Daycare in Long-Term Care?

The Province of Nova Scotia has announced a pilot program to provide onsite childcare for nursing staff, particularly continuing care assistants (CCAs), at the Cove Guest Home in Sydney.

During the CBC Information Morning Cape Breton report on the daycare pilot, Cheryl Deveaux, chief executive officer and administrator of the Cove, gave a refreshingly blunt explanation as to why such a program was needed:

The wages for CCAs is low and the cost of child care is high.

Both Deveaux and Dr. Kevin Orrell, the CEO of the Office of Health Care Professionals Recruitment (and front man for the daycare pilot) were clear that the service, which will initially comprise 10-12 spaces, is intended to “draw more people into” the CCA profession by lowering at least one barrier to entry. Deveaux said finding spaces, particularly for children under 18 months, in daycares that are open in time for workers’ 7 am shifts is very difficult in CBRM.

I have to admit, as an attempt to recruit and retain workers, on-site daycare is a better carrot than the CCA registry introduced by the Liberal government in April. As the NSGEU, which represents about 1,348 CCAs, put it at the time:

Of all the possible steps that could have been taken to address the growing need for CCAs in Nova Scotia, Bill 92 is the smallest one.

But is a 12-space pilot daycare program the answer to a staffing shortage Deveaux calls a crisis?

Chris Parsons of the Nova Scotia Health Coalition (“Medicare’s watchdog”) and Nan McFadgen, regional vice-president of CUPE, which represents 3,000 CCAs in this province, are skeptical, to say the least.

 

Stop-gap

Parsons told me in an email that while the daycare pilot was “an understandable stop-gap solution” to the staffing crisis in long-term care:

…it doesn’t address the fundamental causes of the staffing shortage: absurdly low wages, difficult and dangerous work conditions and a failure by all levels of government to do proper capacity planning and workforce development.

Parsons then made the point that the effect of the pilot may be to:

…attract workers from other facilities to work at The Cove, but it’s just shuffling workers around a continuing care sector which is stretched well past its capacity.

He also noted that in addition to a shortage of CCAs, the province already has a “well documented shortage of early childhood educators,” which he says is the result of “underpaying and disrespecting the people (overwhelmingly women) who do care work.”

Parsons says the notion you should look to underpaid childcare workers to support underpaid continuing care workers “highlights the very gendered way that care work happens”:

…a largely female workforce are employed to care for people, but the workforce is paid so poorly for that work that they can’t afford to pay someone else to care for their own loved ones.

 

Devil in details

McFadgen, a licensed practical nurse who has worked 20 years in long-term care, was more open to the idea — albeit with lots of caveats and “so many questions.” When I spoke to her by phone this morning, she told me,

If someone said to me, “Hey, we’re going to provide childcare in long-term care,” I’d be like, “Wow, what a great idea!” Because I believe it’s a great idea. But the devil, as you would know, would be in the details.

Details like, will this be regulated childcare? (I’d wondered about this myself so I’d looked up the rules governing daycares in NS and it appears that if the center is to have 10-12 spaces, it will have to be regulated.)

But then there’s the question of pay for early childhood educators (ECEs) — will they  be compensated like those in the province’s pre-primary program (where McFadgen said they tend to have benefits) or like those in the province’s broader childcare sector (who generally don’t).

And what about hours — McFadgen noted that CCAs (and “frankly everybody”) work 12-hour shifts. Will the daycare be open 12 hours? Will you drop your child off before your 7 AM shift and leave them until 19:00?

What happens, she asked, when the parent is “mandated” to work additional hours, a situation she says was once rare in long-term care:

When I started, “mandating” was not a word in our vocabulary…”Overtime” was a word. The odd time they’d go around and [say], ‘Would you like an overtime shift?’ And people would take it because it was so rare, it was like a treat, ‘Oh, Christmas is coming, I’ll take the overtime…

Now, she says, 16-hour shifts are not uncommon, and she wonders if the onsite daycare would be prepared to accommodate them — particularly for single parents.

And while she thinks the idea of involving seniors is great — and points to Scandinavian countries where long-term care facilities often incorporate daycares — she worries, in a COVID environment, about mixing “the vaccinated with the unvaccinated.” Still, she said, “We’re not going to be in this pandemic forever,” and the daycare pilot may be a sign of “forward-thinking” on the part of the Department of Health and Wellness. “It’s going to take more than childcare” to fix what’s wrong with long-term care, but, McFadgen says, she would ” never discourage thinking differently for Nova Scotia.”

Still, the bottom line for McFadgen, as for Parsons, seems to be that this is nibbling around the edges of the problems with the healthcare system which she attributes to years of “starving the system of resources.” When the CEO of the Cove says CCA wages are low, “she’s right,” says McFadgen. “and that’s nothing new. If you’re a CCA you’re probably living in poverty.”

What’s needed, she says, is a multi-pronged approach that includes support in education, support in the workplace, a living wage and the restoration of pride in work she says can be both “amazing” and “rewarding” when it is valued properly.

 

Young & Old

If this program actually did live up to its billing — if it resulted in truly affordable (preferably free) daycare, if it allowed workers to drop their children off before their 7 am shifts and visit with them on their lunch and other breaks, if the facility found a way to involve residents into the program, it could be a very good thing.

A quick Google search reveals some pretty inspiring examples of seniors and pre-schoolers sharing space. This Toronto Star story from 2016, for example, focuses on Kipling Acres long-term care home, one of three municipally-owned homes in Toronto that also house city-operated early learning and child-care centers. Twice a week, children from the center go upstairs to “‘move and groove’ with their elderly neighbors.” There are other organized activities — like bingo, crafts and cooking — but as reporter Laurie Monsebraaten writes:

Opportunities for spontaneous interaction, such as strolling through the halls when the weather is bad, or dropping in on the adult day program where one elderly participant loves to lead singsongs with the kids, are also encouraged.

Dr. Samir Sinha, director of geriatrics at Mount Sinai and the University Health Network Hospitals, is “a huge fan of the concept.”

Although Sinha is not aware of any specific studies on the impact of interactions between young children and the frail elderly, volumes of research show that seniors who are socially engaged have better health. They are less likely to feel lonely or depressed and tend to have lower blood pressure and delayed cognitive decline, he notes.

“There is growing interest and support for what we call intergenerational activities — the concept of bringing the generations together to promote intergenerational connectivity,” says Sinha, appointed in 2012 to lead the province’s Seniors Strategy. “It can also help to fight ageism.”

Monsebraaten referenced media reports about a Seattle long-term care facility, Providence Mount St. Vincent, that shares space with a pre-school (it’s the subject of this PBS News Hour documentary) and I also found this 2019 piece about St. Joseph’s Home for the Aged and Hospice in Singapore, which also includes a childcare center for “about 50 children, ages two months to six years.”

As McFadgen says, the devil will be in the details — and as wonderful as such a program could be, it still might not be enough to compensate for the low-pay and hard grift of CCA work — but it does sound like a bureaucracy trying something new and I agree, that’s not to be sneezed at.