Dr. Jane Philpott questions role of for-profit long-term care

Last month, CBC News learned health-care workers make up roughly one in 10 of the known COVID-19 cases in Ontario. Many of those infected are personal support workers (PSWs) who work in long-term care facilities.

Since April 13, former federal health minister Jane Philpott, who is a family physician, has been working alongside many PSWs at Participation House, a health-care facility for highly vulnerable people with special needs.

She spoke to White Coat, Black Art host Dr. Brian Goldman about her experience and her thoughts on how the current crisis is exposing the pre-existing issues that plagued Canada's long-term care system, and the working conditions for PSWs.

You've been volunteering at Participation House since April 13. It's a facility for adults with physical and mental disabilities. How are the staff and residents there faring?

Well, it's been an extraordinarily difficult experience … Participation House has 42 residents who call it their home. These are people with very severe physical, developmental, and intellectual disabilities.

Only four of the 42 can walk on their own … and 40 of them were infected with COVID. And at the same time, it was compounded by this terrible situation where essentially nine per cent of the staff had to leave, most often through no fault of their own.

It was a crisis situation that I walked into that Easter morning, and thankfully, things have stabilized with the exception of the very tragic reality that six of those residents died over the last three weeks.

I'm assuming you had an opportunity to work alongside some PSWs at Participation House and I want to know what that experience was like. What can you tell me about them?

It's really quite exceptional the knowledge that they have.

It's amazing, it's like your own family member — in that you get to know what their preferences are. Sometimes the residents would be uncomfortable in the way they were sitting in their wheelchair, and it would be because there wasn't a worker there who knew them and had gotten to know them over many years.

It's impossible almost to measure the unique knowledge that these workers acquire over time … the amount of compassion that it takes to sit and be patient and take time.

But I see these people coming to work with great joy and vocation and a sense of service that I think is really inspiring.

Do you think we value their work as a society as much as we should?

I've certainly heard from lots of family members who know how valuable their work is … I think that family members understand, but I don't think as a society we have [valued them] ... certainly in this pandemic, in our preparedness.

[There's also] the public health direction that needs to be given to these workers in order to give them guidance on when it's safe for them to go back to work if they have, in fact, acquired the infection themselves.

Over half the deaths in Canada have happened in care homes. We should be definitely devoting over half our attention and over half our resources to making sure that the workforce and other infrastructure needs of these facilities are top of mind for us.

A lot of personal support workers are making ends meet at the rate of being paid $15 an hour? Is that an adequate recompense for personal support workers, in your opinion?

No, that's not adequate.

This is an important conversation that we need to have going forward, that workers need to be paid for the value of their work. And if people like this are caring for the most vulnerable sectors of our society, vulnerable individuals in our society, then that ought to be reflected in the remuneration to which they're assigned. 

I know that health care is a provincial responsibility, but what do you think the federal government can and should do to establish national standards that would be relevant to caring for people who live in care homes of all kinds? 

There's no question that the national standards is a good way to move forward, and the federal government can absolutely play a role in that.

I hope that will be much of the conversation in the future.

Support could be dependent upon provinces, ensuring that a set of regulations or standards were met. This would have saved us a lot of grief in many areas.

Certainly, we've heard absolute horror stories about the kind of care that has been delivered in some of these long-term care facilities across the country, and it's shameful that we have allowed that to occur, that this has essentially been done with everybody turning a blind eye or inadequate accreditation mechanisms.

We really can do better on this. 

What role does for-profit long-term care play in the current crisis, and the way we're managing the crisis, and what we need to do going forward? 

It doesn't take a genius to realize that if one of the goals of an institution is to make a profit for the owners and that puts an incentive in terms of how much you're going to spend on paying your workforce, on upgrading your facility, on ensuring that you keep a stock of personal protective equipment available, etc. So, you know, why is this institution in existence? Is it there to actually provide care? Or is it a business for someone? That will definitely change the kind of care that's provided.

In July you'll be starting as dean of health sciences at Queen's University. Congratulations. I'm curious about whether you could anticipate any programs to train personal support workers at Queen's University?

I'm super excited about being dean of the faculty of health sciences at Queen's and as you may know, that includes a school of medicine and a school of nursing and a school of rehabilitation therapy… Brian, you and I know that the care team requires everybody. That a doctor alone can get very little done unless we've got nurses and [physiotherapists] and [occupational therapists] and personal support workers and therapists, and all kinds  of others around us to be able to provide great care. So, I hope that we're going to be able to jump in and help with some of the building up of recommendations for national standards for personal support workers, for example.

I'll never forget the experience I've lived through in the last month. It will make me a better person, and it will certainly make me a stronger advocate for members of our care team that I think has been really undervalued.

Written by Arianne Robinson. Produced by Jeff Goodes. Q&A edited for length and clarity