Commentary

By Jessica Otoo-Appiah, Lizzie Houlding, Lauren Humphrey & Anonymous

---

Growing up, I could not remember my mother taking time off work when she was sick as a labourer in the manufacturing industry. As the sole income earner in a single-family household, my mother often pushed her body to the brink. There was no room in her life for sickness. She would frequently say that she could not afford to miss a day of work as she was paid minimum wage, had no paid sick days, and had limited benefits. Today,when she experiences aches and pains, I question how much of her pain is related to inadequate treatment of her previous injuries and ailments. I now recognize that my mother worked in precarious employment. The issues associated with precarious employment are longstanding but have been highlighted by the pandemic. The definition of precarious work is broad and complex; however, part-time, casual, temporary, and non-unionized employment are considered precarious; as they are often associated with low wages, job insecurity, and a lack of workplace protections (1,2). Cashiers, grocery store clerks, warehouse workers, and caregivers in long-term care are positions that commonly consist of elements of precarity. These positions were also deemed essential during the COVID-19 pandemic (3,4). Precarious workers maintained access to vital necessities and kept our economy operational while their protections remained largely the same. In severe cases, to the detriment of their health and the health of their communities (3,5,6).

Ontario’s Employment Standards

Under Ontario’s current Employment Standards Act (ESA), most part-and full-time workers in the province only have the right to three job-protected, unpaid sick days (i.e.,sick leave) per calendar year,which cannot be carried over to the following years (7). There is no right to paid time off, but employers may choose to provide this benefit (7); however, this is rare for precarious workers (8,9). Additionally, some precarious workers, such as in-home Personal Support Workers (PSWs), are exempt from the right to break time, time off between shifts, and limits on work hours (10). Precarious workers, mainly women, immigrants, Indigenous peoples, racialized individuals, and young people(7,9,11), often earn significantly less than the average annual income in Canada (in 2018, temporary workers made almost $6 less per hour than their permanent counterparts;(12))and as such do not feel like they can afford unpaid time off. Unsurprisingly, communities with a high population of essential precarious workers, like Brampton and Scarborough, saw the highest rates of COVID-19 infections in the country(13–15).

Lessons from the Recent Pandemic

Throughout the pandemic, there are countless stories where the culmination of limited benefits and poor workplace conditions prevented workers from taking sufficient time from work when they were sick or forced workers to return to work before fully recovered. Leo (a pseudonym used for anonymity) is an in-home personal support worker (PSW). Due to his lack of benefits, he continued to work while sick, fell asleep while driving to see a client, and suffered a devastating car crash. This left him with ongoing psychological and physical trauma that made it hard to return to work —leading to a chronic financial burden. If Leo were to see a rehabilitation therapist, they would probably ask him about his work history and activities he hopes to return to. It is less likely that they would consider the work conditions that led to Leo’s accident, and even if they did, therapists often feel helpless in supporting clients to change their workplace practices. Suppose Leo did not directly have his accident while working. In that case, it is unlikely that he would even have access to rehabilitation therapy, as most PSWs do not have extended health benefits to support recovery from accidents outside the workplace. Suppose the Ontario government had required Leo’s workplace to provide him with healthy working conditions in the first place. In that case, both Leo and the medical system might have avoided more costly personal and financial losses.

Feasibility of Improved Workplace Conditions

When it comes to employment issues such as paid time-off and wage negotiations, workers are often faced with significant pushback, primarily from employers and fellow workers who worry that their demands could have unintended consequences for the workforce. During the pandemic, the most prominent corporations made unprecedented profits while keeping wages and benefits low, resulting in the most significant transfer of wealth from the working class to the elites in human history(18). However, many point to the impact of mandatory paid sick days and minimum wage increases on small businesses, specifically reducing the number of available worker positions due to increased overhead costs for owners, as rebuttals to these proposed solutions. The Canadian Federation of Independent Business released an article “myth-busting” the impact of a minimum wage increase on small businesses. The overarching theme is that the detriment of desperate, sick workers far outweighs the benefits in saved cost (19,20). Workers need advocacy at the legislative level but also need to be empowered to advocate for changes within their workplaces.

