More Than "Just a Health-Care Aide": Immigrant Women Speak About the COVID-19 Crisis in Long-Term Care

Four key areas of concern were highlighted by the immigrant women HCAs (with inevitable overlap between them):

The harsh financial costs of the pandemic

In explaining the severe financial challenges they are currently experiencing, the immigrant women HCAs uniformly pointed to the single-site work policy instituted by the Alberta provincial government in April 2020 as a protective measure to limit cross-contamination of the virus across multiple LTC locations. While the women did not question the wisdom of this policy, the majority of them had been working at more than one job site as an HCA prior to the pandemic in order to pay their bills. Many were currently making 40-70 per cent as much income as they had previously. The women noted current government measures (e.g., the Critical Worker Benefit and $2/hour wage top-up in private continuing care facilities) are inadequate to make up this difference in pay, and they voiced concerns that the rhetoric surrounding gratitude toward essential workers is empty without concrete changes to their wages. In addition, they detailed difficulties in navigating the government and employer benefits available when they had to take time off work due to testing COVID-positive or having to isolate due to (potential) COVID-19 exposure.

Exacerbated Physical & Mental Health Challenges in HCA Work

The interview participants stressed that the physical and mental health demands of being an HCA in LTC in Calgary increased during the pandemic due to a variety of factors. They detailed their increased demands on the job due to additional COVID-19 protective measures (e.g., repeatedly donning and doffing PPE); their heightened levels of stress tied to fears of becoming personally infected with COVID-19 and/or their fears of infecting family members and particularly their children; and their overwhelming and ongoing feelings of loss and helplessness as a result of watching LTC residents die of COVID-19 in large numbers. At the same time, the women noted they were, in some cases, also dealing with anger, blame and racism from LTC residents, some of whom lashed out with accusations that HCAs had “brought the virus” into the LTC site, or who treat HCAs “like servants.”

Institutional (Mis)Management in LTC

The immigrant women HCAs repeatedly critiqued what they perceived as the prioritization of profits over quality of care by LTC management. In particular, those women working in private and non-unionized LTC institutions in Calgary were overall most dissatisfied. The HCAs detailed how institutional mismanagement resulted in a lack of PPE during the first wave of outbreaks and in the consistently inadequate staffing ratios. They also noted a continued reluctance to provide full-time permanent employment to HCAs, which only exacerbated staffing deficits and increased worker precarity. They critiqued the growing reliance on casual HCAs or staff from temp agencies, often without proper training or co-ordination, as their employers’ preferred strategy to fill any staffing gaps. Finally, the women spoke about the movement of workers across floors/units within LTC institutions without regard to limiting cross-contamination as a management decision which contributed to poor COVID-19 outcomes for both workers and residents.

A Need to Centre the Voices of HCAs in Government Decision-Making in LTC

The immigrant women HCAs interviewed identified a need for an increased role for all levels of government in both regulating and investing in public forms of LTC going forward and stressed the need for a greater voice for HCAs in all aspects of LTC decision-making. This, in concrete terms, meant a need to invest in both physical and human infrastructure in LTC workplaces, to ensure accessibility for residents and so that HCAs have the supports that they need at work, including unions, childcare and health benefits. In addition, the women noted: the importance of regular and random inspections of LTC facilities by Alberta Health Services, done on a surprise basis without prior notification to management; a need to amplify, rather than dismiss, the voices of immigrant, racialized women who are HCAs; and, finally, the need for increased recognition of the essential jobs that lower wage healthcare workers, such as HCAs, are providing during the pandemic, to move beyond suggestions that they are “just HCAs.”

Increase compensation and protections for HCAs in LTC

1. Raise hourly wages for all HCAs and ensure privately operated LTC institutions do not pay less than public institutions
2. Implement guaranteed paid sick days for all HCAs in LTC
3. Legislate higher staff-to-resident ratios within LTC
4. Promote unionization for HCAs in all LTC settings
5. Reduce or eliminate the use of casual employees and temp agencies to staff HCAs in LTC
6. Increase supplementary health and mental health benefits and supports for HCAs and their families

Improve oversight, transparency, and equity within Alberta’s LTC sector