An exhausted caregiver wearing a mask and gloves sits against the side of a building

Chapter 4

The Thin Pink Line 

Alongside the hundreds of thousands of seniors who live in Canada’s long term care homes and retirement residences, there’s a veritable army of workers who care for them – kitchen, dietary and housekeeping staff; registered nurses; nurse practitioners; doctors; occupational therapists; physiotherapists. But by far the largest employee category in any long term care home is the personal support worker (PSW).

PSWs are the frontline caregivers who each day help to wash, feed and dress the country’s frail elderly. They participate in residents’ treatment, make their beds and keep them company, often in the absence of any family visitors. In recent years, PSWs have also helped to manage the growing multiple health needs of residents, many of whom suffer from advanced dementias and the behavioural challenges these conditions can bring.

Yet despite the invaluable role PSWs and nurses play in long term care there are not nearly enough of them – nor have there been for several years.

Long before the pandemic hit, the PSW shortage had reached a crisis point in Canadian long term care. Meanwhile, during the first wave – in which 508 Revera staff members contracted COVID-19 and countless more were quarantined – up to a quarter of the company’s full-time PSWs were either unable or unwilling to come to work, and a considerable portion of part-time staff were also unavailable.

The shortage of frontline caregivers added to the impact the first wave of COVID-19 had on the long term care sector. Staff levels reached record lows just as workloads reached record highs. The pandemic triggered the sudden need for staff to receive COVID-specific infection control training, and to take the extra time and effort to practise it, from enhanced cleaning to the donning and doffing of personal protective equipment (PPE). It also brought the urgent task of screening residents twice daily, creating cohorts to separate the infected from the healthy. And the few staff left to provide this extra care had to do so without the usual help of family caregivers barred by strict no-visitor policies and, often, in the absence of doctors who declined to come to the homes. Next to the fundamental challenges of containing a highly contagious virus in outdated buildings with multi-bed rooms, the lack of PSWs ranks as a major contributor to both the severity and duration of the outbreaks.

Analysis conducted by the Revera Expert Advisory Panel has since found that the first wave’s staffing shortages at Revera flowed from three critical inter-connected issues:

  • the shortage of PSWs that plagued the sector before the pandemic hit;
  • the fallout from the one-site rule, which rightly prohibited PSWs from working at multiple homes to reduce the risk of spreading the virus from one home to another;
  • and a dramatic rise in unexplained PSW absences during the first wave, fuelled in part by staff members’ fears of becoming infected or potentially carrying infection home to their loved ones.

None of these issues can be fully resolved in time to confront the pandemic’s second wave. But understanding their root causes points to immediate steps that should be taken toward enabling, expanding and supporting the PSW labour force as the indispensable pillar it represents in the long term care of society’s vulnerable seniors.

A Crisis of Care

The countrywide, and in fact global, shortage of nurses and PSWs is a complex and controversial issue. For starters, the very name – personal support worker – is ambiguous, and its job description so broad that it straddles orderly duties, housekeeping and personal aid. The path to becoming a certified PSW can also vary depending on the training program, as can the scope of practice depending on where a PSW works: providing home care in the community, offering personal care for students with disabilities in schools, or assisting in hospitals and a variety of congregate living settings, including retirement residences and long term care homes.

An older woman sitting in a wheelchair holds hands with a younger woman

Yet despite the critical and growing need for PSWs, the occupation ranks rock bottom in the hierarchy of healthcare positions, often with a wide range in compensation, benefits and job security. Hospital PSWs, for example, earn on average more than $24 an hour. In the retirement and home care sectors, compensation ranges from $16 to $19 an hour.

The variable pay scale can make the relatively high cost of PSW education and training programs a deterrent for many who might otherwise pursue the vocation. Those who do go into this field tend to be women and, often, ethnic minorities or recent immigrants. Many of them regard PSW jobs as an entry-point stepping stone toward higher-level work in health care.

