Getting seniors' care back on track

Restoring standards is key to better work and better care - from the Fall 2023 Guardian
Care aide assisting a senior
The seniors’ care landscape has endured waves of change over the last 20 years, and care aide Jennifer Reitan has had a front row seat since 1997.  

That’s when she left her first job at Lions Gate Hospital and moved to Castlegar, a town of 8,000 set among the powerful rivers and rugged mountains of southeastern B.C. 

Her new employer was and still is a privately operated facility. But in the 1990s, almost all long-term care sites that received public funding were covered under a single collective agreement, and owners were affiliated with the Health Employers Association of BC (HEABC).  

So, when Reitan started her job in the Interior, she was covered by the Facilities Bargaining Association (FBA) contract, with the same wages, benefits, pension and working conditions as care aides at public hospitals.
This “master agreement” was an achievement HEU had bargained hard for. It created more fairness and stability for workers, but it also meant health authorities had more direct oversight of standards and conditions of care. 

Then in 2001, the B.C. Liberal government was elected, and with them came their relentless drive to privatize. 

They passed new laws that removed contracting-out protections that were in the HEU contract since the 1960s, and eliminated employment security language for health care workers. 

The BC Liberals also allowed seniors’ care operators like Reitan’s to opt out of membership in the HEABC, but keep receiving public funding.  

An estimated 8,000 HEU members were fired in the first five years, as health authorities and long-term care operators privatized a long list of health services, and a raft of new private operators entered the sector.  

Workers who were hired back by private contractors took an overnight pay cut of up to 50 per cent. And they no longer had a union.  

HEU scrambled to re-organize the workers, but each deal was an individual, hard-won agreement with a single contractor. There was no way to get the contracted workers back under the master agreement. 

Jennifer Reitan, now an occupational health and safety steward at her local, has represented members on the bargaining committee. 

She says that when her employer withdrew from the HEABC, “we got pulled out of the municipal pension plan immediately. And when we went to bargain a new contract, the employer suddenly told us they were operating at a loss, and we had to take cuts. 

“But we couldn’t afford to lose it all from our wages. So, we also took less holidays, less sick time, a different benefit package.” 

Once her workplace was removed from the FBA agreement, she says, her sense of connection with other long-term care facilities slipped away.  

And without the direct administration of the health authority, Reitan felt there wasn’t much oversight for her small care home in the Kootenays. 

“We all just went under the radar, I guess. It felt like we were just part of a whole bunch of little facilities.”  

Within a decade, the seniors’ care sector was utterly fragmented.  

Wages for care aides varied by as much as $7 an hour, standards of care were hard to measure, and there seemed to be no clear system in place to track the public money given to private companies – how much they spent on care, and how much they took as profit.

When the BC NDP regained power in 2017, they restored succession rights to health care workers, and repealed the Liberal legislation that allowed workers to be fired when operators switched contractors. 

This brought some stability to the sector for workers, but did not address the deterioration and disparity in care and working conditions created by 16 years of privatization. 

In a series of reports, the B.C. Office of the Seniors Advocate found that for-profit operators were spending far less on frontline staff and delivering fewer hours of care than their not-for-profit counterparts. 

A 2021 report linked lack of paid sick leave and the contracting out of care staff to some of the largest COVID-19 outbreaks in B.C.’s long-term care and assisted living homes. 

The pandemic also accelerated a staffing crisis that had been gathering steam.  

“Before the pandemic,” Reitan says, “we were still managing. If you’ve only worked in a private facility, you just accept the conditions, the struggles you have with equipment, and wages.  

“But if you also work at Interior Health, you see the differences.  

“When COVID hit, it was eye-opening to see all those people that left private facilities or chose to work … [in an] Interior Health site. We never got those people back.” 

The wage-levelling program the B.C. government introduced during the pandemic subsidized private facilities so they could maintain staffing levels. 

But wage subsidies still didn’t put workers in private sites on par with comparable FBA jobs – they still fell short on benefits, pension, vacation, and shift differentials. 

And in the just-released 2023 Seniors Advocate report, research shows what many had suspected. Private and non-profit care homes are delivering less care than public facilities, while reaping more profit than ever. 

“This study shows that contracted care home operators – and especially for-profit operators – are diverting public funds away from the frontline to their bottom line,” says HEU secretary-business manager Meena Brisard.

This is no surprise to workers in the sector – or to experts skeptical of the claim that private companies can deliver cheaper care to the same standard as public services. 

Donna Baines, a researcher at UBC, says privatization is often linked to an “austerity” agenda, where some governments call for cost-cutting measures and blame economic woes on “big government” and public spending. 

“There is rarely evidence to show health care privatization does what it claims. It doesn’t save costs, it’s not more efficient, it doesn’t deliver better services. But politicians just keep going back to it,” says Baines. 

“During COVID, polls showed that two-thirds of Canadians supported moving long-term care back to the public sector. The COVID outcomes in Ontario for seniors were the worst in Canada, and feelings were high that private facilities were failing. And yet right now, Ontario is making huge moves towards privatization,” she says.
In B.C., Brisard says it’s time to reverse that trend, starting with re-establishing a level playing field for seniors’ care. 

“A good start would be the implementation of the BC NDP’s 2020 election promise to restore the standard wages, benefits and working conditions dismantled by the previous B.C. Liberal government.”

As for Reitan, she loves her job and her co-workers. And she wants to make sure she is delivering the best resident-centred care possible. 

She hopes it can improve, but fears the staffing crisis will have a negative impact on care over the long term. 

When asked about the biggest change she’s seen over her career, Reitan doesn’t hesitate. 

For herself, “it’s the unknown future. Where am I going to be next year? And my physical and mental well-being, doing this work.”  

Despite the challenges, Reitan wants to keep on doing the meaningful and essential work she fell in love with almost 30 years ago. 

“That’s why I’m so passionate about HEU’s Care Can’t Wait campaign. Because I feel like if there’s something that I can do to benefit the private facilities out there, then I want to do it.”

By Elaine Littmann