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

Infection Control We used to have 5 full-time housekeeping staff. We took infections seriously. We cleaned extensively: closets, drawers, doorframes, lights,. We would get on a ladder every week to ensure ceilings and high corners were clean. Now, well, the approach to cleanliness and infection is much different. This June, we will be down to 2 full-time and one part-time. There just isn’t enough time for me to clean everything. It’s stressful and it also makes me angry. My wing has 12 rooms with carpets. I have to get through those 12 rooms, cleaning and bed changes. Let’s say a person has an accident. The carpet isn’t cleaned or shampooed usually until the next day. That’s not right. This private company that was hired by the hospital to implement cuts is crazy. They send people in to tell you what to do and how to do it. You know what? You can put it all on paper and make it look good, but when it comes down to reality, it’s a much different thing. The guy got really angry with me when I told him “it’s just not feasible to clean your way with all the cuts you are implementing.” All the money they are giving this company could be going to staffing to make sure the residents are ok and the staff don’t get sick and injured from overwork. They don’t care. Sure, I’m angry.

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You are not allowed to spend time cleaning the floors, the toilets and there is always the potential for infection because they cut housekeeping to the bone. At the end of the day, there’s going to be a big price to pay.

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The possibility for infection is very high. Every time someone returns from hospital they are put on MRSA precautions. Nurses are gowned and gloved but we go in

Our management has come up with a new catch phrase: They want us to “assess”. That means they want me to go into a bathroom, look around, and “assess” whether it really is dirty and perhaps doesn’t need cleaning that day. They do this all day and then they preach at you. They tell you to do a better job because this is the residents’ home. They just talk out of both sides of their mouth.

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Bed, staff, and service cuts, hospital closures, and divestments have had a devastating impact on people with mental health needs. Decades of neglect, funding that never materialized and policies that shifted patients into the “community” without adequate supports have produced chilling accounts of tragedies and failures. They are found in coroners’ reports, newspaper stories, and in provincial legislature debates.

By the time the Tories finished with Ontario’s mental health system, almost 20% of psychiatric hospital beds had been cut. The disappearance of more than 500 beds triggered a massive outpouring of needy people on to city streets where they became the new homeless. People desperate for psychiatric and mental health support are also straining the abilities of the justice and corrections systems, community agencies and even nursing and retirement homes.

That is what made the Liberal government’s re-announcement last January of $27.5 million, such an act of hostility. The money, to be divvied up by more than 130 agencies, won’t create even one new assessment bed. It does, however, speak volumes about government intentions to inflict even more pain on this sector and those who depend on it.

Coupled with its refusal to release adequate funding, the government also won’t target funding. This produced a disaster in London when St. Joseph’s Healthcare reallocated $20 million of mental health funding to other purposes. In London, the need is so high, the police department estimates it spends $2 million/year responding to mental health patients in trouble with the law.

Despite being handed a golden opportunity to distinguish themselves from the Tories, the government has instead chosen to follow their blueprint, including the divestment of the only two provincial psychiatric hospitals left.

“They keep making all these cuts and telling everyone that service is moving to the community. Well, where is this mysterious community? No one has ever seen it.” As we traveled across the province, the words we heard the most often from workers in this sector were: “frightening,” “alarming”, “inhumane,” “tragedy.” The message we heard everywhere was of warning: this population cannot endure one more haphazard approach that contains within it the high probability of failure.

For patients, consumers and workers, what is desperately needed is a rebuilding of mental health and psychiatric services. But public policy and funding are moving in a different direction. “They’re plowing ahead with the Harris agenda,” said one worker.

“It’s unforgivable. What are they thinking?”

- 52 The new mental health facilities We see some very aggressive people in our nursing home that need psychiatric care. One man is always talking to a person inside of him. Another one really should be in a psychiatric facility. We’re not trained to deal with this and not sure how to take care of them. They can change on a dime. Too often they do.

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Mental health is huge issue in our area. So many people are ending up in the wrong places. Do you know what the new mental health facilities are in our area? Long Term Care facilities. Our very own nursing homes! Families should know that and make the government rebuild the mental health system. We’re not trained and can’t cope with this.

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When Harris did us in, our nursing home got a rash of cases from the psychiatric hospital. Now, it’s gotten worse. We are not trained to look after this area. When there is a need, we get training in frontal lobe damage, schizophrenia, other conditions, by a speaker who comes in for the day. But a lot of the psych patients are controlled through chemical therapy and that is a big problem. We have actually had a few cases where we’ve had to call in the police, and a few where we have had to return them to the psychiatric hospital. More psych beds and hospitals need to be reopened.

Dangerous for us and for patients

They sent a mental health patient for us to care for at our hospital but he blew and attacked a frail elderly man, dragging him down the hall. The police came – he was placed in another hospital and then sent back to us again because there were no beds there. It’s terrible for all of us – workers, other patients and for him. We’re not trained in this area.

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- 53 When you go down in staff, it puts us and the patients at risk. We keep asking for more staff, especially orderlies, and we’re told no money. I’ve been in Psych for 25 years and it just doesn’t feel safe anymore. We are working short all the time and who knows what is going to happen. In my program, we have patient deaths and that’s terrible.