Recent research suggests that not only is there no reliable pipeline graduating PSWs into the workforce, but that it is a challenge to retain these essential frontline caregivers. A July 2020 Ontario government report on staffing in long term care found that 40 per cent of PSWs leave the healthcare sector within a year of graduating or training, and that each year, roughly 25 per cent of PSWs with two or more years of experience leave the sector.

It is against the backdrop of this chronic staff turnover that COVID-19 broke out in long term care, a sector in which the aging population’s growing care needs were already outpacing the supply of PSWs and driving up their workloads. Recent years, for example, have brought expectations for PSWs to document residents’ conditions, and update their chart in electronic medical records. As well, with the rising incidence of dementia among incoming residents, PSWs assist in the management of difficult behaviours, which can include habitual exit-seeking and physically resisting care.

Generally, PSWs in long term care earn more than those employed in retirement residences, but less than those working in hospitals. In long term care homes, through collective bargaining, operators tightly align their wages for PSWs with the per-resident funding they receive from the provincial government, and they rarely, if ever, exceed what that envelope provides. The older age and increased medical needs of today's long term care residents have resulted in significant funding increases for PSWs in recent years. In Ontario, for example, the formula in 2000 called for residents to receive 2.04 hours of care per day and the current formula mandates 3.73 hours per day (a 180 per cent increase in compensated hours in addition to hourly pay increases). There are no recommendations that specify staff-to-resident ratios.

With the government funding allotted for resident care in Ontario, Revera and other privately-owned long term care operators pay full-time PSWs about $22 an hour, and provide a union-sponsored pension plan, sick leave, a fully insured benefit plan, up to seven weeks of paid vacation and a dozen paid statutory holidays. To date, the company has had no difficulty recruiting or retaining full-time employees with that package: 82 per cent of Revera’s workforce have more than five years of service; 66 per cent have worked for more than 10 years; and the average full-time PSW at Revera has 15 years of service.

Revera would not “save money” by employing a part-time worker, since they receive ministry funding only for the money that they actually pay to staff. There is never a profit made on PSW or nursing compensation payments in long term care.

The ongoing challenge, however, involves part-time employees. To provide care for residents 24 hours a day, seven days a week, and with contracts that typically mandate 10 days of eight-hour shifts for full-time employees over a two-week period, the company relies on part-time workers to cover weekends and hours outside of the full-time shifts – as do many sectors of the Canadian healthcare system, hospitals included. At Revera, part-time employees account for half of the company’s workforce.

Critics allege that home operators, to maximize their profits, prefer to employ part-time staff because they are cheaper than full-time staff. But this is untrue: Hiring part-time staff is not more cost-effective than employing full-time staff, because part-timers receive extra pay in lieu of benefits. As well, it is more cost-effective to employ full-time employees, since the turnover and onboarding costs are much lower for staff who work full-time.

(Based on the funding formula used by the Ontario Ministry of Long-Term Care to pay for clinical care, reconciliation is undertaken annually to ensure that all government payments provided for clinical care are paid to the nurses, registered nurse practitioners and PSWs who provide that care. Revera would not “save money” by employing a part-time worker, since they receive ministry funding only for the money that they actually pay to staff. There is never a profit made on PSW or nursing compensation payments in long term care.)

Part-time PSWs would, however, generally prefer full-time work given the regular hours, benefits, sick pay and job security it brings. While waiting for a full-time position to become available, many employees work part-time with shifts at multiple sites to patch together a full-time wage. But the wait at any given site is often too long – and this represents a significant barrier to retaining part-time staff. They leave for full-time jobs at other companies or in other parts of the health system.

The pandemic hit part-time workers in the senior living sector particularly hard. Orders that restricted them to working at one site only (to reduce the risk of viral spread) effectively barred them from cobbling together a full-time living.

One-Site Fallout

As the first cases of COVID-19 began to appear among Revera staff and residents, the company recognized that its part-time staff might inadvertently carry infection from one long term care home or retirement residence to another. In mid-March, before any government mandate was issued, Revera began restricting its part-time staff from working at several locations, as it adjusted schedules and launched recruitment efforts to bring in additional workers to fill the gaps. Throughout April, the provinces where Revera operates long term care homes – British Columbia, Alberta, Ontario and then Manitoba – issued orders to restrict long term care workers to single-site employment during the pandemic.