Global Fair-work Practice Models

If we look to our counterparts across the ocean, we can see models that utilize a sector-specific model for labour negotiations and fair-work practices. New Zealand has recently implemented the Fair Pay Agreements Bill (21). Employment standards will be negotiated from a sector-specific lens allowing for minimum standards to be tailored depending on the need. For example, healthcare workers would be negotiated separately from restaurant workers. This is not unlike the pandemic-specific wage increases in Ontario, but this model could be extended to other areas. Similarly, this idea could be applied to paid sick days and allow for more far-reaching implementation. For example, the most in-need sectors such as healthcare and public-serving roles could see a more significant number of job-protected paid-sick days allotted more quickly without necessarily being in sync with other sectors. While the intricacies of different labour systems could take novels to uncover, one thing is clear: there are plenty of solutions to address the dire work conditions facing Ontarians today.

The Role of Rehabilitation Healthcare Workers

As healthcare workers in rehabilitation, we examine workplace conditions in terms of workplace injuries, the physical requirements of one’s occupation, and the psychosocial impact of our patients’ work. However, health workers must also consider legislative changes required to circumvent harm. Labour groups, including health-worker unions, have fought hard to demand the provincial government mandate ten employer-provided permanent paid sick days. The fruits of this movement were a begrudging three days of paid sick leave day through the Worker Income Protection Benefit (WIPB). Even still, while unpaid leave has no expiry date (16), the WIPB is set to expire on July 31, 2022. Organizers are now scrambling to protect the meager three days provided by the Ford government (17). Healthcare workers believe better solutions offer more robust protections for their patients. Understanding who has access to paid benefits and who does not is key to understanding who ends up in the ICU or inpatient rehab. With the ending ofthe WIPB, we fear we will see even more patients affected by insufficient health protections, needing to be re-taught how to breathe, walk, and function.

“Workers need advocacy at the legislative level but also need to be empowered to advocate for changes within their workplaces.”

Conclusion

Rehabilitation workers serving these patients, or watching from a distance, may seepatients who cannot access care and may ask themselves —how can I help change a system when all I am trained to treat is the physical? Healthcare workers in all sectors, including rehabilitation, are uniquely positioned to advocate for the needs of their patients. We liaise with insurers and have greater access to governing bodies, which allow us to advocate for change at multiple levels. We see and hear hundreds of stories, not only of broken bones but of broken systems. It is time for us to speak up and say: enough is enough. We know which policies will protect our patients, but are we willing to join the fight to achieve them?

Acknowledgements

We would like to acknowledge and thank Sarah Shahid and the Decent Work and Health Network for all the work they have done to advance workers health and for their guidance in writing this op-ed, including the publication of their recent report “Prescription for a Healthy Pandemic Recovery: Decent Work for All” (27).

Justice Rehab is a group of rehabilitation students from physiotherapy, occupational therapy, rehabilitation science, and speech-language professions fighting for health justice at the University of Toronto and beyond. The students of Justice Rehab were proud to march alongside the Ontario Federation of Labour May 1st Rally to demand ten permanent paid sick leave days and a $20 minimum wage for all Ontario workers.

Featured image by Kampus Production (Pexels).

To refer to this article, it can be cited as:

Otoo-Appiah J, Houlding L, Humphrey L, Anonymous. Are Ontario Workers Paid or Paying to be Sick at Work?. rehabINK. 2022:13. Available from: https://rehabinkmag.com

