Long-term care may not be healthy care

Conditions in Ontario’s nursing homes will not improve unless enforceable standards for care are introduced. A survey by York University researchers of more than 2,000 members of the Canadian Union of Public Employees (CUPE), who are working in 18 Ontario long-term care facilities, provided the data for a report titled There are not enough hands: Conditions in Ontario’s Long-term Care Facilities.

Right: CUPE workers are responsible for one third of the 18,000 long-term care beds in Ontario

The study, conducted by York University Professor Pat Armstrong of the Department of Sociology, Faculty of Arts, and York researcher Tamara Daly, reveals the dire conditions in Ontario’s nursing homes. Critical staff shortages in every job category, an alarming number of tasks left undone because there is no time for appropriate care, high levels of violence among residents and against staff, minimally enforced standards and a reluctance to report unsafe practices to governments or employers are documented in the report.

“Increasing acuity levels, combined with reductions in the numbers of employees, have resulted in overworked staff and under-cared-for residents, according to those who provide care,” said Armstrong. CUPE members are responsible for nearly one-third of the 18,000 long-term care beds in Ontario.

“We need to remember that long-term care facilities are residents’ homes and places of work,” added Daly. “Good quality care requires good working conditions.”

Respondents indicated that each job is critical to care and cutbacks in one area have an impact on all workers and residents. If the dietary and housekeeping staff are not there, nursing staff end up doing cleaning and feeding. And housekeeping staff end up doing nursing work if there are no nurses available for care.

The report provides further support for the findings from an investigation by Monique Smith, parliamentary assistant to the minister of health and long-term care. Her report, released May 2004, incorporated many recommendations from CUPE.

“Unfortunately, Smith’s recommendations left out the key to success in improving long-term care: enforceable minimum standards,” said Sid Ryan, president of CUPE Ontario. “Our call for a minimum 3.5 hours of nursing care per day was ignored. But, if you put in more money for staffing without standards for care, there is no accountability.”

The York survey showed that staff shortages are even greater than official numbers suggest because absent employees are often not replaced. As a result, a task like walking and exercising residents is left undone more than half of the time. Ten per cent of workers said they cared for 40 to 70 residents in their usual morning shift while another 10.9 per cent helped 30 to 40 people each with getting up, dressing and feeding.