Content warning: workplace violence, abuse of long-term care workers
Illustrations by Alex McPhail, BA (Hons)
Hi, my name is Roma (she/her) and I am the author of this post! I am a cisgender, heterosexual, non-disabled, South Asian woman. I currently reside on the traditional territories of the Haudenosaunee, Anishinabewaki, Neutral, Mississaugas of the First Credit Nation, and Mississauga Peoples. This unceded land of Treaty 3 3/4 and Treaty 8 is currently known as Burlington, Ontario. The post you will now read is going to examine the impact of COVID-19 on frontline workers, the majority of whom are women. While I do currently volunteer at a hospice which is considered an essential service, I am allowed to choose my shifts, I do not depend on this work for income, and I would not be required to work if there was a COVID-19 outbreak in the hospice. As such, I do not consider myself a frontline worker during the pandemic. This post includes research on racialized, Indigenous, immigrant, and low-income workers. My intention is not to speak on behalf of these groups, but to bring more attention to the scientifically-backed research and experiences of communities that are historically and currently under-researched. As a researcher and writer who is passionate about health justice, I am committed to responsible allyship. I encourage feedback on this post should I misrepresent any of the communities I attempt to amplify. I hope you find this post helpful and engaging! Happy reading!
In this post we will discuss workers on the frontlines of the COVID-19 pandemic. The topics addressed include:
Overrepresentation of Women in Essential Fields
Globally, across 104 countries, women comprise 70% of healthcare and social care workers, and are earning 11% less than men (1*). This wage gap is even greater for racialized groups. In Canada in 2016, white women earned 67 cents per every dollar earned by white men while Racialized women earned just 59 cents per every dollar earned by white men (2*). This is despite the fact that Racialized women have higher participation rates in the paid workforce than white women. Women are not only negatively impacted by increases in unemployment and unpaid care work during COVID-19, but they are also overrepresented in fields that are considered “essential” and are on the frontlines of the pandemic. Despite providing the majority of this essential work during COVID-19, women’s voices are sorely lacking in policy response due to their underrepresentation in leadership and decision-making positions (3*, 4*).
In Canada, over 56% of all women workers are in jobs within the 5C’s, that is, caring, clerical, catering, cashiering, and cleaning (5*). Women are the majority of workers in long-term care (LTC) homes, which have been hit hardest by the pandemic. For example, 90% of Personal Support Workers (PSWs), who do the majority of care work in LTC, are women (6*, 7*). The majority of workers who disinfect our hospitals and offices, places we are avoiding as we work-from-home and social distance, are women (7*). These jobs are insufficiently paid and experience higher risks of COVID-19 exposure (8-9). These jobs are also absolutely essential during this time for the health and safety of our communities.
Burnout and Exhaustion of Essential Workers
Burnout and exhaustion are of particular concern to essential workers during this time. A survey of 1,381 care aides across LTC facilities in Canada reported that a majority of these workers are women (10*). Half of all care aides in this survey were born outside Canada and did not speak English as a first language. Burnout is a significant issue in this type of work due to long hours, insufficient wages, lack of on-the-job training, having little time to perform tasks, and dealing with dementia-related responsive behaviours from residents. Burnout is also a threat to the quality of care and the health of staff, especially with the added mental strain of COVID-19 and increased caregiving duties at home due to lockdown policies (11*).
A high proportion of PSWs in Canada are women who are immigrants and women who identify with a racialized group. A survey of 364 PSWs across Ontario found that 96% of respondents were women of which the majority identified as Black or Filipino and 5% identified as Indigenous (12*). While PSWs experience burnout and exhaustion for similar reasons as healthcare aides, almost 29% of PSWs in this survey reported working more than one job. Among respondents, the top reasons they give for considering leaving this type of work is low wages and dissatisfaction with working conditions. 65% indicate that their pay is too low, 45% said benefits are poor, and 40% state job security as a problem.
Abuse of LTC Workers
Abuse of PSWs and nurses is also a pervasive issue that is too often swept under the rug and seen as “part of the job.” A 2019 CUPE Ontario poll of 1,223 LTC staff found that 62% of PSWs and nurses experience at least one incidence of physical violence per week (13-14). 69% of racialized and Indigenous staff report regular harassment related to their identity. Many LTC workers are too afraid to report this violence due to fear of being blamed for the incident, being written-up, and even losing their job (15*). “What did you do to trigger the resident?” is a common question that is asked if they do report. A lot of the violence gets rationalized because residents are sick and oftentimes have dementia, but this does not mean that such experiences are not traumatizing for workers. “I’m not the same nurse I used to be. There are such lasting effects. It’s not just over when the bruises heal” (15*).
