The worst day of a COVID-19 outbreak in long-term care is the first day.  There are tears.  How did it get in?  How did we fail?  How do we tell the families? When does the media show up? There is shame, tremendous shame.  Shame that we put on ourselves and that the outside world puts on us.

Then the shame turns to fear.  Where is it?  Who else has it?  Will I get my family sick?  Will I die? Then comes the lockdown.

Exposed staff from the last 48 hours are quarantined, leaving a skeletal crew remaining for the next four weeks to manage the most frail and complicated patients in our medical system. Only the most critical staff remain in order to keep the residents “safe.”  The physicians are no longer allowed in.  Families must stay away.  No allied health is coming.  You are alone.

Everyone knows who nurses are and the fantastic work that they do, but many Canadians do not know who health care aides (HCA) are or what they do.  Care aides or personal support workers (PSWs) are non-medically trained personnel that provide “personal care” for our loved ones in long-term care.  Care aides feed residents, toilet, change soiled incontinence products, shower, and de-escalate undesired behaviors quickly.

As a physician working with long-term care residents, I rely on reports from care aides and nursing staff to identify health issues with residents, such as skin integrity, new physical examination findings, and changes in behavior.  The demands on care aides are high and long-term care only allots each resident about two hours of care aide time per day.  The ratio of residents to care aides can be staggering depending on how a facility structures their staff.

We ask a lot of these people.  I can tell you that working understaffed is more worrisome for many care aides than working in a facility with COVID-19.

Dedicated care staff, including care aides, are essential for effective, non-chemically restrained compassionate care in a long-term care facility, yet we, as a society, fail to recognize and value their work.

Care aides across the country typically make slightly more than minimum wage and are often required to hold several jobs at multiple sites in order to support their families. Thanks to the necessary “one site” rule that many regions instituted after the pandemic outbreaks, many of these care aides have now been forced to consider retail jobs to supplement their income — a sure way to exhaust our work pool and a waste of desperately needed talent during a pandemic.

As the work is undervalued and hard, it tends to fall to those who have few options, such as middle-aged, racialized women. Decades of system-wide failure to recognize and support new and marginalized Canadians has resulted in racialized Canadians in long term care, and other essential yet low-wage jobs during the pandemic, paying the price.

I witnessed families unapologetically blame our health care aides for COVID-19.  Some care aides who had returned to work having recovered from COVID-19 were ostracized by other staff because of a lack of understanding and fear.  In an outbreak with double the work and half the staff, is it any surprise that some workers felt scared or unsafe to go to work?

Yet many stayed.  I saw them and was inspired.  I saw true heroism from those most undervalued.

To those that toiled, thank you.  To those who worked outrageously long shifts and took up extra shifts, thank you.  To those who came to serve others despite the risk to oneself, thank you.  To those that I watched weep when their residents took a turn for the worst, thank you.  For those who were isolated from their families for weeks so they could keep working, thank you.

To the care aides who ensured that I had eaten, I can’t tell you what that meant to me.

Thank you so much for keeping long-term care running during a pandemic.  We, as a society and medical system, have failed you.  Let all Canadians know that the most undervalued and underpaid saved Canada’s most vulnerable population.

We owe all those who were left alone to fight COVID-19 our sincerest thanks.

This essay is cited in the KevinMD record on COVID-19.

Cassandra Hoggard is a family physician.

Image credit: Shutterstock.com