City-run homes have seen fewer deaths. Are wages the reason?
When long-term-care workers were told they had to pick a single employer during the pandemic, an overwhelming number chose their city of Toronto job, the Star has learned.
Data on salary and benefits from two major unions representing workers in Toronto and beyond provided to the Star may explain why: Municipal longterm-care workers in all comparable categories were paid on average $3.18 to $4.65 more per hour than their for-profit and $3.42 to $4.60 more than their non-profit counterparts.
The Star is examining the outbreak’s toll on long-term-care homes, including why the municipal model of management has seen far fewer deaths while advocates call for a review of care models. An earlier Star analysis of public data found a resident in a for-profit home was four times more likely to die from the virus than those in a municipal home.
Staff working at multiple homes was identified as one way the virus spread across Ontario among vulnerable elderly residents.
The wage data recently provided to the
“After almost 30 years with the city I can say the city is an excellent employer — my team treats people very well and our staff are paid fairly.” Paul Raftis, Toronto’s general manager of seniors services and long-term care
Star is not a scientific or complete sample of worker compensation, but it does offer insight into a divided model of care in institutions that have been devastated by COVID-19.
Dave Mitchell, president of CUPE Local 79, which represents the city’s longterm-care workers, believes members’ better-than-industry standard wages and benefits helped reduce cross-home contamination and reduced the death toll. “That was definitely a factor,” said Mitchell.
In April, when staff in Toronto’s cityowned homes were asked to sign a declaration committing to the city as their sole employer during the outbreak, 89 per cent of the 3,000-plus workers signed, said Paul Raftis.
Raftis is the city of Toronto’s general manager of seniors services and longterm care.
“I’m not suggesting anyone else is a bad employer, but after almost 30 years with the city I can say the city is an excellent employer — my team treats people very well and our staff are paid fairly,” he said.
It hasn’t been easy going at municipal homes. The city is responsible for 10 homes with a total of 2,641 beds. There have been serious outbreaks at three — Seven Oaks in Scarborough and Lakeshore Lodge and Kipling Acres in Etobicoke. More than 60 residents have died so far, according to provincial data.
But the infection and death rates at municipal homes remain far lower, on average, than those at private and nonprofit facilities.
The Ontario Long Term Care Association (OLTCA), which represents most long-term-care homes in the province, warned against comparing municipal homes to others in the sector because they receive additional government funding. It also cautioned against using the Star’s analysis of death rates because many factors, they say, may have contributed to the spread of COVID-19.
“(OLTCA)’s preliminary research points to the age of buildings and the number of beds per room as major factors that determine the magnitude of COVID-19’s impact in a home. Nearly half of Ontario’s long-term-care homes are older, and infection control, cohorting and isolation are more challenging in these sites,” the association said in a statement.
Keeping staff from working in other homes, offering part-time staff full-time hours, as well as learning from the early outbreaks and tightening controls so that the others had few or no infections all helped, Raftis said.
Every improvement made in worker health screening, masking and more introduced at the hard-hit homes was rolled out across all the others.
Raftis also had, as part of a government bigger than that of many provinces, huge resources to draw upon that private and non-profit long-term-care homes could never match under Ontario’s current funding system.
He authorized overtime and hired more than 300 additional workers. They were joined by some city staff, unable to work in regular jobs due to a shutdown
Extra costs include 10,000 masks used per day across the 10 homes
of non-essential services, who were redeployed to long-term-care homes.
While Toronto Public Health works with and advises all long-term-care homes in the city, Raftis frequently got advice directly from public health chief, Dr. Eileen de Villa.
Extra costs include 10,000 masks used per day across the 10 homes. Asked how much extra COVID-19 has cost his department, Raftis couldn’t say.
“We haven’t done any financial analysis because we’re still in the middle of the response,” he said. “For sure, our costs are more than they would have been — these are exceptional times. There’s no question that we have benefited from using the full force of the city workforce.”
Canadian soldiers sent to help battle COVID-19 in four seniors homes — three in Toronto, one in Pickering and another in Brampton — found residents in terrible conditions and put at infection risk, according to a report released Monday.
Staffing issues were a common theme among the four private and one nonprofit homes. Staff were “overworked, seem burned out and have no time off (some have not seen their families for weeks),” the report said.
Mitchell, the CUPE 79 president, believes the city fumbled its early response by increasing protections based on what it thought about the virus, rather than going to full protections and scaling down as it got information.
