.1080/08959420.2022.2139984">Our recent paper</a> in the <em>Journal of Aging and Social Policy</em> reveals troubling realities for immigrant women care workers as they age. We found that immigrant women aged 65 and over who entered Canada through the <a href="https://www.canada.ca/en/immigration-refugees-citizenship/services/immigrate-canada/caregivers.html#caregiver">(Live-in) Caregiver program</a> work more but make less than other comparable immigrant women. The required live-in component was <a href="https://mwcbc.ca/downloads/AnOverviewofCanadasNewCaregiverProgram-AShiftfromPermanencetoPrecariousness.pdf">removed in 2014</a> and the program has since been split into <a href="https://www.canada.ca/en/immigration-refugees-citizenship/services/immigrate-canada/caregivers/child-care-home-support-worker/2023-changes.html">two pilot programs</a>. </p>
<p>These findings are crucially important given <a href="https://www12.statcan.gc.ca/census-recensement/2021/as-sa/98-200-X/2021004/98-200-x2021004-eng.cfm">Canada’s rapidly aging population</a> and increasing concern about <a href="https://doi.org/10.1017/S0714980810000814">senior poverty in racialized communities</a>.</p>
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<a href="https://images.theconversation.com/files/510404/original/file-20230215-3589-jwqkr1.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman wearing a blue nurses uniform plays Connect Four with an elderly man." src="https://images.theconversation.com/files/510404/original/file-20230215-3589-jwqkr1.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510404/original/file-20230215-3589-jwqkr1.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510404/original/file-20230215-3589-jwqkr1.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510404/original/file-20230215-3589-jwqkr1.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510404/original/file-20230215-3589-jwqkr1.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510404/original/file-20230215-3589-jwqkr1.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510404/original/file-20230215-3589-jwqkr1.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Jobs like personal support workers, home health aides and child-care workers tend to have low wages.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
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</figure>
<h2>Working past retirement age</h2>
<p>In Canada, we have long known that it is <a href="https://doi.org/10.1177/0958928718768337">disproportionately racialized immigrant women</a> (specifically Black and Filipina women) who do challenging and devalued work as carers. We also know that jobs like personal support workers, home health aides and child-care workers are still usually associated with “women’s work” and tend to have low wages.</p>
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<a href="https://theconversation.com/how-we-treat-migrant-workers-who-put-food-on-our-tables-dont-call-me-resilient-ep-4-153275">How we treat migrant workers who put food on our tables: Don't Call Me Resilient EP 4</a>
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<p>However, what we have not known is whether these women continue to experience these disadvantages later in life. Specifically, we have very little information about the financial challenges immigrant women care workers in Canada face as they age. </p>
<p>On the one hand, it is plausible that care workers are more likely than other workers to continue working past the typical retirement age because of their relatively <a href="https://progressive-economics.ca/wp-content/uploads/2009/02/temppermlcpfinal.pdf">low wages and limited savings</a>. </p>
<p>On the other hand, due to the <a href="https://doi.org/10.1186/s12889-017-4431-4">physically and emotionally demanding nature of care work</a>, which can be <a href="https://doi.org/10.1007/s10834-014-9423-2">detrimental to their health</a>, care workers may be less likely to continue working past age 65 and have higher rates of eligibility for government low-income supports. </p>
<p>Our recent research tried to clarify the situation of immigrant care workers as they age. We examined 11 years of Statistics Canada data from 2007-2017 to compare the income sources and trajectories of immigrant women who entered Canada through three migrant entry programs. </p>
<p>We used Statistics Canada’s <a href="https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5057">Longitudinal Immigration Database</a> to unpack how the gendered and racialized devaluation of caring occupations disadvantages immigrant women as they age. The database is a comprehensive source of administrative data that includes information on the socio-economic status of tax-filing immigrants since their arrival in Canada.</p>
<p>The data show that care workers are more likely to be employed after the age of 65 than other immigrant women, but have a lower and declining total income as they age. </p>
<p>Furthermore, while care workers receive higher rates of government pension benefits, they tend to have lower levels of private pension savings. And the cumulative income they report shows a relative decline over time.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/510405/original/file-20230215-28-zj46uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman in a nurse uniform assists an elderly woman using a walker." src="https://images.theconversation.com/files/510405/original/file-20230215-28-zj46uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510405/original/file-20230215-28-zj46uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510405/original/file-20230215-28-zj46uz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510405/original/file-20230215-28-zj46uz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510405/original/file-20230215-28-zj46uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510405/original/file-20230215-28-zj46uz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510405/original/file-20230215-28-zj46uz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Care workers are more likely to be employed after the age of 65 but have a declining total income as they age.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<h2>Prioritizing care workers as they age</h2>
<p>So what does this all mean? Our study underscores serious concerns about government investment in alleviating senior poverty. The conditions of low-wage care workers, before and after retirement, must be prioritized.</p>
<p>The package of pension supports available in Canada, which includes Old Age Security, the Guaranteed Income Supplement and the Canada Pension Plan, does not offset the decline in earnings immigrant care worker women face as they age. </p>