Violence from residents is often caused by resident fear, confusion, and agitation (15*). Such emotions may be exacerbated by the rampant spread of COVID-19 in LTC and the constantly changing policies as a result. Structural causes for violence against workers in LTC include systemic underfunding, lack of training, lack of recognition of the seriousness of the issue, and lack of public awareness about the issue (15*). However, the more insidious fact is that violence against LTC workers is just one symptom of an institution that undervalues its workers. Our frontline LTC workers may be dealing with more violence in the workplace, while also trying to care for residents and prevent the spread of infection in these high-spread settings. We need to recognize the essential service that LTC homes and workers provide and adequately support the people who live and work there.
Risks of Contracting COVID-19
Workers like care aides and PSWs are also not able to physically distance at the workplace and work in settings where COVID-19 outbreaks are more common (16-17). This means that a large proportion of Canadian women, especially those working in LTC, are taking significant risks to themselves in terms of contracting COVID-19. Compounded with the fact that these jobs are relatively lower paid within healthcare, are highly strenuous, and are disproportionately filled with racialized workers, means that while these women may be “essential workers,” we are treating them as disposable.
In a New York Times article highlighting the plight of cleaners and janitors in the United States (U.S.), several women describe the risk they are taking and fear they experience doing this essential work under dismal working conditions (9). One janitor, Ms. Deborah Santamaria, says that gloves were her only personal protective equipment to clean a building that was later found to have a confirmed case of COVID-19.
‘“I felt as if I didn’t matter” she says’ (9).
Another cleaner, Ms. Elizabeth Carrion, says she was asked to reclean a floor with a new disinfectant only to be later told that people on that floor may have been exposed to the virus.
The article suggests a lack of transparency in communicating risk to low-income essential workers, a lack of protective measures, and a lack of training to follow new COVID-19 procedures for employee health and safety. Notably, both of these essential workers interviewed for the article are immigrants to the U.S.. Women who identify as immigrants and belong to racialized groups are more likely to work in low-income positions which are associated with poor working conditions. A quote by Ms. Carrion sums up the sentiment that essential workers, especially those who are low-income, structurally vulnerable, and women, feel as though they take on disproportionate risks of COVID-19 infection:
‘“We should all be valued the same,” she said. “So who guarantees my safety?”’ (9)
Calls to Action
We suggest the following Calls to Action to ensure that we are taking care of the women on the frontlines of COVID-19, who are taking care of our communities:
Increased research investigating who is working on the frontlines of the COVID-19 pandemic, their experiences, and their needs
Ensure that such research is disaggregated by race, immigration status, and gender identity to get a better idea how different groups are uniquely impacted by working on the frontlines
Ensure that such research is looking at the impact of COVID-19 and relevant policies on the mental and physical wellbeing of essential workers
Ensure that such research translates to policy change to address the unique burdens faced by essential workers (negative mental health, workplace violence, lack of safeguards and personal protective equipment, and more)
Increased investment for care work, such as LTC, PSWs, care aides, nursing, custodial work, etc.
Ensure that women on the frontlines of the crisis are being fairly compensated for their work (wages, benefits, job security).
Increase wages for PSWs, LTC staff, and custodial workers
Address the gender wage gap
Address the wage gap wherein Women of Colour earn less than white women
Extend paid sick leave for women who do end up getting infected with COVID-19 so they do not have to worry about income
Ensure job security wherein women who get sick or have to take time off to care for their families or themselves are not worried about losing their jobs
Provide childcare benefits for women with children
Make sure women on the frontlines have sufficient access to personal protective equipment and vaccinations so these workers are not taking a disproportionate burden of COVID-19 infection risk.
Improve working conditions in LTC facilities and other types of care facilities. Workers should not feel rushed with residents or that they have to provide less quality care to meet demands.
Ensure that care workers are getting sufficient job training, so they feel confident in performing their daily tasks.
Address employee burnout for those working in frontline positions and work towards ameliorating the factors that contribute to job dissatisfaction such as low wages, long hours, and lack of job security.
Recognize the workplace violence that takes place in LTC homes. Provide emotional support to workers who are experiencing trauma as a result of this violence. Address workplace violence in these settings by increasing funding, having more staff per resident, and promoting workers to report these incidents.
Recognize that racialized women and women who speak English as a second language are overrepresented in care work. Conduct research to determine why these groups of women are overrepresented in this work and enact policies to support BIPOC and immigrant workers in these positions.
Increase investments in childcare, so that women on the frontlines do not face greater burnout due to increased unpaid, care work at home.
Facilitate women, especially women of colour, in leadership positions (within unions, advisory councils, businesses, government office) to ensure that feminist polices are enacted to help women during this time.
This involves encouraging women to join leadership positions, listening and amplifying their voice within these roles, and implementing the policies they suggest
Find out how women and gender diverse leaders have gained leadership during COVID-19 and why what we can learn from them.
*These sources do not specify the gender identity of the women included. Historical representation leads us to believe only cisgender women were included.
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References
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