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

Commentary

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?

No. 

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.

Malcolm Jolley: Winter dishes and cold nights call for a clean Mediterranean red

Commentary

I took a flyer on a case of wine this week. I mean that I bought a case of 12 bottles of red wine that I’ve never tasted, by simply clicking through an email offer sent to me by an importer. In Ontario, wine agents can only sell wine directly to consumers in the quantity it was shipped in,Wine agents in Ontario, represent foreign wineries but are actually agents of the Liquor Control Board, which is the sole importer and warehouser of wine. Since the wine must ship directly from the Crown corporation’s warehouse, they presumably don’t want to do the work of breaking up the cases, and if the agent didn’t that would threaten their monopoly. which is usually cases of 12, sometimes cases of six (if the wine is expensive and meant mostly for restaurants), and only in a single bottle if the bottle is very big.The exception to this rule, granted during the COVID lockdowns, is mixed cases, but they also must be in the quantity that the wine was shipped in.

It was an educated guess based on three criteria. First, I know the importer and tend to like the producers he works with. I have read that societies with inefficient markets depend more on personal relationships to establish trust in commercial dealings. A good example of an inefficient market might be one where the consumer is obliged to buy 12 bottles of wine to see if he likes it.

The second criterion was the price. The wine was advertised at $20, which after HST and a $20 shipping charge came out at just under $25 a bottle. That’s not cheap, but it’s not so expensive that if the wine really wasn’t what I was looking for, I could still swallow the loss without feeling too bad.

The third criterion was geography. The wine is from the Marche, in the middle of the Adriatic coast of Italy. The Marche is probably best known, to the extent that it is known, for its white wines made with the Verdicchio grape. But the wine I bought is a Rosso Piceno, a red wine made from a blend of Sangiovese and Montepulciano.

I hadn’t tasted that blend, from that place, for a while, so the offer piqued my curiosity and inspired enough hope to enable a commercial transaction. If I am honest I will confess that my gamble was also made in consideration of a fourth criterion: timing.

The idea that there is a season for a particular wine is one of these magic ideas in the trade that is simultaneously true and false. It’s true because if you’re selling a particular wine at a time consumers seem to prefer it, like rosé in the summer, it’s a great marketing pitch.

It’s also false because if you’re selling a particular wine at a time when consumers don’t usually buy it, like rosé in the dead of winter, then iconoclastically proclaiming rosé should be enjoyed in any season might be the only marketing pitch there is. If you Google “rosé wine winter” you’ll find page after page of articles extolling the virtues of pink wine “off-season”. If scroll hard enough you might even find one that I wrote.

Consumer choice to the extent that one might only drink one kind of wine at one time is a recent phenomenon. Until the wonders of the modern global supply chain (when it’s working), one drank whatever wine one could get. In most wine-producing parts of the world, the wine for sale is the wine that’s made there.

In net wine-importing countries like Canada, where our wine trade is mostly concerned with bringing wine in from other countries, since our domestic production, as fantastic as it can be, is not even close to supplying national demand, we are spoiled for choice. This leads to some neuroses, like worrying about what wines to pair with what foods. But mostly it’s a good thing.

It’s a good thing, for instance, that as we enter the fourth month of Canadian winter, we might warm ourselves, if only metaphysically with wines from warmer lands. It is around this time of year that I really lean on the Mediterranean reds. I lean hardest on the wines from the Western end of that sea, mostly because for whatever reason that’s where I have traveled the most and tasted the most.

I imagine an arc that runs roughly from Valencia to Palermo, and dream of sunlit hillsides on which grow Monastrell, Grenache, Carignan, Syrah, Nebbiolo, Barbera, Sangiovese, Montepulciano, Aglianico, Primitivo, and Nero d’Avolo, to name a few greatest hits. When made judiciously dry and in balance between high alcohol, fruit prominence, and acidity, these wines unfailingly pair with winter dishes, firelight, and looking out the window at the weather.

The wine I order did not disappoint. The 2021 Ciù Ciù Rosso Piceno DOC arrived late on Wednesday morning, and I tasted it before and at lunch. My guesses panned out and the wine delivered on my hopes. I did a bit of search to see what I had bought and why it delivered a pleasant and clean punch of dark cherry and blackberry fruit.

The Rosso Piceno is a 50:50 blend of organic Sangiovese and Montepulciano grapes, which I think roughly corresponds to the red and black fruit flavours. They’re grown at 300 meters above sea level, close to the Adriatic, but also close to the Gran Sasso range of the Apennines. The altitude and cool breezes from both the sea and mountains, which are the highest in Italy south of the Alps, moderate the climate and keep the wine food-friendly fresh with acidity, and in balance with a reasonable alcohol level of 13.5 percent.

The Ciù Ciù winery, named after ancestors who worked on the railways, turns out to have something of a pedigree, so it makes sense they are represented by the agent whose choices I tend to like very much. And the wine paired perfectly with looking out at the snow in my backyard at noon, as it would with the hardy sausage ragu pasta it would meet that night at dinner and the contemplation of warmer weather to come.

More information about Ciù Ciù can be found at https://www.ciuciutenimenti.com/, or at the website of their Ontario agents, Le Sommelier, https://www.lesommelier.com/.