Opinion: Restoring a proper labour market would solve Ontario’s long-term care woes

Cracking down on for-profit agencies will only worsen the problem
A resident and a worker watch as 150 nursing union members show support at rchard Villa Long-Term Care in Pickering, Ontario on Monday June 1, 2020.  Frank Gunn/The Canadian Press.

Temporary staffing agencies are coming under fire in Ontario’s crippled long-term care (LTC) sector. Accusing these “predatory” agencies of “price gouging” and “exploiting the health human resource crisis,” LTC homes and MPPs are calling for the government to intervene by capping hourly rates for agency staff and restricting agencies’ recruitment strategies.

Sadly, they’ve all got the wrong target. 

The troubles we’re seeing are only the latest symptoms of the LTC staffing shortage, created by a nightmarish cocktail of mutually reinforcing problems that the think tank Cardus has outlined before: years of chronic underfunding while serving residents with increasingly intense care needs; a self-feeding cycle of short-staffing, poor working conditions, and burnout; burdensome documentation rules that put paperwork over people; educational barriers to worker supply; and a broken arbitration system that prevents unions from securing fair wages for their workers. 

Ironically, the increasing reliance on temporary staffing agencies charging hefty fees—which arises from a failure of LTC homes to pay wages that attract enough workers—is one of the only parts of LTC’s spectacularly dysfunctional labour market that is responding to the current pressures as it should. 

A functioning labour market with high demand for work should be great for workers. Employers should compete to attract workers by raising wages and improving working conditions. Ontario’s LTC labour market, which is pushing dangerous extremes of high demand and low supply, should be a dream for workers looking for fair compensation and a fulfilling career. Recommendation 49 of the LTC Commission’s report says as much. Instead, we have a system that combines the worst of both state and non-competitive market control to leave frontline workers and the vulnerable seniors they care for in the lurch. 

Most LTC workers belong to unions which have been working tirelessly to win them better wages and working conditions. But unions’ hands are tied. LTC is an essential service, so strikes and lockouts are off the table when labour disputes—such as a union refusing to agree to unfairly low wages for its members—come up. Instead, these disputes go to binding arbitration: the opposing parties hire an arbitrator to review their case and must accept the arbitrator’s decision for their collective agreement. 

Arbitrators lean heavily on the precedent set by other collective agreements in the sector. For LTC in Ontario, the leading precedents are set by master collective agreements negotiated between the Ontario Nurses’ Association or the Service Employees International Union and a large group of LTC homes, which use a centralized system of wage increases. If negotiations with one of these groups achieve only minimal wage increases for workers, as has been the case for over a decade, the rest of the province is effectively stuck with the same result, no matter how valiantly other unions fight for their workers. 

To make matters worse, the government—which controls funding for frontline LTC workers—never negotiates. It’s facility owners who sit across from union representatives—but without any direct levers to increase funding themselves, owners are little more than resource administrators. 

This middle-man system insulated from free labour market rules makes it difficult to hold anybody accountable for results. Employers say with some justification that funding for better wages is out of their control. Governments, meanwhile, choke off funding from a distance, their eyes on health care budgets rather than the proper functioning of the system or its frontline crises. Arbitrators endlessly perpetuate unsustainable industry patterns sending LTC into a staffing tailspin. LTC residents and workers are left holding the bag. 

The effect of this broken bargaining system is that skyrocketing demand for LTC workers has not translated into better wages, but worse wages! Underpaid, overworked, and burned out, nurses and personal support workers are leaving LTC homes in droves. Agencies are the only ones willing to pay frontline workers enough to convince them to stay—to offer wages more in line with the demand. Unsurprisingly, this strategy works. 

So how do LTC homes and the government respond? Will they raise wages for their own workers?


Instead, they call for a crackdown on the agencies that are.

It’s easy to blame for-profit players in LTC for the sector’s problems. There are problems of over-reliance on temporary agencies, including worse continuity of care for residents and, of course, exorbitant costs. Are there for-profit agencies that are benefitting from the desperate worker shortage in LTC? Absolutely. Frontline agency staff may enjoy higher wages than other LTC workers, but a significant portion of the sometimes-extravagant fees homes pay goes back to the agency itself.

Nevertheless, cracking down on agencies will only worsen the problem. Overuse of agencies is unsustainable, but so is the government’s—and owners’—stubborn resistance to paying LTC staff fairly for their work. Restricting options at temporary agencies won’t keep burned-out nurses and PSWs in underpaid positions at LTC homes; it’s more likely to drive them out of the sector altogether. 

The boom in agencies shows that LTC work is far more valuable than what’s reflected in the sector’s standard wages and working conditions. If Ontario won’t pay its workers properly, it shouldn’t be surprised to find that someone else will.  

It’s time for Ontario to restore a proper, functioning LTC labour market.

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