Temporary agency workers have long been a crutch for a care system in crisis, experts say. Now, they are exempt from new COVID-19 health directives

Long before the pandemic hit, "working short" was a chronic problem for personal support worker Febe Jimenez.

Staff were overloaded on a good day at her Hamilton-area retirement home; a single worker's absence could throw an already tenuous care system built on low pay and long hours into disarray. For temporary relief, she says, help was habitually drafted in from three separate staffing agencies: one for nurses, one for night shift, and one for day shift.

"Before this happened, we were going through agencies like crazy," Jimenez said.

A new directive issued by the province this week limits the movement of health-care workers between facilities in a bid to contain the devastating spread of COVID-19 in nursing homes. But the directive does not apply to agency workers, who earn their living floating from home to home.

It's an exemption critics call a health risk - and a sign.

"It shows just how desperate the Ontario government is to adequately staff these long-term care facilities," said Candace Rennick, secretary-treasurer of the Canadian Union of Public Employees and a long-time nursing home worker.

"We know there is a complete staffing crisis with respect to shortages and retention and recruitment. They are so reliant on this temporary agency contract work that they need to exempt them from a fundamental order to keep people safe."

In a statement to the Star, a spokesperson for Minister of Long Term Care Merrilee Fullerton said the order did not apply to "agency workers or other critical contract staff" in order to "ensure a steady supply of staff available to work on an emergency basis in long-term care homes."

"To ensure the safety of long-term care residents, these workers are subject to 'active screening' direction set out in a directive by the Chief Medical Officer of Health, which requires a rigorous screening process before being permitted entry into a long-term care home," the statement said.

Even for directly-hired personal support workers, poor pay has long meant juggling multiple jobs at different homes, says Sharlene Stewart, president of Services Employees International Union Healthcare.

"Workers absolutely want one full-time job. But when you pay them so poorly " you have to work two jobs to barely make a living," she said.

In light of the pandemic, the government has said these workers can pick one employer and take job-protected leaves of absence from others to comply with new directives.The province has also said it "encourages" long-term-care employers to offer full-time hours to part-time workers.

That is what has happened at Jimenez's facility so far, she says. But it does not solve what caused the shortages - and reliance on temporary staff - in the first place.

"It was stressful working short. Even when people came in, they weren't wanting to get hired at our place because they thought the wage was too low," she said.

Years of underfunding and the expansion of for-profit care homes have deeply impacted working conditions, leading to poor pay, high turnover, and the need for a contingent workforce to plug the gaps, says Pat Armstrong, sociology professor at York University.

"If you're trying to make profit out of a long-term care home, your biggest cost is labour."

Armstrong is part of an interdisciplinary team that has studied nursing homes in Canada and five other jurisdictions over the past decade. A forthcoming report on their findings for the Canadian Centre for Policy Alternatives says that "homes run on a for-profit basis tend to have lower staffing levels, more verified complaints, and more transfers to hospitals, as well as higher rates for both ulcers and morbidity."

"Moreover, managerial practices taken from the business sector are designed for just enough labour and for making a profit, rather than for providing good care," the report says.

"These include paying the lowest wages possible, and hiring part-time, casual and those defined as self-employed in order to avoid paying benefits or providing other protections."

Enter staffing agencies.

"PSWs have double the rate of absenteeism due to illness or injury compared to the (Canadian) average," said Kate Laxer, a research associate with Dr. Tamara Daly at York University's Centre for Aging Research and Education.

"If you even were to imagine that just one PSW is sick, and they're dealing with perhaps a ratio of three PSWs to 20 residents, that would have a very serious consequence in the overall ratio," she added.

"That would require an agency staff person to fill in at that point. And it's very common. It happens all the time."

But the reliance on agencies can pose a risk to residents, caused in part by "the lack of familiarity and the discontinuity in care," said Laxer. In the midst of a pandemic, "precarious arrangements are leading to what are probably very problematic levels of traffic under these circumstances," she added.

The model can also pose risks to workers, who often rely heavily on their knowledge of a particular home and its residents to keep themselves safe on the job, said Armstrong.

"Especially in these times, you want that support," she said.

It's an issue that was brought to Workforce Planning for Sudbury & Manitoulin head Reggie Caverson's attention around two years ago - by the head of a private staffing agency.

"They said, 'do you have any idea how many shifts are being missed at our local long-term care homes?'" Caverson recalls.

"Obviously, they were a private staffing agency so it was a fairly lucrative business for them. But they were very, very concerned about the fact that there were so many shifts that were being missed."

Caverson and her team investigated, speaking to staffing agencies, nursing homes, and - most importantly - workers themselves.

"Nothing is worse than our field than going into agencies and they're saying, 'there's nothing wrong here.' But we're hearing from the workers saying, 'oh, there's something really wrong here.' And that's exactly what has happened," said Caverson.

The resulting report, published last year, found that personal support workers in the area were evenly split between full-time and part-time, with 75 per cent earning $20 or less an hour. The report also found that around a third reported working for an employment agency.

Existing research on temporary agency work has long shown that it is often riskier and lower-paid than a permanent job. But while the model poses safety issues in the health care sector too, the concerns around pay sometimes differ, said Caverson.

In some cases, agency workers "get emergency pay to get in there earlier and faster, so they're paid much better than the current PSWs and have a lot more flexibility," she noted. Sometimes, workers may even prefer agency work because permanent positions are so demanding, she added.

"How do you fix that? You fix that by improving conditions," said Armstrong.

And while the rationale behind lean staffing may be low labour costs, Caverson said the end result may be exactly the opposite.

"I talked to some of the directors up here from the long-term-care homes, and (agencies) charge them an arm and a leg for one of these staff members to come in," she said.

"The local health integration network " had charts and everything showing how in debt they were now because it had to pay for all these private staffing people to come in."

But the scale of the problem remains quantify, even amid a crisis where hard numbers would come in handy, said Laxner. Apart from research efforts like the ones undertaken by Caverson, low-wage care workers are often invisible in workforce data.

"The data gets very, very murky especially the more tenuous the employment relationship," Laxer said.

Long-term care facilities, for example, report "full-time equivalents" to represent their staffing numbers, which "lumps together all the workers so that it's impossible to gauge who was working full-time, part time, temporary or agency," she said.

"I would argue that that's really important because the employment relationship is a key indicator of the quality of care," she said.

Now, with capacity stretched more than ever amid a crisis, the government's ability to restrict mobility - long an unwelcome necessity for many workers - is limited by problems of its own making, said Laxer.

"It was very clear that this model of having people come in and out of facilities, or any environment in which they're providing care, poses a tremendous risk if there is some kind of outbreak of any kind of infectious disease. That was known," she said.

"It's heartbreaking and astonishing that it wasn't addressed sooner."

Sara Mojtehedzadeh is a Toronto-based reporter covering work and wealth. Follow her on Twitter: @saramojtehedz