Union blames lack of national standards for disparity in wages, conditions, care levels
As the clock ticks down to the end of the 10-year health accord signed by the provinces and the federal government in 2004, the union representing many of Canada’s homecare workers says they must be a focus of the next round of negotiations.
At the recommendation of the Romanow Report on health care in 2002, expanding home care was a priority for the current accord. The deal set out an extra $41.2 billion over 10 years in dedicated funding to improve health care across the country, with a six per cent increase in health transfer payments each year from the federal to provincial governments until the expiry date of 2014.
The disappointment, according to CUPE’s senior researcher on health, Jennifer Whiteside, is that a decade later many of the same issues still plague the homecare sector in Canada.
“There’s been little progress,” she said, noting homecare workers’ wages and benefits are still among the lowest in the healthcare field and turnover is two to three times higher.
Home care is not covered by the Canada Health Act as a medically necessary service, despite being called “the next essential service” by the Romanow commission. The result, said Whiteside, is that there are no national standards in homecare programs from province to province, whether related to wages, working conditions or educational standards.
“That’s contributed to a really uneven development of the system,” she said.
CUPE recently held a meeting in Ottawa to discuss common challenges across the country. One of the most significant is wages because of the disparity between provinces. In Saskatchewan, for example, where home care is publicly funded and delivered through regional health authorities, wages are much higher than in New Brunswick where they’re hired through a not-for-profit agency.
“In Saskatchewan, homecare workers are part of the general collective agreement with others in the healthcare sector,” said Whiteside. “But there’s been little progress in some other provinces.”
Another major issue is guaranteed hours of work. Whiteside said in provinces such as Ontario, which has moved to a managed competition model, workers are afraid to raise concerns about their working conditions for fear they won’t be rehired.
“It’s problematic for workers to speak out,” she said.
At the same time, Whiteside notes homecare workers’ caseloads are increasingly complex yet they’re given less time with clients. In Ontario, the minimum time for a homecare visit has been reduced from two hours to one.
All of these factors present a challenge when it comes to representing this sector in collective bargaining. Without national standards or even a common job title — they’re called personal support workers, community health workers and continuing care assistants — it’s difficult to get recognition as a single sub-sector of health care. It’s also challenging to define their job roles.
“They’re providing a significant range of services — from changing a dressing to driving people to doctor’s appointments to making sure people are taking their medications,” said Whiteside. “There’s quite an array of services.”
As well, there’s little research on this sector of the health care system. While homecare workers provide 70 to 80 per cent of the care delivered in home according to CUPE, no one knows exactly how many of them are working in Canada or their rate of occupational health and safety reporting.
“More than 900,000 Canadians received home care in 2009, so there’s a huge unmet need,” said Whiteside. “Yet homecare workers are quite off the grid.”