Unions representing PSWs initially protested these moves. But once it became clear that infection with the novel coronavirus could be spread by people without symptoms, or before symptoms appeared, the one-site order was understood to be justified and necessary. What was less clear was how dramatically it would deplete the long term care workforce. At Revera, for instance, the one-site rule resulted in the company losing roughly 14 per cent of all its staff, and virtually all these losses involved the part-time staffing contingent.

A caregiver wearing PPE looks out the window

Revera committed to topping up the part-time hours of employees losing work from other sites, and while this mitigated the impact of the one-site order, it hardly eliminated it. The Single Site Emergency Order was by far the chief reason for staff absences during the first wave, and it severely hampered the company’s ability to provide its residents with optimum care.

The fallout from the one-site order forced long term care homes to rely on greater numbers of temporary staff from employment agencies, and to expand the number of agencies that they traditionally approached for help. While agency staffing helped to alleviate critical shortages in caregiving, it was also a costly option that consumed precious time as already overburdened staff needed to provide ongoing training to temporary employees unfamiliar with a home’s procedures and infection control practices.

For Reasons Unknown

The spate of COVID-19 outbreaks that hit Revera’s long term care homes through the first half of 2020 also gave rise to a new phenomenon at the company: the unexplained absence. More than 500 staff members, or roughly eight per cent of Revera’s long term care workforce, did not show up for work during the pandemic, and, to date, have not returned (though the company has taken no punitive action against them and they remain on the employee roster).

Most absences during the pandemic could easily be traced back to the one-site order, sick leaves, quarantine orders, pregnancy or parental leaves, the need to provide child care, or concerns about family members’ vulnerability to infection. But in other cases – which included employees at homes both with and without COVID-19 outbreaks – workers offered no explanation for their absences. Nor did they respond to the company’s repeated efforts to reach them and find out why they had not turned up for their scheduled shifts.

It is not a stretch to imagine that fear kept many frontline caregivers from going to work. 

While the reasons behind the absenteeism remain unconfirmed, fear likely played a significant role. In the context of COVID-19, long term care homes quickly became high-risk environments. The month of April brought a steady rise in COVID-19 fatalities, including the deaths of three PSWs in Ontario in less than three weeks, a tragedy that garnered intense media coverage. It is not a stretch to imagine that fear kept many frontline care providers from going to work. It had, after all, been a prime reason doctors cited for their refusals to provide in-person care to the residents of long term care.

At the same time, the federal government program that provided financial support to workers directly affected by COVID-19 in the first wave may also have contributed to the steep jump in unexplained absences. Unlike unemployment insurance, in which assistance is tied to prior personal income levels, the Canada Emergency Relief Benefit (CERB) provided a flat rate. All applicants who had been employed or self-employed before the pandemic hit received $2,000 a month. At $500 a week, collecting CERB essentially amounted to slightly more than a part-time employee in long term care would make for three days of work in a week (22.5 hours at $22 per hour), and considerably more than the $18 an hour that part-time employees earn at retirement residences. The federal benefit may have had the unintended consequence of incenting part-time staff not to work, or not to apply for the many part-time positions that were going unfilled.

Revera mitigated the impact of these unexplained staff losses by increasing the hours of part-time staff who continued to work. Still, these absences added to the desperate scramble to find more frontline caregivers to fill the growing gaps. There were, for example, failed attempts to recruit staff from the large pool of available PSWs who, because of the pandemic, were not working their regular jobs in home care. But home care PSWs could not be directed by their various employers to work at a long term care home. As a result, very few employees answered the call for help, particularly if it was coming from a home where COVID-19 had broken out.

Urgent Steps Ahead

The shortage of PSWs was critical across the country well before the emergence of COVID-19. These essential frontline caregivers have become a dwindling resource in the healthcare system, while their work has never been in greater demand.

