Mainstream news sources, for the last decade, have been reporting on the increased frequency of the “hallway healthcare” phenomena in Ontario hospitals. Over this time the problem has grown into a norm, rather than an alarming exception.
Recent studies have indicated that an average of 1,000 patients are being treated in the hallways of Ontario hospitals every day.1 The solution to this problem has been to push patients out of hospital as quickly as possible and to put the burden on in-home-care services. With recent cuts to healthcare from the Ford government, once again the push for in-home-care to solve the problem of inadequate accommodations in Ontario hospitals has resurfaced, despite the province-wide shortage of personal support workers (PSWs) to perform what is the bulk of this care.
According to Stats Canada, in the period of April 2015 to March 2016, an estimated 1.2 million Canadians reported that they were in need of in-home-care at some point in that time. However, only 919,000 people actually received personal care during this time.2 729,357 of these people were clients of the Community Care Access Centre (CCAC), the central body for ensuring the delivery of needed healthcare services for those in the province who are covered by the Ontario Health Insurance Plan (OHIP). 74% of the in-home-care services performed for the CCAC clients during this time were personal care services, the remainder were nursing, physiotherapy, and occupational therapy services.3
The role of PSWs and the parameters of personal care services are not formally codified. The duties to be performed are generally left to the employer’s discretion. There are PSW programs available in colleges across the province (including private colleges), but many people who are hired to perform personal support services are either nursing students or they do not attend college and receive on the job training instead (these workers are frequently referred to as community support workers, rather than personal support workers, to distinguish them from those who have received a formal education in the field). Typically, PSWs are going into the homes of injured, disabled, sick, and elderly people to aid them with hygienic and daily tasks such as showering, grooming, dressing, and meals, as well as transferring patients in and out of bed often with intricate equipment they have been specially trained to operate. These tasks are performed by PSWs in long term care facilities as well. However, PSWs are increasingly performing medical tasks, such as prompting and administering medications, changing and cleaning ostomy bags, and changing wound bandages, among other things. In June 2012, a project to implement a PSW registry and to solidify standards for what constitutes the purview of PSWs was launched.4 The project was slated to be completed by the end of 2019 but at some point it became referred to as a “pilot program” with an end date of March 31st 2020. It is certainly to the advantage of public and private personal care employers to maintain the vague status currently held by the personal support field.
Personal support care covered by OHIP had previously been performed by PSWs employed directly by government bodies. The CCAC inevitably began formally contracting out to private companies to complete this care. When the CCAC transitioned into the Local Health Integration Network (LHIN) in 2017, the practice of contracting out almost all in home personal support care became the norm. Once again, as of last year, Ontario is transitioning into a new type of body responsible for administering healthcare services such as in-home-care, long term care, mental health care, addictions services, and so on. These new bodies are called Ontario Health Teams (OHTs) and are made up of public, non-profit, and for-profit organizations to oversee the administration of these services for particular geographical areas.5 Among the organizations that make up many of these teams are in-home-care giants such as CarePartners, Bayshore, and ParaMed. These particular in-home-care organizations also make up a coalition group called Home Care Ontario,6 which launched a campaign called “End Hallway Healthcare” in 2019 in an attempt to get increased funding from the Ford government for in-home-care services.7 Increased funding is not a guarantee that more personal support workers will be employed by these private companies to oversee the monumental task of meeting the needs required. There is no obligation on the part of these companies to increase wages and benefits, or to ensure safer conditions for workers and patients alike.
A recent report released in December 2019 by Unifor and the Ontario Health Coalition revealed the drastically poor conditions pushing long term care workers out of the field.8 PSWs working in long term care facilities make an average of $20/hr for high stress work where they are expected to complete extensive care in inadequate amounts of time. Long term care facilities are alarmingly understaffed which results in poor care, which is awful in itself but it also results in increased violence from patients towards workers and increased likeliness of injury in performing physically demanding tasks. All of this has resulted in many PSWs leaving the field entirely for over a decade and there is no end in sight. No such study has been conducted for in-home-care, but campaigns such as “Stuck in the Past” have highlighted the stories of a number of workers and patients,9 making it clear that the situation for in-home-care is no different than long term care.
With the movement of public healthcare into contracting private for-profit companies and now to integrating them into the administration of healthcare services more directly with the Ontario Health Teams, it has become more than apparent that the state has reached a point where they cannot carry the full burden of healthcare. There seems to be no way out as hallway healthcare and PSW shortages grow to increasingly alarming levels, workers’ conditions continue to worsen, and patients receive significantly less adequate care. And the state’s solution is to look to for-profit private companies such as CarePartners more directly to fix the problem.
