Amidst the ravages of COVID-19—battered care systems, critical shortages of care staff, growing social and health inequities—we need swift, decisive, and visionary government action. The Nova Scotia Progressive Conservative’s recent election victory owes in part to their Dignity for Seniors election campaign plan, which boasted a detailed budget to fix the continuing care sector. A closer look at this plan, which we presume to be the underpinning of the current government’s agenda in this area, reveals misdirected funding and meagre support for direct care staff—the critically strained backbone of the continuing care sector.
Without a doubt, Nova Scotia’s long-term care (LTC) sector has been devastated by COVID-19, where more than 50% of the COVID-19 deaths happened. Numerous reports have documented horrifying living conditions for residents and grueling working conditions for staff. For years, LTC bed shortages and long waitlists in Nova Scotia (estimated to be more than 1,200) have been documented and discussed.
The Dignity for Seniors plan proposes a variety of strategies to address these issues: a new $500 Seniors’ Care Grant for home care users, increased care hours, and $400 million (a figure based on unsecured federal contributions) to invest in more than 3,500 new LTC beds over the next three years. On the surface, these commitments respond to calls that unions, researchers, and policy makers have been making for decades, but the funding allocation is seriously misaligned. There is a need for more LTC beds. However, with multiple facility closures due to worker shortages, we are losing beds because we do not have the staff required to provide quality care for current LTC residents. We need a plan that prioritizes quality of care by properly supporting those who provide it, not just beds.
For decades, LTC advocates and experts have demonstrated that the conditions of work are the conditions of care. We cannot enhance dignity for seniors without also valorizing the staff who provide care for them.
Despite the rhetoric around “healthcare heroes”, Nova Scotia’s Continuing Care Assistants (CCAs), who provide the majority of direct care to LTC residents, receive some of the lowest wages and salaries in the country. Recent COVID-19-related bonuses were limited and many frontline workers are exempt from pay increases or income support. The $6.4 million that Nova Scotia had still not spent from the federal essential worker top-up should be immediately allocated. The signing bonuses currently offered in many facilities are not sufficient to recruit adequate staff, which is not surprising since many CCAs are still only earning $17 an hour. Even the recent negotiated increases are not sufficient to address their need for decent wages given their starting point.
Large numbers of healthcare staff have already left the sector, multiple facilities have closed because of staffing shortages, and experts estimate that the province has an immediate need for thousands of new healthcare workers.
COVID-19 thrives because of the gaps and weaknesses in how we care for each other in Canada. We need a plan that recognizes that dignified care is much more than building LTC beds.
Dignity for Seniors includes a plan to recruit 2,000 more LTC staff, largely through expanding training capacity and reinstating the CCA bursary. Beyond these measures, their recruitment and retention plans are hazy.
The provincial government’s plan skirts the significant challenges involved in recruiting foreign health care staff, which is now a key strategy for recruiting CCAs in the Atlantic region despite increasing signs of global health worker shortages in traditional “sending” countries. And how will these workers be retained if working conditions are not improved in the long term?
Most importantly, Dignity for Seniors offers nothing in terms of urgently-needed wage/salary increases, paid sick leave, benefits, vacation time, and enhanced job security and occupational health and safety. Their investment in recruiting new CCAs is based on the paltry current average income of $36,778/year, which is significantly below the recently calculated minimum annual income if the wage was based on the calculated living wage. The status quo will not improve the conditions of work nor the conditions of care. Decades of research has demonstrated that such higher pay, respect and security for LTC staff are strongly linked to higher quality of life and care for older LTC residents.
While the plan gives a nod to the importance of enhancing home care options for older people, their proposed $500 Seniors’ Care Grant supports older people to pay for things like home repairs and lawn care, not typically provided by home care services. The grant does little to make home care a feasible alternative for older people and will not attract much-needed home care staff without a commitment to significantly increase wages.
Ultimately, Dignity for Seniors does not provide the vision we need for transformative and structural change. It enshrines the privatization of LTC and ignores the well-documented deficiencies of for-profit LTC facilities which have disproportionately higher COVID-19 death rates and poorer working and living conditions than their non-profit and publicly-funded LTC counterparts across the country. Currently 56% of the LTC sector is for-profit in Nova Scotia; public dollars should not be spent on profit.
The plan also ignores policy recommendations for culture and policy change in LTC that would improve seniors’ dignity by moving away from punitive LTC policy orientations so that LTC families, volunteers and staff are not overly restricted in their ability to provide resident-centred care.
COVID-19 thrives because of the gaps and weaknesses in how we care for each other in Canada. We need a plan that recognizes that dignified care is much more than building LTC beds. We need collective investment in caring relationships that values and supports those who care for us and our loved ones in times of vulnerability.
In the context of this federal election, let’s demand better: federal standards and universal public funding for continuing care, job security, as well as decent wages and working conditions for all continuing care staff.
We need to build a care economy that recognizes care as a fundamental component of our basic social infrastructure.
