Dear Minister Reiter and Mr. Livingstone:
Long-term care in Saskatchewan is provided, in part, by hard-working and dedicated members of the Canadian Union of Public Employees (CUPE) Local 5430.
Last week those CUPE workers listened to the Saskatchewan Health Authority CEO, Scott Livingstone, and Minister of Health, Jim Reiter, speak about “cohorting” in long-term care in Saskatchewan. Cohorting is restricting staffing to a single site or facility, so that workers are not working in more than one facility.
On June 1, 2020, Mr. Livingstone told CBC News that cohorting to avoid the spread of COVID- 19 would be an experiment. He went on to say, “Lots of staff were working part-time at many different facilities, and that also is a challenge for us with respect to consistency, staffing, and hiring and keeping people employed in a single facility.” Further on in the interview, he mused, “It’s going to be interesting to see if we have the ability to continue with that long term …”
On Friday, June 5, 2020, Minister of Health Jim Reiter was interviewed on CBC’s The Morning Edition by Stefani Langenegger on the state of long-term care in Saskatchewan. In that interview Minister Reiter said that they had put cohorting into place and that they would have to see if they could do it permanently, but it would be in place for the foreseeable future or longer. When asked about the downside of having employees work full-time at one facility for consistency and safety, the minister said that there was no downside.
To really understand staffing in long-term care, we need to look back in time. At one time working in long-term care, and in health care in general, meant secure full-time work. Over time the employers, both affiliate and the regional health authorities that merged into the Saskatchewan Health Authority, wanted flexibility and began creating work that was increasingly precarious – part-time, temporary, and relief. The problem that the pandemic has shone a light on – health care workers working at more than one facility and holding two or three positions in order to cobble together enough hours to create a full-time equivalent job and make a living wage – was created by employers. Make no mistake, the current structure is by design, and that design was engineered by the employers.
When it became clear to all Canadians that long-term care homes needed to be protected from COVID-19 because the risks were so high to our most vulnerable citizens, there was a movement to single site staffing in long-term care across this country. Saskatchewan was not the first to implement it, but when it did, it did so by virtue of two things: a public health order and a temporary letter of understanding with all Saskatchewan health care unions. The public health order outlined the single site directive for both long-term care and personal care homes that would begin April 28, 2020.
Is CUPE now railing against cohorting or the single site long-term care staffing model? Not at all. Even before COVID-19, CUPE health care workers, and especially those who work in long- term care, used the cohorting model voluntarily when facilities were under an outbreak of influenza or some other communicable disease. This looked different in the different regions or facilities but was designed to protect the residents and the workers and maintain the employment of the workers. Previous cohorting did not last months as the current cohorting has, nor has it been done on a provincial scale that included private personal care homes.
However, there are problems with the current cohorting model that the Ministry of Health and the Saskatchewan Health Authority refuse to work with CUPE to resolve. The cohorting model isn’t perfect, and neither is long-term care staffing, which still suffers from working short.
One of the consequences of cohorting is that some workers who hold relief positions and are cohorted to a long-term care facility are not getting any work. Perhaps the “ask” of the facility was wrong. Possibly they wanted to make sure that they were not short staffed, so they cohorted too many workers. We have asked that employers look at these situations and release these workers to work at another site where they would be needed and get work. This request has been denied. The response is that changes to cohorting worksites should be based upon operational requirements. So, if they needed to move workers to a different site they would, but they are okay with workers not getting work while cohorted. We are not asking that workers be allowed to go back and forth between sites, but if a decision or assignment was made, and it is not working, it should be corrected.
Also frustrating to the relief staff is that if workers were cohorted to a private personal care home, they would be guaranteed the average of their hours for the last six months worked. The Ministry of Health and the Saskatchewan Health Authority refused to give that same consideration to long-term care workers cohorted to an SHA or affiliate long-term care home, and workers who previously were getting enough hours are now going without work and without access to any income replacement.
Another issue for workers who have been cohorted is vacation assignment. Workers who have been scheduled to cover vacation at a facility that they are not cohorted to cannot rely on that work as they cannot go to that other facility while cohorted. However, the employer is not releasing them from that schedule so that if there is a possibility of picking up shifts at the facility they are cohorted to, they could.
Meanwhile, full-time and part-time staff are being refused summer vacation or limited to only requesting vacation eight weeks into the future as there is no one to back-fill the shifts.
So, Mr. Livingstone and Mr. Reiter, here is our message to you about your musings on permanent implementation of a cohorting model: you need to clean up the mess that you made in the health care system when you adopted the just-in-time model of staffing and created so much precarious work. You need to talk to the health care unions and listen to them about how to create more sustainable full-time single site work in health care. You have collective bargaining agreements in place that need to be respected, and you simply cannot permanently implement cohorting in long-term care. The SHA released a statement on June 9th where they reflect on how the pandemic helped evolve the way they operate and that they seek innovation going forward. CUPE’s position is that any future vision or innovation requires negotiation and a recognition that when innovation leads to negative consequences, intended or not, these consequences must be addressed. Start today by working with CUPE and the other unions to resolve the issues that have been created by temporary cohorting.
CUPE Local 5430 President