On March 31, 2019, two contractual agreements between private in-home-care provider CarePartners and its employees expired in Ontario, Canada. Electing to address the smaller dispute first, CarePartners began negotiations with a bargaining team from the United Steelworkers, the union representing 30 office workers from a scheduling office located in Sudbury, Ontario. The Sudbury scheduling office staff was responsible for scheduling and supporting the PSWs and clients in the North-Eastern Ontario area. It became clear early on that the company was not entering into negotiations with any intention of conceding to the worker’s demands in any capacity. After several months, CarePartners offered a contract that stripped pensions, paid sick days, and vacation time from its oldest office staff members, neglected the proposed formalization of a process for grievances to correct the extremely high turnover rate, and did not offer any significant wage increases. In anticipation that this contract would be rejected by the office workers, CarePartners management announced to its staff that they had pre-emptively planned a lock out of its Sudbury office staff beginning May 31, 2019. CarePartners elected to temporarily relocate all of the office duties to Southern Ontario’s already heavily burdened offices where staff were unfamiliar with the complex geography of the more rural areas, which created what PSWs described as chaos, putting vulnerable clients at risk. Moving forward with the lockout, CarePartners refused to continue negotiations with the United Steelworkers and in early November of 2019 the company permanently relocated the Sudbury office workload to Southern Ontario offices, closing down the Sudbury scheduling office and laying off 30 office workers.10
With the office workers locked out and the cessation of negotations in that dispute, CarePartners began negotiations with the Service Employees International Union (SEIU) in regards to the much larger group of workers’ expired contracts. SEIU, representing the company’s PSWs across Ontario, launched a media campaign called “Stuck in the Past” and its members engaged in a number of union actions, including a demonstration at CarePartners’ Ontario head office in Kitchener.11 Regardless of these efforts, negotiations did not go well, and on January 10, 2020, CarePartners attempted to impose a contractual agreement on its PSWs that saw no significant gains and new language that would allow the company a greater ability to force workers to travel more and work longer days.12 (Doing in-home-care means workers need to complete 8 hours of visits, so their day goes much longer than 8 hours due to travel time between clients’ homes. In rural areas, especially those in North Eastern Ontario where communities and homes are widely dispersed in some areas, PSWs might travel anywhere from 15 minutes to an hour to reach a clients’ home, sometimes more.) SEIU stated that CarePartners was trying to take advantage of Bill 124 and immediately petitioned the labour board to nullify the forced contract. Only a couple of weeks later, CarePartners returned to the negotiating table and after only one day of bargaining offered a contract that SEIU declared “historic” and wholeheartedly endorsed.13 Ultimately, the contract offered meagre wage increases for some employees (mostly to be gained in the third year of the contract) that did not even bring the in-home-care workers within the possibility of achieving the provincial average that long term care workers make.14 Other barely significant “gains” literally amount to pennies. With the strong endorsement from the SEIU, PSWs voted this new “historic” contract with CarePartners through and continue to work under subpar conditions with inadequate compensation for the time and effort they put in to this tremendously difficult field of work.
The negotiation process between CarePartners and SEIU was certainly drawn out and difficult. The culmination of the dispute in SEIU’s enthusiastic proclamation that they “forced” CarePartners back to the table and came out with a “historic” agreement truly highlights the limitations of the unions. The SEIU is a fairly reputable union in Canada, but their success is gauged not by the union’s ability to force the will of workers upon the employer, but rather it is based upon the union staff bartering with capital for “gains” that are barely significant to the workers represented by the union. The SEIU was straight forward about having characterized this agreement as historic because it was simply not as bad as the contract the company attempted to force on its workers. Ultimately, workers are still forced to work for wages that have stagnated for years, their non-standard shift work has become an even greater imposition on their lives, and they will receive a measly penny increase in kilometer coverage as gas prices continue to climb. It is hard to imagine what about this agreement is actually historic. The union could not have demonstrated more clearly that it is nothing more than a professional body for negotiating over the details of the exploitation of workers; this is a tug of war where union and employer negotiate on the terrain of capital, within the bounds of bourgeois law, and the workers are left in the lurch.
What this particular sequence of events makes clear is how the union form is dependent upon the continued employment of the workers they represent. The union, afterall, is not directly controlled and administered by the workers, but rather it is made up of staff that earns a wage. The union is a fixed body like any other business, performing a service in exchange for payment through monthly dues. When the office workers were locked out by CarePartners for six months, not only did Steelworkers lose out on income that could not be shaved off of wages that were not being given, but they lost money by providing a (unliveable) strike wage to 30 workers. Steelworkers recuperated this loss by using these workers to help campaign for the NDP during election season in 2019, a party historically invested in trade unions. SEIU embarrassed itself by proclaiming a terrible contract negotiated over a single day as “historic” because for SEIU the best case scenario was to avoid an Ontario-wide strike action of Care Partners PSWs which would result in tremendous loss of incoming dues and high costs for strike pays. For all that the good intentions of union organizers, staff, and members are worth, unions depend on a working relationship with capitalists to keep themselves afloat.
