Pandemic Pressure

CLAC members working in long term care are facing challenges unlike any they have ever seen—and they want you to know exactly what that means

By Rachel Debling

WHEN IT COMES TO COVID-19 and the pandemic, it can be easy to get caught up in the numbers: more than 200,000 Canadians have caught the virus, and more than 10,000 have died. And based on the progress of the virus, these numbers will undoubtedly continue to grow. 

But the victims of this global crisis aren’t just those who have contracted the virus. The effects of the pandemic are far-reaching and long-lasting, and no sector has felt it more acutely than long term care (LTC), where 80 percent of the deaths resulting from infection have occurred. 

To demystify the stigma surrounding the current LTC landscape and provide a platform for those on the front lines, the Guide spoke with several Local 302 members in the field as well as an LTC facility administrator who have experienced the consequences of the outbreak firsthand. These are their stories. To protect members’ identity, and to allow them to speak freely, aliases have been used. 

'“MY FIRST THOUGHTS WERE FEARFUL,” recalls Sarah, a personal support worker (PSW) in the Niagara region with more than a decade of experience, when asked about her reaction to the initial outbreak in the long term care home where she works. “It wasn’t the fear of contracting the disease. I felt prepared, and I knew the correct ways to sanitize and use personal protective equipment. But I was afraid of the potential for the virus to spread throughout the facility to other vulnerable residents. Our first patient to contract the virus was known to wander.”

Sarah’s apprehensions are echoed by many in the sector, well-recognized as overworked, understaffed, and underpaid even before the events of 2020. Carmen, a PSW working in a St. Catharines, Ontario, LTC home as a clerk and scheduler, remembers the pandemonium that came with the first outbreak in her facility. 

“One of my coworkers came down with the virus,” she says. “Thankfully, the swift actions of staff contained its spread.” But when another case was later diagnosed, they weren’t as lucky.

“That time around it was different,” says Carmen. “Both a resident and a staff member tested positive, and we became anxious. “My concern was making sure we had enough staff on the unit so they would not burn out. Thorough cleaning was conducted twice each day, and meals were served on paper plates to each resident’s room.” 

Despite these and other measures, such as isolating residents and increased cleaning frequency, the outbreak continued, climbing to over 10 cases between staff and patients. 

Though members felt helpless, Carmen says they persevered, with sick calls and absences kept to a minimum. Still, the pandemic had already begun to take its mental and emotional toll. Staff rallied around each other to provide support in the face of the unknown, and Carmen did what she could as a scheduler. 

But like many in her facility, she felt as though her hands were tied. 

“I wanted to support my coworkers and residents but didn’t know how,” she says. “The only thing I could do was make sure we had more than enough staff.” 

THOSE ON THE FRONT LINES of long term care have long been under pressure due primarily to a lack of proper funding and the myriad of problems this creates. The work environment was already stressful, with hands-on staff typically assigned 10, 12, or more residents. 

Then, just when workers thought it couldn’t get any worse, COVID-19 struck. Now, they were being asked to do more, faster, all while putting themselves in harm’s way. The pressure resulted in a level of adversity members had never seen before. 

Tammy has been employed as a PSW at a southern Ontario LTC home since it opened nearly five years ago. She has personally witnessed the chaos caused by lockdowns and outbreaks since the pandemic started in March and eagerly shares her experiences with anyone who will listen. 

“A distressing amount of time constraints have been added to my day-to-day routine,” she says. “Donning and doffing [the technical terms for putting on and taking off PPE] between every room, and sometimes between every patient, can add minutes to an already tight schedule of care.” 

The type of PPE can contribute to delays as well. 

“I prefer the convenience and ease of disposable gloves and gowns over reusable equip-ment, especially since some fabrics and detergents irritate my skin,” says Tammy. “But they often come at a premium and have historically been conserved for the night shift when there are fewer staff on the floor.” 

There is another danger waiting in the wings for PSWs in long term care. Faced with increased restrictions, Tammy says residents have become more “responsive.” For those not familiar with industry jargon, in this situation, being responsive is far from positive. 

