Letter to Premier Moe: Long-Term Care Conditions in Saskatchewan

June 10, 2020

Sent Via E-mail and Regular Mail

Honourable Premier Moe
2405 Legislative Drive
Regina, Sask
S4S0B3

Dear Premier Moe,

RE: Conditions in Long-Term Care in Saskatchewan

SEIU-West has just completed an in-depth review of the 2019 SHA CEO Long-Term Care Facility Visits report (the Report), which your government released in the late afternoon of Friday, May 29, 2020. As part of this review, we have extensively consulted with our members who work in the long-term care (LTC) sector and the union staff who represent them. We have also reviewed our various internal resources that document our members' concerns and challenges.

As detailed in the letter below, our review found that the process that generates the Report has become highly flawed. The result is a Report that seriously underrepresents the prevalence and severity of the issues facing the LTC sector-- issues SEIU-West has been drawing to your government's attention for years.

In light of these findings, we are deeply troubled and outraged by your government's recent efforts to reassure Saskatchewan people that there are no systemic staffing or care-quality issues in the province's LTC sector­ particularly your invocations of the Program Guidelines for Special Care Homes at a press conference on May 28.

Your reassurances are contradicted by the Report, and even more glaringly by the daily lived reality of our LTC members and the residents and families they serve. The status quo in LTC is not acceptable. The 191 pages of guidelines do not properly equip our LTC members with the resources they need and their residents and families deserve.

Report: Inconsistent Process

As you are well aware, the process that produced the current Report dates back to 2013, when the CEOs of each of the former regional health authorities were ordered to visit each of the LTC facilities in their region annually, to inspect and report back on what was working well and what needed improvement. The current Report suggests that the SHA has not maintained this initial level of commitment to the ideals of public accountability and quality improvement for LTC facilities. The Report suggests a tremendous lack of consistency in how the visits were conducted---calling into question the reliability, validity, and legitimacy of the process.

Specifically:

• The numbers and roles of SHA senior leaders present varied widely, in ways that did not appear to correlate with the particular characteristics of the facility or community. Just four facilities got a visit from SHA CEO Scott Livingstone. Participation varied widely among Vice-Presidents (range Oto 11 visits), Physician Executives (0-8), and Executive Directors (6-36).
• The number and role of facility management involved appears to have varied widely.
• The number of in-scope staff who were consulted. Our analysis of the Report suggests that the SHA leader(s) sought the insights of these front line care workers in less than 20% of the facility visits. In LTC facilities represented by SEIU-West, our members were consulted in less than 10 % of the visits.
• The matters that the SHA leaders attempted to explore, and the level of diligence with which they attempted to do so.

Report: Gaps/Missed Issues

SEIU-West represents workers at more than 50 of the LTC facilities visited and reported on in 2019. The Report mentions issues of recruitment/retention and/or understaffing at just 19 of them. This reflects the flaws in the visit and report process noted above.

The following is a partial list of the understaffing and associated care-quality and safety issues unaccountably and unconscionably missed by the 2019 Report process:

