Ontario let a ‘flood’ of temp agencies into long-term care during COVID-19. How precarious work put residents and caregivers at risk

In late January, when Angela Birch clocked in at the long-term-care dwelling the place she’s labored for twenty years, she discovered herself surrounded by unfamiliar faces.

There had been 13 employees she’d by no means seen earlier than — far outnumbering the six employees on the identical flooring, who had been really employed by the house.

Who are these folks? she requested a colleague. “They mentioned: they’re from the agencies.”

Birch is a private help employee in York Region, who requested to not be recognized by her actual title as a result of her employer has not given her permission to talk to the media.

But Birch is talking out as a result of she’s nervous. Her chronically understaffed office has all the time relied on momentary staffing corporations however ever since the pandemic, there’s been a “flood of agencies” in contrast to something she’s seen in 20 years on the job. These are precarious employees, she mentioned, usually latest immigrants with no advantages or sick pay — and little or no coaching.

Her expertise displays a broader pattern throughout Ontario, with a devastating influence. In a research not too long ago supplied to Ontario’s long-term-care fee investigating COVID’s lethal unfold, the Canadian Institute for Health Information linked excessive resident mortality during the primary wave — outlined as 20 per cent or larger — to 2 key components: shortages of private help employees (PSWs) and the use of temp agencies, which specialists say normally indicators deeper points within the dwelling.

But simply what number of momentary employees have been deployed to the COVID-19 entrance traces? Nobody is aware of — not even the provincial ministry overseeing long-term care. While temp employees have performed a essential function in maintaining the well being system afloat, there’s virtually no official accounting of who they’re, the place they’ve labored, or how certified they’re.

They are uncounted.

“They’re an invisible workforce,” mentioned Dr. Nathan Stall, a geriatrician and researcher at Sinai Health System. “These employees are poorly paid, aren’t afforded the identical protections, are possible afforded little to no precise coaching (earlier than) coming into these outbreak conditions that they’re thrust into.

“(But) in the event you’re an invisible workforce, you may neither seize information on them, nor are you able to afford them the safety they deserve.”

Last February, as the primary circumstances of a comparatively unknown virus appeared in Ontario, the province started learning personnel points inside long-term-care properties.

One space of explicit concern was the function of private help employees, lower-paid positions the place 48 per cent of staff are part-time. Of these, half reported wanting extra hours and usually wanted to juggle a number of jobs.

When COVID hit, this motion between work websites turned a enormous risk issue. The drawback was acknowledged early in British Columbia, which moved shortly to restrict employees to a single employer. Importantly, the province additionally provided all employees full-time pay, regardless of what number of shifts had been out there — a transfer that stabilized B.C.’s workforce and, “frankly, set them up for fulfillment during their first wave,” mentioned Dr. Samir Sinha, director of geriatrics at Toronto’s Mount Sinai Hospital.

Ontario additionally issued an emergency order limiting employees to a single web site, however solely after practically 150 long-term-care properties had been in outbreak. Unlike B.C., Ontario didn’t standardize pay — triggering staffing shortages as low-wage PSWs gravitated towards probably the most fascinating employers or left the long-term-care sector.

The directive additionally had a loophole: momentary agencies had been exempted, leaving their employees free to roam.

Meanwhile, the province began spending to assist amenities guard in opposition to COVID-19 and rent badly wanted employees.

Ontario, in different phrases, created a good bigger marketplace for momentary employees simply because the pandemic was taking maintain, Sinha steered. “Did the demand for company employees go up?” he mentioned. “One hundred per cent.”

Understanding the size of this elevated demand, nonetheless, requires understanding the baseline — the quantity of temp employees working within the sector pre-pandemic.

But this information is missing. The Ministry of Long-Term Care solely has estimates, based mostly on its annual staffing surveys, a spokesperson mentioned by e mail. The most up-to-date estimate — from 2018 — is that fewer than two per cent of nurses, registered sensible nurses and PSWs within the sector had been company employees at that point.

This survey isn’t obligatory; 24 LTC amenities didn’t reply. The ministry wouldn’t present its 2018 survey information with out a freedom of data request.

As for retirement properties, the Ministry for Seniors and Accessibility mentioned it additionally makes use of a survey to estimate that 4 per cent of employees are from momentary agencies. The ministry didn’t reply to a number of emails from the Star requesting a copy of its most up-to-date survey outcomes.

The quantity of momentary employees contaminated by COVID-19 at LTC or retirement properties can also be unknown. The Star contacted Ontario’s 34 public well being models and solely two had information on the quantity of temp employee infections in these settings. One was North Bay—Parry Sound, which noticed no temp employee infections in LTC or retirement dwelling outbreaks.

The different was Huron Perth, which reported 17 infections amongst company employees in properties that employed exterior employees during outbreaks — 15 per cent of all employees infections in these eight properties.

While LTC properties know what number of momentary employees they’ve employed, this data shouldn’t be publicly shared. The Star contacted the 20 hardest-hit LTC properties to ask what number of employees had been employed from agencies during the pandemic, and what number of examined constructive.