Residents physically expressed their anger and confusion stemming from the multiple, frequent changes to their day-to-day routines. The fact that they couldn’t have friends and family visit was a source of frustration some could not verbalize, resulting in violent behaviour toward staff: yelling, kicking, and even throwing objects. 

“We were getting the brunt of what was happening to them,” says Tammy. “They didn’t know how to tell us they don’t want to wear PPE. They didn’t understand why they couldn’t see their daughter.” 

Sarah has witnessed the same in her workplace. 

“My thoughts are with the residents and their families,” she says. “Prior to COVID, we had many dedicated family members visiting every day, and that abruptly stopped. Many residents didn’t understand and felt abandoned by their families.” 

This feeling of desertion can lead to depression in otherwise content residents. Members who are tasked with their care become the unwitting victims of their out-of-character, but understandable, behaviour. 

PRIOR TO THE PANDEMIC, ROADBLOCKS in the long term care sector—understaffing, overwork, poor pay, excessive documentation, to name a few—were already souring a workforce that was up against a staggering array of challenges. These roadblocks push many PSWs and other healthcare staff out of the field year after year. But COVID-19 is making the situation much worse. 

“The vast majority of people who work in this field chose it and stay in it because they gain satisfaction by providing care to others,” says Michael Reid, CLAC Ontario healthcare coordinator. “Now, imagine you are put in a situation where people are desperate for care and you cannot provide it. The satisfaction of a job well done, or even just being able to complete your job, is gone. 

“For many of our members, it seems like they are constantly choosing between two or more important and necessary tasks, and they can only do one of them. The need for documentation has skyrocketed, tacking additional paperwork onto already time-strapped employees who, quite simply, just want to get their job done as best they can.” 

Statistics show that a quarter of PSWs with two or more years of experience leave the field every year. A shocking 40 percent of those with less than a year under their belts do the same.

“Understaffing leaves workers feeling devalued, unsupported, and ignored,” says Michael. “The quality of care they are providing can be lost in the shuffle, too. 

“Understaffing causes capable workers to leave in high numbers. It means we see residents suffer more falls, bedsores, and depression, all of which can kill them.” 

FOR MEMBERS, THE ADDED RISK of infecting loved ones is obviously a high concern. But a more silent, and still very dangerous, threat is lurking in the shadows: the emotional baggage that PSWs and other staff of LTC facilities bring home with them. 

“My home life was affected almost as much as my work,” says Lois, a PSW. “I couldn’t see my extended family during the outbreak, and my husband and I slept in different rooms. I was scared and sad, afraid of how long I would have to be away from my family.” 

Many in the sector also report a growing stigma surrounding front-line workers. Their friends and family have become increasingly cautious about interacting with them out of concern of contracting the virus. 

“People are scared to even be near you if they know you work in long term care or the healthcare sector,” says Tammy. “They think you automatically have it. They would wear a hazmat suit around you if they could.” 

The media has also contributed to this unearned reputation. 

Sally is an administrator at an LTC facility that has been subject to dozens of positive COVID cases, including 47 staff members, over the course of a single outbreak. Because of their high case count, her workplace was targeted in the local media—at the cost of staff morale. 

“Communities rallied around the residents and staff of other facilities with drive-bys and socially distanced shows of support,” she says. “Meanwhile, our staff were having difficulty getting taxis and items delivered to our location.” 

Sally and her coworkers found ways to encourage each other and residents in any way they could. 

“One PSW would take to the loudspeaker to entertain everyone with her rendition of ‘Amazing Grace,’” she says. “Others would offer their chauffeur services to those who could not secure a ride to work.” 

Sally shared supportive stories and messages of thanks from the residents’ families with staff whenever she could. In retrospect, she considers the hurdles they faced as opportunities to bond. 

“I can’t believe the resiliency of this team,” she says. “I couldn’t have designed anything that could have brought the staff together more.” 

MOST WHO OPT TO ENTER healthcare as a PSW don’t get into the field for the money or the glamour—there is little of either. They do so because they find personal satisfaction in helping others. 

