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Long-term care workers are in the vanguard in the war against COVID-19. They’re not the kinds of workers who get movies or TV shows made about them. In fact, their stories are rarely told. But not only are they battling heroically against this pandemic. They’re fighting for recognition and respect within a system built to marginalize them.
COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada.
Featured in this episode: Joadel Concepcion, Joanna Bulatao, Lisa Burke, Naomi Lightman, Zaid Noorsumar
To learn more:
“‘We are dropping like flies,’ says Ontario home care nurse” by Zaid Noorsumar in Rank and File
“Fear and exhaustion: Working as a PSW in long-term care during the coronavirus” by Alanna Mitchell in Maclean’s
“Comparing Care Regimes: Worker Characteristics and Wage Penalties in the Global Care Chain” by Naomi Lightman in Social Politics: International Studies in Gender, State & Society
This episode is sponsored by Freshbooks
Additional music from Audio Network
TRANSCRIPT:
EPISODE 7 – “THE FRONTLINE”
COLD OPEN
[ARSHY MANN]
Joadel Concepcion’s been working as a registered nurse in long-term care for almost two decades. And she remembers the last time things seemed this frightening. It was 2003. That was when a different coronavirus was sweeping the world, causing Severe Acute Respiratory Syndrome, or “SARS” for short.
[JOADEL CONCEPCION]
During SARS time there is a lot of nurses <indistinct> got sick. Even my sister-in-law, she got sick. We have that fear. Why am I going to have this stress again? We don’t know.
[ARSHY]
So when she started feeling feverish in early April, Joadel went out to get tested right away.
[CONCEPCION]
My first symptoms started on a Saturday, which is April four. I went right away to Scarborough Grace to get tested. And then when I came back home, I had a little bit of OCD for even from SRS time. So when–when I came home, I took a shower because I thought the fever will just subside.
[ARSHY]
But the fever didn’t subside. Instead, the symptoms started to get more intense.
[CONCEPCION]
I was coughing. I was vomiting. When my husband give me the food, like… I don’t have an appetite. I don’t smell it and I don’t taste it.
[ARSHY]
For a few days, Joadel stayed at home, trying to get rest and stay hydrated. But by April 8, she was having trouble breathing.
[CONCEPCION]
My airway’s blocked. I can’t breathe. You want to like raise your chest or trying to catch the air, but you can’t. That’s how I feel.
[ARSHY]
She asked her son to drive her to Scarborough Grace Hospital. And when they got to the emergency room, a man was outside screening people and asking them questions.
[CONCEPCION]
He was saying, “I have to screen you.” I said, “No, don’t screen me.” And I feel like I’m going to die. I can’t breathe.
[ARSHY]
The man tried to determine whether she should come wait in the emergency room.
[CONCEPCION]
And I can tell my son and my husband are crying. Yelling at them, “Don’t come near me. Don’t come near me.” So I said to one of the staff, I said, “I’m gonna pass out. Please help me. I have COVID. I’m an RN and I work in long-term care.” That’s all I said. And then they took me right away
[ARSHY]
They put her on oxygen. But then they realized she was developing congestive heart failure. So they gave her injections, antibiotics, anti-clotting agents… Luckily, Joadel had gotten there in time. She didn’t die. She’s now out of the hospital and fully recovered.
But a lot of people haven’t been so lucky. Since the beginning of the pandemic, thousands of long-term care workers have come down with COVID-19. And 16 of them have died.
I’m Arshy Mann, and from CANADALAND, this is Commons.
PART ONE
[ARSHY]
In stories about long-term care, the workers are often left out of the picture. It’s the nurses, the personal support workers and so many others in these facilities that really have been on the front-line of this pandemic. But they’re work isn’t viewed as sexy or captivating. After all, people don’t make TV shows or movies about long-term care, like they do with hospitals.
And compared to their counterparts in emergency rooms and critical care units, their frontline labour is often devalued.
[NAOMI LIGHTMAN]
And they’re often what we refer to as the three “D”s. So, jobs that are dirty, difficult, and, especially during times of a health pandemic, highly dangerous. My name is Naomi Lightman and I’m an assistant professor of sociology at the University of Calgary. My research focuses on the intersection between gender, migration, race and care work.
[ARSHY]
According to her research, it’s clear that these jobs, especially personal support workers who provide a big chunk of the day-to-day care, are occupied by specific kinds of people.
[LIGHTMAN]
So this is overwhelmingly a female workforce and it’s very much racialized. When we talk just broadly about racialized women, it doesn’t actually capture it. It’s really specifically two groups that we’re talking about. We’re talking about black women and Filipino women who are, in the case of black women, over two times as likely as white women to be working in these jobs and with Filipino women over three times as likely.
