Don’t overlook home-care workers in LTC reform
Most of our attention is being paid to workers in large facilities
My mother, 94, died April 2 of pulmonary edema. She died in her own home surrounded by her loving family, supported by her family physician and cared for by a wonderful cadre of personal support workers and palliative care nurses. The hospice was full, there were no thought of sending her to the hospital that was gearing up for the pandemic. So our family greatly appreciated the support of the visiting home health-care workers that allowed my mother to die at home. At the same time we were worried that they may be bringing COVID-19 into her home and they, no doubt, worried about catching it from us.
During this COVID-19 pandemic we are witnessing the death of many older frail adults in long-term care as well as the spread of the virus to the health care workers who care for them. This has been partly attributed to lack of PPE as well as the fact that many longterm care employees work in multiple long-term care homes and can carry the disease from one home to the next. The reason most health care workers do this is because the sector offers very few full-time jobs. Workers must accumulate fulltime hours by working in multiple sites. Very little has been said about home health-care workers who face the same employment conditions and who could be contributing to the spread of the virus in the community as well as endangering their own health and the health of their families.
During my career at McMaster University, along with co-researcher, Dr. Isik Zeytinoglu and Dr. Catherine Brookman, I studied the health and safety of visiting home care workers, in particular personal support workers (PSWs) who provide 70-80 per cent of community care. In 2015 we conducted a survey of 2,341 PSWs, the first comprehensive study of PSWs in Ontario. PSWs work in many sectors of community care including home health care, adult day programs, retirement homes, supportive housing programs and privately for clients in their homes. As hospitals began releasing patients “quicker and sicker” into the community, PSWs are increasingly caring for clients with higher health care demands. With the aging of our population, many clients are frail older adults with multiple chronic diseases.
In our 2015 study we found that close to 60 per cent of PSWs worked full-time hours, but many did so by working for multiple home health care employers as well as hospitals and long-term-care homes. Only 40 per cent of PSWs had guaranteed hours and half of the PSWs surveyed would prefer more hours per week. The vast majority work on the weekend, work shifts, sometimes split shifts. Over 80 per cent are paid on an hourly basis and the rate of pay is only at about $16.50 to $19 per hour for the time spent doing direct client care. The majority do not receive benefits such as paid travel, sick leave, prescription drugs, dental care or a pension. As a result, there is a shortage of PSWs in Ontario and retention and recruitment are challenging issues for the home health care industry, especially because PSW wages are higher in the long-termcare and hospital sectors.
Working in the community, PSWs most commonly spend up to an hour providing care in each client’s home and then must travel to their next visit, some by car but many use public transportation. In retirement homes and supportive housing, PSWs visit more clients without travel time is less.
Very little has been said about the risk of PSWs working in community care of spreading the COVID-19 virus as they visit from client to client as well as the risk to themselves and their families of catching the virus from their clients. In my mother’s situation, the visiting health-care workers washed their hands when they entered the home and wore gloves. Some wore masks, the nurses wore gowns but none had the N95 masks. A number of the PSWs arrived by public transportation which was a growing concern for our family given the community spread of the COVID-19 virus.
An important lesson from the SARS epidemic which was transferable to the COVID-19 pandemic is that when health-care workers work in multiple long-term-care homes they spread the disease from one site to the next. This same lesson must be applied to the home health care sector. To minimize the risk of spreading diseases, the Ontario government must consider improving the employment conditions of PSWs working in community. Consideration should be given to increasing funding to home health care so that PSWs are guaranteed full-time hours at one agency and they are not forced to work for multiple employers and to work in multiple health care sectors in order to secure full-time hours. This would reduce the risk of community spread but also importantly demonstrate the value that we, as Ontarians, attribute to PSWs who care for our loved ones in their homes.