In long term care, the PSW shortage proved to be a major contributor to the tragedy that unfolded in the sector during the pandemic’s first wave. More than 10,000 long term care staff contracted COVID-19 across the country, and 16 died. Countless workers were quarantined and isolated, all of which further depleted an already threadbare workforce.

At Revera, the staffing crisis that emerged during the pandemic was further exacerbated by the fallout from the one-site work restriction that likely pushed part-time employees to look elsewhere for full-time jobs, and also by a dramatic and sudden spike in the unexplained absences of staff members.

COVID-19 has unfortunately added to negative perceptions of the PSW field, one practised largely by ethnic-minority women often struggling to make ends meet. Their public accounts of working through the pandemic have described heavy workloads and emotional burdens, while some families have blamed PSWs as the source of outbreaks in senior living centres. All of this has made the vocation, in long term care in particular, less appealing than it had been. Yet with the ever-rising need for the essential care PSWs provide, it is urgent that meaningful steps be taken to shore up confidence, compensation and respect for those committed to caring for society’s vulnerable elderly.

Recommendations

What follows are detailed recommendations compiled by Revera’s Expert Advisory Panel to improve staffing levels in the short and medium/long term, support the pipeline of graduating PSWs, and ensure the safety of all frontline caregivers so that they feel comfortable going to work.
Improving PSW Staffing by Alleviating Workloads and Creating More Full-time Positions
Priority Recommendations for Immediate Implementation
  1. Employers can implement the position of Personal Service Assistant/Resident Support Aide:
    1. The Personal Service Assistant is a position to supplement the PSW’s work. This employee can perform tasks that will reduce the workload for PSWs.
    2. Some of these examples include making beds, cleaning rooms, distributing laundry or providing companionship for residents.
    3. Many employers have implemented this new position to offset staff shortages created by the outbreak of COVID-19; many others, including Revera, had implemented this prior to the pandemic.
    4. To ensure the success of this initiative, the Ontario Ministry of Long-Term Care could confirm that the costs of this role would be covered under the Nursing envelope.
    5. Collective agreements enable the employer to implement such classification. Unions can grieve the wage rate, but not management’s right to create a new classification.

    Revera logoRevera Response: Implementation of recommendation is in progress.
    These additional roles have already been implemented in Ontario, and implementation is underway in the western provinces. Continuation of this role in long term care requires legislative changes.  
     

  2. Employers can create the position of Full-Time Weekend Worker:
    1. Creating a full-time Weekend Worker position would involve an employee working 30 hours and getting paid for 37.5 hours. The employee would work every weekend, plus extra shifts on Friday and/or Monday to reach the 30 hours.
    2. The attraction is full-time pay, a consistent schedule and benefits associated with full-time work.
    3. The position could be attractive for those with young families (i.e., be home for family during the week and work on weekends) or for employees in full-time education.
    4. This would assist in creating more full-time positions, which is the most attractive option to employees.
    5. There is precedent set out in the ONA (Ontario Nurses Association) Nursing Home Language

    Revera logoRevera Response: Implementation of recommendation is not feasible.
    Revera had trialled this strategy in the past with registered nurses (RNs) without success, as we were not able to recruit RNs who were willing to work only on the weekends. Keeping the weekend workers up to date on the latest policies, procedures and resident care issues also becomes a challenge. This model also posed challenges when weekend worker employees called in sick.
     

  3. Employers can create full-time cross-site positions:
    1. Employees would work part-time at two or more long term care home locations, but would be treated like full-time employees under the collective agreement and entitled to full benefits.
    2. Employees in Ontario must choose one site to be their true employer (for purposes of WSIB and seniority).
    3. Long term care homes in close proximity to each other could have employment agreements that cover the logistics of these cross-site employment engagements.
    4. There is precedent set out in the ONA Nursing Home Language

    Revera logoRevera Response: Recommendation to be considered as part of a broader strategy.
    Implementation of this strategy is not currently feasible given single-site work orders. Once single-site cohorting orders are removed, we will consider this recommendation as part of a broader strategy.
     