<p>That means there is a need to enhance policies that address senior poverty, recognizing that immigrant care worker women are among Canada’s most vulnerable populations. These women experience <a href="https://doi.org/10.1111/imig.12851">intersectional disadvantages</a> as immigrants, women and racialized minorities. </p>
<p>Our findings also reinforce the need for more full-time, permanent and well-paying jobs in the Canadian care sector. As of 2017, the unemployment rate of female immigrants in Canada was <a href="https://www150.statcan.gc.ca/n1/pub/71-606-x/71-606-x2018001-eng.htm">nearly double</a> that of their Canadian-born counterparts. <a href="https://doi.org/10.1108/EDI-09-2020-0255">Recent research</a> finds that the pandemic increased rates of unemployment and led to shifts to precarious work for many immigrant women in Canada.</p>
<p>The federal government must enhance access to and the amount of money provided through the Guaranteed Income Supplement to address senior poverty within underserved communities. Any government invested in reducing social inequalities and protecting vulnerable senior populations must consider the financial challenges immigrant care worker women face as they age and equalize their income over time with other comparable groups. And we, as the electorate, must do our part to keep governments accountable to this goal. </p>
<p>Ultimately, immigrant women are doing the essential jobs that most Canadians rely on. They are caring for our elderly, sick or young family members when we are in need. </p>
<p>It is the very least we can do to ensure that immigrant women care workers are able to age with financial security, dignity and adequate social protections.</p><img src="https://counter.theconversation.com/content/199240/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Naomi Lightman receives funding from the Social Sciences and Humanities Research Council of Canada (file number 435-2021-0486).</span></em></p><p class="fine-print"><em><span>Hamid Akbary received funding from the Social Sciences and Humanities Research Council of Canada (grant number 752-2019-2640). In addition to his academic affiliation, he works as an Analyst for Statistics Canada. </span></em></p>Immigrant care workers are having to work into retirement age to make ends meet. The Canadian government must do more to support them.Naomi Lightman, Associate Professor of Sociology, Toronto Metropolitan UniversityHamid Akbary, Postdoctoral Fellow, Department of Sociology, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1937252022-12-19T21:23:31Z2022-12-19T21:23:31Z5 steps for tackling Canada’s long-term care crisis: It starts with valuing the well-being of workers<figure><img src="https://images.theconversation.com/files/501615/original/file-20221216-37196-hf7jl5.JPG?ixlib=rb-1.1.0&rect=238%2C175%2C2267%2C1706&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For workers in long-term care homes, distress due to difficult working conditions is often dismissed as a part of the job description. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span></figcaption></figure><p>Canada’s long-term care sector was <a href="https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/long-term-care">hard hit</a> by the COVID-19 pandemic. Rapidly climbing <a href="https://www.cbc.ca/news/canada/ottawa/canada-record-covid-19-deaths-wealthy-countries-cihi-1.5968749">patient deaths</a>, a <a href="https://doi.org/10.1139/facets-2020-0056">lack of safety provisions</a> coupled with <a href="https://doi.org/10.9778/cmajo.20210338">already-precarious employment</a> and difficult working conditions took its toll on the mental health of health-care workers.</p>
<p>Yet, wellness in the long-term care sector is rarely discussed. Distress due to difficult working conditions is often dismissed as a part of the job description. Workers are expected to “<a href="https://doi.org/10.1007/s12126-017-9288-4">suck it up</a>” and manage their own emotions on their own time.</p>
<p>The sector is currently being held together by a very vulnerable workforce and it is situated to fail without immediate intervention.</p>
<h2>Support for self-care and protection from moral distress</h2>
<p>In our research, we examined the impacts of two critical psychological safety factors on the long-term care workforce amidst the COVID-19 pandemic — <a href="https://mentalhealthcommission.ca/what-we-do/workplace/workplace-healthcare/">support for self-care and protection from moral distress</a>. Health-care workers expressed the increased need for resources to support their well-being and to address longstanding workforce issues. Five recommendations for a stronger long-term care sector are proposed.</p>
<h2>1. Address long-standing structural issues</h2>
<p>Structural issues have been brought to light during the COVID-19 pandemic. This includes issues that are economic, social and organizational in nature.</p>
<p>While the COVID-19 pandemic exacerbated the challenges facing the long-term care sector, workers stated that these issues are not new. Rather, <a href="https://files.ontario.ca/mltc-ltcc-final-report-en-2021-04-30.pdf">decades of neglect</a> and lack of funding has made low pay and unsafe working conditions acceptable.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign reading 'Now hiring PSWs RPNs RNs support services full/part time avail'" src="https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A masked worker walks behind a hiring sign on his way into the Dover Cliffs long term care home in Port Dover, Ont. in November 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span>
</figcaption>
</figure>
<p>The pandemic intensified existing problems with staffing shortages. In 2020, long-term care staff members made up <a href="https://www.cihi.ca/sites/default/files/document/covid-19-rapid-response-long-term-care-snapshot-en.pdf">more than 10 per cent</a> of Canada’s total COVID-19 infection cases. Further, restricting <a href="https://www.mdpi.com/2079-9721/9/4/70/htm">informal caregivers</a> from entering homes contributed to increased workloads.</p>
<p>Institutional support for any sort of resource (mental health, personal protective equipment (PPE), staffing) was stretched thin to keep care homes running. Resource limitations kept the hands of management teams tied, suggesting that distress was endemic across the sector.</p>
<h2>2. Continuing education and training for self-care</h2>