---

References

1. Rodgers G. Precarious work in Western Europe: The state of the debate. Precarious jobs in labour market regulation: The growth of atypical employment in Western Europe [Internet]. Geneva: International Labour Organisation; 1989 [cited 2022 Apr 28]. p. 1–17.
2. Famira-Muehlberger U. Precarious Work. In: Michalos AC, editor. Encyclopedia of Quality of Life and Well-Being Research. Dordrecht: Springer Netherlands; 2014. p. 5000–3.
3. Mojtehedzadeh S. Their work is keeping Canada safe. But they earn a fraction of the national average. Toronto Star. 2020 Mar 31.
4. Stanford J. 10 ways the COVID-19 pandemic must change work for good. Vancouver, Canada: Centre for Future Work; 2020 Jun.
5. Brandie B. Why Canada’s low-paid, precariously employed essential workers need a better deal [Internet]. CBC Radio. 2021 [cited 2022 Apr 6]. Available from: https://www.cbc.ca/radio/sunday/future-of-essential-work-1.6095387
6. Araneta P. ‘Precarious work is a health hazard’: When staying home isn’t an option [Internet]. Global News. 2021 [cited 2022 Apr 6]. Available from: https://globalnews.ca/news/7577119/coronavirus-stay-home-order-workers-covid19/
7. Employment Standards Act, SO 2007, c 41, s 50.
8. Mitchell CM, Murray J. Vulnerable workers in precarious jobs. Ontario, Canada: Ministry of Labour; 2019 Oct.
9. Noack A, Vosko L. Precarious jobs in Ontario: Mapping dimensions of labour market insecurity by workers’ social location and context [Internet]. Ontario, Canada: Law Commission of Ontario; 2011 Nov [cited 2022 Apr 6]. Available from: https://www.lco-cdo.org/en/our-current-projects/vulnerable-workers-and-precarious-work/commissioned-papers/precarious-jobs-in-ontario-mapping-dimensions-of-labour-market-insecurity-by-workers-social-location-and-context/
10. Ministry of Labour, Training and Skills Development. Household, landscaping and residential building services [Internet]. Government of Ontario; [updated 2019 Oct 21; cited 2022 Apr 28]. Available from: https://www.ontario.ca/document/industries-and-jobs-exemptions-or-special-rules/household-landscaping-and-residential-building-services
11. Bradley R. Why does precarious work matter? The implications of precarious work on job and life satisfaction In Canada [Internet] [Undergraduate thesis]. Acadia University; 2021 [cited 2022 Apr 6]. Available from: https://scholar.acadiau.ca/islandora/object/theses:3648/datastream/PDF/file.pdf
12. Statistics Canada. Temporary employment in Canada [Internet]. Statistics Canada. 2019 [cited 2022 Apr 19]. Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/190514/dq190514b-eng.htm
13. Frisque G. COVID-19 Map: Jan. 7 report shows areas of Brampton hardest hit by Omicron variant with entire city a hot spot. The Star [Internet]. 2022 Jan 7 [cited 2022 Apr 28]; Available from: https://www.thestar.com/local-brampton/news/2022/01/07/covid-19-map-jan-7-report-shows-areas-of-brampton-hardest-hit-by-omicron-variant-with-entire-city-a-hot-spot.html
14. Jennifer Ferreira. Brampton, Ont. mayor urges province to continue prioritizing COVID-19 hotspots [Internet]. CTV News. 2021 [cited 2022 Apr 14]. Available from: https://www.ctvnews.ca/health/coronavirus/brampton-ont-mayor-urges-province-to-continue-prioritizing-covid-19-hotspots-1.5446754
15. Katawazi M. 31 Toronto neighbourhoods mark zero COVID-19 cases, including some hot spots  [Internet]. CTV News Toronto. 2021 [cited 2022 Apr 14]. Available from: https://toronto.ctvnews.ca/31-toronto-neighbourhoods-mark-zero-covid-19-cases-including-some-hot-spots-1.5519546
16. Government of Ontario. Infectious disease emergency leave [Internet]. Ontario. 2022 [cited 2022 Apr 26]. Available from: https://www.ontario.ca/document/your-guide-employment-standards-act-0/infectious-disease-emergency-leave
17. Employment Standards Act, SO 2007, c 41, s 50.1.
18. Lai E, Bush D. To defeat Ford we need to put workers first. Spring [Internet]. 2022 Feb 16 [cited 2022 Apr 11]; Available from: https://springmag.ca/to-defeat-ford-we-need-to-put-workers-first
19. Wong Q. Debunking Minimum Wage Myths: Impact on Payroll [Internet]. Canadian Federation of Independent Business; 2015 Sep 30 [cited 2022 Apr 28]. Available from: https://content.cfib-fcei.ca/sites/default/files/article/documents/rr3368%20%281%29_0.pdf
20. Wong Q. Debunking Minimum Wage Myths: Impact on Jobs [Internet]. Canadian Federation of Independent Business; 2015 Sep 30 [cited 2022 Apr 28]. Available from: https://content.cfib-fcei.ca/sites/default/files/article/documents/rr3369%20%281%29.pdf
21. Ministry of Business, Innovation & Employment. Fair Pay Agreements [Internet]. New Zealand Government; [updated 2022 Apr 06; cited 2022 Apr 28]. Available from: https://www.mbie.govt.nz/business-and-employment/employment-and-skills/employment-legislation-reviews/fair-pay-agreements
22. Canada Revenue Agency. Who can apply: Canada Recovery Sickness Benefit (CRSB) [Internet]. Government of Canada; [updated 2022 Mar 02; cited 2022 Apr 28]. Available from: https://www.canada.ca/en/revenue-agency/services/benefits/recovery-sickness-benefit/crsb-who-apply.html
23. Who can apply: Canada Revenue Agency. Canada Recovery Caregiving Benefit (CRCB): [Internet]. Government of Canada; [updated 2022 Mar 02; cited 2022 Apr 28]. Available from: https://www.canada.ca/en/revenue-agency/services/benefits/recovery-caregiving-benefit/crcb-who-apply.html
24. Government of Canada. EI sickness benefits: What these benefits offer [Internet]. Government of Canada; [updated 2022 Apr 11; cited 2022 Apr 28]. Available from: https://www.canada.ca/en/services/benefits/ei/ei-sickness.html
25. Government of Canada. Caregiving benefits and leave [Internet]. Government of Canada; [updated 2022 Apr 11; cited 2022 Apr 28]. Available from: https://www.canada.ca/en/services/benefits/ei/caregiving.html
26. Ministry of Labour, Training and Skills Development. Critical illness leave [Internet]. Government of Ontario; [updated 2022 April 04; cited 2022 Apr 28]. Available from: https://www.ontario.ca/document/your-guide-employment-standards-act-0/critical-illness-leave
27. Decent Work and Health Network, http://www.decentworkandhealth.org. 2022. Prescription for a Pandemic Recovery: Decent Work for All. [online] Available at: <https://drive.google.com/file/d/1LDnDVSK6RH4E48eFhjmQiVUzStp1dYEM/view&gt; [cited 17 May 2022].