For example, he said, “in the early days the (protective physical equipment) was surgical masks if you were dealing with a resident who didn’t have COVID.”
Staff should have had N95 masks, shields and gloves, Mitchell said, adding the city did learn from early mistakes and has dramatically scaled up PPE protocols.
“We implemented (a masking protocol) early,” said Raftis, “but clearly if we had implemented it earlier it would have made that much more of a difference for Seven Oaks and Lakeshore Lodge.”
There is no centralized data about wages and benefits at long-term-care homes. The Star asked CUPE and other unions representing Ontario long-termcare workers to provide that information.
Comparing an incomplete sample of 208 Ontario homes largely in the GTHA represented by those unions — and multiple collective agreements from 2018 to 2019 — the Star found municipal workers had, on average, higher wages across the board and more desirable benefits than their counterparts.
On average, municipal workers — including aides, personal support workers and registered practical nurses — made $3.18 to $4.65 more per hour than those under other ownership models, a wage difference of 13 to 17 per cent.
The largest difference in pay was for personal support workers, who made nearly 17 per cent more under the municipal model.
Looking at benefits in the sampled homes located in Toronto, it also appeared municipal employment offered other financial and health advantages — significantly better shift premiums, sick leave and entry into the municipal employees’ pension plan.
OLTCA said the “vast majority” of the sector is unionized and that many factors have contributed to staffing shortages, including COVID-19 diagnoses, self-isolation requirements and childcare issues. The association also noted there was a “human resource emergency” before the pandemic, especially with personal support workers, in homes of all ownership structures.
The emailed statement said the average wage for a personal support worker in the sector at privately owned, nonprofit and charitable homes is $22 per hour, which is consistent with the data provided to the Star by the unions. The municipal average was nearly $26 per hour. OLTCA said wages can’t be compared because the municipal homes receive additional government funding from their municipality.
Dr. Samir Sinha, director of geriatrics for Sinai Health System, said there is a tension over pay, both between higherpaying hospitals and long-term care, and different models of long-term care. This has also led to difficulty recruiting and retaining staff.
“When you just look at the wages right now, when you have not-for-profit and municipal homes significantly supplementing their budgets with other sources of income, that tells you that they don’t feel that the funding envelope they’re getting is adequate to provide the care that they think needs to be provided,” Sinha said.
A registered practical nurse represented by Service Employees International Union, which has over 23,000 members in nursing homes, could make, on average, $2.42 more per hour in a hospital setting compared to a longterm-care home, according to the union’s data.
Dr. Danyaal Raza, board chair of advocacy group Canadian Doctors for Medicare and a family physician, said relatively low wages for long-term-care workers put them in a position where they’re “stitching together multiple jobs.”
“And we’ve seen what that’s done to catalyze the spread of COVID-19 and ensuring that people are appropriately paid so they can provide care at one specific institution, I think that makes sense both from an infection control perspective but also from a continuity of care and familiarity with protocols and just in general a wellness perspective for both workers — staff — and people living in the home.”
He said the data also speaks to a larger issue of unequal pay between the hospital and long-term-care sectors.
“Rightfully so, there’s been a movement and recognition that we have to organize more around chronic care and community-based care,” he said.
Sheila Block, a senior economist with the Canadian Centre for Policy Alternatives, said she’s not surprised by the pay gap in the data provided to the Star.
“Any private sector organization has an obligation to its shareholders to maximize profits and therefore there’s an additional pressure on those owners to reduce costs,” she said.
“We also know that labour costs are a very high share of the costs in longterm-care homes.”
She said in pre-pandemic days longterm-care homes were underfunded across the board.
“I think the crisis in long-term care started long before COVID-19,” she said. “We need governments to invest more in this care and to provide workers in these situations with wages that are commensurate with the importance, the danger and the difficulty associated with this work.”
Coun. Josh Matlow, the city’s seniors advocate, said it would be reasonable for a planned provincial review of longterm-care homes to look at a move away from private care. He is urging council to recommend an “independent, objective and impartial” provincial inquiry into long-term care, saying “transformational change” is needed in the system.
“The question really should be, whether a home is public or private, is there enough accountability, scrutiny and a focus on safety and care rather than a profit motive to be able to protect staff and residents at their homes?” he said.
“The trend has clearly been that publicly operated homes have been safer and have been able to protect their residents through this pandemic better than many privately run homes. That’s just a fact,” he added.
“We can’t pretend that that isn’t what is happening.”