<p>Supporting staff through continuing education and training can increase their capacity for psychological self-care and help protect them from moral distress.</p>
<figure class="align-center ">
<img alt="A woman with gray hair and a woman in scrubs and a face mask hold hands in a corridor" src="https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A resident holds hands with a health-care worker in a COVID-19 infected ward at Idola Saint-Jean long-term care home in Laval, Que. in February 2022.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1002/gps.4488">Continuing education and training</a> can significantly improve psychological well-being among long-term care workers. Communication-focused training approaches have resulted in improvements in staff turnover, depression and anxiety. <a href="https://doi.org/10.1111/jgs.17155">Self-compassion</a> and <a href="https://doi.org/10.1089/acm.2019.0087">acceptance-based approaches</a> found a significant reduction in mental health symptoms. </p>
<p>Educational sessions connect staff with other staff, allowing them to share their expertise and frustrations — helping to alleviate conflicts and tensions amongst teams. Virtual forums can be used for peer-to-peer learning, community building and moral support.</p>
<p>Training must be made available to all staff. <a href="https://mentalhealthcommission.ca/resource/examining-two-psychosocial-factors-in-long-term-care-during-the-covid-19-pandemic-policy-brief/">Our study</a> found that unregulated staff such as personal support workers were often not invited to take part in training programs or company resources.</p>
<h2>3. Invest in leadership development</h2>
<p>Improved leadership can foster improved team functioning.</p>
<p><a href="https://doi.org/10.1093/geront/gnaa203">Bullying and gossip is particularly rampant</a> in the long-term care workplace. Workers expect one another to work through distress and asking for a day off can be seen as a weakness and increasing the workload for others. </p>
<p>Supportive managers are critical to the psychological well-being of staff. A study on <a href="https://doi.org/10.1080/02678370801979430">transformative leadership</a> found a reciprocal relationship between leadership, self-reported staff well-being, team efficacy and self-efficacy — leading to job satisfaction and well-being. Transformative leaders encourage employees to create change inwardly by connecting professional goals to a wider sense of belonging in their workplace.</p>
<p>Underfunding and resource constraints make it difficult to provide meaningful and accessible supports, reducing workers’ ability to protect themselves against moral distress in the workplace.</p>
<h2>4. Ensure safe working conditions</h2>
<figure class="align-center ">
<img alt="Three people in PPE seen through a window" src="https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Long-term care workers in PPE look out the window of a long term care home in Québec during the first wave of COVID-19 in 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p>Insufficient <a href="https://www.cihi.ca/en/health-workforce-in-canada-highlights-of-the-impact-of-covid-19/the-impact-of-covid-19-on-canadas">personal protection equipment (PPE)</a> at the workplace was a concern for workers in the sector. <a href="https://science.gc.ca/site/science/en/office-chief-science-advisor/initiatives-covid-19/long-term-care-and-covid-19">Staff shortages and lack of knowledge from management</a> contribute to poor infection control and safety. Low wages and limited benefits also place workers in vulnerable situations, with limited options to practice physical and psychological self-care.</p>
<p>Funnelling resources and funding into this sector will not only improve staffing. It is critical for reducing the rapid turnover caused by uncontrolled exposure to COVID-19.</p>
<h2>5. Supportive human resource policies</h2>
<p>Long-term care needs to develop and/or improve human resource policies that support workers and acknowledge their value.</p>
<p>Low wages and precarious employment characterize this sector. Workers were fearful to take time off to get the <a href="https://www.cbc.ca/news/canada/toronto/long-term-care-workers-covid-vaccine-hesitancy-1.5953946">COVID-19 vaccine</a> for fear of losing wages.</p>
<p>Part-time and contract workers in the sector, often personal support workers, are not eligible for medical benefits and must pay out-of-pocket for injuries incurred at work. Many of these workers are <a href="https://www.criaw-icref.ca/wp-content/uploads/2021/04/Racialized-Women-_-COVID-19-Challenges-in-Canada.pdf">racialized, immigrant women</a>. Workers also often do not have entitlement to paid sick days. These factors point to systemic discrimination and undervaluing compared to other professionals in the sector.</p>
<h2>A call to action</h2>
<p>The Royal Society of Canada argues that the <a href="https://rsc-src.ca/sites/default/files/LTC%20PB%20ES_EN_0.pdf">very first step</a> to tackling the long-term care crisis is through workforce reform and redesign. This not only addresses low wages and resource shortages but serves more importantly to rebuild trust and dignity. To bolster support for the sector, public awareness and advocacy play a <a href="https://nccdh.ca/images/uploads/comments/Advocacy_EN.pdf">key role</a> in advancing health-care reform.</p><img src="https://counter.theconversation.com/content/193725/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The long-term care sector is currently being held together by a very vulnerable workforce, and is at risk of failing without immediate solutions.Sophy Chan-Nguyen, Research Associate, Queen's University, OntarioColleen Grady, Associate Professor, Family Medicine, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1907452022-09-27T20:21:39Z2022-09-27T20:21:39ZHow health-care leaders can foster psychologically safer workplaces<figure><img src="https://images.theconversation.com/files/486635/original/file-20220926-26-578e68.JPG?ixlib=rb-1.1.0&rect=134%2C143%2C2694%2C1895&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Building safer workplaces requires leaders who understand how years of resource constraints, unhealthy work environments, abuse from patients and a pandemic have contributed to overwhelming burnout and job dissatisfaction among workers.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span></figcaption></figure><p>Every day it seems the Canadian health-care staffing crisis worsens, with <a href="https://www.nytimes.com/2022/09/14/world/canada/nurse-shortage-emergency-rooms.html">emergency room closures</a>, <a href="https://theconversation.com/with-family-doctors-heading-for-the-exits-addressing-the-crisis-in-primary-care-is-key-to-easing-pressure-on-emergency-rooms-189199">not enough family doctors</a> and <a href="https://www.wellesleyinstitute.com/wp-content/uploads/2020/09/Waiting-for-Long-Term-Care-in-the-GTA.pdf">long wait times to get into long-term care</a>. </p>
