In LTC homes, the conditions of work are the conditions of care

By Linda Silas and Pat Armstrong

As Canada faces the reality of entering a fourth wave, COVID-19 continues to take an immense toll on Canada’s long-term care sector, where conditions have reached crisis proportions for residents and staff.

We’ve known for many years that Canada’s population is aging and that we face significant challenges in funding and staffing for long-term care. Tragically, it took a global pandemic and the avoidable deaths of thousands of seniors to finally shine a light on this longstanding crisis.


Many of the critical challenges in this sector are the direct result of decades of underinvestment, privatization and regulation that is both fragmented and unenforced. The current patchwork of services and the reliance on for-profit care in many parts of the country has resulted in soaring costs, inadequate facilities, insufficient staffing and few protections for the health and safety of residents and workers.

Last summer’s release of the Canadian Forces’ troubling reports of the impacts of COVID-19 on predominantly private, for-profit long-term care facilities in Quebec and Ontario shocked the public and decision-makers, and highlighted the deplorable conditions faced by too many seniors and workers. To date, 57 per cent of all Canadian COVID-19-related deaths have taken place in long-term care.

The sad reality is that these problems have persisted for decades out of the public eye.

This tragedy was the culmination of an approach that has long privileged business practices based on the search for profit over care, with too many employers failing to meet basic labour and care standards in favour of padding their bottom line.

The result is that workers – often racialized and/or newcomer women – face the impossible challenge of providing optimal care while contending with high resident-to-staff ratios, limited resources and few workplace protections.

As the federal government undertakes efforts to develop national standards for long-term care, we must ensure that they include conditions that will facilitate a robust publicly delivered and publicly administered system that will support workers in applying their skills to provide the care residents need.

The government must enact federal legislation to bring long-term care into the public health care system following the principles of the Canada Health Act, along with conditions that provinces and territories would be required to meet in order to obtain federal funding.

As a nation, our objective should be to eliminate for-profit business from the long-term care sector – beginning with a moratorium on additional for-profit homes, followed by the gradual phasing out of existing long-term care facilities from private to public, or not-for-profit, ownership. This measure will be critical to reverse the current race to the bottom in the long-term care sector.

As multiple commissions and research studies make clear, any efforts to overhaul long-term care must recognize that the conditions of work are the conditions of care, and include basic standards for care, occupational health and safety, and staffing.

Safe staffing levels are an essential condition for decent care. We must ensure a minimum of 4.5 hours of direct care per resident each day, with a minimum of 45 per cent of this care provided by licensed nurses and at least one Registered Nurse per shift. Where resident acuity is higher, staffing should be increased accordingly. Currently, there is no jurisdiction in Canada meeting these basic standards.

It’s time we recognized the critical value of care work by ensuring that wages and benefits for long-term care workers match the value of the work they perform, and that care workers have job security as well as access to full-time employment.

With aging an inescapable reality for all of us, it makes little sense for governments to avoid addressing the issue or to hand off responsibility for the care of seniors to private, for-profit companies whose ultimate focus is generating profit for their shareholders – not ensuring optimal working and living conditions in long-term care homes.

We call on federal, provincial and territorial governments to immediately implement these important recommendations to protect seniors and long-term care staff today and into the future.

Our loved ones deserve nothing less.

Linda Silas is a nurse and President of the Canadian Federation of Nurses Unions and Pat Armstrong is a Distinguished Research Professor Emerita at York University in Toronto.