N.S. groups sound alarm on staffing crisis in long-term care

Difficulties recruiting and retaining staff have plagued long-term care for years, but the pandemic has magnified existing problems and created a new crisis, according to unions and officials in the sector.

Nan McFadgen, president of Canadian Union of Public Employees Nova Scotia, said the sector is beyond "code critical," a term used in a new campaign from the Nova Scotia Paramedics Union to illustrate that sector's staffing shortages.

"We were at code critical before the pandemic.... We're in big trouble," said McFadgen, whose union represents thousands of continuing care assistants from long-term care homes across the province.

Michelle Lowe, director of the Nursing Homes of Nova Scotia Association, said recruitment and retention of staff is not a new problem.

Lowe said continuing care assistants, registered nurses and licensed practical nurses are in short supply across the health-care sector, so long-term care homes are pitted against each other, but also against hospitals and home care programs.

Overworked staff

Pay in acute care settings and hospitals tend to be slightly better than what long-term care homes can offer.

"There definitely have been nursing homes that have offered hiring bursaries, but we're really robbing from one another," she said.

Lowe said the pandemic has increased the burden on already overworked staff.

She said long-term care workers had to contend with increased workloads due to new infection prevention protocols.

They also had to provide additional support for residents in isolation and families desperate to connect with their loved ones via technology.

The additional stress of COVID-19 was the last straw for many working in long-term care, Lowe said. 

"They've left the sector completely because they are just so tired," said Lowe.

A shrinking workforce

Long-term care work is physically and emotionally demanding, and getting even harder as the residents coming in are increasingly in need of acute care, McFadgen said.

At one time, eight out of 16 residents would require almost total care — needing staff to dress, feed and move them. Now, often 14 out of the 16 require total care, she said.

In addition to increasing demands, McFadgen said, the workforce is shrinking because older staff are retiring and not enough new people are entering the workforce. 

And this was before the pandemic ramped up stress levels. 

Jason MacLean, president of the Nova Scotia Government and General Employees, said the fact that long-term care homes are running bare-bones operations is further compounding the toll on existing workers.

MacLean, whose union represents staff at long-term care homes in the Halifax area, said he's hearing of situations where one nurse is left to run two floors of a facility.

"I don't even believe that's legal," he said. "But those are the types of things that I'm hearing."

Increase legislated staffing ratios: association

MacLean and McFadgen both say people are regularly working overtime and having their vacations refused or cancelled, leaving them completely burnt out.

"People are just flat out quitting because they cannot do this work anymore," MacLean said.

While no one could provide hard figures on staffing levels, Lowe said the recently announced closure of a 38-bed facility in Beaver Bank, N.S., due to staffing issues is just the tip of the iceberg.

She said a massive boost is needed to the number of people entering the workforce just to meet current legislated staffing levels.

But, she said, they also desperately need to increase legislated staffing ratios. While she acknowledged that means an even bigger demand for new staff, she believes it would improve recruitment and retention by improving quality of life and job satisfaction. 

Lowe said successful international recruitment has prevented more bed closures thus far, and remains an important part of the puzzle, but they also need improved access to education.

Better pay also needed

She pointed to the fact that several of the NSCC's licensed practical nurse programs currently have a multi-year waitlist. The NSCC website shows that half of their continuing care assistant programs are also currently wait-listed. 

MacLean and McFadgen both said in addition to improving the staff-to-resident ratios, staff need to be paid better.

"Frankly, everyone that works in long-term care risked their lives during the pandemic so they could live in poverty," said McFadgen.

The Department of Health declined a request for an interview.

The Liberal government recently announced $96.5 million for long-term care, which will add 264 new beds in the central zone and replace 1,298 beds at 14 nursing homes and three residential care facilities across the province.

The NDP's election platform states they will commit to a room for every resident by 2030, increasing minimum care hours per resident to the recommended 4.1 and increasing wages. The NDP also stated that all new money for the sector would go to public and non-profit long-term care facilities.

The Progressive Conservatives recently announced they would hire 2000 more staff for long-term care homes, create 2,500 new single long-term care beds and restore the student rebates for the continuing care assistance program to previous levels. When asked, Leader Tim Houston said he would be open to increasing wages.