<p>At the core are health-care workers who are physically and mentally burnt out from the unsafe work environments they’ve been asked to work in for years, which were made remarkably worse during COVID-19. </p>
<p>Health-care leaders have a key role to play in developing psychologically safer workplaces to support the well-being of our health-care workers. Building safer workplaces requires leaders who understand how years of resource constraints, unhealthy work environments, <a href="https://doi.org/10.1186/s12913-020-05084-x">abuse from patients</a>, and <a href="https://doi.org/10.3389/fpubh.2021.750529">the pandemic</a> have contributed to the overwhelming burnout and job dissatisfaction evident among workers.</p>
<h2>Physically and emotionally unsafe</h2>
<p>Even before the COVID-19 pandemic, Canadian health-care workers were experiencing <a href="https://www.cma.ca/sites/default/files/2018-11/nph-survey-e.pdf">burnout and depression</a>. The pandemic has worsened already poor working environments, exposing them not only to a life-threatening virus, but <a href="http://doi.org/10.1001/jama.2021.2701">mounting physical and verbal abuse</a>, <a href="https://www.cma.ca/sites/default/files/2022-08/NPHS_final_report_EN.pdf">increasing rates of burnout and depression</a>.</p>
<p>It is not surprising, then, that health-care workers are leaving the profession in greater numbers, <a href="https://www.cbc.ca/news/canada/nurses-canada-overtime-pandemic-burnout-1.6545963">further exacerbating the working conditions for the remaining health-care workers</a>. </p>
<figure class="align-center ">
<img alt="A paramedic in a face shield wearing a neon yellow jacket walks past patients on gurneys in a hospital corridor" src="https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The challenges are not limited to one group of health-care workers, or one type of workplace; personal support workers, nurses, physicians, paramedics working in hospitals, long-term care, primary care clinics and emergency services are all reporting burnout.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>The challenges are not limited to one group of health-care workers, or one type of workplace; personal support workers (PSWs), nurses, physicians, paramedics working in hospitals, long-term care, primary care clinics and emergency services are all reporting higher levels of stress. <a href="https://clri-ltc.ca/files/2021/02/PSW_Perspectives_FinalReport_Feb25_Accessible.pdf">PSWs working in long-term care report</a> physically and emotionally unsafe work environments, insufficient staff-to-patient ratios and disrespectful work environments.</p>
<p>We know that <a href="https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/Workforce_Psychological_Safety_in_the_Workplace_ENG.pdf">psychological health and safety in the workplace</a> is directly tied to productivity, retention, absenteeism, workplace conflict and the overall operational success of the workplace. Canadian health-care leaders, managers and supervisors are exceptionally placed to help health-care organizations build work environments where staff feel supported and safe. </p>
<figure class="align-right ">
<img alt="An outdoor sign reading 'Hiring PSWs - many shifts - benefits'" src="https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=514&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">PSWs working in long-term care report physically and emotionally unsafe work environments, insufficient staff-to-patient ratios and disrespectful work environments.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span>
</figcaption>
</figure>
<p>Our research team was recently funded by the <a href="https://mentalhealthcommission.ca">Mental Health Commission of Canada</a> to examine the facilitators and barriers that health-care organizations face in creating safe work environments. We surveyed and interviewed <a href="https://mentalhealthcommission.ca/resource/exploring-two-psychosocial-factors-for-health-care-workers/">hundreds of health-care workers from across disciplines, workplaces and provinces</a>. Here’s what they told us: </p>
<ul>
<li><p>There is much focus placed on health-care workers building resiliency, but without giving them the time and space to do so. Organizations can help by protecting time off for workers. </p></li>
<li><p>Health-care workers have told us that long-term organizational resources such as wellness champions, ethicists and effective health benefits for all health-care workers (for example, benefits that cover counselling services) would help support their well-being. </p></li>
<li><p>Appropriate and transparent operational policies and procedures related to clinical care and/or human resources that pervade an entire organization help to develop a fair and safe working climate. Managers can further support their workers by ensuring those policies and procedures are consistently applied and followed.</p></li>
<li><p>Organizations should seek out and support effective, compassionate and authentic leaders. Developing health-care leaders who are skilled and rise to the job in their stressful environments is critical and should be cultivated and rewarded. Managers have also been through the wringer over the past several years and need to be supported by their organizations. </p></li>
<li><p>Fewer than 50 per cent of health-care workers in our study reported working in an ethical climate. For example, many health-care workers do not have access to the necessary supports to work through ethical dilemmas. This is a great place for health-care organizations to focus; cultivating an ethical work environment can demonstrate to its employees that they want to protect them from moral distress. </p></li>
<li><p>Health-care workers have told us that transparency and effective communications are critical and increase trust in their leaders. </p></li>
</ul>
