Rationing care: "Who doesn't get a bath today?"

This article is reprinted from Direct Impact, the Alberta Union of Provincial Employees member magazine.

Every night, a health-care aide spends her shift in a car, driving back and forth between several nursing homes a few kilometres apart in northern Alberta.

Her job is to float between the 20-bed facilities, which are all owned by a single operator and have only one employee stationed at them overnight. The floater must race around helping whoever needs an extra pair of hands while onsite staffers pray there aren’t two emergencies at the same time. It’s one of many ways that corporate and not-for-profit continuing care operators around Alberta cut corners to keep costs down. 

Deb Arcand isn’t even fazed by this story. The chair of AUPE Local 047, which represents health-care aides and support staff in privately run continuing care facilities, has heard countless reports of short-staffing, impossible workloads and management cutting corners to the detriment of the elderly and infirm residents.

“People get into this line of work because they care,” she says. “Yes, conditions can be extremely frustrating and stressful for the staff, but the people who suffer most are the residents.”

One health-care aide said staffing is so chronically short at her nursing home that it’s become the norm for staff to triage residents’ needs.

“It’s always, ‘okay, who doesn’t get a bath today?’”

Many nursing home residents get few, if any, visitors, but staff are constantly hectored by management not to waste time chatting with them.

Arcand fears the situation will only get worse as demand for continuing care spaces keeps growing. With our aging population and increasing life expectancy, continuing care has become a growth industry and an attractive investment opportunity.

Weak regulation

Alberta taxpayers pour hundreds of millions of dollars a year into these facilities, through government funding for the residents’ care, fee subsidies and, in recent years, $600-million worth of direct subsidies for construction of new spaces. 

Despite the heavy public investment, the province’s regulation of the industry is riddled with loopholes that allow operators to cut corners, and the government seems to be in no hurry to tighten them up.

Back in 2005, the provincial auditor general gave a harsh assessment of the system, saying one-third of facilities inspected failed to meet the basic standards of care. Six years later, a new auditor general’s report revealed that the government still didn’t have a consistent monitoring and inspection program across the province.

Meanwhile, Alberta Health Services has begun phasing in a new funding system that provides consistent funding for salaries equivalent to what AHS budgets for wages at its own continuing care facilities.

But astoundingly, there’s no requirement for employers to use the increased funding to match AHS wages, giving employers the opportunity to skim more profits off the top.

“Provincial standardized salaries are being developed in order to ensure consistent funding for (supportive living) sites,” one AHS document says. “This standardization of salaries does not however mandate how much a site can pay its providers.”

AHS pays for staffing based on the mid-range of its own salary grid, regardless of what the employer is paying staff. If an employer can keep salaries below that level, it can pocket the difference. 

The danger for residents is that low-paying employers will have constant staffing problems. Casual and part-time employees, who often work at two or more facilities, will refuse shifts to work at their better-paying jobsites. High turnover will mean residents and staff won’t be able to develop strong relationships, and the facility will only be able to attract the least experienced employees, who will look for another job as soon as they gain experience.

New designations

A few years ago the government moved to standardize the qualifications for health-care aides. At first, employers supported the idea of standardization… until it became clear that it also meant a standardization of wages.

Suddenly, new designations began appearing at various worksites — such as “lodge attendant” — while some duties were redesignated under terms like “hospitality services.” Employers argued these “new” jobs don’t require the training or the pay of health-care aides, regardless of how the government funds the positions.

On top of that, the rules mandating staffing levels are Byzantine in their complexity, with gaping holes in accountability.

The system takes into account the varying levels of care needed among the residents. Each resident is given a classification that determines the number of hours and type of care they need in a given day. The government uses those designations to determine funding.

Historically, employers could use either of two methods to report how they use this funding. In the first, all they had to do is show that 90% of all funding for “direct care” was actually used for that purpose. In the second, they must account for the hours of direct-care funding they received. But included in that calculation are things like staff sick time, vacations, other paid leave, etc., creating a false picture of how much staffing is actually on site. 


Arcand says that because her members’ working conditions dictate residents’ living conditions, it’s up to the employees to advocate for residents. 

“We need to ensure that there’s proper regulation and accountability,” she said. “The residents, they’re the ones who built this province. They worked hard all their lives. In some of these places it’s shameful that in the final years of their lives, this is the way they’re treated. We owe them more.”