text: By May, the worst-case scenario everyone feared had silently engulfed long-term care facilities across Canada. Cleave them out, and it looked like the country had mainly managed to escape a full-on nightmare during the first wave. There was no broad shortage of PPE inside hospitals. No body bags trimming the hallways. Sirens did not play a soundtrack on the street. Masses of doctors had not been forced into gut-wrenching ethical decisions, choosing who would live and die. Inside care homes, however, a different narrative stretched into chaos. Staff in many facilities reported low or no PPE. In some places, management locked up protective equipment, fearing the staff would steal it, leaving them with nothing to wear on their shifts. New policy and training procedures were developed too slowly, and often, once they were in place, were poorly communicated. Fear and misinformation wormed through countless care centres. Plenty of people quit or got sick, and staffing schedules began to resemble emptied honeycombs. While Canada had a relatively low COVID-19 mortality rate compared to other developed countries, in the initial months of the pandemic it earned the dubious distinction of having the highest proportion of deaths occurring in long-term care. Here, long-term care residents accounted for 81 per cent of all COVID-19 deaths; the average in other countries stood at 38 per cent. More than 9,650 staff members had become infected, representing 10 per cent of all virus cases in Canada. Nine of those workers had died.
  
  The disaster rumbled under the radar until, that same month, the Canadian Armed Forces (CAF) released a report on five care homes in Ontario. The province had called on the military in April to help with the urgent staffing crisis—or, as the CAF put it, "to provide humanitarian relief and medical support." The resulting report, which matter-of-factly detailed the distressed state of five homes in the province, was both devastating and nauseating. At one home in Etobicoke, residents with COVID-19 were not isolated and staff were given inadequate PPE and the (false) impression that PPE didn't have to be changed between patients or rooms. New staff weren't trained. Many personal support workers (PSWs) at the home couldn't access supplies to properly care for the residents, and they feared for their jobs if they used too many. Expired medication stocked the shelves. Cockroaches and other insects, like flies and ants, infested at least two homes. At one, in North York, some residents hadn't been bathed for weeks. Military staff observed patients crying for help with no response from PSWs or nurses for anywhere between thirty minutes to over two hours. At the other, in Pickering, patients were left in bed wearing soiled diapers. Food and belongings were kept out of reach. Mattresses were placed on floors, and walkers were hidden to prevent residents with mobility issues from wandering.
  
  Underfeeding, poor hygiene, and bed confinement were reported at several of the homes. At one, the smell of rotten food belched through the air. At others, evening shifts went completely unstaffed. Decontamination procedures often didn't exist or weren't followed. At a home in Brampton, PSWs didn't wash their hands between patients. Workers in many homes were under the same misconception as those in Etobicoke: PPE wasn't changed in between rooms, even when a resident was known to be COVID-positive; some wore scarves under their masks; equipment wasn't disinfected and neither were rooms. Across the board, staff burnout was rife. People were bone-tired. Some staff hadn't seen their families in months. In most cases, the lowered level of care wasn't intentionally cruel, or even wilfully subpar. The vast majority of PSWs were doing the best they could with little direction or training, even less protection, and severe shortages. A lot of them were being asked to perform nurses' duties beyond their skills or training. It was like trying to spread a tablespoon of jam over a dozen loaves of bread. As the CAF report noted, "The staffing is such that it is impossible to provide care at a pace that is appropriate to each resident or allow them any kind of independence."
  
  The report was surprising, and it wasn't. Laura Bulmer is a PSW advocate, registered nurse, and a full-time professor at a community college in Ontario. At first, she didn't pay too much attention to the incoming pandemic—in fact, she "pooh-poohed" the virus at the beginning of 2020. She had, to put it lightly, other things to worry about. In July 2019, her younger sister died from ovarian cancer. Six months later, Bulmer herself was diagnosed with uterine cancer after contracting pneumonia. She had surgery to remove her tumours in January, then later left the city for her family lake house to recuperate. Once the WHO declared COVID-19 a pandemic, Bulmer began to feel guilty for not being able to join the front line. She knew her health put her at sky-high risk levels, but she badly wanted to help. She wanted to be slogging it out with her fellow nurses. In April, she returned to work at her college—here she uses air quotes around "returned" because, really, she stayed at the lake house, working from her makeshift desk.
  
