Personal support workers caring for some 80,000 long-term care home residents in Ontario feel anger, frustration and burnout as they struggle to meet expectations while routinely working in understaffed facilities, a new report says.

According to Caring in Crisis: Ontario’s Long-Term Care PSW Shortage, commissioned for the Ontario Health Coalition by Unifor, the situation has become an epidemic.

The report – announced Wednesday at media events in Chatham and London – is based on accounts from the more than 350 people, including PSWs, nurses, family members, union members and long-term care home managers who took part in meetings held provincewide since May 2018.

The first “eye-opening” meeting, along with stories of “crisis-level PSW shortages” at facilities in Southwestern Ontario, prompted the health coalition and Unifor to document the problems and propose solutions. Seven more roundtable meetings were held, beginning in London last February, with stops in Chatham, Windsor, Kitchener-Waterloo, Hamilton, Sault Ste. Marie, Sudbury and Hamilton.

“There was total consensus that PSW shortages across Ontario in long-term care are epidemic and severe,” the report states. “Long-term care homes are short-staffed every day; in fact, virtually every shift, and in every area of Ontario.”

Andy Savela, director of health care for Unifor’s national office who has worked in nursing for 30 years, said the province needs to provide more funding that’s directly tied to hands-on care to create an acceptable resident-to-staff ratio.

There’s a stigma attached to working in long-term care, resulting in people avoiding the field, he said during the Chatham event.

“Even if the funding is adjusted, it’s going to take time to change the mindset about what’s going on in our long-term care facilities because, frankly, there’s a lot of suffering happening,” he said. “Our elderly are suffering.Staff are suffering. Everybody’s suffering.”

Cathy Baker, a PSW at the Chatham-Kent-owned Riverview Gardens, said there was a time when PSWs could do the job and still be able to talk with residents.

That changed when the Ministry of Health implemented “point-click care,” a time-consuming electronic process that records care given to a resident, she said.

Baker said the number of staff has declined at Riverview Gardens, which is taking a physical toll on the short-staffed workers.

“It’s detrimental to all the humans involved in the long-term care – the residents and the workers,” she said.

Both of Patsy Dykeman’s parents lived at Riverview Gardens before they passed away. She found PSWs didn’t have enough time to spend helping feed her father, who had trouble swallowing after recovering from a stroke, so family members stepped in. When she was still working, Dykeman said she would often arrive at the home to find her mother sitting in soaking wet pants.

Staff shortages were so severe she would often walk the halls hearing residents calling for help from their rooms, Dykeman said. She would often break the rules and help residents.

“It was unreal. I couldn’t believe all the things that I saw,” Dykeman said. “I saw more and more, which made me feel I needed to be there more and more.”

The report notes PSWs who shared their stories gave vivid descriptions of their difficult work conditions and the quality of care and life for residents.

“In many cases, workers are angry and upset,” the report states. “This mostly female, often racialized workforce feels that they themselves are being abused and neglected.”

The report states this is due, in part, to negative media coverage about long-term care that doesn’t reflect the care, generosity and compassion given to residents every day.

“At the same time, they are frightened of the levels of aggressive behaviours and violence that they face,” the report adds. “They feel they are being held accountable for a level of care that is impossible to provide with the resources that they have been given.”

Accounts from managers supported the reports of inadequate staffing, the impact of negative media, the extreme level of PSW shortages, and the pressure of meeting high expectations of care without enough staff, the report states.

“This is not a local problem. The situation that was described to us is pressing and it requires urgent systemic action by policy makers,” the report says.

Shirley Roebuck, chair of the Chatham-Kent and Sarnia chapters of the Ontario Health Coalition, said the group has been advocating to improve care levels in long-term care homes for at least 20 years.

“What we’re advocating for is a minimum care standard of four hours of hands-on care, per day, per resident,” she said.

THE KEY ISSUES

Critical PSW staffing shortage

Long-term care homes report working short one to two PSWs on nearly all shifts, which means homes can be short five to 10 PSWs in every 24-hour period. Some are short 20 to 50 PSWs.

Weekends, summertime and less-appealing shifts can sometimes leave homes operating with double the shortage of PSWs.

Pay that is barely above minimum wage, with considerably heavier workloads than jobs with comparable wages, is driving PSWs to quit to work in retail or restaurants. Some PSWs opt to work in less onerous housekeeping positions at the same home.

PSW jobs in hospitals and school boards, with better pay and working conditions, also take away from the already too-small pool of available workers.

Staff shortages means vacation time is often denied, resulting in PSWs working double shifts to cover for staff calling in sick, which has increased their own sick time and injuries.

Long-term care injury rates are high as is the turnover, particularly with young PSWs.

Burnout is a major issue, which is compounded by “compassion fatigue” frequently described as a problem among staff having to cope with grief as residents die; high expectations from families, management and government; stressful workloads; and inadequate (or nonexistent) emotional support.

INCREASING REQUIREMENTS OF CARE

Compounding PSW shortages is the increase in care for many residents who are medically complex and frail.

Many residents require peritoneal dialysis, wound treatments, palliative care, post-operative care, pain management and suctioning, among other types of care.

Complex care is being provided in environments not physically designed to provide it with insufficient numbers of nursing and PSW staff.

IMPACTS ON CARE

Residents are not getting basic care, with many feeling they are a “burden” to overworked staff.

In London, roundtable participants report “assembly-line care” forces staff to cut corners and not meet the basic needs of residents.

In Chatham, the reported toll on residents includes increased odours, falls, depression, infections, errors, complaints, behaviours, anxiety and conflicts.

In Windsor, delays in care were reported, or no care provided at all, such as receiving baths.

Residents experience frustration waiting for assistance, leading to increased aggression and anxiety.

IMPACTS ON WORKING CONDITIONS

Long-term care home managers and staff raised concerns about injuries and violence along with increased WSIB claims and leaves that worsen existing staff shortages.

Staff are feeling unsafe because they are working short.

RECRUITMENT AND RETENTION

An increase in the number of PSWs is needed to address this crisis, but enrolment is low in programs at colleges.

PSW recruitment has been impacted by such factors as high tuition costs and negative media reports contributing to stigmatizing long-term care and PSW work.

RECOMMENDATIONS