In 2023, the most significant foodborne illness outbreak in Canada was reported. At the centre of the epidemic was Fueling Brains Daycare, located in Calgary, Alberta. The leading cause was E. coli. Before the outbreak, public health inspections of the daycare reported several violations, such as lack of cleanliness in the facility, cockroach infestation, and poor-to-no temperature controls during the transportation of food, cooking food, and/or food preparation. The result of this case has not only impacted the daycare, attending children, and staff but also had an enormous financial impact on the centre. Those children who got sick may face long-term and potentially chronic damage to their health. Ultimately, this outbreak could have been avoided or mitigated as the real cause was human negligence, lack of enforcement from the local health board, food safety awareness, overworked staff, labour costs, and lack of proper food safety training. (Sousa, A. 2024, July 4).
According to the Public Health Agency of Canada (PHAC), foodborne illness are estimated to affect 4 million Canadians each year; of those, roughly 11,600 are hospitalized and 238 die. Of the estimated 4 million illnesses yearly, 1.6 million are caused by known bacteria, viruses, or parasites, while 2.4 million cases come from unknown causes (Mcintosh, 2023).
On review of this case, retirement and long-term care residences face similar issues, mainly labour shortages and the lack of food safety training. Many of the reoccurring problems facing long-term care employees and the health care sector have been exacerbated by the COVID-19 pandemic. During the height of the pandemic, several long-term care homes across the province reported critical staffing shortages, impacting the quality of resident care and employee safety. As per the media, the health sector in Canada is in crisis due to the impact of COVID-19. At the forefront is the shortage of nurses, doctors, and personal support workers, however, what is not widely noted is the chronic shortage of qualified cooks and food/dietary service workers. This has often left the dietary department working short and struggling to find suitable staff coverage for shifts. This may lead to increased overtime costs, staff burnout from excessive workload, diminished workplace morale, lower employee retention rates, decreased quality in food production, inadequate or nonexistent food safety monitoring protocols, and temporarily staffing shifts with unqualified personnel. All these factors could adversely affect the quality and safety of care provided to residents.
Suitable staffing is essential to meeting the needs of all long-term care residents. Although this article focuses on long-term care, staffing issues are broader than this area of health care and dietary departments. This concern also extends to retirement homes.
As noted, the impact of COVID-19 was unprecedented, rippling through the health care system and challenging all levels of health care providers and their staff. Tragically, it was the residents, their families, caregivers, and loved ones who were most impacted. This resulted in a public inquiry into the Ministry of Health at the provincial level, how health care policy was governed, and what the health care sector needed to change and update regarding its current practices.
At the provincial level, it has been long recognized that health care has been subjected to budget restraints, one of which leads to fewer on-site audits and monitoring. This even occurs at the municipal level in food safety inspections, unless there is a complaint or food safety concern. Resident homes were restrained, and the government, especially in Ontario, adopted the attitude that health care should follow an “if it isn’t broken, don’t fix it” approach. Additionally, regulatory guidelines were often complex and restrictive. In a long-term care staffing study (February 2020), Ontario’s Ministry of Health sought strategic input on staffing in long-term care in Ontario. It is important to note that input was comprised of operators, experts in the health care field, care representatives, residents, residents’ families, and academics analyzing or studying the health care sector.
One of the main concerns based on feedback from the long-term care staffing study (February 2020) is that “while the demand for long-term care and resident acuity has increased year over year, staffing levels and access to training have not kept a corresponding pace.” Further to the feedback from the study was that there was greater demand and workload placed on staff at all levels and increased risk of injury (physical and mental) to staff, and ultimately the residents, as safety policies, regulations, standard procedures, and practices were skipped or completed at minimum level with less attention. This resulted in an already stressful environment due to the current pressures and impact of COVID-19. (Longterm care staffing study, February 2020). In addition, given the circumstances and media reports, the climate of working within health care itself had become a staffing challenge as, to potential new hires or appropriate candidates, this was now an unattractive career choice. Adding to the problem was, and still is, rural homes and care facilities facing a much-diminished labour pool to draw on. The populations of these areas are small and those who wish to work at the facility may require significant travel at their expense. This brings in the factor of a cost-benefit ratio that often informs their decision.
CHANGES NEEDED IN LONG-TERM CARE HOMES
Among the 85 key findings from the February 2020 Long-Term Care Staffing Study to address the staffing crisis were recommendations to invest in staff, position long-term care homes as a top career choice, and make these facilities better workplaces that promote work-life balance. Investing in staff includes offering professional growth and job promotion opportunities and working toward creating a healthy long-term care culture. This is not to say that individual homes do not try to maintain a healthy work environment for staff, but due to extensive workload pressures this has become an added reasonability with little engagement and intended outcome.
Further to these recommendations, all provincial governments in Canada need to increase funding and provide leadership that is manageable by regulatory legislation by modernizing this process. Provinces must also improve public perception of health care as a career of choice, develop partnerships with local college programs that offer culinary arts and apprenticeships, and market long-term care as a career alternative to working in hotels, restaurants, or other organizations as food service providers. It is important to note that working as a chef or a cook in long-term care or retirement homes is often perceived as less desirable and creatively restrictive. However, resident taste changes, satisfaction, and investment in some retirement residences, mainly retirement homes, are usually comparable to five-star hotels, which desire advanced culinary skills and scratch cooking.
At the core of this article is resident and patient safety through safe food-handling practices and the importance of having trained staff to ensure these practices are adhered to. Yes, Canada’s health care system has many staffing challenges, although, to some degree, this is nothing new. What it took was the impact of COVID-19 to bring to the forefront the changes must be made in the wake of unprecedented tragedy.
Wes Wilkinson, a professor in the School of Business & Hospitality at Algonquin College, is deeply committed to education. His passion for teaching is evident in his roles instructing culinary management, the four-year Bachelor of Culinary Arts and Food Science, and the four-year Bachelor of Hospitality and Tourism Management. Wes’ dedication to his students is further demonstrated by his membership in the Canadian Society of Nutrition Management for over 20 years and his pursuit of higher education, holding a master’s degree in tourism management and a master’s in education. Before joining Algonquin, Wes honed his skills in various restaurants, hotels, long-term care, and retirement homes.
SOURCES
Sousa, A. “Calgary Daycare will reopen after the E. Coli scare.” Global News. 4 July 2024. globalnews.ca/News/10604474/Calgary-Daycare-Fueling-Brains-E-Coli/
“The Long-Term Care Staffing Study,” Long- Term Care Staffing Study Advisory Group, Ontario, https://files.ontario.ca/mltc-long-term-care-staffing-study-en-2020-07-31.pdf
Chini, Joey. “What are the most common causes of food poisoning in Canada?” CTV News. 14 Sept. 2023. www.ctvnews.ca/health/what-are-the-most-common-causes-of-food-poisoning-in-canada-1.6562104