Only three properties responded; one mentioned it didn’t rent any company employees and two declined to offer figures.

But working circumstances and high quality of care are deeply linked. Several research have proven an inverse relationship between staffing ranges or care hours and poorer outcomes, like an infection charges or resident hospitalizations.

This is why gathering higher data on temp company employees is so vital, mentioned Pat Armstrong, a distinguished analysis professor of sociology at York University. Relying on company employees is “tougher on everyone, on the residents, on the employees that’s there, and on the (company) folks,” she mentioned.

“You’re not half of the group in the identical means … you’re an outsider coming in.”

In its damning assessments of the chaos inside some nursing properties, the Canadian Armed Forces recognized this as a drawback, too; new and company employees, it famous, weren’t receiving sufficient coaching and typically didn’t know the place to seek out primary provides.

“There’s a complete casual workforce as we speak,” mentioned Sinha. “Right now we don’t even have a customary for what it takes to grow to be a PSW.”

At Birch’s long-term-care dwelling, she has needed to prepare many of the brand new company employees introduced in during the pandemic. “They don’t even know the right way to put a diaper on,” she mentioned. “The degree of care shouldn’t be there with these agencies … It’s not honest to the older people; they’re at risk.”

For new Canadians, jobs within the least regulated and “most casualized” corners of the health-care system usually function employees’ introduction to the sector, mentioned Cynthia Cranford, an affiliate professor of sociology at the University of Toronto.

“They may need labored at a hospital however as a contracted cleaner,” mentioned Cranford. “They may need labored in a long-term-care dwelling, however their employer was the temp company, or a household.”

Darryl Singer, head of the industrial and civil litigation follow group at Diamond & Diamond Law, is a component of a group of companies representing family members of COVID-19 victims in a mega-class motion naming round 100 hard-hit LTC properties and authorities authorities. In that capability, Singer has taken “lots of and lots of of calls” from households, employees and managers; many, he says, expressed grave considerations about precarious jobs and employees turnover in properties.

“We’ve mentioned as half of a lawsuit that by permitting this to happen, they’ve primarily invited the virus in.”

While temp agencies could function a stopgap, counting on them is “an insidious means, as an employer, to function your corporation,” particularly in LTC amenities

“They’re trying to economize on the wage burden and shift the accountability for the employer-employee relationship to someone else,” mentioned Singer. “And in doing so, they’re risking lives.”

But the heightened demand for temp work created enterprise alternatives for some agencies, with out a corresponding improve in regulation and oversight. Well-established agencies within the care sector are noticing the sudden arrival of new gamers, some of which don’t have the expertise and abilities wanted to work with weak shoppers.

“We’ve seen a quantity of practices the place the security measures have been thrown out the window to be able to maximize” the underside line, mentioned Robert Handelman, head of the Richmond Hill-based company Staff Relief Health Care. “To have a PSW are available in and take up a shift shouldn’t be precisely the identical as having someone choose up a shift at a restaurant washing dishes at the again, or serve meals.”

There are greater than 200 health-care-related temp agencies registered at the employees’ compensation board, information requested by the Star exhibits. While some have formal places of work, different listed addresses which might be suburban properties; one shares an deal with with a taco restaurant.

The registered temp agencies don’t embrace dwelling care suppliers, though these typically act as quasi-temp agencies and employees into a selection of settings together with nursing properties, mentioned Cranford, who not too long ago authored a guide on Ontario’s dwelling care sector.

“Many of them are primarily performing like temp agencies in that they’ve a listing of folks that they ship out with little or no administration or oversight, and they barely deal with them as staff.”

In truth, some employees — employed by dwelling care suppliers, agencies, and now even apps — should not categorised as staff at all, excluding them from even probably the most primary protections underneath provincial employment regulation.

While many of these employees are sometimes paid much less for doing the identical work as everlasting employees, the pandemic has examples of this hole working in reverse. Birch mentioned at her long-term-care dwelling, some company PSWs who’re underqualified have been getting $35 an hour, whereas she makes $22.95. “You don’t wish to rent common employees, however you’ll usher in an company and pay them $35 an hour?”

Even if some company employees could obtain premiums, they lack entry to the advantages for everlasting employees, together with paid sick days. To Matt Cathmoir, head of strategic analysis at SEIU Healthcare, a union representing front-line employees, dependency on these employees is a alternative.

Many properties, he famous, are reluctant to extend their complement of full-time employees as a result of it means extra wage and profit entitlements — despite the fact that doing so may scale back staffing gaps.

The Ford authorities has not too long ago introduced new investments in direction of bettering senior care, together with funding to coach 8,200 PSWs and create greater than 27,000 LTC jobs over 4 years.

But Sinha is skeptical the system may be fastened with out understanding who’s really working on this sector, and “how we are able to really make it a higher place to work within the first place.”

“Whatever technique we’ve got (going ahead) is constructed on a home of playing cards,” Sinha mentioned. “Unless you get the basics of staffing proper, the place you might have employees which might be nicely educated and nicely supported, all of our long-term-care properties will probably be a fixed revolving door.”

Friday, Part 2: The ‘Uber-ization’ of health-care jobs