Health-care worker shortages are impacting the well-being of patients and employees in British Columbia.
More than half of care aides in B.C. say they don’t have enough time to meet residents’ care needs and more than 80 per cent say they’ve been abused or assaulted while on the job, according to a recent poll from the Hospital Employee’s Union released last week.
This survey confirms what the HEU has been hearing anecdotally from its members for years, HEU secretary-business manager Meena Brisard told The Tyee.
Nearly half of the care aides said they’re thinking about leaving health care altogether.
At the same time, workers have been asked to increase their overtime hours to compensate for an increase in sick days taken by hospital staff since the start of the pandemic, according to a recent report from the Canadian Institute for Health Information.
This has led to a rise in the number of injuries and infections in patients who were staying in hospital. From 2014 to 2021 the average rate of hospital harm across Canada was steady around five per cent, which increased to six per cent from 2021 onwards. That translates to one in 17 patients admitted to hospital being unintentionally harmed during their stay.
Health Minister Adrian Dix said he has “taken unprecedented steps to support staff who work in long-term care and assisted living — including actions on wages and labour rights.” Over the last five years the province has invested $2 billion to improve care for seniors, he said.
Brisard also pointed to these policies as a reason for many of today’s problems with long-term care.
In the ’90s, Brisard says, all care aides across B.C. were covered under a single collective bargaining agreement, which created comparable wages, benefits and working conditions at every care facility across the province.
Then the BC United Party “fragmented” the collective agreement, creating the “hundreds of agreements” that exist today.
The HEU says this was done to save the government money. But over time it has created wide disparities in wages, working conditions and benefits.
In B.C., long-term care facilities can be contracted by the government out to for-profit or not-for-profit companies, or run by one of the government’s health authorities.
Long-term care aides only want to work for health authorities or not-for-profits because the working conditions and benefits are extremely poor at for-profit facilities, Brisard says. It’s gotten to the point where for-profit care homes are struggling to recruit workers, let alone retain them, she says.
In 2019 the BC NDP repealed the 2002 and 2003 policies, which helped rehire “thousands” of workers for the regional health authorities. While this helped end contract flipping, where long-term care facilities would lay off unionized workers and hire them back outside the union at lower wages, the HEU estimates around two-thirds of contracted care aides are still outside of the collective agreement.
Dix also pointed to how investments by the BC NDP during the pandemic helped level wages across the province for care aides, so everyone got paid as if they were under the HEU’s collective agreement.
This has helped equalize wages across the province, but, as the Office of the Seniors Advocate pointed out in a report last month, the province was already providing funding for all long-term care facilities to pay care aides equally across the province. Before the pandemic many for-profit care homes were underpaying their employees and instead putting money towards expenses like building maintenance, management and mortgages. The wage-levelling program therefore increased the funding for these for-profit care homes because it provided funding for employees wages twice, the report notes.
How patients are being affected
Hospital injuries are “the result of a chain reaction, a failure of the system at multiple stages,” and can be prevented “by implementing known evidence-based practices,” the Canadian Institute for Health Information report says.
During the pandemic the rate of patients contracting urinary tract infections and pneumonia increased by about 20 per cent, aspiration pneumonia increased by 25 per cent and pressure ulcers by over 50 per cent, compared with pre-pandemic levels.
Aspiration pneumonia can happen when a patient has swallowing difficulties and is at risk of food or fluids getting in their lungs.
These harms reflect how overworked the national nursing pool is, the report suggests.
To reduce these harms the Health Ministry said it is working on recruiting, training and retaining employees, and has created a working group to identify and analyze individual units and work out what harms are happening where, and how to prevent them.
During the pandemic provinces and territories scrambled to meet staffing needs. The report notes how hospital health workers worked overtime and were redeployed to other service areas, how retired health workers were asked to come back to work and new workers’ licence requirements were streamlined. Many hospitals also brought in nursing students and hired agency nurses.
Then nurses got walloped by the virus itself.
In 2021-22 there was a 17 per cent increase in reported sick time compared to the previous year, which the Canadian Institute for Health Information calculates to be equivalent to missing 6,500 full-time nursing positions across the country.
