To the Editor:
During the first wave of the COVID-19 pandemic, Québec was the hardest hit province in Canada with close to half the deaths due to the virus in the entire country. The vast majority of those deaths occurred in long-term care institutions, or nursing homes. If these facilities had been chronically understaffed, as the pandemic progressed, low staffing levels became an even bigger problem as many workers left or became sick.
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For this reason, in April of 2020, Premier Legault of Québec requested the help of the army to increase the numbers of workers in nursing homes and the federal government agreed.- Andrew-Gee E.
- Stone L.
Under staffing turned seniors’ homes into COVID-19 danger zones, health workers say. What can be done to fix that? Globe and Mail.
https://www.theglobeandmail.com/canada/article-understaffing-turned-seniors-homes-into-covid-19-danger-zones-health/
Date: 2020
Date accessed: September 6, 2021
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The military filed a report stating that they had observed staff shortages, lack of PPEs, and improper infection control in many facilities.- Banerjee S.
Quebec calls for military help to bolster long-term care staffing. National Post.
https://nationalpost.com/pmn/news-pmn/canada-news-pmn/quebec-calls-for-military-help-to-bolster-long-term-care-staffing
Date: 2020
Date accessed: September 6, 2021
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Premier Legault acknowledged that he was not surprised by these findings. Staff shortages were a known weakness of the extended care system; however, the government had failed to act prior to the pandemic.- Sevunts L.
Radio Canada International, Military report on conditions in Quebec nursing homes details several flaws.
https://www.rcinet.ca/en/2020/05/27/military-report-on-conditions-in-quebec-nursing-homes-finds-several-challenges/
Date: 2020
Date accessed: September 6, 2021
In addition to inadequate staffing levels, many personal support workers were not full-time employees at one facility and had to work in multiple homes in order to make ends meet. If Québec seemed oblivious to the threat of virus transmission between facilities, British Columbia understood the possible consequences of worker migration. In March of 2020, Dr Henry, the provincial health officer of British Columbia, put forward 2 provincial orders, one banning staff from working at more than 1 facility and the other requiring nursing home operators to turn over staff rosters.
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She declared that the government would take control of personal support workers. This meant that for 6 months personal support workers would get equal pay and would be hired full-time in one facility. This limited working options, but workers were guaranteed a living wage at one facility. A 2020 report by Ernst and Young for the government of British Columbia's ministry of health found that “single site staffing had a positive impact on reducing the overall spread” but that it had led to loss of staff.- Eagland N.
COVID-19: Long-term care workers ordered to work at one facility only, Vancouver Sun.
https://vancouversun.com/news/local-news/covid-19-long-term-care-workers-ordered-to-work-at-one-facility-only
Date: 2020
Date accessed: September 6, 2021
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This unintended consequence has raised concerns as it left homes vulnerable to staff shortages. In addition, the single-site policy may have been a good measure in the short run, but it had differential impacts on the various types of facilities, which were not all beneficial.Ernst and Young.
https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf
Date: 2020
Date accessed: September 6, 2021
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Personal support workers moving from one facility to another should have drawn concern from the start in Québec; however, it was not perceived as crucial as the focus was on families and visitors bringing the virus into the homes. Rather, the government sought to address staff shortages and Premier Legault called for better salaries for personal support workers. In June of 2020, he announced that the government was looking to recruit and train 10,000 personal support workers.
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Potential workers were paid CAD$21/h to train and if they completed the training, they were guaranteed a job at CAD$26/h in a publicly funded nursing home.- Bashra B.
“We need you”: Quebec launches ambitious plan to hire 10,000 orderlies for embattled seniors’ residences. CTV News.
https://montreal.ctvnews.ca/we-need-you-quebec-launches-ambitious-plan-to-hire-10-000-orderlies-for-embattled-seniors-residences-1.4965339
Date: 2020
Date accessed: September 6, 2021
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By July of 2021, 92% of those recruited, called “préposés à Legault” in the media (Legault's personal support workers), are still working in nursing homes. The numbers are 8357 out of 9127, which indicates high retention, but the goal of 10,000 has not been reached. The government is looking at immigration to increase the numbers.- Mignaca F.
Thousands send in applications to work in Quebec long-term care homes. Canadian Broadcasting Corporation.
https://www.cbc.ca/news/canada/montreal/chsld-orderlies-training-program-announced-1.5595010
Date: 2020
Date accessed: September 6, 2021
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The Québec initiative is directed at staffing, and unlike its counterpart in British Columbia, Québec public health was not involved. Rather, the issue was framed as one to be addressed by the government to support the extended health care sector.- Le Soleil Richer J.
