When Quebec Premier François Legault sent out that desperate plea for more frontline healthcare workers last week, imploring general practitioners and medical specialists to step in to help in critically short-staffed seniors’ homes — where more than half of Quebec’s COVID-19 deaths have occurred so far — I understood his desperation, but cringed at the optics and the language used.
“I understand that they’re overqualified to do the work of nurses in CHSLDs… I know this isn’t fun,” he said, “but there is no one else to do it.”
By the time the press conference had ended he had repeated the word “overqualified” two or three more times while referencing doctors. Each time, I bristled.
That persistence on the Premier’s part to keep focusing on how doctors are “overqualified” to do what nurses and orderlies do was deeply revealing of how our society undervalues these vital professions. Not only when it comes to remuneration, but also public perception, which are often one and the same thing.
Doctors aren’t overqualified to do nurses’ jobs! Those are two completely different professions within the field of medicine, both vital and necessary in their own way, as is the role of an orderly, or Préposé aux Bénéficiares (PAB) as they’re called here in Quebec. If this is how we speak of these professions (not to mention how badly we compensate them financially), is it any wonder that Quebec’s seniors’ homes and our hospitals have been so short-staffed and under-equipped for so long, and have now been left to fend for themselves? Frontline staff, like the residents in senior homes, have been left to their own devices.
Nothing “basic” about it
“How dare they call it ‘basic care,’ as if it’s dirty and lowly,” Natalie Stake-Doucet, a registered nurse currently deployed in a CHSLD, and the president of the Quebec Nurses Association, told me, when I reached out to her for her thoughts.
“No food, water and bathing equals death. It’s life care, vital care. And in CHSLDs, it’s highly complex care. MDs, unless they are geriatricians (and even then) do not know how to safely feed or bathe fragile elders.”
This tendency to hierarchize healthcare workers may have also contributed to an unwillingness by the government and upper administrations to listen to frontline workers at the lower rung of the healthcare ladder when they were sounding the alarm.
As early as April 9, the Quebec Nurses Association sent a policy brief to the Ministry of Health, warning about the consequences of inaction and containing urgent recommendations to curb the outbreak in nursing homes.
“Nurse practitioners are currently communicating their distress over work conditions that do not meet the most basic needs of their patients and the lack of attentiveness to their clinical judgment on the situation in several long-term settings,” read the brief.
Yet the province, intent on preventing a patient overload in hospital ERs, didn’t prioritize long-term care senior homes until it was too late. The ticking-time-bomb trifecta of underfunding, lack of basic protective equipment and fragile residents went off.
“We could have avoided this if we had actually trusted and listened to the frontline staff in CHSLDs,” Stake-Doucet continues. “We weren’t allowed masks at the beginning because we weren’t trusted to use them ‘judiciously.’ In some cases, CIUSSS managers removed PPE from CHSLDs to add them to the hospital stash, that’s why we had nothing. If we had been allowed to use proper PPE (and given the information on how to prepare) we wouldn’t be in this situation now. On top of that, former Health Minister Gaetan Barrette’s reforms crippled our system’s capacity to respond quickly. A lot of people still don’t know who does what after so many managerial positions were fused.”
Frontline workers sacrificed
Chronic underfunding and underappreciation of these vital frontline tasks, exacerbated by ageism and an unwillingness to prioritize senior care, inevitably placed both residents and staff in harm’s way.
This past Saturday, Victoria Salvan, an orderly with 25 years of experience in the healthcare field, died alone in her home from COVID-19. She had been working double shifts in the “hot zone” of the Grace Dart CHSLS, one of the worst hit by the virus, and an extended-care facility where staff have been (anonymously for fear of retribution) complaining of a lack of protective equipment. Described by her co-workers as “one of the very best” who “thought of everyone else before herself,” Salvan was only months away from retirement.
Of Filipino origin, Salvan is the perfect example of the kind of frontline worker so often worked to the bone and sacrificed because of government oversight and budgetary cutbacks. If you’ve ever spent a good chunk of time at a hospital, you’ll have certainly noticed how orderlies, nurses’ aides and nurses are overwhelmingly female and often from an immigrant background. It’s no accident. Many of these jobs are very hard and often thankless, and the mediocre pay never comes close to compensating them for what they do daily for patients. And everyone who works closely with them knows this.
The importance of a caring orderly
I contacted a young nurse who I had recently “met” in a secret Facebook group of people who have family members in a CHSLD and are desperate for news from them. This nurse (who agreed to speak to me on condition of anonymity) has somehow found it in her heart to not only tackle her daily nursing duties, but to take and post daily videos and photos of the elderly residents for their families, who are cut off from them right now, to see and find some momentary peace. It’s such a basic thing to do, but so desperately needed and so deeply humane that I was moved by it. I wanted to speak to her about the importance of nursing — instead, she launched into this amazing defence of orderlies and the indispensable work that they do, because she had worked as one in the past.
“The importance of having a regular, competent and caring PAB (Préposé aux bénéficiares) cannot be overstated in long-term care,” she told me. “Each resident has a routine to which they would like to adhere, and having the PAB know what that is and to be able to deliver is paramount to their sense of ease. Someone who tries to find the resources to make these things happen are so appreciated by the residents. Serving that one resident a cup of tea when everyone else gets coffee means a lot to them. Knowing how to put their dentures in properly and how much denture cream is needed is important. Knowing how to put in and take out hearing aids, and to open the casing at bedtime so the battery doesn’t wear out are important. Knowing who needs special creams and where to apply them, who needs compression stockings and how to put them on properly is vital.
“More than anything else, a PAB needs to stick up for their residents, especially on an Alzheimer’s ward. They need to be an advocate and report skin breakdown before it becomes a bed sore. They need to report bruises and cuts, redness that could denote an eye infection, any difficulty with food and drink. A PAB spends the most time with the residents and they deal with them in the most intimate matter.”
Some of these acts might seem “basic” to you, since they don’t require years of studying and a university degree. That is until you’re old and frail in a senior home, cut off from your family because of a deadly virus, and relying on the kindness and competency of staff to make your life livable. Suddenly, the sum of all these acts define everything: the quality of your daily life, your dignity and the way you will live out your final years. Perhaps, the way you will die. There is nothing basic about them. These frontline healthcare workers are essential.
A vicious cycle
“Long-term care workers are extremely undervalued,” the nurse says. “It wouldn’t be that way if the elderly were treated with the respect they deserve. The entire healthcare system has, pardon me, shit the bed on this one.”
And that’s exactly the crux of the problem. Our seniors are undervalued, and they are being cared for primarily by a workforce that is undervalued, too. It’s become clear that it was only able to hobble along because of the (also undervalued and unpaid) work of family caregivers who were able to fill in the gaps created by lack of funding and care.
Now that COVID has blown the lid on all our system’s shortcomings, the Quebec government is sending frontline healthcare workers to war with no weapons. These “guardian angels” and “heroes” have been abandoned and left to their own devices. Butter knives in their arsenal, as Salvan’s co-worker said in a recent interview, instead of real weapons to fight a deadly virus with.
“Ask any long-term care worker, everybody knew exactly what was coming,” Stake-Doucet says. “As per usual, we were completely ignored. And people died. Lots of people. That’s what is hardest for my colleagues. It’s like a desperate rage. You’re crying angry tears while giving care because we know this could have been prevented.” ■
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