[ARSHY]
And the people working in these types of positions are also much more likely to be recent immigrants.
[LIGHTMAN]
So, when we look at personal support workers or people working specifically in long term care institutions, these are, in fact, among the most precarious and the lowest wage workers, especially in private institutions.
When we compare them to just the average worker and we’re still controlling for factors like their education and their family structure… So holding these factors constant, we see that there is a 40 percent wage penalty for low-skill care work.
[ARSHY]
Naomi Lightman says that this is because caring for people has historically been viewed as, quote-unquote, women’s work.
[LIGHTMAN]
And I think as this kind of work has entered the paid labor force, we’ve continued to view it through a lens of work that doesn’t really matter or doesn’t hold the same value to other types of paid work. So, we rely on women who are coming from the Global South to do this work that we don’t want to do, and we continue to view it as labor that doesn’t hold the same value as other kinds of work.
[ARSHY]
Lisa Burke is a personal support worker at peopleCare Oakcrossing, a long-term care facility in London, Ontario. Here’s what a typical day looks like for her.
[LISA BURKE]
I work straight day-shifts. I work 6 a.m. to 2 p.m. When we get to our unit, we have to come a few minutes early to get a report. There’s usually three to four staff to 32 residents.
We get report. They tell us if there’s anybody who’s been hospitalized, any changes, any med changes, any behaviors, any falls, anything like that. We have two hours to get the 32 residents up, dressed, bathed, hairbrush, teeth in, and into the dining room to be fed for breakfast. Some of these residents are aggressive. Some of the residents are fairly independent. And we just have to help with small things, like picking out their clothes.
Some people need total care where they have to be dressed, rolled, changed, use a mechanical lift. If we have to use a mechanical lift there has to be a minimum of two people to then get that person up and into their wheelchair. We’re supposed to chart at the same time as getting them ready, which is near impossible. And then we have an hour to feed them breakfast. Most times we don’t get into the dining room exactly when we’re supposed to. We’re usually late because there’s just so much care to be done and we don’t have enough people to do it.
And then we have to feed them. We’re only supposed to feed two people at a time. So a lot of people have to wait to get their meal because we can only feed two people at a time.
After breakfast, we would have to take them back to their rooms. If we can, get a break in. And then you would start toileting residents. Helping, taking them to activities, changing them. Some people lay down for a nap. Finish some baths. And then you would get people back up, toilet people, and then we’d go for lunch, and feed them lunch, the same thing. And then we have like an hour to get people out of the dining room and then back to the rooms, toilet them, change them, lay them down for a nap, if they need to have a nap, and try to chart and get everything done at the same time.
[ARSHY]
Lisa Burke says that her home is always understaffed. And when they ask for more help, management tells them that they don’t have enough funding.
[BURKE]
We don’t have enough staff at all to give any of the residents the type of care they need and deserve.
[ARSHY]
Zaid Noorsumar is a labour reporter who’s been covering long-term care workers. And he says that, even as the care needs of long-term residents have been growing, staff aren’t getting more of the resources they need.
[ZAID NOORSUMAR]
Residents coming into long-term care now have increasingly complex needs and they require a higher level of care, while, at the same time, the staffing ratios have not kept up. They haven’t been increased in accordance with the acuity of patients. So that’s a big factor, and what that means is that staff are constantly rushing. They’re running around. They don’t have the time to spend with residents.
[BURKE]
People think that we get paid this giant amount of money and that we’re lazy because we’re complaining that we don’t have enough time or the manpower to do the work. I don’t think they know how physically, mentally, emotionally draining the job actually is.
[ARSHY]
Joanna Bulatao agrees. She’s a registered practical nurse at Villa Leonardo Gambin, the same facility that Joedel Concepcion works at.
[JOANNA BULATAO]
A lot of our staff, they’re constantly, like… Overwork themselves or, like, they really give their all when they’re providing, like, care to our residents. And it gets very, very tiring, like, especially during now. It does get exhausting. It’s not that we don’t want to provide care. It’s just that we become so drained because we want to help.
[ARSHY]
And long-term care workers form close personal bonds with the people they take care of.
[NOORSUMAR]
They think of residents as their family members, and they really feel they–they want to provide the best care that they can. In fact, one of the workers that I spoke with, who used to be in home care… I think now she works long-term care. She said, “Mentally, it’s a very draining job. You get attached to your client and then you get frustrated because you know the need for care but they aren’t getting it. Most of us PSWs are the type that, if the client’s having a bad day, it’s hard not to take that with you. And she said, after years and years of not being able to provide health care, she was burned out and she quit. She said, “I started my car and I started crying and I couldn’t stop.” And that’s the day she quit.
