Carole Estabrooks is the scientific director of Translating Research in Elder Care and a professor in the Faculty of Nursing at the University of Alberta. Yuting Song is a postdoctoral fellow at the University of Alberta.
It’s been almost a year since nursing home workers began fighting on the front lines of COVID-19 – a year of extreme trauma.
They’ve seen seniors they care for suffer in fear and loneliness during lockdowns. They’ve seen residents fall catastrophically ill, and seen too many of them die: more than 19,000 people in Canada have been killed by COVID-19, more than 17,000 of them aged over 60 years and the majority of those deaths occurring in long-term care homes. They’ve seen the bodies – too many bodies.
They’ve fielded the panicked calls and pleas from families anxious with prolonged separation from their loved ones and full of grief for those they’ve lost. They’ve watched colleagues fall ill with the deadly virus, suffer long-haul symptoms or, in far too many cases, die tragically young. At least 33 workers in Canada’ health care settings have died from COVID-19, many of whom worked in nursing homes – the youngest one a 19-year-old janitorial worker in long-term care.
They’ve endured their own sleepless nights and anxiety, with some staying away from their homes for long periods, worried they’d bring COVID-19 back to their families. They’ve worked long shifts, understaffed, underpaid, working overtime and stretched too thin to do all the tasks that need to be done to keep the vulnerable humans in their care well.
And yet, we’ve seen some Canadians blame them for the tragedies befalling Canada’s seniors. When hospital doctors and nurses got applause, they got finger-pointing.
It is little wonder that nursing home workers are at catastrophic levels of burnout and trauma. And yet, still, our governments have largely failed to come to their aid in meaningful ways to keep both them, and our vulnerable seniors, safe. How did it come to this?
We’ve always undervalued nursing home staff. Care aides, also known as personal support workers, are the largest work force in long-term care in Canada providing upward of 90 per cent of the direct care. Their role is central to the quality of care and quality of life of individuals living in nursing homes.
In a December article for JAMA Network Open, our team at Translating Research in Elder Care (TREC) collected data across more than 90 long-term care facilities in B.C., Alberta and Manitoba and found that care aides are both a neglected and socioeconomically disadvantaged work force, as well as a critical source of emotional and social support for residents. According to that survey data, which was collected between September, 2019 and February, 2020 – meaning that this reflected a time even before the horrors of the pandemic – the care aide work force is under significant strain.
The study found that the majority of care aides are middle-aged to older women who speak English as an additional language. They work in a resource-constrained environment. More than 70 per cent of care aides reported moderate to high risk for emotional exhaustion. Care aides also reported frequently rushing or missing essential care tasks, and one half reported they had worked short-staffed daily or weekly in the last month. Care tasks left undone due to lack of time on the most recent shifts included taking residents for a walk (41 per cent), talking with residents (34 per cent), mouth care (16 per cent), toileting (10 per cent), bathing (9 per cent) and feeding (6 per cent). The majority also said they experienced significant rates of dementia-related verbal, physical or sexual behaviours from residents on a routine basis.
Again, this is all before COVID-19.
Imagine, now, the same people – already overwhelmingly on the brink of burnout and mental-health distress – now holding down the fort during a pandemic that has swept through nursing homes with vengeance. They are warriors without witness.
We’ve had a nursing home staffing shortage across this country for many years prior to the pandemic, and it is catastrophic now. Is it any wonder why?
Governments and operators are finally coming up with some creative solutions to address staffing shortages – though years too late, and in a piecemeal approach. One B.C. nursing home has offered to pay relatives to provide care. Ontario and Quebec created new support roles with free training in the hopes that students and the unemployed would apply. Postsecondary institutions are offering fast-tracked training certificates. Several provinces have implemented a salary top-up.
Now is the time for meaningful federal leadership. Growing old, becoming infirm, developing dementia – these things must not mean that any of us is less Canadian, less human, less deserving of a good end of life, lived with dignity, free from fear. If Prime Minister Justin Trudeau were seeking an enduring legacy, he should start here.
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