<p>The future of our health system is dependent on recruiting and retaining passionate, hardworking and highly skilled health-care workers. Every health-care worker, in ever workplace, across every province needs an organization that values and prioritizes their psychological health and safety. For the full report please visit: <a href="https://mentalhealthcommission.ca/resource/exploring-two-psychosocial-factors-for-health-care-workers/">MHCC – Exploring Two Psychosocial Factors for Health-Care Workers</a>.</p><img src="https://counter.theconversation.com/content/190745/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The future of our health system depends on recruiting and retaining passionate and highly skilled health-care workers. It’s essential to build work environments where they feel supported and safe.Angela Coderre-Ball, Assistant Professor (Adjunct), Family Medicine, Queen's University, OntarioColleen Grady, Associate Professor, Family Medicine, Queen's University, OntarioDenis Chênevert, Professor and director of healthcare management hub, HEC MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1397632020-06-07T11:20:26Z2020-06-07T11:20:26ZAfter COVID-19’s tragic toll, Canada must improve quality of life in long-term care homes<figure><img src="https://images.theconversation.com/files/338763/original/file-20200601-83195-18jm1k5.jpg?ixlib=rb-1.1.0&rect=528%2C0%2C3070%2C2644&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A resident walks down a hallway at a seniors' residence in Montréal on Jan. 30, 2020. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span></figcaption></figure><p>Long-term care homes and nursing homes have become the centre of attention in the midst of the COVID-19 pandemic, with <a href="https://www.thestar.com/politics/federal/2020/05/07/82-of-canadas-covid-19-deaths-have-been-in-long-term-care.html">over 80 per cent of deaths</a> from the virus in Canada occurring in these homes. </p>
<p>This tragedy leads us to reflect on what we learned from a decade-long <a href="https://www.cbc.ca/radio/thesundayedition/the-sunday-edition-for-april-26-2020-1.5536429/canada-s-for-profit-model-of-long-term-care-has-failed-the-elderly-says-leading-expert-1.5540891">project led by Pat Armstrong</a>, a distinguished research professor at York University, that <a href="https://reltc.apps01.yorku.ca">looked at long-term care</a> in four Canadian provinces (British Columbia, Manitoba, Ontario and Nova Scotia) and five countries (Germany, Sweden, Norway, the United Kingdom and the United States).</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/338765/original/file-20200601-83243-1b2q8z8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338765/original/file-20200601-83243-1b2q8z8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338765/original/file-20200601-83243-1b2q8z8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338765/original/file-20200601-83243-1b2q8z8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338765/original/file-20200601-83243-1b2q8z8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=523&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338765/original/file-20200601-83243-1b2q8z8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=523&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338765/original/file-20200601-83243-1b2q8z8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=523&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A man looks out the window at the Camilla Care Community centre overlooking crosses marking the deaths of multiple people that occured during the COVID-19 pandemic in Mississauga, Ont., on May 26, 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>Our perspective was not as academics but as doctors: Bob James was a family physician and medical director of a nursing home in Dundas, Ont.; and Joel Lexchin an emergency physician in Toronto who frequently saw patients sent from long-term care homes.</p>
<p>When Bob worked in his nursing home, he was primarily in contact with the registered nurses (RNs), and we suspect this is a common pattern for doctors. When Joel would call to get more information about the patients he was seeing in the emergency room, the people he spoke with were the nurses (usually the RNs). This was largely because of the RNs’ roles in leading the care teams for the homes.</p>
<p>But working in this project taught us many things that changed the way we thought about long-term care homes and the people who live and work in them.</p>
<h2>Laundry, support and care</h2>
<p>First and foremost, was the importance of the other workers to the care of residents. Specifically, <a href="https://laps.yorku.ca/2018/08/new-study-about-the-elderly-and-their-laundry-asks-long-term-care-facilities-to-clean-up-their-act/">cleaning and laundry staff</a>, as well as kitchen staff, and of course the care aids, or personal support workers (PSWs). We suspected that they played an important role, but over the course of the project it became increasingly clear the importance of those roles in making life for the residents more enjoyable, or even more tolerable.</p>
<p>Laundry and food matters to residents and their families; and the cleaning staff often have long-term and close relationships with the residents. These relationships improve the quality of residents’ lives and their physical health. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/338768/original/file-20200601-83243-1jte14r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338768/original/file-20200601-83243-1jte14r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338768/original/file-20200601-83243-1jte14r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338768/original/file-20200601-83243-1jte14r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338768/original/file-20200601-83243-1jte14r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338768/original/file-20200601-83243-1jte14r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338768/original/file-20200601-83243-1jte14r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Martima, a Personal Support Worker with West Neighbourhood House’s Parkdale Assisted Living Program, prepares to help a resident wash in his room at Toronto’s May Robinson apartments, part of TCHC seniors housing, in Toronto, on April 17, 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chris Young</span></span>
</figcaption>
</figure>
<p>That recognition has become even more acute during the crisis in long-term care homes that has followed the COVID-19 pandemic. First, these workers are women — almost 100 per cent of PSWs, plus the majority of laundry, kitchen and cleaning staff, are women. As well, <a href="https://dx.doi.org/10.12927%2Fhcpol.2017.25324">many are immigrants</a>. They are the <a href="https://thelocal.to/providing-care-barely-getting-by/">backbone of the care</a> that residents receive in these homes. When these women are not able to work because they are ill or fear being ill, care collapses — especially when families are not able to step into the breach. Many are also single mothers or are precarious in their employment, so they travel between jobs at two or three homes to earn enough income to survive.</p>