Nursing Homes: Quebec wants to recruit 550 personal support workers from abroad [CHSLD: Québec veut recruter 550 préposés aux bénéficiares à l’étranger].
https://www.lesoleil.com/actualite/chsld-quebec-veut-recruter-550-preposes-aux-beneficiaires-a-letranger-380919e850299428da14c4906f109715
Date: 2021
Date accessed: September 6, 2021
Recruitment and retention of personal support workers is an ongoing concern. British Columbia's initiative made staffing worse, and Québec is still grappling with the problem. Salaries and stability are important, which explain the partial success of Québec's initiative. Nevertheless, it has taken more than a year for the Legault government to entice workers. This indicates that there are deep-seated problems with this type of occupation. In part, it is because the work is socially devalued but there has to be other reasons. A crucial first step is to consult personal support workers in order to identify some of the roadblocks to job satisfaction. Before the pandemic, the Ontario Centres for Learning, Research & Innovation in Long-Term Care along with the Research Institute for Aging conducted a survey of personal support workers. Among the findings, workers stated that they wished to be part of the decision-making processes in their facilities.
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Worker involvement increases worker satisfaction. Consulting and listening to workers will help improve working conditions and, in turn, the quality of the care provided.Ontario Centres for Learning Research and Innovation in Long-Term Care and Research Institute for Aging
PSW perspectives on the staffing challenge in long-term care: Report on challenges, possible solutions and visions for the future from PSWs across Ontario.
PSW perspectives on the staffing challenge in long-term care: Report on challenges, possible solutions and visions for the future from PSWs across Ontario.
Ontario CLRI at the RIA,
Ontario, Canada2021
Acknowledgments
Even though it is now officially finished, the project, Re-Imagining Long-Term Care has been instrumental in helping me broaden by perspective on long-term care.
References
- Under staffing turned seniors’ homes into COVID-19 danger zones, health workers say. What can be done to fix that? Globe and Mail.(Available at:)https://www.theglobeandmail.com/canada/article-understaffing-turned-seniors-homes-into-covid-19-danger-zones-health/Date: 2020Date accessed: September 6, 2021
- Quebec calls for military help to bolster long-term care staffing. National Post.(Available at:)https://nationalpost.com/pmn/news-pmn/canada-news-pmn/quebec-calls-for-military-help-to-bolster-long-term-care-staffingDate: 2020Date accessed: September 6, 2021
- Radio Canada International, Military report on conditions in Quebec nursing homes details several flaws.(Available at:)https://www.rcinet.ca/en/2020/05/27/military-report-on-conditions-in-quebec-nursing-homes-finds-several-challenges/Date: 2020Date accessed: September 6, 2021
- COVID-19: Long-term care workers ordered to work at one facility only, Vancouver Sun.(Available at:)https://vancouversun.com/news/local-news/covid-19-long-term-care-workers-ordered-to-work-at-one-facility-onlyDate: 2020Date accessed: September 6, 2021
- Ernst and Young.(Available at:)https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdfDate: 2020Date accessed: September 6, 2021
- Care aides working multiple jobs: Considerations for staffing policies in long-term care homes during and after the COVID-19 pandemic.J Am Med Dir Assoc. 2020; 21: 1390-1391
- “We need you”: Quebec launches ambitious plan to hire 10,000 orderlies for embattled seniors’ residences. CTV News.(Available at:)https://montreal.ctvnews.ca/we-need-you-quebec-launches-ambitious-plan-to-hire-10-000-orderlies-for-embattled-seniors-residences-1.4965339Date: 2020Date accessed: September 6, 2021
- Thousands send in applications to work in Quebec long-term care homes. Canadian Broadcasting Corporation.(Available at:)https://www.cbc.ca/news/canada/montreal/chsld-orderlies-training-program-announced-1.5595010Date: 2020Date accessed: September 6, 2021
- Nursing Homes: Quebec wants to recruit 550 personal support workers from abroad [CHSLD: Québec veut recruter 550 préposés aux bénéficiares à l’étranger].(Available at:)https://www.lesoleil.com/actualite/chsld-quebec-veut-recruter-550-preposes-aux-beneficiaires-a-letranger-380919e850299428da14c4906f109715Date: 2021Date accessed: September 6, 2021
- PSW perspectives on the staffing challenge in long-term care: Report on challenges, possible solutions and visions for the future from PSWs across Ontario.Ontario CLRI at the RIA, Ontario, Canada2021
Article info
Publication history
Published online: August 23, 2021
Footnotes
The author declares no conflicts of interest.
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© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