This, of course, is not exemplary of a single failure, but rather it demonstrates the nature of the trade union as an apparatus of capitalism. The union is first and foremost the bureaucratic representation for their membership and is not an expression of workers' power. The union is not capable of more than minor single workplace concessions that are given and taken away at the whims of capital. While private firms profit off of public funds for in-home-care, it has become very clear that no union can possibly negotiate for meaningful gains for healthcare workers when it is not in the state’s capability to provide sufficient funding to simultaneously significantly increase wages and contribute to the survival of capital. The union cannot possibly provide a way out for PSWs and the increased burden being forced on them through the health care crisis in Ontario. As Onorato Damen stated to Amadeo Bordiga in a letter: “due to its essential role in the revival of the capitalist system, [the union] is destined to continue until the end of the economic, social and political hardships of a dying capitalism, and will only be defeated when the assault of the revolutionary proletariat brings down the imperialist state.”15 Increasingly, we will see these types of miniscule gains touted as major wins across the social services fields.
In-home-care workers are one of the many types of workers that fall under the umbrella of social service work. Social services are considered to be any work which focuses on the welfare of people. In more specific terms, it speaks to the fields of healthcare (including mental healthcare), education, and housing. The vague categorization of social services encompasses all classes, but when we speak of social service workers, we are not speaking to the bourgeoisie and petit-bourgeoisie who are situated within the social service sector. An emergency room nurse and a practice-owning doctor do not share the same relationship to capital, no more than PSWs and Linda Knight, the owner of Care Partners, share a relationship to capital. The practice-owning doctor in Canada and the owner of an in-home healthcare company are merely the state sponsored bourgeoisie. Nurses and PSWs sell their labour power, either directly to the state in hospitals or to capitalists who pay for their labour through funds granted to them by the state.
We too often take for granted the supposed accessibility of universal healthcare systems and fail to recognize that they still function as capitalist enterprises. We are more prone to seeing state subsidies for businesses such as the bailing out of auto vehicle companies like General Motors as a capitulation to capital than we are at seeing state sponsored healthcare as such. While not bailing out companies like GM can have a devastating impact on workers, it is important to recognize the direct impact state sponsored healthcare systems have on the working class which encourages the refusal to see social services as part of the capitalist apparatus. There is no doubt that American workers are put at constant risk of homelessness and complete destitution at the slightest possibility of illness or injury that can cost thousands to tens of thousands of dollars in a short period of time. But it is through our analysis of the Canadian healthcare system and its various moving parts that we can see how universal healthcare under capitalism is still directed by the needs of capital.
Healthcare is not a concession to workers, whether hospitals are public or private, tax funded, employer funded, or directly paid out of pocket. As Red Hughes said in his 2017 article on the American healthcare system: “The US failed to create socialized medicine and gradually dismantled the socialized aspects of its healthcare system but we should be clear socialized medicine refers to healthcare being consigned to the whole of society — the socialized medicine of the United Kingdom or France serves to strengthen those capitalist societies rather than being anything like positive steps to socialism.”16 It functions as part of the social wage, maintaining and reproducing labour power, freeing workers up to work for lower wages, and making contradictions less defined. If we discuss personal care specifically, and even more specifically in-home personal care, this is a cost effective way to avoid the erection of nursing homes and hospitals while also (inconsistently and poorly) alleviating the burden of those who are capable of working from the care of their elderly, disabled, or sick loved ones. In-home personal care keeps workers working and subsidises low wages in the most cost effective way possible, while also placating social attitudes about the way things are. Inevitably, the need and ability to do this becomes more and less intense given the conditions of capital at any given time.
As we enter into more intense capitalist crises, we see the creativity of capital in managing social service costs. We see wage freezes for workers in these fields such as the introduction of Bill 124, Protecting a Sustainable Public Sector for Future Generations Act, 2019, which limits raises to well below the inflation rate.17 We also saw around 360 million dollars of cuts to Ontario healthcare in 2019, when Ontario was already the lowest funded healthcare system based on population in Canada.18 It should come as no surprise that we are moving towards cutting out the superfluous mirage of the manufactured division between the private and public sphere, so as to cut costs, regardless of the harm this will do to working class people. While the effect on workers requiring healthcare is obvious, this is especially relevant right now to Personal Support Workers. The movement towards increased privatization, with the sponsorship of state funds, has been happening for the last couple of decades. Instead of publicly funded personal support workers all working for the state, they are divided amongst multiple private employers, and as separate contracts under the ownership of (mostly) the same union, an arrangement that serves the needs of unions, the state, and private companies, because their needs are in fact all tied to capital in opposition to workers. The field has been opened for a tremendously devastating attack on workers, lowering the organizing capacity of these workers to fight for fair wages from multiple directions and increasing the vulnerability of workers who have no labour power to sell, in the face of a growing economic crisis.