[ARSHY]
All of the workers we spoke to said the same thing: the people they care for become like family to them.
[BURKE]
Even when we have a person who becomes palliative or passes away, a part of us goes with them, too. Like, a lot of the time we’re in the room with them, or with the family. We’re crying with the family. Or even if they’re alone, we’re with them, holding them, as they take their last breath. Like, it’s… It’s like losing a part of your family.
[BULATAO]
I think people don’t really realize that, like, when you’re with the same residents, they kind of become like a part of you. Like, they become, like, your–your family. That’s–that’s who we’re taking care of. We’re taking care of them just like we would our grandparents.
PART TWO
[ARSHY]
Joadel Concepcion, who you heard at the top of the show, came to Canada from the Philippines in 1995. She first worked as a nanny and then took some courses and became a registered nurse. Soon, she was working in long-term care. And, since 2004, she’s been working at Villa Leonardo Gambin, a long-term care home in Woodbridge, Ontario. The home was built for the nearby Italian community, so in order to be able to care for the residents, Jodel’s learned as much Italian as she could.
[CONCEPCION]
So you have to encourage them and say… [speaking Italian]
[ARSHY]
Villa Leonardo Gambin is technically a non-profit home, but it’s run by Sienna, one of the largest for-profit long-term care providers. The home would have pandemic preparedness training every year and Joadel was one of the people tasked with ensuring that people’s masks fit properly. By early March of this year, Joadel was getting more and more worried about COVID-19. She’d had family members who had gotten SARS, and she knew how scary things could get.
And she says that, early on, it became clear that the staff weren’t going to get the proper personal protective equipment. By mid-March, the doctor who used to come do rounds refused to enter the building.
[CONCEPCION]
They don’t do rounds in the building because they know that the administrator is not giving him PPE. Dr. Bujon will only do OTN with me using my cell phone to see his patients from the middle of March, or almost third week of March.
[ARSHY]
By the weekend of March 27th, some of the residents on Joadel’s floor started coming down with COVID-19 symptoms, like fevers and coughs. And the staff started to ask management for masks.
[CONCEPCION]
When are they giving us mass? This resident is coughing. We don’t have enough masks. We’re talking about surgical masks, okay? She says, “I gave you guys. If you finish it, that’s your problem.” That’s always her comment. Everybody knew that.
[ARSHY]
And because Joadel is the union steward, staff started to come to her, saying that they were short on PPE. But Joadel says that when she took those concerns to management, they were just brushed off.
[CONCEPCION]
What? Did I told you to talk to me? I told her to talk to me. Why she’s telling you? I said, no, she’s telling me now, because I’m the union steward. It’s my responsibility to follow up. So then she says, “Well, the public health say that you have to wear masks.”
[ARSHY]
A spokesperson for Sienna denied that staff at Villa Leonardo Gambin were ever told not to wear PPE, especially when they were supporting residents displaying respiratory flu-like symptoms. Over the next few days, a number of residents started to experience upper respiratory issues, a telltale COVID-19 symptom.
[CONCEPCION]
And some staff, they put on their own from their home. They would get mad at you.
[ARSHY]
Joadel says that the message from management was clear. Because Public Health Ontario had yet to mandate it, no one had to wear a mask. And so they weren’t going to be provided any. Joanna Bulatao says that it was very difficult for staff members to get PPE.
[BULATAO]
I don’t think that they were prepared for that to spread to other floors, because when it did, it didn’t really feel, like, that we had as much supplies and they felt like we were, like, pulling teeth to get, like, the supplies because we were running low in the home.
[ARSHY]
The staff continued to work in close proximity to each other and to provide bedside care. And all the while, residents were moving around the facility.
[CONCEPCION]
They’re in the rooms, but they come out. They’re wandering. What are you going to do, tie them on their beds? You’re going to lose your job.
[ARSHY]
On March 28, Joadel says that managers asked her to test a number of residents for COVID-19, even though it wasn’t her job. She wasn’t given the proper PPE, but she did it anyways. The next day, another nurse came down with a fever. And within a week, Joadel came down with one, too. That same day, she heard that one of the residents she had tested was now positive.
Within another week, Joadel Concepcion was in the emergency room at Scarborough Grace Hospital, convinced that she was going to die.
