Relying on newcomers to fill labour shortages in Nova Scotia’s long-term care sector needs to come hand-in-hand with big changes to both the immigration and health-care systems in the province.
A report published by the Canadian Centre for Policy Alternatives (CCPA) said existing policies to recruit newcomers in the sector are “myopic and ethically fraught.”
“Refugee and migrant health-care workers are relied on heavily during the pandemic, but their conditions of work continue to be poor,” said Mary Jean Hande, senior researcher with the CCPA and author of the report, during a webinar Wednesday evening.
Prince Owusu, a PhD candidate at Carleton University, has been studying the experiences of racialized care workers in rural and small town Canadian long-term residential care facilities, including in Nova Scotia.
He said racialized CCAs in Nova Scotia have “precarious” working conditions across multiple long-term care facilities. They work full time — and often longer than full-time hours — on temporary contracts without essential benefits while suffering from overt and covert racism.
“Some of these workers were RNs in their home countries. And when they moved here, they had to de-skill and try to gain Canadian certification in order to … commensurate with the levels they were employed at in their home countries,” said Owusu.
“Some of them de-skilled temporarily … but some over time just give up because of the arduous certification requirements.”
Owusu said retaining racialized and migrant workers requires improving working conditions, compensating workers adequately and creating an environment that nurtures and celebrates the workers.
Long-term care homes have been understaffed for years, long before the COVID-19 pandemic. Burn out and low pay are among the factors contributing to low staff retention rates in the sector.
With the pandemic, the shortages have been intensified, leading the provincial and federal governments to introduce several recruitment strategies, including immigration streams, to attract foreign health-care workers and refugees already living in Nova Scotia into these positions.
According to Nova Scotia’s Office of Immigration and Population Growth, the province has prioritized the applications of foreign health-care workers including continuing care assistants (CCAs), nurses and physicians.
The Nova Scotia Nominee Program (NSNP) has highlighted CCAs as a key “occupation in demand,” meaning that international students and migrant workers in Nova Scotia can apply for permanent residency (PR) if they receive a permanent job offer as a CCA from a Nova Scotian employer.
The federal government also introduced a unique temporary program to support refugee health-care workers whose applications failed or are pending. The program, which launched in December 2020 closed in August 2021, helped successful applicants gain PR status in eight to 10 months.
“Each program has its own set of requirements and restrictions. ... But the important piece is that the pathways to permanent residency continue to be complex and difficult for workers to navigate,” said Hande.
Permanent residency guarantees the legal right to permanently reside in Canada and gain access to job opportunities and health care.
But policies such as the NSNP and the federal program don’t have “promising rates” of successful PR applications, according to the report.
The number of successful PR applications through the NSNP, for example, have dropped significantly from 2015 to 2019, despite increasing recruitment.
As of May 1, 2021, none of the applicants to the “COVID-19 PR pathway for refugee care workers” in Nova Scotia had been approved for PR.
Immigration lawyer Gabriella Utreras Sandoval said the temporary federal program is an example of how complex coupling immigration status with occupation can be during the pandemic.
Although the program provided a relatively fast route for PR and relieved applicants of the psychologically draining aspects of refugee claim hearings, the eligibility criteria was restrictive.
The program required refugees to have filed a status claim before March 2020 and to have worked in one of six occupation categories during a designated period of time for a minimum of 120 hours and a minimum of six months full-time.
Sandoval said she encountered an applicant who was rejected because they were short as few as five hours. Applicants who worked as a security guard or housekeeper at a long-term care home did not qualify. She said such a program should include all front-line workers in long-term care.
“It’s just as essential, even if it’s not providing bedside care and companionship.”
Making the program contingent on working in specific occupations for a number of hours feeds into the narrative that refugees are exploitable resources.
“One particular call left an impression on me because the individual felt so humiliated, having been working for so long in the health sector and doing some very precarious work, terrible hours and not having that work valued and not being able to be part of this process was for her very demoralizing,” said Sandoval.
The federal program should be renewed, said Sandoval, provided the eligibility criteria is more flexible and inclusive.
Any recruitment program for CCAs or other health-care professionals should put the workers at the centre, said Hande.
“We need to value these workers for much more than their labour. We need to provide that PR status, and we need … settlement supports for them. They’re just not sufficient right now.”
Nebal Snan is a local journalism initiative reporter, a position funded by the federal government.