left facilities unprepared for pandemic
has suffered chronic shortfalls of resources and staff, experts say
The result was a decreased share of care homes owned and operated by health authorities directly and an increase in those owned and operated by the for-profit sector. Today, roughly one-third of long-term care homes in B.C. are operated by health authorities, one-third are run by non-profits, and one third are run by the private sector.
Increasingly, for-profit care homes that used to be family-run businesses are operated by corporate chains that own multiple care facilities.
Jennifer Whiteside, secretary business manager of the Hospital Employees Union that represents care aides at unionized care homes, characterizes the early 2000s as “a real deregulation of our long-term care system. I think there was a real perspective on the part of health authorities that long-term care operators were businesses. And the operating model wasn’t really the concern of the health authorities .... I don’t think there were enough checks and balances in the system.”
To avoid higher labour costs, operators of nursing homes stopped hiring employees directly and instead contracted those services through third-party companies.
“We have many, many examples of contract flipping over the years,” said Whiteside, pointing to Inglewood Care Home in West Vancouver as a prime example, where the previous owner of that facility “contracted out [with different companies] six times in 10 or 12 years,” she said.
Klassen said care home operators were forced by the government to contract out their labour costs as funding was squeezed. “The only way [many care homes] could actually operate and not be constantly in the red was to try to address some of the costs of labour.”
The upshot was many care aides, who are responsible for about 67% of direct care and previously earned a standard provincial wage of up to $25 an hour with benefits, found their wages repeatedly cut – to as little as $17 an hour in some cases. According to BC Care Providers, the average starting salary for a care aide in B.C. is $19 an hour.
Care aides frequently needed several jobs in different care homes to make ends meet.
The consequence, said Whiteside, is that it made working in care homes “very unattractive to people.”
“It tends to be a precarious workforce,” said Whiteside. Most workers are women and many are from vulnerable communities. Some are temporary foreign workers recruited to work in jobs other health care workers have rejected.
The scale of how much changing that would cost is evident in the over $10 million a month the province has been paying since the spring to ensure all care aides work at a single facility – while being paid a higher wage.
Care homes receive block funding that is negotiated individually with health authorities to subsidize the costs of publicly funded care beds.
Health authorities specify the number of direct care hours care homes are expected to deliver.
Contracted long-term care homes cost taxpayers almost $1.3 billion a year in B.C. But as Mackenzie pointed out this year in her report, A Billion Reasons to Care, there is inadequate transparency on exactly where that money goes and how much of it is spent on direct care.
Staff who work in this environment are under pressure to provide care as efficiently as possible.
“They’re given a certain amount of time to do a certain task,” said Althea Gibb-Carsley, Mikhail’s partner. “And as people’s cognition changes, it’s very seldom enough. And it often is grossly inadequate…. They’re pushed, pushed, pushed, in relation to that task list.”
Theoretically, she said, every resident has a care plan driven by their unique needs. “And theoretically, each of the staff who comes in to take care of the residents is acquainted with that care plan.” The reality is often different. “It’s feed, clothe, clean,” said Mikhail. If you’re lucky. Everything else falls by the wayside.
“To put it crudely we’re warehousing seniors,” said Chaudhury.
The idea that someone could sleep in late or go for a walk in the garden has been replaced by the need to make sure “they are fed, they are clean, they are calm,” he said.
According to Mackenzie, 25% of long-term care residents are given antipsychotic medication without a diagnosis of psychosis and twice as many residents take anti-depressants as those with a diagnosis of depression.
“We use psychotropic medications to help people calm down and stay put,” said Chaudhury.
Putting a parent or other family member in residential care is often a difficult decision.
“It’s not a light switch,” said Wong. “Typically, seniors and their loved ones or families have really struggled. They’ve struggled for a long time in the community with all kinds of supportive services, home care, etc. And then finally, as a result of multiple health conditions, and sometimes it includes things like mental health conditions, like dementia or Alzheimer’s disease, or significant disability, or significant burnout from the caregivers, then they go in there.”
“Nobody says, ‘I’m dreaming of going to a care home when I get old,’” said Bauschbusch. “And so it’s not something we like to think about a lot. And when the government is having their calls around, informing the next budget, this is not necessarily an area that people have stood up for.”
The system in place until very recently where families had to take the first available bed in the region has in itself been “a traumatic experience,” she said. “You get a call from the hospital saying transport is coming to take your parent to care home B. People have very limited choice.”
At a fundamental level, seniors’ care is an uncomfortable topic, tied up with the issue of ageism, said Chaudhury, plus scarce health care dollars and a vulnerable population with limited power to advocate.
“Definitely at the policy level, it is a reflection of how we have devalued seniors’ care.”