Staff shortages and sense of duty discouraging health-care workers from staying home when sick, unions say

Questions about the working conditions of health-care workers are being raised, as 46 care homes across the province deal with active outbreaks of COVID-19.

On Thursday, when asked to explain why workers with symptoms might continue to show up to work, Provincial Health Officer Dr. Bonnie Henry talked about "a culture of presenteeism in health care, especially in care homes."

"We know that the people who work there are there to provide the best support they can to the residents," she said. "They care a lot. They become like family in many of these, in many of our care homes." 

"Nobody intentionally wants to bring it in, but we have seen that in many cases where people are in denial that I'm sick or that this could be really this, that it's affecting me."

B.C.'s top doctor seemed to point to a sense of obligation that exists among health-care workers as the main reason why symptoms of illness may be unnoticed. She said that's why facilities with outbreaks test staff several times a week.

Difficult working conditions precede pandemic

Some of the unions representing those workers say there's more to it than duty of care.

"The problem with the term presenteeism is it puts a lot of responsibility on the individual worker," said Mike Old, a spokesperson for the B.C. Hospital Employees Union. "It kind of detracts from our collective responsibility to make sure that these workers have the kind of working and caring conditions where they can look after residents and in a manner that is safe for the residents and safe for themselves." 

Old says working in long-term care was not easy even before the pandemic. According to him, care aides and other workers have injury rates that are four to five times the provincial average. 

"You put a pandemic on top of that and have really serious staff shortages that result from workers being off with COVID infections or being isolated."

The president of the B.C. Nurses Union says staff shortages and presenteeism go hand in hand. She says nurses who are going to work are only going when they're healthy but they're not getting much time off.

"Nurses committed to providing that patient care go in on their days off, on their vacation days, usually at the call of a colleague who is desperately looking for another nurse to work and share the patient load," said Christine Sorensen.

While she says many nurses can access paid sick leave, that isn't the case for some new nurses.

Old says the province's "fragmented long-term care system," where facilities are run under three different publicly-funded models— the health authority itself, a for-profit company or a non-profit association — means that the amount of paid sick leave is not consistent for all employees across the sector.

The provincial collective agreement mandates a day and a half of sick leave a month, but he says it's not uncommon for some publicly-funded care homes to provide less than half that amount.

"It's really important that across the system we go to a common standard of wages, benefits and working conditions, including better sick leave for workers."

Temporary pandemic pay

On Friday, Health Minister Adrian Dix said the province has a plan to hire 7,000 additional people to work in health care, with 1,200 already hired.

He also said health-care workers did receive $271 million in temporary pandemic pay, but the rollout has been stalled for some, and the increase only amounted to about $4 per hour for a 16-week period starting last March.  

Bernadette Cheung, whose grandmother Yuet Wan died in the outbreak at Little Mountain place, places no blame on the workers caring for residents.

"Management needs to take accountability for either creating this culture [of presenteeism] or not being vigilant in their monitoring to recognize that this is happening," she said. "At the end of the day, it's management's responsibility to take care of their staff."

While Old says the community as a whole has a responsibility to keep transmission low, he agrees that the ultimate responsibility is with employers.

"We need better paid sick leave and we need fair wages for workers so that they don't need to make those decisions."