  4. Create more full-time positions within a home:
    1. Establish full-time float positions:
      • Simply create more full-time staff and recognize that some shifts will have more coverage than required. This could potentially increase costs significantly and result in staffing imbalances between shifts.
      • Creating more full-time float positions could, however, enable employers to cover absences and maintain more flexible schedules, while benefiting the employee by providing full-time hours and full-time entitlements.
    2. Establish temporary summer positions:
      • In summer, long term care homes could create temporary full-time lines.
      • This would create a consistent schedule for the employees who take the line.
      • This would represent the potential for greater earnings for summer employees.
      • This would create possibilities to allow other employees to enjoy better vacation time.
    3. Negotiate greater flexibility in scheduling and fewer weekends off (it will be challenging to roll back scheduling achievements of the unions).
    4. Establish 12-hour shifts that would increase the ratio of full-time to part-time staff, although the longer 12-hour shift also increases a heavy workload.
    5. Alternatively, the employer could establish 12-hour shifts and eight-hour shifts for PSWs. As part of this, eliminate the drop shift. Employees would do a rotation across a bi-weekly pay period where they work 12-hour shifts and eight-hour shifts combined. Most importantly, changing the schedule to a 12-hour schedule, or a 12-hour and eight-hour rotation, gives employees more days off and more consecutive days off. It also allows more employees access to full-time benefits and provides them with a consistent schedule. People often use drop shift to reduce the number of days they work. This can be achieved through these rotations. Since they are not dropping a shift, employees will be able to make more money. To achieve this, the home may need to stagger shift start and stop times to ensure, for example, that all three meals don’t start on one shift.

    Revera logoRevera Response: Recommendation to be considered as part of a broader strategy.
    Revera has undertaken a review of its workforce management strategies and will be considering this as part of the broader workforce management strategy, which will require a reset of master schedules and union engagement. In Ontario, we will be better positioned to implement this recommendation given the new announcement from the provincial government that it will increase government-paid care hours for residents to four hours by 2024-25.

     

  5. Create job-share arrangements:
    1. Allow two employees to split a full-time line, with each one covering the other’s absence.
    2. This would provide an attractive option for some employees and confirm a consistent schedule.
    3. Precedent for this arrangement exists in the ONA Nursing Home Language

    Revera logoRevera Response: Recommendation to be considered as part of a broader strategy.
    Revera has undertaken a review of its workforce management strategies and will be considering this as part of the broader workforce management strategy, which will require a reset of master schedules and union engagement.
Improving Staffing and Combatting Unexplained Absences with Safety Measures
Priority Recommendations for Immediate Implementation
  1. A solution to decrease potential leaves of absence or unexplained absences because the staff member is afraid of infection is to take meaningful steps to reduce the risk of infection and ensure employees feel comfortable coming into work.
    1. Like Revera, provide sufficient and appropriate PPE at all sites.
    2. Conduct regular testing of all employees at all sites by the best means available.
    3. Follow rigorous screening procedures before allowing anyone to enter the long term care site.
    4. Conduct rigorous screening of visitors and apply all applicable rules to avoid high-risk entries.

    Revera logoRevera Response: Recommendation already implemented.
    At the onset of the pandemic, Revera secured adequate PPE for its staff and has since established a strong inventory of PPE. Starting in June, we also started twice-monthly surveillance testing for our staff in Ontario, and in October partnered with a private laboratory chain to bring staff surveillance testing to the western provinces. Rigorous screening of all staff and visitors has also been in place since the onset of the pandemic.  
     
     
  2. Develop trust and understanding with employees by assuring them that the company learned valuable lessons in the first wave, their workplace is safe, and their family members are protected. This might be most effective coming from an expert physician who has knowledge of the virus, infection prevention and control (IPAC), and PPE. This could be done via webinar.
     
