'Telling us we are not important': Lack of permanent paid sick days making health-care crisis worse, say experts

Nurses leaving amid health-care system condition Now part time nurse, Sonja, highlights the pressure being put on health-care workers during COVID-19 and why many are now leaving the field.

Major viruses are impacting Canada’s hospital systems— and a shortage of staff at a critical time is being exacerbated by poor working conditions for the lowest paid in the health-care sector, several physicians and academics told CTVNews.ca

Those conditions include a lack of permanent paid sick days, and it’s only fuelling workers' desire to leave the field, they said.

When the pandemic led to lockdowns across Canada in March 2020, only two provinces offered any kind of permanent sick days. Prince Edward Island provided one day, and Quebec provided two.

Since then, only B.C. has been added to the mix. In January, it legislated that five permanent sick days be provided to all workers. Other provinces have offered paid leave, but they are temporary policies implemented due to the pandemic that come with expiry dates.

Kwame McKenzie, CEO of the Toronto-based health equity policy group Wellesley Institute, said it’s “very worrying” that permanent paid sick days are not available for these workers, especially at this point in the pandemic.

“We don’t seem to learn the lessons from pandemics, and we know that not having sick days caused problems. People went to work sick and they passed on COVID-19 to others, making workplaces hazardous,” he said in an interview with CTVNews.ca.

Not having access to paid sick days prevented people from getting vaccinated, he said.

“It also meant people didn’t want to be tested because they thought, ‘If I test positive, that’s a problem, because maybe I won’t be able to pay the rent,’” he said.

Now, amid RSV and flu season and while COVID-19 is still spreading, we have a “triple threat” occurring, he said.

“Having paid sick days is a triple imperative, instead of a single imperative,” McKenzie said.

With hospitals overwhelmed, academics and public health experts say governments across the country missed another opportunity to ensure the most vulnerable workers are protected, keep patients safe, and retain health-care staff.

WHAT WORKERS ARE SAYING

Personal support worker Daniella works at two long-term care homes in Toronto. CTVNews.ca is granting Daniella anonymity due to fears they could face punishment at work.

They emigrated from Colombia in 2018, and was “starting from scratch” when they arrived in Canada, Daniella said in a phone interview.

When they first moved, Daniella was cleaning homes, but then decided to take a course to become a PSW, along with learning English at the same time.

They said it’s not just themselves that they have to provide for: “I’m living with my partner here and I have to send money back to my mother, I have to support her.”

With people to support and the inflation rate skyrocketing, Daniella says they can’t afford to miss a single day of work. They work six days a week in order to pay her bills and send money to family back home.

As a contracted worker, their employers offer no paid sick days, under any circumstance. More than two-and-a-half years into the pandemic, caring for the most vulnerable older people in the long-term care system, many workers like Daniella still can't afford to stay home if they are sick, or if their children are sick, workers 'rights organizations and academics tell CTVNews.ca.

At the end of 2021, Daniella got COVID-19. They had to stay home for the 10-day isolation period, and they were not paid for any of it.  Their employer did not let her know about the province’s three-paid sick days program, and by the time they found out about it, it was too late to apply, they said.

“It was really bad, I had to live under my savings,” said Daniella.

They said if they go to work sick, the residents in long-term care could die, due to their fragile condition.

“I feel like the government is telling us we are not important for them. They want us to work for Canada, no matter how, and in what conditions. They are trying to tell us we are some kind of machine,” they said.

PAID SICK DAYS ACROSS CANADA

Though the discussion on sick days has focused on health-care workers, any enacted legislation would likely cover workers across multiple sectors.

There is no province or territory in Canada that offers 10 paid sick days in a calendar year despite recommendations from advocacy organizations over the last two years to allow that amount of time off.

Employers can offer more leave to their employees— but advocates want to ensure all workers are entitled to a minimum of 10 days per year under legislation.

Based on current sick days legislation, some jurisdictions are requiring businesses to shoulder those costs.

For instance, in B.C., legislation went into effect at the start of 2022 that mandated all workers in the province be entitled to five days of paid sick leave if they’ve been on the job for 90 days or longer. It's the only province that has provided five days permanently to its residents. B.C. instructs employers they will need to pay stafffor those five days.

Others have implemented policies that are temporary, due to COVID-19.

However, the B.C. legislation does not cover those excluded by its Employment Standards Act.This includes unionized workplaces, independent contractors, and other workers,like a home care worker who is employed for less than 15 hours per week.

Currently, workers in Ontario are entitled to three paid sick days that were implemented in April 2021 during the height of the third wave of COVID-19, after calls from advocacy groups that said the lack of paid leave was fuelling what was one of the most devastating waves of COVID-19 in the province.

On Dec.5, the Ontario Conservative government voted against a bill introduced by NDP MPPs Jill Andrew, Peggy Sattler, Doly Begum and Sara Singh titled the Stay Home If You Are Sick Act, 2022 or Bill 4. The legislation would have provided 10 paid sick days and 14 days during public health emergencies within a calendar year.