<h2>Art and space</h2>
<p>Second, incorporating <a href="https://www.policyalternatives.ca/publications/reports/physical-environments-long-term-care">architecture, history and art</a> into the project provided insight into a whole other way of looking at long-term care — one that we had mostly ignored. We realized how much these aspects of homes influence the way that residents interact among themselves and with the staff.</p>
<p>Space matters. How long and wide are the corridors? How is the dining area set up — how many residents to a table? Do people always sit in the same place at every meal? And outside of meals, is there an easily accessible and safe outdoor space for residents to experience the natural world?</p>
<p>What kind of artwork and music does the home have, and does it resonate with the life experience of the residents and provide something to look at other than the ubiquitous television set?</p>
<h2>Re-thermalized on a budget of $8.33 per day</h2>
<p>We also looked at food and food service in a new way. When Bob was the director of the Dundas home in the late 1990s, the province provided $7 per resident per day for food; by 2017, that had only risen to <a href="https://www.thestar.com/news/canada/2017/03/10/ontario-nursing-homes-feed-seniors-on-833-a-day.html">$8.33 per day</a>. That meant that the kitchen had to accommodate all the special diets (regular, minced, puréed, diabetic, renal and so on) on less money than our federal government gives to prisons to feed their prisoners.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/338766/original/file-20200601-83225-3y7gvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338766/original/file-20200601-83225-3y7gvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338766/original/file-20200601-83225-3y7gvr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338766/original/file-20200601-83225-3y7gvr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338766/original/file-20200601-83225-3y7gvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338766/original/file-20200601-83225-3y7gvr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338766/original/file-20200601-83225-3y7gvr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Food may be prepared off-site and delivered for reheating.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
</figcaption>
</figure>
<p>Many homes don’t prepare their own food and don’t use locally available foods. It is trucked in and then reheated — or in the terminology of some homes, re-thermalized. Missing were the smells of food being prepared, <a href="https://www.thestar.com/news/canada/2017/03/10/ontario-nursing-homes-feed-seniors-on-833-a-day.html">smells that are often meaningful to residents</a>. In some homes we visited, the quality of the food was wonderful, but in others it was bland and didn’t carry any appeal beyond just filling people’s stomachs.</p>
<p>Of course, with COVID-19, we have learned that every time a new worker comes into the building to deliver food or services, a new risk is introduced as well.</p>
<h2>Future directions</h2>
<p>We were struck by the <a href="https://www.policyalternatives.ca/publications/reports/promising-practices-long-term-care">innovation seen in Germany</a> where there was adequate staffing, and co-operative workspaces (here we mean co-operative between the various staff positions, as well as between the staff and the residents). In Germany, one of the staff doubled as a clown, and her non-verbal way of communicating through touch and facial expressions were also lessons for Bob in working with patients with dementia. </p>
<p>The German staff were able and, in fact, encouraged, to do the work that was needed, whether that meant that RNs washed dishes or registered practical nurses combed a resident’s hair. And the residents were encouraged to help with the “chores” of the units, sweeping floors, setting tables, even cutting up the vegetables for the lunch meals! There seemed to be a much more relaxed attitude toward the hierarchy than we see in Canadian homes.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/338770/original/file-20200601-83297-19rjf36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338770/original/file-20200601-83297-19rjf36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=438&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338770/original/file-20200601-83297-19rjf36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=438&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338770/original/file-20200601-83297-19rjf36.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=438&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338770/original/file-20200601-83297-19rjf36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=551&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338770/original/file-20200601-83297-19rjf36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=551&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338770/original/file-20200601-83297-19rjf36.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=551&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A resident sits in her room at a seniors’ residence in Montréal on Jan. 30, 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
</figcaption>
</figure>
<p>For those of us doctors who are interested in changing the system, and we suspect that there are many, the project and its conclusions has given us a vocabulary to use when working for change.</p>
<p>COVID-19 has taught us how much we in Canada have to do to improve long-term care, as we cope with over-stressed staff in understaffed and aging, underfunded facilities where workers — instead of being seen as essential — are paid at minimal wages and treated as temporary staff.</p>
