Early one evening a year ago, Susan Buchanan was lying in her bed at Castleview Wychwood Towers, Toronto’s largest city-owned long-term-care home, when she suddenly had difficulty breathing.
Buchanan, who is not ambulatory, immediately pressed the call button next to her bed that was supposed to summon the personal support worker (PSW) on duty that night.
Half an hour went by. Buchanan kept pressing the button, but no one came. An hour passed. Then an hour and a half. Finally, after two hours, the Registered Practical Nurse (RPN) on duty arrived to check Buchanan’s vitals and administer oxygen.
“Even though I was all right after my breathing difficulties, it should not have taken more than 20 minutes to respond. If it had been critical, I would have died,” said Buchanan, 77, who is a six-year resident at the nursing home, located near the intersection of Christie and Dupont Streets.
While alarmed by the length of time it took to get help, Buchanan says she wasn’t surprised given what she and other residents describe as “chronic” understaffing and mismanagement that is hurting the quality of care.
Residents and employees at the home say staffing shortages have left residents with dementia wandering about “like zombies, yelling and screaming” at each other, while some are not monitored appropriately to prevent violent behaviour.
The situation at Castleview Wychwood Towers is emblematic of the general state of affairs facing the City of Toronto’s Seniors Services and Long-Term Care division as a whole, according to the Canadian Union of Public Employees (CUPE) Local 79, the union representing staff at the home and some 4,000 other public nursing home workers in the city. Problems include staffing shortages, uncompetitive wages, burnout and poor management-employee relationships.
Just last month, workers at Kipling Acres Long-Term Care Home in Rexdale held a rally in front of that home to raise awareness about staffing shortages and what they called “unsafe” working conditions.
The union says there are 462 job vacancies across Toronto’s 10 city-owned long-term-care homes, with 111 of those vacancies at the 456-bed Castleview Wychwood Towers alone.
Local 79 President Nas Yadollahi says that until more staff are hired at competitive wages, retention in city-owned homes will continue to be a problem.
The union says its registered nurses at the top of the pay grid earn about $6 less an hour than other long-term care homes in Ontario, and nearly $10 less than registered nurses in hospitals.
“You have to create an environment,” Yadollahi said, “where people actually want to come and work for you.”
In an emailed statement to the Star, the City of Toronto said it is “committed to supporting the overall health and well-being of all staff and its residents in its long-term care homes.”
“We recognize that the work can be demanding, and we take seriously any concerns brought forward by city staff and the long-term-care residents,” said city spokesperson Shane Gerard. “Over the past few years, the city has created space to actively engage long-term-care workers within all of its homes and has made meaningful improvements for staff as well as the more than 2,600 people living in city-operated long-term-care homes, both proactively and as a result of staff feedback.”
For more than two years, Doreen Bible, president of Castleview Wychwood Towers’ resident council, says she has been pleading with City Hall to step in and provide stability at the home.
She cites the home’s “revolving door” of employment at the top with four directors of nursing in a little over a year, with PSWs and nurses coming and going. Such inconsistency can be confusing to residents, Bible says, and results in delayed care as existing staff are usually swamped training new hires and agency nurses.
“We’re constantly waiting for care,” said Bible, 65, who moved into the home’s young adult unit 18 years ago at the age of 47 after being diagnosed with multiple sclerosis.
In September, after writing to the mayor and the city manager, Bible met with officials from the Seniors Services and Long-Term Care division to discuss residents’ concerns.
“The message was ‘basically, you have to live with it,’” Bible said. “That’s not good enough.”
When she first moved into Castleview Wychwood Towers, it was an “amazing” place that felt like a real home, she says. But no longer.
“This is the first time that I’m not happy,” she said. “I waffle between sadness and anger. This is not how a home should be run.”
The Star spoke to three workers at Castleview Wychwood Towers who echoed Bible’s concerns.
The employees, who described their work environment on condition of anonymity out of fear of losing their jobs, say they are constantly pressured into working overtime shifts to cover staffing shortages, resulting in residents failing to receive the level of care they deserve.
One nurse expressed concern that because residents with dementia are not receiving constant one-on-one monitoring, there is a risk they could become violent and threaten the safety of other residents.
“If we can’t isolate and find out what that trigger was,” the nurse said, “we won’t be able to prevent it from happening in future.”
A lack of an appropriate number of PSWs also means not every resident is guaranteed to be washed on their regular shower day, the nurse said, adding that insufficient cleaning, especially if a resident soils themselves regularly, can lead to skin breakdown.
Another employee said the current ratio of PSWs to residents is 1-to-10 in one area of the home, which makes it impossible to meet the needs of residents.
“If one resident needs to go to the washroom four or five times in eight hours, and another is calling from their bed, how can you manage to work for the 10 residents?” the employee said. “That’s why we are burned out mentally, physically.”
The City told the Star that staffing ratios at its long-term-care homes are within provincially regulated ratios, but it is continuing to implement new strategies to improve recruitment efforts. City spokesperson Gerard said recruitment is “actively ongoing” for positions at Castleview Wychwood Towers, with more than 75 positions in the process of being filled.
Toronto councillor Josh Matlow, a long-time seniors’ advocate and in whose ward Castleview Wychwood Towers is located, says the city is “failing” its long-term-care residents and nursing home staff.
“We need to make sure that each resident has the time with their PSW or any other member of the staff to be able to make sure their needs are met and that they are healthy and safe,” he said. “But it will be impossible for the city of Toronto to retain staff if they’re not paid fairly or they are underpaid compared to other jurisdictions and hospitals.” Matlow added that job vacancy rates in the city’s homes are “unacceptable.”
“Castleview is a very alarming example of what’s happening at homes across our city and I want to see the people who work in our long-term-care homes supported fairly so that they can support our residents well.”