  As she made her way from the summit of Email Mountain, she read note after note that made her "blood boil." More than most, Bulmer knew the challenges PSWs faced: endemic short-staffing and scant resources, depressingly low pay, suffocating pressure to perform care that wasn't in their job description and for which they hadn't trained. For her entire career, Bulmer had worked to give PSWs the recognition they deserved—she'd created dedicated career fairs at her college, lobbied governments, and become chair of the Canadian Association of Continuing Care Educators—all so they wouldn't be treated, as one former student put it during the pandemic, like "glorified shit cleaners." Bulmer knew it would be far, far too easy to scapegoat them for the burgeoning long-term care crisis. She decided she wouldn't let it happen. This was how she could help.
  
  In May, she wrote an op-ed in Maclean's arguing that the national regulation of PSWs could have largely prevented the unfolding tragedy in long-term care facilities. The lack of standardization puts workers, residents, and the general public at risk, she told me, starting with an inconsistency in training and education. Training can take place in a high school, a community college, or a private career college. If they wanted to, she added, anyone, with or without experience, could join the bogus ranks and start their own school for training PSWs, luring new Canadians with the promise of quick learning, and even quicker hiring—all for an exorbitant fee, of course. On top of this, there isn't a singular name to describe such care work. A person may be called a PSW or a care aide, or they may be called a clinical assistant, a certified health aide, a home attendant, an orderly, or, as Bulmer put it, "tens of other names." Attempting to standardize a profession that has no standard name can feel like a dog chasing its tail. Without such regulation, however, it isn't only training that can vary wildly, but also pay and contract terms. As a result, many PSWs work at several homes at once to make ends meet. A pandemic like COVID-19, or an epidemic like SARS, forces them to pick one job site, creating a domino effect of short staff. The result of all this is a workforce that is majority women, many of whom are racialized or new to Canada.
  
  "We're talking about voiceless, vulnerable people looking after other voiceless, vulnerable people," said Bulmer. "And it's just a big shit show." Regulation would mean licensing, proper advocacy and ethics boards, and public registries. PSWs would commit to a professional code of ethics and standards of practice; so too would their employers. The public would be able to bring complaints and concerns forward to a professional college, which would, in turn, mete out discipline as necessary—a structure that exists for other professions that are responsible for the bulk of society's care, such as nurses, doctors, teachers, and so on. Bulmer believes standardization would also mitigate what she calls "scope creep," which can happen when overloaded facilities begin demanding PSWs do things for which they were never trained. Examples of this might be delegating a PSW to administer medication or change wound dressings, among other things, all of which require a level of medical assessment and are, incidentally, actions that the CAF reported being performed improperly. Bulmer and others have been advocating for regulation for at least fifteen years, stressing the benefits of all-around improved safety and care. If anything could nudge their dream closer to reality, it seemed—from the outside at least—like the pandemic might be it. As cases and deaths tallied higher and higher in care homes across the country, though, that isn't exactly what happened.
  
  The same day Bulmer officially returned to work, she also saw an email from a company that wanted to create a six-to-eight-week online PSW course. She lost it. How could a truncated online course hope to safely and effectively teach students everything they needed? You can't change a person's sheets through a screen, learn how to feed them, lift an unwieldy body into a wheelchair. She also wondered how many companies would try to cash in on the shortage. Bulmer lost it again when Quebec announced its own in-person fast-track program to train an additional ten thousand PSWs for fall. She understood the need to replenish the workforce. Quebec had been slow to enforce a ban on working at multiple care homes, and as a result, the disease had spread fast. By May, around nine thousand PSWs in Quebec had either refused to work or had become sick with COVID-19. But Bulmer doubted the mass of new students could learn how to provide effective care in just a few months, no matter the urgent need. She, and others, also worried about the burden it would place on PSWs already in the field, who had to help train the thousands of new workers. None of this would have happened if PSWs were already regulated, she surmised. More than that, she didn't think a quick fix would fix anything. After all, the pandemic hadn't created the mess; it had only exacerbated it.