    Revera logoRevera Response: Recommendation already implemented.
    We have put in place a cohesive communication strategy, including emails from our chief medical officer, virtual town halls and huddles, and other ongoing channels to address this. Additionally, we have incorporated all the lessons learned into an actionable “Pandemic Playbook” tool that allows our site managers to access tips, best practices and procedures, and checklists to prevent, prepare for and manage outbreaks. This tool has been adopted organization-wide and has received a resounding positive response.  


  3. Another potential means of alleviating employee safety concerns is to invite presentations and training from staff and regional leaders who worked during, and/or managed, a COVID-19 outbreak in the first wave. This would be key for homes and staff who did not see an outbreak in the first half of 2020, and may help to decrease unexplained absences while increasing pandemic preparedness.

    Revera logoRevera Response: Recommendation already implemented.
    In addition to various webinars where we spotlight site managers who experienced outbreaks, we have set up dedicated weekly regional calls where the sharing of stories, learnings and best practices occurs.
     
     
Priority Recommendations for Medium to Longer Term Implementation
  1. Arrange for external parties to conduct confidential interviews with staff, with a written guarantee of anonymity and protection against retribution, to learn the reasons for unexplained absences. Derive solutions from these interviews and act upon them.

    Revera logoRevera Response: Recommendation already implemented.
    Interviews were already conducted by site leadership and we have also had hospital Health & Safety resources providing support. Continued public misinformation, and personal family situations, are continuing to cause fear and drive a subset of employees to be unwilling to come to work. 
     
     
  2. Continue to work with unions to provide assurances to employees that their safety is a company priority with the support and understanding of the unions.

    Revera logoRevera Response: Implementation of recommendation is in progress.
    We have been working with the unions from the onset of the pandemic, and communicate to them the strategies that we have put in place (screening, testing, PPE, communications, playbook, etc.) to create a safe environment for our employees.
     
     
  3. Lobby to make certain the temporary CERB/Employment Insurance federal legislation is modified to the extent possible so as not to dis-incent part-time employment.
     
    Revera logoRevera Response: Implementation of recommendation is in progress.
    Revera has been working with industry associations to work with the government in modifying these incentives to help with our staffing challenges.
Improving Access to the PSW Pipeline, Expanding It and Supporting the Field

Over the long term, the position of PSW, and barriers to entry or success in the position, should be assessed. Some solutions are set out below.

  1. Change the reporting requirements:
    1. The reporting requirements of PSWs have dramatically increased. The need to chart residents’ “status quo” and requiring all activities to be recorded in writing – including food consumed and bowel movements – is taking up a significant portion of their shift.
    2. Registered staff should be the primary individuals doing reporting.
    3. Instead of reporting everything, PSWs could report only when something was an exception to the normal.
    4. Employees would have more time to perform the care elements of their job.
    5. This would require working with the Ministries of Health and Long-Term Care to amend reporting requirements.

    Revera logoRevera Response: Implementation of recommendation is not feasible in the foreseeable future.
    We currently do not see this recommendation as feasible, as PSW documentation is critical and legislation would need to be changed. Note that Revera has previously invested heavily in automation and digitization of documentation in order to streamline and reduce this task.
     
