Letter to Ministers: Work conditions of long-term care employees and residents’ care conditions

On May 17, 2019, the following letter was sent to Minister of Health and Wellness Randy Delorey and Minister of Justice Mark Furey.

The letter also appears in the Opinion section of the Chronicle Herald on May 29, 2019.

Dear Honourable Sirs:

Please allow us the opportunity to introduce ourselves. We are Nan McFadgen, President of CUPE Nova Scotia, and Louise Riley, Chair of the CUPE Nova Scotia Long-Term Care Coordinating Committee. CUPE represents the majority of employees working in long-term care facilities in Nova Scotia; in fact, we represent employees in 48 facilities. CUPE hears, and acts upon, the working experiences of our front-line members, which puts us in the best place to support our position that there is a direct correlation between the working conditions of long-term care employees and the residents’ care conditions.

In December of 2018, the Nova Scotia Expert Advisory Panel to Recommend Improvements in Long-Term Care reported that an urgent need existed “to invest in human resources to alleviate the unsustainable workload and untenable physical and mental fatigue of staff”.

We agree with this observation and would like to share our concerns with you regarding what has become a very polarized issue in this province – specifically, the alleged resident abuse that has received media attention during the last several weeks.

Honourable sirs, long-term care staff morale is at an all-time low, and urgent and immediate action is necessary to address the staffing crisis. When these employees go to work, they go there with the intention of providing the best possible care to some of our most vulnerable citizens, often under extremely challenging work conditions. They do not go to work with the intention of failing to provide high-quality care. No matter how much effort is made, no matter how much overtime is being issued, there are not enough employees available to provide full coverage.

We understand that employers are attempting to correct the staff shortage problem; however, in most cases, the only way to do this currently is to request that staff work overtime. Working in a long-term care facility can be extremely demanding, both physically and mentally. Working an abundance of overtime is exacerbating an already tenuous situation.

In 2018, 42% of our members had been mandated to work overtime shifts they did not want. This year, that figure has increased to 44%. The average length of a mandatory overtime shift is 15.7 hours, with a maximum shift of 38 hours. That situation is impossible to manage or sustain especially when one considers that the regular rotation of these employees must also be covered. Effectively, an 80-hour work period could actually become a work period of more than 100 hours. This is unsustainable and is leading to burnout, injuries and an exodus of workers from the sector.

In June 2018, CUPE met with you, Minister Furey, to discuss labour relations in the province; however, the discussion quickly moved to the urgent need for a long-term care recruitment strategy. We proposed a partnership between the province and CUPE to explore the best options to successfully recruit long-term care employees, particularly continuing care assistants (CCAs). Unfortunately, that partnership has not yet come to fruition.

Also in 2018, CUPE prepared a submission to the Nova Scotia Expert Advisory Panel recommending improvements in long-term care entitled “Fix Residential Long-Term Care Workers’ Conditions of Work To Improve Conditions of Care”. Contained in this submission (copy attached) are examples of inadequate staffing levels and what effect those staffing levels has on the sector. We request that you consider the options to improve working conditions outlined in the submission.

There are many contributing factors that must be considered when examining the problem of staff shortages. Nova Scotians are not entering this field of employment for a number of reasons – some of the main ones being low wages, violence in the workplace and a lack of accessible training opportunities.

Violence directed at our caregivers is on the rise in Nova Scotia. An ongoing survey CUPE is conducting with long-term care workers across the province reveals that fully 20% of frontline workers are experiencing violence from clients on a daily basis. Another 28% of our members in the sector report experiencing violence on a weekly basis. Only 17% of the over 500 respondents to date indicated that they are not experiencing violence at work. The resulting injuries are compromising our health care system with workers unable to continue to provide the high quality of care Nova Scotians have come to expect, and in turn, leaving other care providers at a higher risk. Fully 74% of our members in the sector report they are working short on a regular basis and 36% are working short each and every day. There is an indication that there will be “temporary assistants” hired. This will only add to the stress, anxiety and injuries in the workplace. Those temporary assistants, although well-meaning, will not be trained and will only add to the workload of a CCA.

Our front-line members have suggested that the following steps are crucial in resolving the current staffing crisis:

  • Begin discussions to increase wages and benefits for long-term care employees to attract and retain staff;
  • Immediately increase funding so that all publicly funded long-term care facilities reach a minimum staff funding for continuing care assistants of 4 hprd;
  • By the end of 2019, begin a comprehensive review involving leading health policy and long-term care experts and key stakeholders to establish an appropriate legislated minimum staffing level for continuing care assistants and all members of the care team that is necessary to provide quality care;
  • Reinstate financial support for CCA program students at a Nova Scotia public education institution ($5,000 bursary) cancelled in 2013. There are many Nova Scotians who live below the poverty line who cannot afford the cost of tuition or child care. Instead of upgrading their abilities to increase their opportunity to enter the long-term care sector which would ultimately help solve the problem of staff shortages, they must continue to rely on social assistance. It is not an opportunity that should be ignored or wasted;
  • Develop a study grant and full-tuition grant system for CCA students to be implement in the 2019-2020 academic year.

In closing, we would appreciate an opportunity to discuss our mutual concerns and CUPE’s vision for sustainability in the long-term care sector, with the ultimate goal of improving the lives of long-term care recipients and staff.


Nan McFadgen
President, CUPE Nova Scotia

Louise Riley
Chair, CUPE Long-Term Care Coordinating Committee