It’s natural for them to become close to the residents that they care for. This certainly rings true during the pandemic, when they may see those they are caring for more than their own family members. 

“We help residents maintain their independence the best way we can,” says Tammy. “But as restrictions were imposed and the death count across the province continues to mount, the dignity we were once proud to provide is slowly beginning to slip away.” 

She points to the process following the passing of a resident as an example. 

“Previously, PSWs would wash, dress, and prepare the body for the family to visit,” she says. “From there, the funeral director would take the body from the facility. As it left the building, if the family agreed, staff would perform what we refer to as an honour guard. Workers line the hallway as the body is taken out of the building, offering their respect as it passes by. 

“Now, that process is much quicker and lacking in emotion. Once the washing is complete, the staff—not the funeral director— must shroud the body.” 

The ceremonious show of respect that once helped the facility’s workers deal with the loss of a resident who became like a cherished friend to them must now be abandoned. 

“Our jobs are normally to care for and bring comfort to our residents in life,” says Lois. “We help them pass comfortably, with dignity, love, and support—not by putting them into a bag and zipping it up. 

“I cried every time I had to assist with this process. But now I’m used to doing it. And that is not normal.” 

ALONG WITH THE EMOTIONAL TOLL caused by the pandemic, members are also paying a financial toll. To help, CLAC has advocated for governments to increase the pay of healthcare workers, who are carrying the heaviest burden created by COVID-19. Unfortunately, the pandemic has caused these already cash-strapped workers to feel an even greater financial pinch. 

Though some LTC homes were thankfully able to add staff to shifts or offer extra hours to front-line workers, Ontario-wide emergency orders meant that those working both in homecare and in LTC facilities, or in multiple facilities, had to choose one over the other, essentially stymieing their sources of income. 

“I have been affected financially as I am unable to work my other homecare job,” says Sarah. “This in turn has caused me financial and emotional stress. I’m a single mother with three children, and I am now finding it hard to make ends meet.” 

Lois echoes Sarah’s concerns. 

“Some of our staff went on stress leave while others had to choose which facility to work in,” she says. “Some had to take a leave of absence because their age or other factors put them in a high-risk category.” 

The economic consequences of being forced to work in only one workplace have caused financial hardship for some, and CLAC has been calling on the government, including presenting to Ontario’s Long-Term Care Staffing Study, Staffing Strategy Advisory Group, and Long-Term Care COVID-19 Commission, to address these hardships. The union is also petitioning for permanent wage increases for all hands-on healthcare workers across the province, including staff providing care and support to residents in LTC homes. 

CLAC has also supported members by keeping them informed throughout the pandemic. 

“We’ve communicated to members about available programs and health directives, instructions on how to properly use common PPE, and the advocation for necessary and fair assistance from the government,” says Michael. “Knowledge goes a long way toward helping people cope with stress, especially when much of the stress is caused by rapidly changing plans and directions from public health.” 

ON THE FRONT LINES, THINGS may never be truly normal again. But members working in long term care are hopeful that the industry will soon settle into a new, better routine. 

“I have adapted to the new normal for the time being,” says Sarah. “I know that if I do my part by wearing a mask and shield and using correct handwashing and sanitizing techniques, things will return to prepandemic ways.” 

Other members are also cautiously optimistic. 

“I don’t believe we will ever be ready for another COVID outbreak,” says Carmen. “But we do have the knowledge on how to deal with it effectively. Still, we are scared every time there is a new round of testing at our home. We all hold our breath.” 

Above all, PSWs and other healthcare staff recognize their role in the country’s return to peak health and the obstacles they have to overcome. And they are holding their heads up high. 

“I am proud to tell you I work in long term care and that I worked through this pandemic,” says Tammy. 

Lois agrees, citing the camaraderie of her fellow workers as something that pushes her to survive and thrive on a daily basis. “We work together as a team to get through each day, doing our jobs to the best of our abilities and caring for our residents with excellence, love, and dignity,” she says. “I have faith we can get through anything together. 