• A review of SHA job postings on Gateway Online on June 8, 2020 found 216 vacant positions represented by SEIU-West. A third of these are vacant Licensed Practical Nurse (LPN) or Continuing Care Assistant (CCA) positions. At the Meadows LTC facility (Swift Current--see below) alone there are 12 CCA job postings. About 10% of the
  SEIU-West vacancies are in food services, and a further 10% in environmental services. A number of these job postings date back a year or more.
• The Report's account of the visits to the Saskatoon facilities Sherbrooke Community Centre (September 4, 2019) and Parkridge Centre (October 3, 2019) makes no mention of any staff shortages or associated safety issues. In a letter to the Health Minister dated December 2, 2019 we detailed ongoing staffing issues at these two facilities: at least 40 vacant CCA positions at Sherbrooke, and 12 unfilled CCA vacancies at Parkridge (as well as a further gap of at least nine CCA positions at Lutheran Sunset Home (Saskatoon). CCAs provide the bulk of the front line hands-on care in these facilities. Was there any due diligence within the Ministry as a follow-up to these shared safety issues? We note this because we did not receive any reply from the Minister.
• In the past 12 months, though our Occupational Health & Safety training programs and our work with SEIU-West member representatives on facility-level Occupational Health Committees (OHCs), we identified understaffing-related safety issues at the following LTC facilities. These issues are not reflected in the Report.
  • Davidson & District Health Centre
  • Extendicare (various communities)
  • Leader Integrated Healthcare Facility
  • Nokomis Health Centre
  • St. Mary's Villa (Humboldt)
  • Sherbrooke Community Centre
  • Southwest Integrated Health Care Facility (Maple Creek)
  • Stensrud Lodge (Saskatoon)
  • Wolf Willow Lodge (Eastend)
• Since April 2019 when the first of the 2019 facility visits took place SEIU-West has received Workload Tracking Forms (reports of incidents of understaffing and related issues) from members in the following LTC facilities whose 2019 CEO visit account in the Report makes no mention of such issues:
  • Central Butte Regency Hospital
  • Davidson & District Health Centre
  • Kyle Health Centre
  • Pleasantview Care Home (Wadena)
  • Ross Payant Nursing Home (Assiniboia)
  • Samaritan Place (Saskatoon)
  • St. Mary's Villa (Humboldt)
  • Stensrud Lodge (Saskatoon)
• SEIU-West has had to file a grievance at Oliver Lodge (Saskatoon) based on the employer's continuing denial of vacation requests which they identify are due to staffing shortages, yet the visit to this unit does not reflect the shortages at all.
• Our consultations regarding the Craik & District Health Centre found understaffing in all classifications. Staff are routinely denied vacation as the employer has indicated that they have no replacement. CCAs and RNs have been required to work 24 hour shifts due to a lack of replacement. When the RN is needed in the primary health area to assist the doctor, the CCA is left alone in the LTC area to manage the needs of 15 residents- many of whom are two-person transfers. This is not an acceptable safety practice under the Saskatchewan Association for Safe Workplaces in Health (SASWH) protocols for Transfer, Lifting and Repositioning (TLR). There is a kitchen position that has remained unfilled since November 2019.
• We are aware of three CCA positions at Herbert & District Integrated Care facility that have sat vacant for several years, which has prevented our CCAs from getting proper access to vacation leave. There is just one LPN and one CCA on nights at the facility, so if there is an emergency on the acute care side of the facility, the LPN must attend, leaving the single CCA to manage the care needs of 31 LTC residents. Can this honestly be described as a safe care plan?
• We understand that the Prairie Health Care Centre (Cabri) has insufficient staffing levels, which can be verified based on significant overtime costs specific to the CCA classification.
• At Western Senior Citizen's Home (Leader), chronic short-staffing has meant that our members are required to do one-person lifts, leave requests are consistently denied, and there is a no-replacement policy in effect for evening shifts. We have multiple grievances at this facility due to these issues.
• The Southwest Integrated Health Care Facility (Maple Creek) has workload and understaffing issues in both the CCA and Combined Lab and X-Ray Technologist (CLXT) classifications, with outstanding grievances and OHC reporting related to both. Lab staffing is also an issue in Ponteix, Vanguard and Hodgeville; the inability to recruit has the potential to disrupt future access to lab services in rural Saskatchewan.
• The Meadows (Swift Current), touted by your government as a P3 success story, has been plagued by understaffing since it opened. What the Employer has deemed to be full staffing is reported as insufficient by front line staff. Residents live in "houses" of l 0-15 each, and the CCAs provide all hands-on care as well as cooking/feeding/cleaning and laundry services for the house residents. Currently on night shifts there is just one CCA assigned per house, with an added CCA who "floats" between two houses as needed? The Employer deems this to be sufficient, but our front line members tell us that this is far from adequate: for example, it leads to one-person lifts and a justified fear of injury. As noted above, there are currently 12 vacant CCA postings at this facility. Members advise that there has been up to 120 available shifts on smart call for a given weekend which means that there have been prior occasions to have no staff present in a house for the night shift.

The above is not an exhaustive list but ratl1er a few examples of what we know exists in the LTC sector in facilities which the Report did not identify as having staff shortages. Our perspective is grounded in engagement with front line LTC caregivers and their experiences. Unfortunately, the Report sorely lacks this perspective because its process did not prioritize engagement with front line care providers.

If you truly believe (based on your public remarks of May 28) that there are no systemic staffing issues in LTC in Saskatchewan, we invite you to prove it: have an independent audit conducted
- a truly reliable review that will result in verifiable, consistent trusted information as the public needs to know what is transpiring in our long term care sector, if it is ever going to be truly remedied. We remain of the view, based on our member experience, that there is a critical need to address understaffing today. Things have deteriorated greatly since your government repealed the care hours standards in the Housing and Special-care Homes Regulations in 2011.

Respectfully, we fear that leadership within this sector and the Ministry have normalized this problem to the extent that only the most grievous incident would likely receive your attention. In an effort to avoid this, we ask that you get an unbiased independent third party review and immediately thereafter begin consultation with front line health care providers and representatives of same in an effort to make some much-needed improvements.

Sincerely,

Barbara Cape
President, SEIU-West 

BC/jl USW 5917

cc. Minister of Health, Jim Reiter
Minister of Remote & Rural Health, Warren Kaeding Ryan Meili, Leader of Opposition
Danielle Chartier, Opposition Senior Critic
Vicki Mowat, Opposition Health Critic SEIU-West Executive Board

Click here to download the printable PDF file of SEIU-West President Barbara Cape's letter to Premier Moe re: Conditions in Long-Term Care in Saskatchewan.