Finally, after years of fighting for more staff and better caring conditions, action is being taken to relieve B.C.’s extreme staffing shortage in long-term care.
February’s provincial budget outlined a major commitment by the NDP government to address chronic issues in seniors’ care – which is welcome news for a depleted system in desperate need.
Over the next three years, $548 million in new funding will go toward improving seniors’ care, including more staff in long-term care. This is on top of the $20 million that’s been rolling out as an emergency stopgap measure, targeting sites with the lowest staffing levels.
That first round of funding focuses on converting casual and part-time care aide positions to full-time.
How did we get here?
HEU members have struggled long and hard over the past many years to get government and their health authorities to deal with understaffing in long-term care.
The union’s most recent campaign Care Can’t Wait took the case public with a comprehensive advertising strategy, petitions, a grassroots member outreach effort on the shop floor, and meetings with MLAs.
At the same time, HEU members’ concerns were underscored by B.C.’s seniors advocate Isobel Mackenzie. Her reports over the last three years showed that up to 90 per cent of residential care homes were not adequately funded to meet government’s staffing guidelines.
By last spring, seniors’ care had become a priority issue in the provincial election.
“Our efforts to make seniors’ care an election issue succeeded,” says HEU’s secretary-business manager Jennifer Whiteside. “All three parties in the legislature promised to improve staffing levels in residential care. “Clearly, the political will is now there to make sure our seniors’ homes get the resources they need to deliver safe, quality care.”
HEU member Amy Nand is a care aide in Abbotsford. She sees some light at the end of the tunnel. “For so long, it has felt too big for us to solve on our own or within our work sites,” says Nand, who was part of the union’s Care Can’t Wait campaign.
Nand says it was critical for care staff, who face the same daily struggles, to come together and advocate for themselves and their residents.
“We found common ground,” she says. “We dug deep, shared our stories, got at the issues and made connections with the public.”
Shawna Lockhart, an activity aide from Kamloops, agrees.
“It’s been heartbreaking to see some of the serious problems out there,” says Lockhart. “Hearing stories from members who face tough situations on a daily basis was difficult, but also empowering. Together, we worked hard to make sure government and decision-makers listened.”
What's needed now?
In the four years since Mackenzie’s appointment, her reports have proven instrumental in putting seniors’ care issues squarely in the public eye.
To that end, Mackenzie has tackled a wide variety of issues from staffing to seniors’ poverty to housing.
But while the first steps to deal with the staffing crisis are now being taken, there are other critical problems facing seniors in care.
Last fall, Mackenzie released the results of B.C.’s first-ever resident survey. It underscored the need for more timely assistance with basic care needs, more flexibility with meal times, and higher levels of social interaction and activities.
And her most recent report released at the end of January – Residential Care Facilities Quick Fact Directory – also covered a variety of issues related to seniors’ care, including food services, social engagement and overmedication.
According to that report, the provincial average for food costs per resident per day is $8, but can dip as low as $4.92. And about half of all seniors in care experience isolation, loneliness and a low sense of social engagement.
Just as disturbing, the report says one in every four residents receives antidepressants without a prescription, and it’s the same statistic for residents getting antipsychotics without a diagnosis.
Quality care
Kim Slater, chair of the Vancouver Island Association of Family Councils, is pleased the seniors advocate is tracking issues that are top of mind for families with loved ones in care, but wants to see more changes.
“Care should focus on the needs of the resident,” says Slater. “What a tragic way to spend the remainder of your life – feeling lonely and isolated in a facility full of people. It shouldn’t be happening.”
In a 2014 Viewpoints Research survey of HEU care aides, more than 70 per cent reported they did not have the time to engage with residents or comfort someone who may be confused, agitated or afraid.
Lockhart says it takes a toll on staff working in long-term care. “You get into this thinking you are going to be able to help and provide care with dignity for residents, but the reality is very different,” she says. “We need to close that gap.”
Research shows that residents who participate in social and recreational activities – and have a close relationship with at least one staff member – are more likely to have positive self-perceived health.
“But what is interesting is the link to the caregiver relationship,” says Slater. “If a resident is happy to see their caregiver, feels close to their caregiver – they live longer. What we’re talking about is quality of life. But there’s mounting evidence that we are also talking about health.”
Quality of life is not determined by basic care alone. The whole package – care, food, medication and socialization – is vital to good residential care.
One thing impacts the other. For example, a lack of socialization can lead to more complicated issues such as overuse of medication.
“Every person needs stimulation,” says Lockhart.
“When we don’t provide that, it leads to more complicated issues such as aggression and depression.”
The amount of money spent on food raises questions about the quality, amount, and nutritional value of the food provided to residents. Some sites have full kitchens and dietary staff to prepare wholesome food, while other facilities, to save money, serve reheated, prepared food.
“Over the years, there have been some improvements,” says Slater. “We’re heading in the right direction, and it’s great that the seniors advocate is monitoring overmedication, but there’s still a lot to do. Improved staffing levels would go a long way to help.”
Contracting out
Although HEU is welcoming these first steps to relieve the staffing crisis in seniors’ care, contracting out and flipping contracts remains a top concern.
The union is continuing to press for changes that are urgently needed to stop the practice of laying off entire care teams.
“We cannot solve our staffing crisis if we don’t deal with contracting out and contract-flipping,” says Whiteside. “It not only creates a race to the bottom, it destabilizes care and has a profoundly damaging effect on seniors.”
Long-term residential care has become one of the most stressful and unsafe working environments in B.C., with workers regularly exposed to violence and injuries. Moving to stabilize the sector by ending contracting out, raising staffing levels, and legislating enforceable standards would improve both working and caring conditions.
HEU is also calling for strong accountability measures to ensure funds go to increased staffing, not to profits or administration.
“We need enforceable standards that are legislated,” says Whiteside. “We need strong mechanisms in place to make sure that new public funding gets to the front lines where it’s needed.”
Recently, Mackenzie and the Minister of Health Adrian Dix recognized a need for increased transparency and funding accountability.
“After all of the hard work put into this campaign by HEU members and supporters, it’s encouraging to see our new NDP government take action,” says Whiteside. “And we will continue to make sure our voices are heard on all issues impacting seniors and the people who provide their care.”
by Sara Rozell