<p>As they say, this is a marathon rather than a sprint. We were hoping to have some reforms of the system before we need residential care ourselves since both of us are now over 70. We are no longer sure of that, but we still have hope that in the post-COVID-19 world, things might begin to change in the directions we have witnessed elsewhere.</p><img src="https://counter.theconversation.com/content/139763/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>In 2017-2020, Joel Lexchin received payments for being on a panel at the American Diabetes Association, for talks at the Toronto Reference Library, for writing a brief in an action for side effects of a drug for Michael F. Smith, Lawyer and a second brief on the role of promotion in generating prescriptions for Goodmans LLP and from the Canadian Institutes of Health Research for presenting at a workshop on conflict-of-interest in clinical practice guidelines. He is currently a member of research groups that are receiving money from the Canadian Institutes of Health Research and the Australian National Health and Medical Research Council. He is a member of the Foundation Board of Health Action International and the Board of Canadian Doctors for Medicare. He receives royalties from University of Toronto Press and James Lorimer & Co. Ltd. for books he has written. </span></em></p><p class="fine-print"><em><span>Robert James does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A research project may offer insight into how factors like laundry, food and art may be good places to start in addressing problems in long-term care homes.Robert James, Associate Clinical Professor, Family Medicine, McMaster UniversityJoel Lexchin, Professor Emeritus of Health Policy and Management, York University, Emergency Physician at University Health Network, Associate Professor of Family and Community Medicine, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1390172020-05-25T18:59:54Z2020-05-25T18:59:54ZInquiry into coronavirus nursing home deaths needs to include discussion of workers and race<figure><img src="https://images.theconversation.com/files/337417/original/file-20200525-106836-aev468.jpg?ixlib=rb-1.1.0&rect=14%2C95%2C1183%2C634&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Residents and staff wave to family and friends who came out to show support of those in the McKenzie Towne Long Term Care centre in Calgary, Alta.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Jeff McIntosh</span></span></figcaption></figure><p>COVID-19 has most severely affected elderly residents and their caregivers in long-term care nursing homes. <a href="https://www.cbc.ca/news/canada/toronto%20/ontario-long-term-care-commission-1.5575035">In Ontario, coronavirus has claimed the lives of well over 1,400 people, both residents and caregivers, in the long-term care system</a>. Although many issues have been discussed in relation to this crisis in long-term care, one crucial factor has not been discussed as much: the issue of race. </p>
<p>Why is race important here? Nursing homes and long-term care in Canada are <a href="https://policyoptions.irpp.org/magazines/may-2020/canadas-covid-19-blind-spots-on-race-immigration-and-labour/">predominantly staffed by immigrant women, migrants and refugees — mostly women of colour</a>. In Montréal, <a href="https://ici.radio-canada.ca/premiere/emissions/tout-un-matin/segments/chronique/166242/femmes-racisees-exploitation-chsld-cisss-centre-sud">up to 80 per cent</a> of the workers in long-term care are racialized women.</p>
<p>Many of us have recently learned that <a href="https://www.cbc.ca/news/politics/long-term-care-infrastructure-1.5559331">long-term care homes are increasingly funded by the private sector animated by profit-making</a>. This business model has created challenging conditions within which COVID-19 and other infections rapidly spread. </p>
<p>A <a href="https://www.policyalternatives.ca/publications/reports/re-imagining-long-term-residential-care-covid-19-crisis">team of researchers led by Pat Armstrong at the Canadian Centre for Policy Alternatives (CCPA)</a> said the high incidence of deaths in long-term care homes are an indication of the lack of value placed on two groups of people: the elderly and their caregivers. </p>
<p>Having a conversation on racism is a challenge in an environment where race talk is often seen as an indication of racism. <a href="https://www.ctvnews.ca/health/coronavirus/canada-still-only-considering-gathering-race-based-covid-19-data-1.4927648">Even the collection of race-based data has been controversial</a>. </p>
<p>The reluctance to speak about race in long-term care homes may be contributing to what appears to be race-blind reporting of the way the pandemic is impacting communities. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/337409/original/file-20200525-106832-1k313df.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/337409/original/file-20200525-106832-1k313df.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/337409/original/file-20200525-106832-1k313df.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/337409/original/file-20200525-106832-1k313df.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/337409/original/file-20200525-106832-1k313df.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/337409/original/file-20200525-106832-1k313df.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/337409/original/file-20200525-106832-1k313df.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Employees demonstrate outside a nursing home of the Korian group, one of the market leaders in the lucrative industry of providing care and assisted living facilities for older adults, May 25, 2020, in Paris, France.</span>
<span class="attribution"><span class="source">(AP Photo/Thibault Camus)</span></span>
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<h2>Essential workers earning low pay</h2>
<p>In general, long-term care workers are so poorly paid that many have to survive by combining multiple jobs in different care homes. As a result, they can inadvertently become potential carriers of infection. But they often have little choice.</p>
<p>Many are not unionized, which means they do not have sick leave benefits. Even if they are not feeling well, some would hesitate to stay home because of lost income. </p>
<p>British Columbia recognized this issue and acted quickly. The province restricted caregivers to one nursing home, <a href="https://www.cbc.ca/news/canada/british-columbia/bc-seniors-support-covid-19-1.5545727">topped up their wages and made them full-time workers</a>. If we were not in the middle of a pandemic affecting elderly residents would these reforms have been made? Probably not. </p>
<p>To make profits in these privately owned and operated care centres, owners have relied on a racialized and gendered workforce of immigrant and migrant women, assumed to be both cheap and disposable. Their cheapness and disposability are predicated on societal assumptions about their inferior quality of labour, lack of skills and unavailability of better employment opportunities. </p>
<p>Despite the fact that they are considered “essential” workers, they earn low wages, are insecure and even subjected to workplace violence. Expendability becomes synonymous with long-term care workers.</p>