In the summer, Ontario announced it was extending the temporary three sick days program until March 2023. The program works by allowing employers to be reimbursed by the government up to $200 a day, for a maximum of three days, for pandemic-related absences including vaccination, isolation or caring for relatives.

In an emailed statement to CTVNews.ca, the Ontario Ministry of Labour, Immigration and Skills Development said the province's COVID-19 sick days program has supported over 500,000 workers since it was implemented. As the program was extended to March 31, this will give workers the ability to "take time off when they needed," it stated.

In Prince Edward Island, a bill introduced by the Opposition Green Party that proposed 10 paid days a year was voted down at the end of November. Currently, the province mandates one paid sick day per year be provided to workers who have been at a job for at least five years.

And in Quebec, workers are able to take two paid sick days a year. That legislation was in place prior to the pandemic.

The federal government recently implemented 10 days of paid sick leave but only for the one million workers across the country who are employed in federally regulated private sector workplaces. The federal government announced in November that the policy was introduced so that those workers do not have to choose between their pay and staying home when sick.

While legislation would cover all workers, those in precarious jobs, especially contracted health-care workers would benefit from legislation—as would the health-care system overall, experts told CTVNews.ca

WHAT EXPERTS ARE SAYING

According to McKenzie, there is currently a “two-tiered” system, where some health-care workers, often in hospitals, are paid better and receive benefits like sick days, while others are low-wage, and work on contract.

“It makes very little sense to me, to be saying that this is the time where we ignore what is a basic public health imperative, if not a human right,” he said.

“They’re the people we really need to be focusing on, because they are the fundamental building blocks which the whole of the health-system is based, doing face-to-face care in the community or long-term care.”

In October, the Wellesley Institute published a report titled Thriving at work: A health-based framework for decent work. The report said that, according to the Workplace Safety and Insurance Board, more than 27,000 Ontario workers had been infected with COVID-19 on the job.

Neighbourhoods in Toronto that had the highest proportion of COVID-19 cases contained the highest amount of essential workers, who were more likely to be racialized and not able to work from home, it states.

The institute determined that in order for workers to thrive, adequate income, benefits, job security and inclusive work environments are critical for an individual’s health and well-being.

Maxwell Smith, a bioethicist and assistant professor in the faculty of health sciences at Western University said via a phone interview with CTVNews.ca last month that paid sick leave is a strategy that's not only a way to curb infection, but makes good economic sense too.

“It also reduces absenteeism, by preventing outbreaks and the chance of workplace closures that could come because there’s so much infection,” he said. This will protect the health of workers, communities and it’s good for businesses, said Smith.

“It seems pretty barndoor-obvious to me that it’s good from whichever perspective you want to take on it,” he said.

Without protections, it may be difficult to recruit new health-care workers into a system amid a pandemic as there’s a fear of becoming infected and repeat infections, especially with the threat of long-COVID, said Smith.

“It’s incumbent on the government to provide as safe an environment as possible for people to do these jobs,” he said.

If Ontario expects individuals to stay home when they are sick, and wear a mask if they are sick at home, as Dr. Kieron Moore has recommend, then provincial governments should give workers the tools to be able to stay home, said Smith.

In May 2021, the Ontario science table released a paperon the benefits of paid sick leave. Its research highlighted that in the U.S., introduction of paid sick leave was associated with a 50 per cent reduction in COVID-19 cases per state, per day.

The paper found that essential workers experienced “disproportionate rates” of COVID-19 infections. It also indicated that the economic impact of paid sick leave was a factor in economic stability and recovery, through increasing productivity, preventing absences and stopping workplace closures.

And according to a 2022 paper from the Decent Work and Health Network, a health and labour rights advocacy group, the lack of paid leave has impacted Ontario’s most diverse neighbourhoods the most, as immigrants and newcomers are more likely to take low-wage, precarious work due to employment barriers.

The lack of paid leave is also a factor in increased burnout among health-care workers, according to Decent Work and Health.

A report released in June from Statistics Canada that surveyed health-care workers found 86.5 per cent, including doctors, nurses and personal support workers, were feeling more stressed on the job during the period of September 2021 to November 2021.

But nurses were the most likely to report they planned to leave their job or change their job in the next three years, according to the survey.

A 2018 analysis of OECD nations found there will be a shortage of 120,000 nurses in Ontario by 2030, and a 2020 report from the RNAO found a third of nurses that provide direct patient care are approaching retirement.

At of the end of October, Ontario’s nursing college allowed nurses educated outside of the country to temporarily practice while they work toward being fully licensed in Canada, to help bring more nurses into the system.

But increasing conditions overall including leave policies would help as well, according to Decent Work and Health.

Dr. Naheed Dosani, a physician and member of the health network, told CTVNews.ca in a phone interview that he was very disappointed the Ontario government had voted against the NDP proposed sick day legislation.

“It would have really helped a lot of people,” he said. “It will undoubtedly have negative impacts on workers across the province,” he said.

Dosani said he and his colleagues who are working on the frontlines are “very frustrated” and “upset” by the province’s inaction on more sick days. Workers need to be able to stay home when they are sick or when their children are sick, he said.