It’s been almost a year since nursing home workers began fighting on the front lines of COVID-19. They’ve witnessed and experienced extreme trauma. They’ve seen seniors they care for suffer in fear and loneliness during prolonged and repeated lockdowns.  They’ve seen residents fall catastrophically ill and too many of them die.

More than 17,000 seniors are dead from COVID-19 in Canada; the majority have occurred in long-term care homes.

They’ve seen the bodies, too many bodies. They’ve fielded the panicked calls and pleas from families anxious with prolonged separation from their loved ones and full of grief for those they’ve lost.

Nursing home staff have also watched their colleagues fall ill with the deadly virus, suffer long-hauler symptoms or, in far too many cases, die tragically young. At least 33 health workers in Canada have died from COVID-19, the majority of them care aides – the youngest, age 19.

They’ve endured their own sleepless nights and anxiety, some staying away from their homes for long periods, worried they’d bring COVID-19 back to their families.

They’ve worked long shifts, understaffed, underpaid, working over-time, and stretched too thin to do all the tasks that need to be done to keep the vulnerable humans in their care well. All the while, they’ve seen some blame them for tragedies befalling Canada’s seniors.  When hospital doctors and nurses got applause, they got finger-pointing.

Nursing home workers are at catastrophic levels of burnout and trauma. And still our governments have largely failed to come to their aid in meaningful ways to keep both them, and our vulnerable seniors, safe. How did it get to this?

We’ve always undervalued nursing home staff.

Care aides, also known as personal support workers, are the largest workforce in long-term care in Canada, providing upwards of 90 percent of the direct care. Their role is central to the quality of care and quality of life of individuals living in nursing homes.

In a recent article for JAMA Network OPEN, our team at Translating Research in Elder Care (TREC) collected data across more than 90 long-term care facilities in BC, Alberta, and Manitoba and found that care aides are both a neglected and socioeconomically disadvantaged workforce, as well as a critical source of emotional and social support for residents.

We examined survey data collected between September 2019 and February 2020 – just before the pandemic – and found that the care aide workforce is under significant strain.

Data show the majority of care aides are middle-aged to older women who speak English as an additional language. They work in a resource-constrained environment.  More than 70 percent of care aides reported moderate to high risk for emotional exhaustion.

Care aides also reported frequently rushing or missing essential care tasks, and one half reported they worked short-staffed daily or weekly in the last month. Care tasks left undone due to lack of time on the most recent shifts included taking residents for a walk (41 percent), talking with residents (34 percent), mouth care (16 percent), toileting (10 percent), bathing (9 percent) and feeding (6 percent).

The majority also experience significant rates of dementia-related verbal, physical and sexual behaviors from residents on a routine basis.

That was before COVID-19.

Imagine, now, the same people, already overwhelmingly on the brink of burnout and mental health distress almost single-handedly holding the fort during a pandemic that has swept through nursing homes with vengeance. They are warriors without witness.

We’ve had a nursing home staffing shortage across this country for many years prior to the pandemic – it is catastrophic now. Is it any wonder why?

Governments and operators are finally coming up with some creative solutions to address staffing shortages – though years too late, and in a piecemeal approach.

A BC nursing home has offered to pay relatives to provide care. Ontario and Quebec created new support roles with free training in hopes students and the unemployed will apply. Post-secondary institutions are offering fast-tracked training certificates. And several provinces have implemented a salary top up.

This is the time for meaningful federal leadership.

Growing old, becoming infirm, developing dementia – these things must not mean that any of us is less Canadian, less human, less deserving of a good end of life, lived with dignity, free from fear.  Prime Minister Trudeau, this would be an enduring legacy.

Carole A. Estabrooks is a professor, faculty of nursing, University of Alberta and Scientific Director of the Knowledge Utilization Studies Program (KUSP) and the pan-Canadian Translating Research in Elder Care (TREC) research program, Alberta, Canada. Yuting Song is a postdoctoral fellow. 

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