During the same year there were more than 14 million overtime hours logged, which is an increase in 50 per cent from the previous year and is equivalent to 7,300 full-time nursing positions.
There was already a staffing shortage before the pandemic hit. In 2022 Statistics Canada said there were 95,800 vacant nursing, personal support worker and health-care worker jobs unfilled across the country.
The BC Nurses’ Union said in an emailed statement that there are currently 5,825 nursing vacancies in B.C.
BC Nurses’ Union president Adriane Gear wasn’t available for an interview to comment on the Canadian Institute for Health Information report but said in a statement the province’s commitment to implement minimum nursing-patient ratios “will go far to meet the needs of patients in B.C. and address the staffing crisis.”
Minimum nurse-patient ratios help reduce nursing workloads, increase staff safety, improve nurse retention and improve access to safe, quality nursing services, she added. The statement ended by calling on the government to implement these ratios in B.C.
To help fill vacancies provinces and territories turned to agency nurses, who are private contract workers. Contract nurses don’t get access to the benefits or pensions offered to public nurses, but they are usually paid more and have a more flexible schedule, the report notes.
All-in-all, agency nurses make up about one per cent of the total hours worked in hospital inpatient units, the report says. But their hours increased by 80 per cent when the pandemic hit, rising to over 1.5 million hours worked in 2021-22 compared to 850,000 in 2020-21.
Another way of looking at that is the number of registered nurses that were self-employed or working for private nursing agencies increased by six per cent in 2022, or by 867 more registered nurses.
Health-care workers experience burnout, violence and ‘moral distress’
The report also says during the pandemic nurses in the hospital sector increasingly reported they were experiencing burnout, moral distress (which occurs when “when one feels unable to take what they believe to be an ethically appropriate or right course of action,” according to the Canadian Medical Association) and a desire to leave the profession.
These are similar to concerns reported by the Hospital Employee Union’s poll of care aides, who provide personal care to nursing home residents, home care clients and hospital patients.
HEU represents more than 60,000 health-care workers across B.C., including about 28,000 working directly with seniors in long-term care and other care settings. Secretary-business manager Brisard says she wasn’t surprised to hear about the high rates of workplace violence, because she’d already been hearing reports from HEU members. What surprised her was to hear how nearly half of care aides were thinking of leaving health care altogether. Part of the reason for that, the report notes, is because care aides and community health workers are “short-staffed and struggling to deliver quality care.” Many patients have complex care needs resulting from illnesses such as dementia.
Staffing shortages mean more than two-thirds of care-aides say they have to rush through basic care routines and don’t have enough time to properly comfort, reassure or calm people who are confused, agitated or fearful, the survey notes.
This leads to workplace violence, with 82 per cent of care aides saying they’ve been hit, scratched, spit on or subjected to other forms of violence from a care home resident, patient or home care client. Forty-five per cent say they’ve taken time off work due to a workplace injury.
When the pandemic hit, it increased the workload for 40 per cent of care aides. This resulted in even less time to care for patients, worsening the cycle.
The situation is leading to burnout, with 62 per cent of care aides saying they “always” or “usually” end their shift feeling mentally or physically exhausted.
The Ministry of Health told The Tyee it is working on hiring 320 new security guards and 14 violence prevention workers for health-care facilities across the province. The security guards will have trauma-informed training and the violence prevention workers will have Indigenous cultural safety training as well, the ministry adds.
The HEU says it is working to improve the working conditions for care aides.
For Brisard, a major but obtainable fix would be to bring all care aids back under a single collective agreement.
The BC NDP effectively promised to do this during its 2020 election campaign, but it hasn’t happened yet, she says.
Dix told The Tyee he would continue to “focus on wage levelling, increasing staffing levels in long term care, increasing direct care hours and actively working with health authorities on the development of a long-term care funding model.”
A provincial program that pays for the post-secondary education of care aides has helped B.C. hire 6,546 new workers since the program was introduced September 2020, the Health Ministry adds.
Brisard says recent graduates still don’t want to work in for-profit care homes and, when they do accept a job there, it’s usually just to improve their training to make them more attractive for a job with a health authority or not-for-profit facility.