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«UNDERSTAFFED AND UNDER PRESSURE A reality check by Ontario health care workers October, 2005 UNDERSTAFFED AND UNDER PRESSURE A reality check by ...»

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Accurate information is the foundation on which to build a home care sector that is focused on continuous improvement, innovation, and best practices, all of which must be aimed at the ultimate goals: client and family satisfaction.” The substitution of bureaucracy and reporting mechanisms for the fundamental changes needed and promised is fast becoming McGuinty’s hallmark.

In keeping with its long history of rushing to gain favour with the government of the day, the organization representing Ontario’s 42 CCACs, not only welcomed the report, but went so far as to thank Caplan for her team’s collaborative approach to the review.

“We’ve gone through nine years of bullshit, and nothing is going to change, except they’ll be more of it with all this reporting and new bureaucracy,” noted one home care worker.

–  –  –

As one union noted, “Tinkering with the fundamentally rotten system that currently exists will do nothing for home care workers or for their patients.” _________________________

Get in, get out, do it fast We used to be in the home for three hours. Now it’s so rushed. I only have one hour to do it all and it’s not possible. In a few places it’s even been cut to 45 minutes.

They’d love to make it 30 minutes. I mean, we are dealing with serious acute cases just discharged from hospital, or elderly people, or people with MS. They push us to do everything quick – get in, get out, and our people are starting to see us as bullies. I’d love to give McGuinty a bath the way we have to bathe our home care clients. Maybe then he’d understand what he is doing to people.


They have a person in hospital to divvy out the home care, but people almost have to crawl to get it. They have to crawl to get 1/2 hour for a bath. It’s disgusting. You go in and you are given a 1/2 hour for a bath. By the time you get them in, your 1/2 hour is shot and guess what, they expect you to leave and get on with the next person. WelI, I won’t walk out and leave someone. There’s not a chance in hell I’ll just leave them like that. No way. These people are too fragile.


Home care is getting worse and worse. So, when you ask me if it’s getting better, it makes me mad. The answer is “No.” They don’t care who they send out of hospital before they are ready – people with hip replacements and others who have just gone through major surgeries, and is there any adequate home care for them? No. Sometimes there is no homecare at all, never mind adequate. And this is what makes me mad and

–  –  –

At our agency, so many people who need care can’t get it. We need more home care workers, but you won’t get them until we’re paid fair wages. Clients are getting cheated of hours. Our CCAC has a board. That board should be required to have a PSW, an OT, nurse, doctor, people who know what it is to work in the field – not just bureaucrats. Have they actually ever done the work? No way. These people who sit behind a desk have no idea of what home care is. I want them to walk in my shoes and see what I see. Make this government look into my patients’ eyes. Things would change fast. Oh, and one more thing. You know what the kicker is? They tell us we are not supposed to care or get close to our patients! Do you believe it? Who are these people running things? How did they get here?


I don’t care what they say. Of course services have been cut. Our agency has 58% less staff than we used to, but we are still providing more than 40% of the services in our area. People that would have gotten care for 3 – 4 weeks are cut to one week, or 10 days max. That’s a big cut. But what really blew us all away was the CCAC coming at us with a planned discharge date! They were actually deciding by what date people should get better. They were forced to stop last month, but you can see, can’t you, where their instincts lie.


When you look at the lack of staff, you just know there are many people not getting service. The average nurse sees 9 – 11 people a day. We are using 30 less nurses than we used to. So where are these people going? And we’re just one agency in one city in Ontario. You do the math. You can see how many thousands of people aren’t getting the help they need. In fact, our numbers should be climbing, but they are gradually decreasing.

- 22 The seniors, they were lied to big time. At a time in their life when they are very ill, seniors deserve this care. Most of them still think Home Care is about letting them stay in their homes, because that was what it was supposed to be about. It’s big lie. It’s not about that.


People aren’t getting the kind of care and support they need in our area. We are very rigid. And our policies are very restrictive with regards to what services people are eligible to receive. We used to have 2 hours, which wasn’t enough time even then for a client. Now that’s been cut to only one hour.


There is no comprehension. For example, someone might be able to get their hair washed and have a bath once a week. That’s bad enough, only once a week. But then, if they don’t have clean clothes and sheets to get into, what’s the point. They deserve to be clean. And, more than that, they might have this minimal bathing support from us, but they need so much more than that. Patients with complex care needs are just being released from hospitals. Who is setting up this regime? These people are deteriorating.

They can’t do without a bath!! Once a week is not enough!! Sometimes they only get a sponge bath in a week. They are not clean and that puts them at risk of infection. They also feel demeaned. Who wouldn’t?

- 23 Behind closed doors Pain control for people in their homes is often bad. In hospital, there’s a team and open scrutiny. In the home, it’s behind closed doors. A lot of people don’t get the pain control they need. They can wait and wait and wait. It is agony for us, too, when we have to watch our clients in pain and can’t do anything to help them. In the hospital, they can get that help quickly. But what happens in the home can always be hidden away.


I’m frustrated and it’s depressing. For a limited amount of money people could stay comfortably and safely in their homes. I had a lady die on me. I had asked for extra services. They went and did assessment and decided she didn’t need any. A week later, the worker found her dead. Meanwhile, I’m told you shouldn’t advocate so much for your clients. But what am I here for? I can’t just stand by and watch.