     
  2. Reduce the barrier to entry:
    1. The high cost of tuition and closure of community colleges can be a major barrier to entry.
    2. Employers, the individual colleges and the government can address these issues in many ways.
    3. Employer and college solution: Partnership with colleges
      • Some long term care homes have partnered with local community colleges to provide in-house education with a commitment from future graduates that they will work for the employer for a certain length of time after they complete the training.
      • Starting in 2018-2019, Revera partnered with a college on a pilot project involving three long term care homes in three different regions of Ontario. With the project’s remarkable success, the pilot has since gone Canada-wide and more colleges have partnered with Revera. The company has since hired a campus partner who works with colleges and school boards to get them started. The longest-running success of college programs involved a Kitchener home, but it has also enjoyed success in other regions. The company has also supported training initiatives with private colleges and partnered with school boards to create a PSW certification process through high school curriculums and placements.
      • Students spend four months in class learning at the college and then complete an eight-week unpaid practicum program in a Revera long term care home. (This program is also available for placement in retirement residences with a four-week unpaid practicum.) Once students successfully complete the program, they could be offered conditional employment.
      • Revera does not pay for the course, but multiple avenues for tuition relief are available. For students who were not previously employed at Revera, they may qualify for a high-performer grant of up to $2,000. In some cases, the grant has been offered to two students in one class. Students can also seek tuition relief if they are given a conditional offer during their placement. Accepting the offer makes them eligible to receive $75 per pay period for a maximum of two years.
      • Existing employees who want to enrol in a PSW course (a housekeeper, for example, who wants to be a PSW) can apply for a scholarship program through Revera. This is allocated on a regional basis and will pay for successful applicants to take the PSW course. Two staff members at Revera’s ReachView site, for instance, have become PSWs after Revera covered the costs of their night school program.
      • Two privately-owned long term care chains partnered with a private Canadian college to run a successful PSW certification program on site. The employer paid the tuition for the PSWs and was able to get a return from a government grant for a portion of the tuition. The employers do not pay the students during the program. The students are in the classroom for the first three months, and then for the next three months they complete a placement in a long term care home and perform community work in retirement residences. The private college condensed the program to six months.
      • Employers should also explore the option of having students work part-time as personal service assistants while they obtain their education to become a certified PSW.
    4. Employer and college solution – Partnership with Ontario Learning Centre
      • The Ontario Learning Centre is offering a program where high school students can take six PSW credits as part of their Grade 12 credit requirement.
      • On completion, these students obtain their PSW certificate.
      • Some employers offer to pay the tuition for students if the student commits to working for them after graduation.
    5. College and government solution – Reduce the cost of the PSW program
      • This would reduce the barrier to entry into the PSW field, and could further expand it if it is designated a high-need vocation and training offered at no charge for tuition.
      • The government could create bursaries/scholarships for PSW education.
      • In Quebec, the government has created a program to encourage people to join the profession. They have created a 375-hour, 12-week program with a combination of training in a vocational setting and distance learning. The program is free and there is a scholarship program of up to $760/week. Since opening, they have had 10,000 applicants.
      • In Quebec, on completion of the program, students can receive a job where they earn $49,000 annually.
    6. Government solution – Develop creative programs for employees to become certified
      • Some creative solutions include:
        • The government could create apprenticeship programs (this could further reduce the cost barrier to entry, as individuals would be paid while doing the apprenticeship).
        • The government could create a shorter program for training.
        • The government could add an element of healthcare training to high school education requirements; this could spark an early interest in working in health care.

    Revera logoRevera Response: Recommendation already implemented.
    As outlined in the body of the recommendation above, even prior to the pandemic, Revera had established partnerships with local colleges to create a pipeline for PSWs.  
     
     
  3. Work to address the negative stigma attached to working in long term care:
    • The job of PSW is not portrayed in the media as a desirable career.
    • Employers, the government and the media can work to portray all of the positive work that long term care employees and employers do.

    Revera logoRevera Response: Implementation of recommendation is in progress.
    The Canadian Association for Long Term Care (CALTC), Ontario Long Term Care Association (OLTCA) and other provincial associations have invested in campaigns to help change the media perception of long term care. Additionally, Revera invested in a paid media campaign designed to increase confidence in congregate living.
     
     
  4. Recruit overseas and change the scoring of the immigration point system:
    • Current immigration rules prioritize higher education under a points system.
    • This system diminishes the ability of trained PSWs to come to Canada.
    • A concerted lobbying effort to change the points system to prioritize PSWs would assist in the PSW shortage across Canada.

    Revera logoRevera Response: Implementation of recommendation is not feasible in the foreseeable future.
    Implementation of this recommendation would require changes in immigration laws and is thus not in Revera’s control. However, we believe it is being discussed at various government levels, and we will continue to monitor and actively lobby for it through our various industry associations.

This report is dedicated to Revera’s employees, residents, their families, and all those on the front lines of the senior living sector who are working through the worst pandemic in living history.
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