My name is Jennifer Lyle. I am the CEO of SafeCare BC and one of the founding members of NASHH, the National Alliance for Safety and Health in Healthcare. I am here today on behalf of CALTC, the Canadian Association for Long Term Care, as the NASHH-CALTC liaison.
CALTC is a national organization composed of provincial associations and long-term care providers that publicly deliver health care services for seniors across Canada. It also represents care providers who deliver home support services and care for younger adults with disabilities.
The National Alliance for Safety and Health in Healthcare, NASHH, is a national-level collaboration of workplace health and safety associations that works with health care organizations and workers across Canada to promote safer, healthier workplaces.
Mr. Chair, honourable members, our continuing care sector is in a state of crisis. Our care providers are understaffed, under-resourced and under incredible pressure to provide quality care to an increasingly complex population. This set of factors creates a toxic mix that not only leads to burnout but also to workplace injuries.
Consider the numbers. Nationally, time lost claims due to violence in health and social services have increased by over 65% in the past 10 years. In B.C. alone, health and social services account for over 60% of all workplace violence claims among major industry groups, according to WorkSafeBC, and yet this sector amounts to only 11% of the total provincial workforce of this group.
Overall, violence is one of the leading causes of workplace injuries in B.C.'s continuing care sector, and B.C. is not unique. Across Canada we all face the same challenge: how to address the root causes of workplace violence in health care.
In order to address the root cause of an issue, you first need to identify and understand it, and that leads me back to my earlier remarks about being understaffed, under-resourced and under pressure.
To understand the pressure care providers are under, you need to understand how those relying on the continuing care sector have changed over the past decade and where we're headed. Today 62% of long-term care and 28% of home care clients have some form of dementia, a number that's expected to increase. By 2031, over 937,000 Canadians will have dementia. That's an increase of 66% from the present day.
In addition to the trends we see around dementia, we're also seeing an overall increase in complexity of the needs of those being cared for in a community setting as we continue to move away from an institutional model of care. This includes people with psychiatric disorders and addictions who may also now be facing dementia as they age. These things are all risk factors for violence.
Violence is not a foregone conclusion in any of these instances, but too often our system puts care providers at risk because of how care is being delivered. That brings me to my next point—being understaffed.
In a recent survey conducted by SafeCare BC of the continuing care sector, 95% of respondents indicated that their organization was short-staffed. You might wonder what staffing shortages have to do with violence; in that survey, we asked. We asked how staffing shortages impact care provider safety, and what they told us is that staffing shortages lead to rushing, to fatigue, to feeling like you don't have time to ask for help. All of these things put care providers at risk.
Not only that, but when you're working with vulnerable populations—for example, seniors with dementia—it's vital that you have the time to understand their needs and their triggers, yet it's this time that's in such short supply for our care providers because of chronic staffing shortages.
Not only that, but just as staffing shortages lead to workplace injuries, workplace injuries lead to staffing shortages. Take B.C. as an example. In 2018 the equivalent of nearly 650 full-time positions were lost because of workplace injury. Imagine an organization—or several organizations, for that matter—losing that number of full-time employees. Imagine the impact. That's the cost of workplace injuries.
Beyond the numbers, there is the human toll. There is the care aid who is sexually assaulted by a home care client with dementia. There is the nurse who is punched in the jaw by a senior suffering from delirium. There is the personal support worker who doesn't know how she could possibly face going back to work. Finally, there is the senior whose care is impacted because the person they rely on, the person they have developed a relationship with, is no longer available to help because of workplace injury.
What can be done? One option is a renewed national health human resource strategy—one that incorporates a seniors care lens and a workplace safety lens, one that reflects the changing demographics of our society and the shift towards community-based care, and one that places both the physical and the psychological well-being of our care providers at its centre, because ultimately we're talking about people, people who are trying to do the very best they can with what they have.
That brings me to my last point: being under-resourced. This is a big topic, so for brevity's sake I'll focus on three key areas: infrastructure, education and data.
From an infrastructure perspective, research has proven the power of design, specifically dementia-friendly design. Dementia-friendly environments support the person with dementia and minimize the risk of responsive behaviours. Put simply, dementia-friendly environments are not only associated with better care, but they're also safer for the care providers.
However, we face significant challenges across the country. CALTC estimates that 40% of care homes need significant renovation. In B.C., the average age of a care home is 30 years. A lot has changed in 30 years. Our understanding of dementia and the power of smart design has increased significantly, and at the same time, seniors entering care homes have changed. Gone are the days when a senior would drive herself to the care home and unpack her own suitcase. The care homes in which these seniors live are no longer designed for their needs, and that absence of design affects both the quality of their lives and the safety of the care providers who support them.
The federal government has an opportunity to make an impact in this area. One opportunity is to build on the $6 billion in community health investments made in the Investing in Canada plan to include investment in care home infrastructure, because, make no mistake, these are not care facilities or hospitals: These are people's homes. Such investments could be used to incorporate the last three decades' worth of research and knowledge into retrofits and new builds that better support safe care.
Our care providers are also under-resourced when it comes to education. Presently there's no national standard on workplace safety core competencies for health care workers, and there's also significant variation between health care occupations as to what core competencies are required.
Part of our work at SafeCare BC has been focused on making inroads with this group for that very reason. Working in continuing care is a high-risk activity, and therefore all health care providers should be required to exhibit baseline workplace safety competencies prior to entering the field, yet we see that this is not the case.
Part of this stems from a lack of awareness, and therein lies opportunity. There is opportunity for a public-facing campaign to raise awareness of the issues of violence in health care and the tools and strategies available to mitigate it. There's also an opportunity to address the lack of standardization in education, such as by establishing a national task group to create guidelines on core competencies and workplace safety for care providers.
Finally, there's data. Data is how we make informed decisions. It's as much a resource as physical infrastructure, yet when it comes to national-level data, we struggle. There is no standardized national definition of “the health care industry”, and when it comes to workplace injury data, each province's workers' compensation board codes workplace injury data differently. That makes it difficult to do an apples-to-apples comparison of the data and identify national trends.
In this challenge lies opportunity again, such as taking a leadership role to create a national-level workplace safety data benchmark, as was done similarly in previous pan-Canadian projects such as the Canadian medication incident reporting and prevention system.
Understaffed, under-resourced and under pressure—there's no doubt that these are big challenges, but there is an opportunity for the federal government to drive positive change, and change we must. The future of the health care system depends on its people. If we don't take care of the care providers, who's going to take care of us and our loved ones when we need it?