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Five Steps to Fix the Long-Term Care Crisis


The system is set to fail. A solution starts with better support for workers

The woman in a mask is going out of the building
Christinne Muschi/Bloomberg via Getty Images

Canada’s long-term care sector was hard hit by the Covid-19 pandemic. Rapidly climbing patient deaths, a lack of safety provisions coupled with already precarious employment and difficult working conditions took its toll on the mental health of health-care workers.

Yet, wellness in the long-term care sector is rarely discussed. Distress due to difficult working conditions is often dismissed as a part of the job description. Workers are expected to “suck it up” and manage their emotions on their time.

The sector is currently held together by a very vulnerable workforce and it is set up to fail without immediate intervention.

In our research, we examined the impacts of two critical psychological safety factors on the long-term care workforce amidst the Covid-19 pandemic: support for self-care and protection from moral distress. Health-care workers expressed the increased need for resources to support their well-being and to address longstanding workforce issues. Five recommendations for a stronger long-term care sector are proposed. 

1. Address long-standing structural issues

Structural issues have been brought to light during the Covid-19 pandemic. This includes issues that are economic, social and organizational.

While the pandemic exacerbated the challenges facing the long-term care sector, workers stated that these issues are not new. Rather, decades of neglect and lack of funding have made low pay and unsafe working conditions acceptable.

 The pandemic intensified existing problems with staffing shortages. In 2020, long-term care staff members made up more than 10 per cent of Canada’s total Covid-19 infection cases. Further, restricting informal caregivers from entering homes contributed to higher workloads.

Institutional support for any sort of resource (mental health, personal protective equipment, staffing) was stretched thin to keep care homes running. Resource limitations kept the hands of management teams tied, suggesting that distress was endemic across the sector. 

2. Offer continuing education and training for self-care

Supporting staff through continuing education and training can increase their capacity for psychological self-care and help protect them from moral distress. 

Continuing education and training can significantly improve psychological well-being among long-term care workers. Communication-focused training approaches have resulted in improvements in staff turnover, depression and anxiety. Self-compassion and acceptance-based approaches found a significant reduction in mental health symptoms. 

Educational sessions connect staff with other staff, allowing them to share their expertise and frustrations—helping to alleviate conflicts and tensions among teams. Virtual forums can be used for peer-to-peer learning, community building and moral support. 

Training must be made available to all staff. Our study found that unregulated staff, such as personal support workers, were often not invited to take part in training programs or given access to company resources. 

3. Invest in leadership development

Improved leadership can foster improved team functioning. Bullying and gossip are particularly rampant in the long-term care workplace. Workers expect one another to work through distress. Asking for a day off can be seen as a weakness that increases the workload for others.

Supportive managers are critical to the psychological well-being of staff. A study on transformative leadership found a reciprocal relationship between leadership, self-reported staff well-being, team efficacy and self-efficacy—leading to job satisfaction and well-being. Transformative leaders encourage employees to create change inwardly by connecting professional goals to a wider sense of belonging in their workplace. 

Underfunding and resource constraints make it difficult to provide meaningful and accessible support, reducing workers’ ability to protect themselves against moral distress in the workplace. 

4. Ensure safe working conditions 

Insufficient personal protection equipment (PPE) was a concern for workers in the sector. Staff shortages and lack of knowledge from management contribute to poor infection control and safety. Low wages and limited benefits also place workers in vulnerable situations, with limited options to practice physical and psychological self-care. 

Funnelling resources and funding into this sector will not only improve staffing. It is critical for reducing the rapid turnover caused by uncontrolled exposure to Covid-19. 

5. Create supportive human resource policies

Long-term care needs to develop and/or improve human resource policies that support workers and acknowledge their value. 

Low wages and precarious employment characterize this sector. Workers have even been afraid to take time off to get the Covid-19 vaccine for fear of losing wages. 

Part-time and contract workers in the sector, often personal support workers, are not eligible for medical benefits and must pay out of pocket for injuries incurred at work. Many of these workers are racialized, immigrant women. Workers also often do not have entitlement to paid sick days. These factors point to systemic discrimination and undervaluing compared to other professionals in the sector. 

So where to do we go from here? The Royal Society of Canada argues that the first step to tackling the long-term care crisis is through workforce reform and redesign. This not only addresses low wages and resource shortages but serves more importantly to rebuild trust and dignity. To bolster support for the sector, public awareness and advocacy play a key role in advancing health-care reform. 

Colleen Grady is an associate professor of family medicine at Queen’s University. Sophy Chan-Nguyen is a research associate at Queen’s University. A version of this article first appeared in The Conversation.