Two months after CarePartners boasted about their “historic” agreement, a personal support worker who was employed by a similar company called Sienna Senior Living at a long term care facility in Scarborough, Ontario contracted and died from COVID-19.19 18 other staff members at the facility contracted the virus. 46 residents have also tested positive and 5 have died. A union representative from SEIU, which also represents PSWs for Sienna Senior Living, expressed disappointment in management for failing to provide appropriate PPE but it appears no serious action will be taken by the union, whose main purpose is to participate in the negotiation of contracts every 2 or 3 years. As the ICT has stated: “The possibility of concessions somehow favourable to the class of wage earners is definitively exhausted. Today each reform is synonymous with bourgeois attacks on the working class. The trade union could do nothing other than develop a mediating role in accordance with the survival of capital, and the passive acceptance of the workers.”20 This is not to say that workers should shy away from struggle or that there cannot be modest, immediate, defensive victories. But rather, inside and dominated by the union there can only be a generalized decline. The unions, tied to the logic of capital and its state can only function as a passive organ to manage and negotiate the attack on the class. The struggle for social service workers could not be clearer than it is right now, amidst a global pandemic. Only two months ago, PSWs were duped by their union to be gracious for a terrible contract from their employer. Today these same PSWs are risking their lives to continue attending to the needs of hundreds of thousands of working class people across the country with nothing but signs and Facebook posts to thank them. And there is no doubt that coming out of this crisis there will be excuse after excuse for withdrawing funding from healthcare even further and denying any sort of relevant gains to workers who are at the frontline of the current pandemic, as the government funnels money into the economy because the need to maintain the labour reserves and relieve the home burdens of working class people will not be quite as needed until capital manages to recuperate from this latest crisis. The unions are barely capable of fighting and winning in the arena of barter over the price of labour, they certainly are not suited to rescue workers from the onslaught of attacks to come. It is more than time for our class to take it upon ourselves to organize for our own interests. To clarify the interests of the working class as a whole, revolutionaries today work towards the creation of the future world communist party. This organ will be both a product and agent of class struggle. It will be formed through the real work of revolutionaries today analyzing and participating in the real struggles of the working class as a whole, fighting for, and giving our class a clear sense of the bosses’ tricks and the need for independence. Moving towards ending capital's hold over the world and liberating ourselves from its exploitation for good.
- 1Mike Crawley “Some of Ontario's biggest hospitals are filled beyond capacity nearly every day, new data reveals” CBC, Toronto, January 22 2020. cbc.ca
- 2Heather Gilmour “Unmet Homecare Needs in Canada” Stats Canada, Canada, November 18 2018. www150.statcan.gc.ca
- 3“Facts and Figures: Publicly Funded Home Care” Home Care Ontario, Ontario. homecareontario.ca
- 4Karen Born and Andreas Laupacis “Ontario’s plan for personal support workers” Healthy Debate, Ontario, May 10 2012. healthydebate.ca
- 7Mike Crawley “Homecare pitches as solution to hospital overcrowding problem” CBC, Toronto, February 14 2019. cbc.ca
- 8Zaid Noorsumar “Personal support worker shortage plaguing Ontario Nursing Homes” Rabble, Canada, December 24 2019. rabble.ca
- 10“CarePartners ends six-month lockout by pulling jobs out of Sudbury” CBC, Sudbury, November 13, 2019. cbc.ca
- 11“Personal Support Workers Rally at Homecare Agency to Avoid a Lockout by the CarePartners Corporation” Cision, Kitchener, December 11 2019. newswire.ca
- 12Zaid Noorsumar “CarePartners imposes rejected contract on homecare workers” Rank and File, January 9 2020. rankandfile.ca
- 15Onorato Damen and Amadeo Bordiga “On the Union Question”, Bordiga: Beyond the Myth. Prometheus Publications, London, pg. 66. leftcom.org
- 16Red Hughes “Capital’s Health Dilemma” Intransigence, North America, October 2 2017. intransigence.org
- 18Linda McQuaig “Ontario healthcare spending lowest in Canada – and going lower” The Star, Canada, November 20 2019. thestar.com
- 19Bryann Aguilar “Health-care worker at Scarborough long term care home dies from COVID-19” CTV, Canada, April 16 2020. cp24.com
- 20“Communist Work and the Trades Unions Today” ICT, June 1 1997. leftcom.org