Long-term care aides are key to the entire system

Working conditions must improve, Sienna Caspar says.

One of the most devastating aspects of COVID-19 is that eight out of 10 deaths in Canada are of people living in long-term care homes. This tragedy is prompting governments to release new guidelines to help contain illness and deaths among residents and staff.

While important to fight the pandemic, temporary fixes, including sending in the military, will do little to make lasting improvements to quality of life for those in care homes. Almost one-third of Canadians 85 and over live in them and the number of people overall requiring long-term care is projected to quadruple to 690,000 in under 20 years.

The operation of private and public longterm care homes is already one of the most highly regulated areas of health care. Rules govern hallway widths, how often baths occur, timelines for assessments and care planning, bedrail heights, the temperature at which meals are served, how much space each person has at their dining table — and the list goes on. Yet these stringent regulations were ineffective in reducing the harm. Why? Because regulations have repeatedly stopped short of addressing a fundamental issue, which is the quality of working life for those providing the care.

Care aides provide 80 per cent of the care in nursing homes. This unregulated workforce consists primarily of women, many of whom are immigrants or from marginalized racial groups. Long before COVID-19, research demonstrated that their working lives needed to be vastly improved. We know that care aides account for the highest number of on-the-job injuries, more than logging, construction or mining; that without full-time hours with benefits, they work at multiple facilities to make ends meet; and that they rarely feel appreciated by management. For over a decade they have been reporting stress due to increasing workloads and decreasing job satisfaction as residents’ needs became more complex. With no minimum staffing ratios, little control over how they get their work done, and a lack of resources, care aides frequently experience moral distress because of the tension between what they want to do for residents and what they can do.

Research repeatedly shows that poor working conditions, most often indicated by staff turnover and job dissatisfaction, is linked directly to poor quality of care and, in some cases, greater aggression towards residents and other workers. When staff members deserted a care home in Quebec, dehydrated and malnourished residents were left lying in soiled linens, some for days. Rather than presume that these workers are heartless, we should instead presume that their employer did not respond to their valid fears and concerns about the pandemic and felt so powerless and disrespected that the only response they believed they had was to leave.

The vast majority of care aides carry on, working short-staffed, fearing for their health and that of their families, and short of supplies. They continue to have a strong sense of their work’s worth, despite how our ageist society devalues it. At 7 p.m. every day, people around the nation applaud our health workers; I clap for care aides, often with tears of gratitude.

They deserve better working conditions not just now, but for the future — because the lives they hold in their hands matter. So do theirs.

Regulations and quality reviews must address minimum staffing ratios (including provisions that ensure staff do not “work short” when team members call in sick), sweeping wage reviews (the average is about $19 an hour), and the percentage of casual and part-time positions that can be converted to regular full-time positions with benefits. These reviews should assess staff access to supplies and resources, and their perceptions of discrepancies between written safety policies and daily procedures, such as when policy states that two staff members must lift a resident, but daily care routines make that impossible.

When researchers like me ask what they need most, care aides say they want managers to hear and respond to their concerns; work-place conditions that create supportive, collaborative teams; and recognition for their work. When we do this, we will empower care aides to develop and implement solutions to common workplace challenges — and, when galvanized, care aides can be unstoppable in improving care.

People yearn to return to the way things were. That can’t happen in long-term care. We need radical change. A starting point is the development of quality reviews that emphasize a profoundly simple idea — that when we feel cared for, we care better for others.

Sienna Caspar is an associate professor in the faculty of health sciences — therapeutic recreation program at the University of Lethbridge.