Precarious working conditions, perpetually anemic funding, understaffing, and low pay. The list of grievances and structural deficiencies in the long-term care sector is long and overwhelming – and in the time of COVID-19, the problems have been magnified by the tragic human toll caused by the most devastating health crisis in a century.
At the peak of the pandemic, care workers and family members witnessed first-hand how the deadly virus swept through nursing homes, killing residents and infecting caregivers at unprecedented rates. Those on the frontlines are heartbroken, frustrated, and exhausted because they know that, with the right tools and support, many lives could have been saved. Especially because we know that when care workers have institutions, power and decision-making capacity—in one word, unions—more lives can be saved.
The latest study on the issue conducted in New York this spring is clear. The researchers found that unionized centers had a staggering 30 percent lower mortality compare to facilities without health care worker unions. Long-term care centers with union staff tend to have more workers with better trained and higher pay. Unions also demand more access to protective equipment and stronger infection prevention protocols. And we have known for quite some time that higher staffing rates result in better quality of care for residents and a more positive working environment which ultimately reduces burnout, stabilizes the workforce, and saves money in the long term.
Every day, we are confronted with reminders that the pandemic is far from finished and that nursing homes are particularly vulnerable to the virus. An estimated half of the COVID-19 deaths in England occurred in care homes. A similar situation played out in Switzerland, and in Belgium, two-out-of-three coronavirus deaths between mid-March and May were nursing home residents. And this disastrous pattern persists across Europe and OECD countries. Without immediate action, our long-term care systems remain a powder keg, unprepared for a COVID-19 resurgence, and any future outbreaks.
To be better prepared for the now seemingly inevitable second wave, we´ll need to put life at the center of care work, protect care workers, and set new standards across the sector.
Staffing levels, in many countries, are not high enough to provide high-quality care—especially during a pandemic where more attention and detailed care is needed. In addition to more stringent sanitation measures, workers need to spend more time caring for residents, more time to observe changes in their health, more time to provide emotional care which so many people are longing for, and more time to care for behavior challenges resulting from such disease like dementia. A review of this pandemic shows that when staffing levels are higher infection rates are lower. In the United States, the same types of findings were published, facilities with higher staffing have lower COVID cases.
But the staffing crisis in care was brewing long before the coronavirus made it boil over. The rise of a for-profit model in long-term care has pushed to keep costs — staffing — low, and now, both workers and those who receive care pay are paying the price in deteriorating conditions and outcomes.
About 90 percent of care workers are women, and the workforce is also made up of a high number of migrants and people of color. They have been undervalued and underappreciated for decades, including their pay.
The median hourly wage for care workers across eleven OECD countries was EUR 9 per hour–35 percent less than acute care workers doing the same job. Also, unlike acute workers, long-term care employees—particularly those in homecare—have erratic hours and zero-hour contracts. Part-time work is nearly twice as prominent for long-term care workers than in acute care.
The high death rate in long-term care cannot be divorced from the precariousness of the work. Currently, long-term care workers often must cobble together hours from multiple worksites, which means that they could be unintentionally carrying the virus from workplace to workplace. Living wages and regular, full-time hours would mean less exposure between facilities. Despite this reality, workers have been pushing back, and we have seen real gains during the pandemic, like the unionized SEIU care workers in Illinois which saw higher baseline wages bringing all workers above $15 an hour.
Ensuring that care workers receive a much-needed pay rise, regular hours, and adequate staffing will require an investment, but shoring up our frayed care systems it will pay off.
More government investment is needed to make necessary improvements to the care industry. Unfortunately, on the heels of one of the largest bailout packages in the EU and the U.S., we saw no direct funding for care. That is one reason why unions play a key role right now in raising standards in care, and during the COVID-19 crisis, some are already making progress. In Austria, as part of a new sectoral agreement negotiated by unions GPA-DJP and Vida, workers on the frontlines are receiving a bonus of 500 euros. Similarly, in Wales, care home and domiciliary care workers are expected to receive a £500 bonus thanks to the support of UK care unions like GMB.
During these uncertain times, one thing is clear—whether you are a caregiver or a care-receiver, we all want to fight COVID-19 and get our lives back. But to put health and safety first —and put the virus to rest—we will need more collective bargaining and unions in the care sector. That is how we build a shield against COVID-19.
Christy Hoffman is General Secretary of UNI Global Union.
Photo: Needpix
