Long-term care workers were already overloaded. Then the pandemic came

As long-term care homes struggle to figure out what the future holds during COVID-19, solutions for the sector are receiving new attention.

They include things like single rooms for all residents, better pay and mental health support for staff, and personal protective equipment training before family visits.

The discussion is also raising questions about who will pay for those solutions, and how.

For Janice Keefe, a professor of gerontology and director of the Nova Scotia Centre on Aging at Mount Saint Vincent University, one of the biggest messages from the pandemic has been how the hospital system is often prioritized over long-term care.

"It's just a symptom of how we put a lot of emphasis in one area and the long-term care system ends up being that poor cousin that has to survive on far less resources," she said in an interview in May. 

In March, hospitals across the province were preparing to transfer 163 people to long-term care facilities as they got ready for a surge of patients. Keefe believes long-term care didn't benefit from the same kind of intensive pandemic planning.

The Northwood long-term care facility in Halifax became the epicentre of the COVID-19 outbreak in Nova Scotia. In all, 53 residents have died due to the virus.

Long-term care homes have a major staffing problem because they're often considered unattractive places to work. Pay is low, but stress, injuries and illness are high. 

Nursing homes are still trying to attract care assistants, housekeepers and laundry workers with pay rates from $13.55 to $18 per hour. Minimum wage in Nova Scotia is $12.55 per hour.

Keefe said good care depends on relationships between caregivers and residents, and society has failed to value relationship-building skills by paying properly for them. 

"Some of that has to do with the prestige, the value that we fail to place on this work because it's often considered women's work," she said. "That's an atrocity in my mind because it's some of the most important care that we are giving to these individuals to take care of our elderly parents."

The residents in nursing homes are mostly women, and so are almost all of the staff. That's why in Nova Scotia, where many of the COVID-19 cases were linked to long-term care, 62 per cent of those infected in the province were women.

A 2018 expert report on long-term care in Nova Scotia noted many workers reported feeling "guilt and shame" for being too busy to deliver good care — and that was before the pandemic arrived.

Keefe, a member of the expert panel, fears many of the staff who've worked through the first wave are going to need mental health support or more will leave the profession. 

"They've experienced a lot of death. They've experienced a lot of fear and they're still going to work every day and wanting to do the best they can for their residents," she said. 

The lack of long-term care staff is going to hinder families who want to see their loved ones through video conference or in person.

Dr. Robert Strang, Nova Scotia's chief medical officer of health, announced that starting Monday family visits to long-term care homes will resume, as long as the visitors keep two metres away from residents and staff. The family visits must be outdoors, monitored by staff, and visitors must wear a non-medical mask.

Some — though not all — families were allowed end-of-life visits with their loved ones during the pandemic while wearing masks.

Having staff monitor visits and teach families to wear masks properly will take time. Keefe said putting this responsibility on staff will take them away from other duties.

"I'm not saying that it's not doable. What I'm saying is we would need to invest some resources in order to make that happen," she said. "You can't just walk in with a mask and say, 'I'm OK.'"

In the 2020-2021 budget, Nova Scotia allocated $612.4 million for long-term care, which represents about 13 per cent of the total health budget of $4.8 billion.

Health Minister Randy Delorey declined to do an interview about the future of long-term care funding. His department sent a statement that said it is "too early" to comment on any changes that might come out of the pandemic and that the system will be reviewed. 

"That review will build upon the expert panel review from January 2019, which [the Department of Health and Wellness] has been working with partners to implement," the statement said.

Keefe said the federal government must step in as well and "put some resources to help the province to meet these needs."

Premier Stephen McNeil has said he would welcome a conversation about federal funding, although Prime Minister Justin Trudeau has been non-committal.

In 2017, the federal budget laid out $11 billion in funding to the provinces and territories rolling out over 10 years and directed to home care and mental health, but not for long-term care.

Nova Scotia's slice of the funding is in addition to the Canada Health Transfer of $1.08 billion the province received this year.

"Going forward, Canadians want to see us doing better by our elders right across the country, even beyond this pandemic. We're going to be there to work with the provinces on the right way to move forward," Trudeau told reporters on May 27.