Supplementary Materials

Differences and similarities between sick leave and infectious disease emergency leave:

Each leave can be taken as full or partial days; however, employers can count partial sick days taken as full sick days to determine if a worker has used all eligible leave, if they pay workers for the time actually worked (7,17). It may be considered reasonable (7,17) for employers to request proof for either leave, depending on duration, attendance record, and availability and cost of the proof. Employers seeking medical notes to justify sick leaves can only ask for the expected duration if the healthcare provider providing the note assessed the worker in person, and the date of the assessment (7). However, medical notes cannot be requested to justify infectious disease emergency leave (17).

Some workers may have contracts that contain more rights than those provided by the ESA (e.g. four paid or unpaid sick days), in which case the contract applies rather than the ESA. If the contract is similar to the ESA (e.g. three paid or unpaid sick days), any sick leave taken is considered to be taken under both their contract and the ESA (e.g. a worker who takes all three paid sick days under their contract has no more unpaid sick days under the ESA either) (7). For paid infectious disease emergency leave, workers who had no more paid sick days under their contract as of the program’s implementation may still have had three days of infectious disease emergency leave under the ESA, but there are specific situations that left some workers without any WIPB (17). Additionally, workers whose pay varies because it includes performance-related wages (e.g. commission and piece work) are typically entitled to the minimum wage for hours missed (17).

Comparison of sick leave, infectious disease emergency leave, and other related programs:

Program	Reason	Benefit	Duration
Sick leave	Personal illness, non-work-related injury, or medical emergency (7)	Unpaid job-protected leave (7)	Up to 3 days per calendar year (7)
Infectious disease emergency leave, unpaid	Personally having COVID-19, obtaining the vaccine, side effects from the vaccine, workplace closures, mental health concerns, recent travel, or travel restrictions preventing return to Ontario Caring for family as a result of these events (17)	Unpaid job-protected leave (17)	Up to 3 days beginning January  25; ongoing (17)
Infectious disease emergency leave, paid (COVID-19 Worker Income Protection Benefit, WIPB)	As above, except for reasons related to travel and orders such as workplace closures (17)	Usual wage, up to $200/day (17)	Up to 3 days beginning April 19, 2021; set to expire July 31, 2022 (17)
Canada Recovery Sickness Benefit (CRSB)	Unable to work >50% of the week due to illness, self-isolating, or at risk of health complications due to COVID-19 (22)	$500/week (22,23)	Up to 6 weeks; between September 27, 2020 and May 7, 2022 (22,23)
Canada Recovery Caregiving Benefit (CRCB)	Unable to work >50% of the week due to  caring for a family member who needs supervision for the above reasons or if their regular facility (e.g. school) is unavailable due to COVID-19 (23)
Employee Insurance (EI) Sickness Benefits	Being sick, injured, or quarantined (24)	Up to 55% of earnings (maximum $638/week) (24,25)	Up to 15 weeks (24); ongoing
EI Caregiving Benefits	Caring for someone who is “critically ill or injured”, or providing end-of-life care (25)		Critically ill or injured person: under 18: up to 35 weeks; 18+: up to 15 weeks (25) End-of-life care, any age: up to 26 weeks (25)
Critical Illness Leave	Caring for someone who is “critically ill or injured”, not including chronic conditions (26)	Unpaid job-protected leave (26)	Person under 18: up to 37 weeks (26) Person 18+: up to 17 weeks (26)