'It is truly the wild west': Ontario non-profit LTC homes demand caps on temp agency fees

Not-for-profit long-term care homes in Ontario are spending millions of dollars on temporary health-care staff because the agencies they work for are "exploiting the health human resource crisis," a provincial association says.

In a voluntary survey conducted among members of AdvantAge — the association representing the majority of the province's not-for-profit and municipal long-term care homes — one agency was found to be charging homes as much as $150 per hour for a registered nurse, 249 per cent more than the typical rate.

"We have agencies who wait in our parking lot and talk to our staff on their departure from their day of work," said Steven Harrison, the CEO of Tri-County Mennonite Homes, which runs homes in Stratford and the Kitchener-Waterloo area. 

Harrison's group is among the 100 facilities that took part in the survey — roughly half of AdvantAge's membership. The results come as many Ontario health-care staffers, including nurses, personal support workers and others, have been leaving permanent public-sector positions. Some have turned to agencies that often promise more flexibility and higher wages amid chronic understaffing, overwork and burnout due to the pandemic.

Agencies then tell staff, "you don't need to work as long or as hard with as much commitment and we can get you more money to do basically the same work," Harrison said.

"People are tired; there is no reprieve right now for anyone on the front-line and resiliency is starting to wane," he added.

"What [the agencies] are doing is taking advantage of a very desperate situation in the health-care sphere."

Harrison says non-profit homes like his continue to lose staff to agencies but have  been unable to raise salaries significantly due to Bill 124 — legislation passed by the Ford government to limit wage increases for public sector workers. He says they are at the mercy of whatever agencies want to charge to meet their staffing shortfalls.

"For the agencies, it is truly the wild west," said Harrison.

He says his homes are projected to spend more than $3 million on agency workers in the fiscal year ending March 31, compared to close to $150,000 the year before the pandemic. They had originally budgeted to spend just under $300,000 this fiscal year.

"These are taxpayers' dollars that we are funded with and they are being … squandered in a manner that was never anticipated when the dollars were being allocated to us to deliver this care," he said.

Harrison, AdvantAge and others are calling on the provincial government to implement a framework limiting what agencies can charge and what extra charges are reasonable. They say such a move would bring accountability to a situation where homes might no longer be able to provide adequate care because they can't afford to pay wages at these rates.

28% of registered nurse roles unfilled each day

"It's a really serious situation," said Lisa Levin, CEO of AdvantAge. With agencies charging more than double the typical wage for a registered nurse, the government "needs to restrict these hourly agency rates and they need to do this urgently," she said.

AdvantAge's survey found that agency health care workers were performing about seven per cent of the work in the last six months of 2022, but receiving more than 16 per cent of the wages in long-term care homes.

With more than 28 per cent of registered nurse positions a day in these homes unfilled, she says homes are relying on temporary workers more often to meet a desperate need.

The Ontario Nurses' Association (ONA) says it has repeatedly expressed its concerns that "registered nurses (RNs) would leave long-term care employment in order to join private, for-profit nursing agencies."

"For the RNs who have been repeatedly traumatized by COVID-19 outbreaks at long-term care facilities, and who are suffering from PTSD and utter exhaustion due to the shortage of nurses, the prospect of working for a nursing agency is more attractive than ever," said Angela Preocanin, the ONA vice president, in a statement emailed to CBC Toronto.

Preocanin says with nurses suffering burnout, it's logical that they would see the appeal of an option that allows them to spend more time with their family and get paid much higher rates.

She says the Ford government's decision to appeal a court ruling that struck down Bill 124 sends a message to workers, like registered nurses that working in the public sector will leave their wages suppressed and leave them working in poor conditions.

The situation is also harming long-term care residents, says Preocanin, by reducing continuity of care, especially if they have complex care needs. The ONA is calling on the government to do more to address the issue.

Ontario NDP health critic France Gélinas said, "You cannot provide quality care without continuity of care and agencies cannot give you continuity of care." 

She says organizations are now telling her they are having to cut back services or the number of clients they serve because agency fees are "just through the roof."

Gélinas says she'd rather invest in permanent staff to tackle the problem than focus on capping what temp agencies can charge. She says not appealing Bill 124 would be the easiest step the government could take to retain staff.

Jake Roseman, a spokesperson for the Ontario minister of long-term care, is unwilling to comment on Bill 124, saying it is before the courts. But he says the government continues to monitor the staffing challenges in long-term care.

"The government is investing $4.9 billion to recruit and retain nurses, personal support workers, and allied health professionals," Roseman said.

He says the government is hiring 27,000 long-term care staff as the government heads toward its goal of four hours of care per resident per day by 2025 and is providing $673 million to homes to hire and retain workers.