[CONCEPCION]
I have a lot of diarrhea, vomiting, and so my potassium is low. My heart arrhythmia acted up. I developed congestive heart failure. I had COVID-19 pneumonia.
[ARSHY]
Joadel prayed to God that she would survive and be able to spend time with her family.
[CONCEPCION]
I’m not a perfect human being. Just give me another chance to live. I still want to see my son get married and have grandkids. And, you know, um, He has to give me another chance to live again.
But you know, Arshy, I was… I was just praying. And I just prayed and I said, “God…” And you’re making me cry. [indistinct] It’s so sad.
[ARSHY]
But during that time, she couldn’t help but feel betrayed. She had thought that her managers were her friends, that they looked out for her.
[CONCEPCION]
I work… I worked with these managers for many years. And I… I… I’m not nobody to them. And then they… Just to give me the N95. They says there’s no supply.
[ARSHY]
While she was sitting in that hospital bed recovering, Joedel was amazed by what she saw around her. The protocols, the protections in the hospital were nothing like in long-term care.
[CONCEPCION]
When I was in Scarborough Grace, they disinfect. They come to my room three times, the full shift, the whole day, to take the garbage. Do proper disinfection. They’re wearing double masks, one N95 and the surgical mask under facial, and double gowns, and three pairs of gloves. In long term care, you share everything. They don’t do proper disinfection from the beginning before the COVID. How about now?
[ARSHY]
At least twelve residents of Villa Leonardo Gambin have died of COVID-19. And, according to Joadel, 31 employees, including herself, have been infected with the coronavirus. She says that the last staff member who got sick was on May 17the, a month and a half after the outbreak began.
We reached out to Sienna for comment about all of this, and, in an emailed statement, they said that throughout the pandemic, their highest priority has been to ensure the safety of their team members and residents. They say that they ensured ample supplies of PPE were available, including N95 masks, and that charge nurses have access to the residence’s storage room to ensure that team members can acquire new PPE at all times.
According to Sienna, team members were encouraged to wear PPE provided by the home, instead of their own, to ensure it met the appropriate standard, and they thanked their team members for their heroic work and their ongoing dedication throughout this pandemic.
OUTRO
[ARSHY]
As the COVID-19 outbreak was sweeping through the long-term care facility where she worked, Joanna Bulatao was scared.
[BULATAO]
It was horrible. <laughs> I mean, it’s like a whole internal battle with yourself because it’s like you want to go into work, you want to help yourself. You want to help your residents. Like, you want to be there and–and do your job. Like, you want to actually help them. But obviously, at the back of your mind, you’re always thinking, like, “Oh, my God, what if I get sick? Like, what if I bring this home to my family? What if I…” You know, “What if I… What if I’m a carrier?”
[ARSHY]
And like so many of her colleagues, she became infected and had to stop coming into work.
[BULATAO]
As a nurse, I want to be helping. I want to be there. I want to give as much as I can during, like, these difficult times. And knowing that I can’t, and knowing that as I want to, I can’t do anything about it. It’s really frustrating. And it really takes a toll on, like, mental health. And it’s just the worst feeling ever.
[ARSHY]
But what got to her the most was that so many of the people she was charged with caring for are now dead. She was stationed on the floor that lost the most residents.
[BULATAO]
It was honestly the hardest thing. When I found out that, like, residents were starting to pass on a unit, it was… Either I was breaking down on–on the phone when someone was telling me or I was trying to, like, hold it together. And, it’s just because you build that relationship with them. You remember all of the memories that you have with them. And then to just think that, like, “Oh, well, that’s all you have now, are just memories.” It’s… It’s very hard. Very hard.
[ARSHY]
Lisa Burke was lucky enough to not become infected with the coronavirus. But she is frustrated by the state of long-term care. And she thinks enough is enough.
[BURKE]
We’ve been… Us, like, in the union, have been yelling, like, “We need more help, we need more staff, we need more of this.” Like, you guys need to come in and regulate more things. And I just think it’s–it’s very, very sad that a pandemic has to show the world what we’ve been shouting for many, many years now.
We are the backbone of the healthcare system, and a lot of people just don’t see the hard work and the dedication of long-term care employees.
END CREDITS
[ARSHY]
That’s your episode of Commons for the week. If you want to support us, click on the link in your show notes or go to commonspodcast.com
This episode relied on work done by Naomi Lightman, Zaid Noorsumar, Tamara Daly, Pat Armstrong and Nora Loreto.
If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com
This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt. And our music is by Nathan Burley.
If you like what we do, please help us make this show. Click on the link in your shownotes or go to commonspodcast.com