We’re a hospital but we are not run like that. I don’t understand why we are open from 9Mon. through Fri. We’ve got 32 acutely ill and often unpredictable patients but here we are with full staffing only during the week from 9-5.

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Our hospital recently offered voluntary exit packages and early retirement since it wants to cut back even more in staffing. I don’t know the number of layoffs yet, but when they say not to expect too many RNs to go, that’s supposed to be a relief to nurses. But it just shows they don’t understand the needs. If housekeeping gets cut, infection rates will soar; cut security and violence and injury will likely ensue. It’s a domino effect, always has been.

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Low staffing creates a really volatile atmosphere. Staff are often alone on a ward of 15 patients.. This should not be happening. And you have staff that have to run from one end of the hospital to the other if there is a code. It’s ¼ mile! Our employer is completely neglecting the staffing issues. There is always some excuse. Morale is way down and frustration is up. We can’t care for people the way we know we should and want to. We are seeing more injuries, more staff unrest. There’s a great exodus of staff leaving mental health. It’s just too stressful and unstable. More and more, they hire unclassifieds, instead of full time people. The bottom line is money: without it, you don’t have staff. If you cut off the head, the body is going to die. They are starving the system and nobody cares, and that’s the god awful truth. Nobody seems to give a shit.

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Code White in our hospital means an extreme emergency and indicates violence. It means that staff or another patient are being attacked. In many places, there are only two

Pressure, threats and arm-twisting Our success rate is based on whether 80% of patients can be discharged from hospital because we need to empty the beds. Professionally and ethically, I just don’t feel comfortable with it. People in need are having huge difficulty. It’s hard to get admitted because they have raised the bar, leaving many people without a capacity to deal with their situation. When we ask about the beds that aren’t being used, they tell us there are diminishing needs. But diminishing needs exist because they raised the bar and won’t staff those beds. Many people who should be admitted just aren’t.

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Patients aren’t getting the care they deserve and staff are being placed in jeopardy.

I’ve been doing this for 26 years. The inadequate staff has a huge effect every day on those left. Instead of any appreciation or understanding of how hard we’re running to keep up, we’re getting penalized. They do that by threatening our liscenses. They hold your liscense as a club over your head. If you dare take sick time, they’ll call you and say, “You’ve missed so many days so we’re scheduling for the attendance support program and if it continues, we will report you to your college.” If we are unable to handle the new workloads, they threaten to report us to our college. Some people are working twenty 12-hour shifts. When you are dealing with the 12-hour shifts, anything more than five and you screw up. It happens. You’re tired, can’t concentrate as well. But they keep scheduling this overtime and when you make a mistake, they threaten to report you to your college.

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We can't do a good job and because people who are depending on us can’t get the services they need, complaints are rolling in to our college. So not only do we feel bad about residents, but we are also worried about our licenses. There is a big move now to a fixed period of treatment. There’s just no individualized care anymore. “Take a number, please” is more like it. If cancer patients were sleeping in the streets there would be a public outcry. Someone has to see what is happening and do something.

This isn’t the way we would run things!

The level of service has decreased but when I say that you must understand that when people don’t receive treatment here, they don’t receive treatment, period. Everyone is pushed. The caseloads are so tight. The waiting list is 8 months for people who have experienced serious trauma. For children and young people, it is really difficult. People need to get care for their children. Early detection and identification is important and produces results. The situation is worse now than it ever was and that includes the Harris years. Another consequence of low staffing is a reactive approach to problems. Since the staffing and funding are not there, it’s no longer a case of early detection. It’s now a process where problems are responded to only in the critical stage and by then, they are so severe they often can’t be resolved. I’d say mental health, by and large, is now a maintenance program. We can’t help people the way we once could. It’s difficult for all of us.

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- 56 Our hours have changed since restructuring. Any patients not seen after 10 p.m.

must stay overnight if no beds are available anywhere else. And often, no beds exist. The psych hospital has also had bed cuts, so when they have none, we must try other places.

Often those places don’t have beds either and then the only place that person can go is hospital emergency. But the emergency is crazy busy and it’s one of the worst places for someone needing this kind of help. It doesn’t seem even civilized to put these vulnerable people into this situation.

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My biggest concern from all this understaffing is for psychiatric patients. It takes a good deal of courage just to turn up at emergency and when there are no beds available it makes it very stressful. Others pretend to be ok and say they can wait until the next day, but they aren’t ok, and you just hold your breath hoping they’ll make it through the night. You take it home with you. Five years ago we wouldn’t have sent people home that need to be admitted, but there is no room anymore.

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Nurses historically go on no matter what. But even we are seeing increased stress levels, and depression. I mean you rarely go home at the end of the day feeling like you did a good job for your patients, especially in emergency. The public is totally unaware about what a restructured health care system means. They expect the same care and service. Even some of the physicians don’t get it. Some don’t know that we aren’t open overnight anymore.

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Three people have left but they’ve only filled one position. We have a waiting list of clients but are expected to do the same amount of work. Don’t get me wrong. You want to do it because it is what the client needs. But you just can’t, so sometimes you run around like chickens with your head cut off. It can be chaos. Your client might be threatening suicide and needs you now. But then, the short staffing means that backs up everything else. We are always running against time. We know that there are probably going to be