Is safe home care possible during a pandemic?

Many Ontarians with disabilities count on personal-support workers to live independently — and that’s sparking worries about a heightened risk of COVID-19
By Mary Baxter - Published on Jul 11, 2020
Current provincial guidelines require care providers and other “priority populations” to get tested for COVID-19 if they have at least one symptom. (iStock/Niq Steele)

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Since 2014, after experiencing a spinal-cord injury that left him paralyzed, Chris Stigas has relied on personal-support workers to help with routine activities, such as getting in and out of bed or fixing lunch. At the supported-living facility in downtown Toronto where the business owner— who consults about and sells accessibility products — lives, assistance is available around the clock. It’s provided by PACE Independent Living, a local non-profit organization. “It really offers a greater level of independence to be able to come and go as you please in your community,” he says.

After COVID-19 cases began to appear in Ontario earlier this year, however, Stigas came to see those support workers as a health threat. Many people enter his home throughout the day, “different people at that,” he says. Most of the attendants — qualified personal-support workers — work part-time and hold jobs with other employers in health care. That, he says “leaves you wondering how diligent they're being in their other jobs and how diligent they're being in their own safety getting to and from work [because] so many people take public transportation.” He also notes that he has a compromised respiratory system: “All it takes is a slip-up [in safety precautions] in my home to put me at risk.”

Stigas is one of more than 2.5 million people in Ontario who live with disabilities. Many of them, as he does, count on home-care supports to live independently. He’s not alone in his worry. “A number of the cases that we've seen involve people who have cancelled services from their usual service provider and relied on family and friends because there couldn't be any guarantee about social distancing,” says Dianne Wintermute, a lawyer with ARCH Disability Law Centre in Toronto. “The services provided are very personal, and there weren’t any controls over where or with whom people worked.”

In early June, Stigas was concerned about PACE’s decision to allow one of its workers to go back and forth between two of the nine supportive-housing locations the organization serves. (It also supports clients in private homes in the city.)

Stigas wants staff to be regularly tested for COVID-19: “At least, if they're testing, then we know that it’s being monitored in real time instead of waiting for tragedy.”

Laura Visser, CEO of PACE, says that she appreciates “that there is anxiety among client and staff around what risks they might be facing as a result of the nature of the service delivery that we provide to clients — and the fact that service cannot be provided without, at times, breaching social distancing.” But, right now, she says, the agency doesn't have the legal right to compel workers to take such testing.

“It's a question that’s at sort of the intersection of a number of different factors, including health and safety of staff, public health of clients and staff, privacy human rights, and other factors,” that require government legislation to empower, she explains, adding that “at this moment, the government has not introduced mandatory surveillance testing” in home and community care. A spokesperson for the Ministry of Health tells TVO.org via email, though, that current provincial guidelines do require care providers and other “priority populations” to get tested if they have at least one symptom of the virus.

Visser says that the staff member ceased crossing between the two facilities in early June and was the only one to have done so. As of July 6, three of the more than 200 clients the agency serves and two of its 220 staff members had contracted the virus, she says. Of those cases, three are still active.

Enhanced measures, such as those PACE has introduced, Wintermute says, may stop short of mandatory testing but “would provide additional protections for persons with disabilities.” She adds, though, that “testing for personal-support workers would be an important protection for people who live with disabilities.”

Unlike Stigas, Londoner Sharlene Kapp coordinates her own care, but that doesn’t alleviate her concerns about risks of exposure to COVID-19 from her workers. Of her current roster of five personal-support workers, three also work part-time in retail. It’s “a little bit scary,” says the mother of two, who has multiple sclerosis.

To protect herself, she requires that workers leave all their belongings at the front door, wash their hands, and wear gloves. After they leave, she wipes down the door handles with Lysol — which she has to buy herself.

And that’s not her only worker-related health and safety challenge: she has also had issues retaining staff since the crisis began.

She thinks that both issues are linked to poor pay for those who deliver services in the home. “Nobody that works in home care, realistically, can only work in home care,” she says. “The pay is crappy, and there are not enough hours — I personally only have four hours a day that I can give to my girls.”

She pays her workers $19 an hour, the maximum permitted her — $7 an hour less than what she says local long-term-care homes pay — and obtains funding through a provincial program.

Kapp says she hasn’t yet received the $4-per-hour pay boost that the province said would be coming to front-line workers as an incentive to work during COVID-19; she’s heard it could take until October to receive the funding, which will be retroactive. A spokesperson for the Centre for Independent Living in Toronto, which administers the program, confirms by email that the province has not yet issued the pay-boost funding to the organization. Even if she did have it, Kapp says, the extra pay wouldn’t be incentive enough for her workers to quit their retail jobs.

Erika Katzman, a disability-studies professor at Western University, notes that many of the risks of viral spread are linked to systemic issues, such as workers not being issued adequate personal protective equipment. “I’ve heard stories of people provided with 10 masks and [told to] use these wisely,” she says. “What does that mean, exactly, when you're going from home to home throughout the course of a day, every day?”

Home-care workers earn low wages, she adds: “They may be more likely to be in public spaces, like public transit, as they go from home to home [and] perhaps living in higher-density housing.”

Christian Hasse, a spokesperson with the Ministry of Health, says by email that the provincial government committed to several initiatives to improve the pay and working conditions of home- and community-care personal-support workers well before the pandemic: increasing their wages by $4 per hour over three years, setting their minimum hourly wage rate at $16.50 per hour, and, for publicly funded home-care services, introducing a 2 per cent home-care contract rate increase. “This increase was intended to support wages, benefits and other compensation such as travel reimbursement, that would improve working conditions for PSWs,” Hasse writes.

Douglas Waxman, chair of ARCH, says that, in order to address issues in the industry, it’s critical that home-care workers be paid higher wages. The fact that part-time workers helped spread viral outbreaks from one long-term facility to another at the height of the pandemic, he says, is another sign that the system needs to change: “Clearly, that is the weakness in the system right now in terms of [putting] people at risk.”

This is one in a series of stories about issues affecting southwestern Ontario. It's brought to you with the assistance of faculty and students from Western University’s Faculty of Information and Media Studies.

Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.​​​​​​​

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