I’m frustrated. I love my clients but there is a limit to what I can do. I’ll often phone the CCAC office on their behalf, but nothing ever gets done. For example, they refused to give any extra support at all to an 80-year old woman just discharged from

hospital after a hip operation. I put it to them this way, hoping they would get the picture:

“Are you telling me that this woman, who had a fall and lay on the floor for 12 hours before getting any help and who has just been sent home from hospital after major surgery, and who has to take care of her son with a disability, can’t get any extra help?

No cooking, no cleaning, no laundry, nothing that will allow her to recover?” I put it just like that. There answer was “No.” Just plain “No.” _________________________

If you could only see what’s happening to people in their homes. Most of my clients are dirty. Nobody knows that because they are in their homes. But I’m not allowed to give them any more time to bathe them. I keep telling the CCAC, but they don’t care.

–  –  –

Wow. It’s really unbelievable how many of these people actually survive, because, in a way, they are doing it on their own. We are there on paper, but not for real. I think you need to be tough to survive this home care system, because it doesn’t really exist.


You wouldn’t believe what I see every day. Hungry people, dirty people, people in pain. None of them are getting real help. Out of sight, out of mind, is probably the way this government thinks.

The many reasons we are leaving If you try to phone in sick, they’ll push you to come in anyway – even with a fever.

They don’t care what they expose clients to. One of the girls called in sick with 104 fever and they didn’t want to count her out because they have no one to sub for her, so they told her to call in her status every hour! It’s nuts.


A lot of our members have left because there is just no stability in this sector.

Nurses are always being pressured to work huge amounts of overtime because there are not enough of them. Our clients are often called and asked if they can do without service!

We have days where there are 60 clients requiring nursing care and no nurse to make the visits. I mean this sector is in very bad shape.


You know what? The stress is so bad, at this point it would probably be ok with everyone if we just lost our contract because it would finally put an end to all this craziness. We’ve had enough. We don’t want to go through another 10 years of this.

- 25 People doing the assessments are employees like me. We are prevented from giving more and of course, clients get frustrated and angry. I would too. Not being able to give them services is tearing me apart. I tell people when they ask for more services, that I have to prove that they are at risk. This is so very psychologically damaging. They won’t do it. They don’t want to crawl and beg, especially when they are not well and can’t muster the energy. They set this up so that it is as humiliating as possible. And I’m not sure I can bear to watch it anymore.


If a person wants a cup of tea or a meal, I’ll do it on my own time. The agency takes advantage of us that way. They know I won’t walk out and leave my clients in an unsafe situation. Most of the older girls, they will go that extra distance. The younger ones have been trained differently – just go by the clock. By the way, I have to work with two companies just to make ends meet, because the pay is so bad. Funny, eh? You’re in charge of someone’s life and you get paid crap.


This system is cheating people. It makes me feel ill to think I’m a part of it. I just don’t kno. What button do you have to push to get clients the care they need? We are becoming a very ugly society. Where’s McGuinty? Why isn’t he listening to this?


You can understand why this is so emotionally draining. Really, in this area we feel like we just don’t matter. And the truth be told, we don’t. And neither do our home care clients.

–  –  –

In the past 10 years, so many hospitals have been closed and staff, services, and beds have been cut, Ontario’s health system, including home care, emergency services, and long-term care facilities are groaning under the weight of added responsibilities.

–  –  –

For seven dreadful and frightening years, communities, citizens, and unions were embroiled in pitched battles to retain their hospitals, services and staff who were responsible for delivering those services and ensuring the smooth operation of the infrastructure. And, like the Mental Health sector, media stories and “Letters to the Editor” sections of daily newspapers spoke of deaths and of seriously impaired prospects for recovery for hospital patients.

When Health Minister George Smitherman made his chilling comment about cutting lengths of stay, a collective shiver ran through the ranks. Shortened length of stay has always been a code for governments’ intentions to cut staffing and contract out services. And, indeed, another round of layoffs is now underway.

–  –  –

These facts and figures paint a picture of a hospital system that requires a dramatic increase in staff, not cuts. How can lengths of stay be shortened any further? On the basis of what evidence?

“It’s as if Mike Harris never left” Emergency rooms are often called “the heart” of the hospital. Funding and policy decisions manifest themselves minute-by-minute. This government’s hospital emergency rooms stand as testimony to the failure of its health policies and the consequences of refusing to take real, and not rhetorical, action.

• Ambulance workers spend hours in emergency because there are not enough staff or beds. While they wait, they cannot respond to other calls;

• Emergency workers talk about “hospital waiting room rage,” that places them directly in the line of fire for verbal abuse, often escalating to physical attacks;

• Nurses describe the enormous stress and risks they take daily with their licenses because there are not enough of them to ensure that everyone is seen within 15 minutes.

These are but a few examples of what takes place every day in Ontario.

As we finalize this report, a patient at the Peterborough Regional Health Centre who spent the night in the emergency room hallway has just died. Officials report there were 18 patients on gurneys in the emergency room's halls waiting for a regular bed.

–  –  –

No worker should be called on to substitute for government policy that places us all, workers and patients, in harm’s way.

Looming dangers from bad health policy The McGuinty government’s policy and legislative changes are making matters worse, not better.

For example, Bill 8, renamed by one union as “The Commitment to Hospital Privatization Act,” pressures hospitals to balance their budgets through accountability agreements negotiated with the province. Over the last ten years, hospital boards have become decidedly corporate in their focus. Because patient care is no longer the priority it once was, employers will step up their assault on staffing levels and patient services in favour of false economies.

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