Care work by day, shelter by night

Economic reality for the sector `shocking,' medical official says

When two women living in an Ottawa homeless shelter tested positive for COVID-19 last spring, causing an outbreak, Dr. Jeff Turnbull couldn't understand how they had become infected.

But then he learned that, although they slept at the shelter each night, the homeless women worked as personal support workers during the day in long-term care homes.

“It turns out that they live in a shelter, but they work outside of the shelter. They just can't earn enough money to afford Ottawa's rental circumstances,” Turnbull, the medical director of Inner City Health, told Ontario's Long Term Care Commission last month.

“And where do they work? Longterm care. And so they brought COVID from a long-term care facility into the shelters, where we had an outbreak.”

The commission has heard hundreds of hours of testimony — much of it shocking — since it was launched last fall to investigate the spread of COVID-19 in Ontario's long-term care homes. But Turnbull's revelation about the reality of trying to live on a personal support worker's wages could be the most stunning.

“It was stupid of me,” he told the commission of his failure to initially understand that some long-term care workers would not earn enough to afford rent. “I just didn't think that would be a likely possibility — of people working outside and exposing themselves and bringing COVID in that way.”

Those workers were far from the only ones sleeping in Ottawa homeless shelters by night and working in long-term care homes and elsewhere during the day.

In fact there are so many precarious workers — including PSWs — living in the city's shelter system, that some of them are now being housed at the COVID-19 isolation centre set up in a hotel in Ottawa for people who need to isolate but don't have room to do so safely at home, said Wendy Muckle, executive director of Inner City Health, which provides health care for the city's homeless population.

The homeless workers are not at the isolation centre because they have tested positive or come in contact with someone with COVID-19, but because they have nowhere else to go. Some homeless workers, who remained in shelters, were cohorted together to minimize contact with others.

Muckle said at least 25 people living in homeless shelters in Ottawa work — many of them in long-term care homes. The actual number is likely much higher, she said, because people staying in shelters are often hesitant to admit they have jobs.

“I know it was very shocking to a lot of people that we had so many people in that circumstance.”

Muckle said one of the images that “ripped my guts out” during the first wave of the pandemic was seeing personal support workers in full protective gear heading off on foot from the shelter to walk to work.

Because of staff shortages, longterm care workers were able to work, even if they had been in contact with a positive case and were in isolation. But because of that potential contact, they weren't able to get on a bus and had no option but to walk.

“You know how in every event there is a picture that sticks with you? That one broke my heart,” she said.

“They would get up, put on their PPE and walk to work. They are poor and trying to earn enough to be able to get housing. They can't afford not to be paid. I remember watching them walk down the road and thinking `This is a low point in my COVID experience.' It is sad.”

Although personal support workers received a $4-an-hour pay increase during some of the pandemic, it has been sporadic. In addition, workers are only allowed to work at one health institution during the pandemic to reduce COVID-19 spread. But because many workers do not have full-time hours, that has created a financial crisis for some workers, she said. It also encouraged some long-term care workers to move to other jobs, often in retail, where they were also at high risk of contracting COVID-19.

“They are not being paid anything close to a living wage,” Muckle said.

There have been widespread calls for better pay and better hours for long-term care workers. The inquiry has recommended more full-time hours for long-term care workers — who often work in multiple homes because they don't receive enough hours to support themselves, or benefits.

“You are not going to be able to reform the long-term care system in any meaningful way if we don't address their wages,” Muckle said. “They have to be able to earn a living wage working in one job or you can't retain them and you can't train them.”

Provincial NDP critics Joel Harden (Ottawa Centre) and Rima Berns-McGown (Beaches-East York) said they were horrified by Turnbull's account of essential health-care workers “being paid such a low wage that they are living in a homeless shelter.

“We can't fathom working long, dangerous, physically and emotionally devastating days in a long-term care home during this pandemic, then checking into a crowded shelter to sleep between shifts. We can't fathom hearing Doug Ford call health-care workers heroes, then receiving a paycheque that can't cover even the most basic of needs.”

The NDP is calling for an end to for-profit long-term care homes in the province. In Ontario, the vast majority of COVID-19 deaths have been among long-term care residents. Those living in for-profit homes fared significantly worse than those in not-for-profit and municipal homes.

Ottawa's homeless shelters, supported by Inner City Health, have avoided major outbreaks and deaths during the pandemic.

“We have a population that is at very high risk. We should have been overrun, but we haven't been,” Turnbull said.