It is no secret that the long term care sector is in crisis. Part of that crisis is the lack of planning to prepare for the grey wave. With an aging population, the need for more beds in long term care is urgent.
The provincial government has made recent announcements for an investment of an additional 15,000 licensed beds over the next 4 years. We already know this won’t be enough. A recent report from the Financial Accountability Office of Ontario notes these beds won’t make a real dent in wait times. The report goes on to project a need for an additional 55,000 beds by 2033 to prepare for the grey wave. A sobering thought indeed.
But an equally challenging dilemma arises when we ask the question, who will provide the care? Staffing in long term care (LTC) homes has been the most pressing challenge faced by the sector in recent years.
With an increasingly finite pool of qualified staff to choose from, LTC homes have invested significant resources into recruitment. But with very little success. Enrolment in PSW courses across the province has plummeted resulting in the cancellation of courses. High seniority staff are retiring or leaving the sector for less stressful and less dangerous work. The increasing pressure to provide dignified care while being short-staffed takes it toll, as staff face physical and morale burnout.
Normally, competition for qualified staff drives wages and compensation up. But given the public funding structure of LTC, wages continue to decline in relation to inflation. Declining wages and declining PSW enrolment coupled with an increasingly aging population and increasing beds = CRISIS.
How have industry and government responded? The government has been silent on the issue of attracting qualified staff into the sector. Unable to attract PSWs, many employers are desperately turning to a new classification of employee—the personal support assistant (or some other variant).
The Long Term Care Act requires that all direct personal care is performed by qualified PSWs. This care is funded by the nursing envelope. Job routines of PSWs have traditionally included direct front-line care, but also tasks such as portering residents, assisting with feeding, making beds, spotting for lifts and transfers, bed making, and a host of other functions only tacitly related to direct care.
The thought process is that if we can separate direct care tasks from nondirect care tasks, we can bundle the nondirect care tasks into a new job routine. We can then have that routine performed by cheaper, non-PSW qualified staff, without violating the Long Term Care Act.
Not surprisingly, many PSWs welcome the new classification. When you’re drowning in work, any life-preserver—even a poorly designed one—is better than none at all.
It is hard to rally against a life preserver. But the systemic issues plaguing the industry go unresolved. We need to address why staff are drowning in the first place. Punitive regulatory oversight, documentation burden, lack of mandated staffing levels, increasing workplace violence, and declining wages are all good places to start.
Creating a new classification may be a welcome life preserver, but it won’t stop us from swimming in circles as we wait for rescue. It’s time for government, industry stakeholders, and unions alike to start addressing the real issues.