<p>Research conducted by the Canadian Union of Public Employees and Ontario Council of Hospital unions concluded that about <a href="https://globalnews.ca/news/5150703/ontario-long-term-care-staff-experience-violence-reports/">90 per cent of long-term care staff in Ontario have suffered physical violence, while around 70 per cent of racialized and Indigenous staff have experienced related harassment</a>. This culture of violence is due to their social vulnerability as women of colour and as immigrants.</p>
<h2>Lack of personal protective equipment</h2>
<p>The perceived disposability of these workers is perpetuated not only by their insecure status as part-time, temporary and contractual workers, but also due to their status as newcomers and non-citizens. </p>
<p>Most importantly, society has marked their disposability on their brown and Black bodies. </p>
<p>It seems that “<a href="https://www.thestar.com/news/investigations/2020/05/05/they-said-there-was-no-playbook-for-dealing-with-covid-19-outbreak-at-nursing-homes-there-were-several.html">this government chose who lives and dies</a>” as Sharleen Stewart, president of the Service Employees International Union, aptly commented at the funeral of a personal support worker. Stewart was referring to the lack of PPE for workers in long-term care and nursing homes. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/337410/original/file-20200525-106823-ztkg0j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/337410/original/file-20200525-106823-ztkg0j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/337410/original/file-20200525-106823-ztkg0j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/337410/original/file-20200525-106823-ztkg0j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/337410/original/file-20200525-106823-ztkg0j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/337410/original/file-20200525-106823-ztkg0j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/337410/original/file-20200525-106823-ztkg0j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Mary Mack, right, a resident of senior housing, is tested for COVID-19 in Paterson, N.J., May 8, 2020. New York City is offering to test all nursing home residents and staffers for the coronavirus.</span>
<span class="attribution"><span class="source">(AP Photo/Seth Wenig)</span></span>
</figcaption>
</figure>
<p>Recently, <a href="https://toronto.ctvnews.ca/ontario-long-term-care-nurses-make-shocking-allegations-about-access-to-ppe-during-pandemic-1.4907563">the Ontario Nurses’ Association went to court</a> seeking orders against a number of long-term care homes that had restricted or not provided protective equipment for its members and residents. Many failed to provide N95 respirators to workers looking after residents. These were homes where a significant number of deaths had already taken place from COVID-19.</p>
<p>The association alleged that in some cases workers had been ordered not to wear masks lest it frighten the residents. Nurses and caregivers were in close contact with coughs, sneezes and spit up food from elderly patients with trouble swallowing. The Ontario Superior Court <a href="https://toronto.ctvnews.ca/ontario-nurses-win-court-battle-to-secure-access-to-ppe-in-long-term-care-homes-1.4909643">ruled in the association’s favour</a>. </p>
<h2>Ensuring human rights</h2>
<p>Despite their essential service, nursing home workers and personal support workers are often portrayed as being unskilled, untrained and <a href="https://globalnews.ca/news/6801945/pinecrest-psw-coronavirus-covid-19/">even neglectful in their conduct</a>. Indeed, they have sometimes been portrayed as being responsible for the spread of COVID-19 in nursing homes.</p>
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<a href="https://images.theconversation.com/files/337419/original/file-20200525-106842-1tavzaw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/337419/original/file-20200525-106842-1tavzaw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/337419/original/file-20200525-106842-1tavzaw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=433&fit=crop&dpr=1 600w, https://images.theconversation.com/files/337419/original/file-20200525-106842-1tavzaw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=433&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/337419/original/file-20200525-106842-1tavzaw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=433&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/337419/original/file-20200525-106842-1tavzaw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=544&fit=crop&dpr=1 754w, https://images.theconversation.com/files/337419/original/file-20200525-106842-1tavzaw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=544&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/337419/original/file-20200525-106842-1tavzaw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=544&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A health-care worker at Pinecrest Nursing Home acknowledges people driving by and honking their horns in support of health-care workers in Bobcaygeon Ont., on Mar. 30, 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Fred Thornhill</span></span>
</figcaption>
</figure>
<p>Recently, the Ontario government announced a plan <a href="https://news.ontario.ca/mltc/en/2020/05/ontario-announces-independent-commission-into-long-term-care.html">to establish an independent commission into Ontario’s long-term care system</a>. As we contemplate the terms of reference of such a commission, the issue of race in long-term care work is important to address.</p>
<p>As Armstrong and her team at CCPA succinctly said, the “conditions of work are the conditions of care.” COVID-19 related deaths in long-term care homes have made visible not only the neglect of the elderly in our society but also the neglect of support workers — many of whom are migrant and immigrant women — providing essential work in these centres. </p>
<p>Both are vulnerable to infections, illness and death. The question of race in long-term care is not only important for ensuring the best care for seniors but also to ensure their human rights and those of their caregivers. This requires that we acknowledge and open up a conversation about race on the job.</p><img src="https://counter.theconversation.com/content/139017/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tania Das Gupta does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nursing homes and long term care in Canada are predominantly staffed by immigrant women, migrants and refugees — mostly women of colour.Tania Das Gupta, Professor, Department of Equity Studies, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.