“That being said, I never want to experience another outbreak again. But if we have to, we will get through it. Because that’s what we do.”

Cindy Moore is a personal support worker and Local 304 member on a mission: to bring attention and funding to her field, where both have been desperately needed for some time. She says that the issues in the sector have been compounded by COVID-19, which has left the industry strapped and scared. 

“The pandemic highlighted every bad part of what goes on in long term care,” she says. “It has always been so easy to blame PSWs for not performing well enough to give good care. This is unfair and untrue.” 

Cindy became vocal about problems in long term care (LTC) earlier this year after CLAC rallied its healthcare members through a letter-writing campaign. Tired of her position being disrespected and dismissed, the project resonated with her. Along with three coworkers from Country Lane, an LTC home in Chatsworth, Ontario, she sent letters to her MPP, Bill Walker. Their pleas caught his attention, and the letters were forwarded to Merrilee Fullerton, Ontario’s minister of long-term care. 

Cindy also sent an email to Ontario’s Long- Term Care COVID-19 Commission that outlined the biggest issues affecting the sector. Some of these concerns included the pay disparity between rural private for-profit LTC homes like Country Lane and those in urban centres; the growing ratio of patients to PSWs, which showed no signs of slowing during the pandemic; cuts to their facility’s housekeeping budget and its effect on staff; and the dismal pay raises she and her fellow Country Lane coworkers are provided each year via an arbitration award, which Cindy reports amounts to about $0.26 per hour annually. 

Permanent change is hopefully on the horizon. After a phone conversation with Bill Walker and 14 of her fellow members in October, Cindy was asked to send another letter outlining the biggest challenges to recruiting and retaining LTC workers. This letter was delivered to Minister Fullerton for consideration, an achievement that Cindy was proud to be a part of. Though pleased with some of the programs that have recently been implemented by the Ontario government to help retain and attract more workers to the sector, Cindy is hesitant to say that PSWs are in the clear. 

“My biggest fear is that once the smoke settles, everything will go right back to the way they were, and nothing will have changed for the better,” she says. “Until things are made right, we will continue to champion for change, on behalf of our coworkers, the residents we care for, and the province at large.”

For more information on how to make an impact regarding Ontario’s long term care sector, visit the Ontario Long-Term Care COVID-19 Commission's website.

5 Ways Management Can Help

1. Recognize the severity of the situation. Admitting that problems like understaffing are contributing to a lower quality of care is the first step toward change.

2. Don’t play the blame game. Resident neglect is bound to happen when understaffing is an issue, which is not an individual worker’s fault.

3. Roll up your sleeves. Some members reported that management, supervisors, and even human resources staff  helped with tasks such as dining room and tray service during the thick of the lockdowns.

4. Ensure proper communication. With today’s rapidly changing procedures and health directives, communicating updates in an efficient and timely manner is key to preventing the spread of the virus and making staff feel prepared and protected.

5. Be an advocate. The simple act of pushing for more funding can help negate many of the issues listed above and make staff feel heard and understood.

Are your hands blistered from constant washing and harsh sanitizers? Do you wish that you could for once figure out whether the person behind the face mask is smiling or glaring?

Though many across the country are slowly and carefully returning to their workplaces, COVID-19 prevention is here to stay. And for the most part, Canadians have been diligently following recommendations. 

According to surveys and polls conducted over the summer,

• 90% will continue to wash their hands with greater frequency even as restrictions are lifted.
• 80% will avoid large crowds and continue to physically distance as the country reopens.
• 70% said thermal temperature scanners installed in their workplace would make them feel more comfortable as they returned to work.
• 60% said they would be likely to get in line for a COVID-19 vaccine.

Canadian women are more likely to wear masks in public than men. The same goes for older demographics (65+) versus those aged 15 to 24.

Companies from coast to coast have been answering the call to create safer work environments for their employees and clients, too. Statistics Canada reports that already
by July 2020, nearly four million litres of hand sanitizer and more than 275 million disinfectant wipes were used in businesses in the fight against COVID-19.

Sources: Statistics Canada, hrreporter.com