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HSABC research examines widespread staffing shortages, erosion of public rehab care

Many British Columbians, lack access to rehabilitative care that can help them recover from COVID-19, avoid developing other debilitating chronic diseases or help self-manage conditions that can lead to hospitalization or require surgery. Improving public access to rehabilitative care will go a long way in addressing health equity. 

Vancouver (01 Nov. 2021) A new report released today by Health Sciences Association of B.C. (HSABC/NUPGE) provides the first comprehensive assessment of the state of public rehabilitative care in British Columbia.

The report’s findings paint a troubling picture of severe staffing shortages, a lack of services in many communities, and long wait times for patients and clients, including children and their families.

Report shows lack of access to rehab care slows recovery from COVID-19 and makes health worse

We’re Chronically Understaffed: A Report on Public Rehabilitative Care in BC draws on statistical data and interviews and focus groups with HSA members who provide frontline care for patients requiring therapy for debilitating illness, chronic disease, injury, or for recovering from surgery.

Rehabilitative care includes physiotherapy for strength and to enable movement, occupational therapy is for the skills necessary for everyday living, and speech and language therapy for communication and swallowing.

44% of adults 20 and older have at least 1 of 10 common chronic conditions, which increases to 73% of adults in those 65 and older. Many of these chronic diseases are preventable or manageable with the appropriate therapy and support. COVID-19 has also increased the need for therapy for patients suffering from acute illness and long COVID.

However, many British Columbians lack access to rehabilitative care that can help them recover from COVID-19, avoid developing other debilitating chronic diseases, or help self-manage conditions that can lead to hospitalization or require surgery. Improving public access to rehabilitative care will go a long way in addressing health equity.

Key findings

The report reveals a number of findings. 

  • Real per capita funding for hospital diagnostic and therapeutic care in B.C. declined from $232 to $217 between 2005/06 and 2018/19.
  • Access to public rehabilitative care is stagnant or declining in most regions due to inadequate funding, understaffing, and privatization.
  • Low baseline staffing levels constrain B.C.’s ability to meet the public rehabilitation needs of a growing population:
    • 17 full-time equivalent (FTE) public physiotherapists per 100,000 British Columbians
    • 19 FTE public occupational therapists per 100,000 British Columbians
    • 5 FTE public speech-language pathologists per 100,000 British Columbians
  • B.C. has the second-highest number of physiotherapists per capita practicing compared to other provinces, and yet the fewest working in the public sector among provinces with available data.
  • Shortages undermine care quality as frontline therapists are unable to work to their full scope of practice and have adequate time with patients.
  • Chronically unfilled vacancies are sometimes used to justify funding cuts. Rehab services are left with more severe staffing shortages and, as caseloads increase, more therapists leave the public system.
  • B.C. is not training enough rehabilitation therapists. B.C. falls far behind other provinces when it comes to in-province training and retention of professionals trained here.
  • There are limited or no opportunities for clinical leadership and career advancement for therapists in health authorities.
  • Outpatient rehabilitation is limited or non-existent in most communities. The erosion of public rehabilitative care and outpatient closures are the result of inadequate funding and staffing levels as the demand for therapy grows.
  • Public pediatric therapy services provided by Child Development Centres are understaffed and have long wait times.
  • Low compensation in the public sector means new graduates are attracted to private practice for the combination of smaller caseloads and higher compensation in a province where the cost of living is very high.
  • Public practice therapists are deeply committed to their patients, teamwork, and public health care.

More must be done

These challenges have been acknowledged by government and employers, and while some positive action has been taken, much more must be done.

The staffing shortages crisis is taking a toll on both patients and frontline professionals. In a 2021 survey of HSABC/NUPGE members, 41% said that they are considering leaving public practice due to unmanageable workload.

With an aging population, increasing demand for musculoskeletal care and pain management, and the acute and post-acute rehabilitation required for COVID-19 patients, public rehabilitative care is needed now more than ever.

And yet, B.C. faces widespread understaffing and professional shortages, a lack of services in many communities, and long wait times. It is placing a greater burden on emergency services, acute and long-term care because patients do not have access to preventative therapy in the first place.

You can find the report's recommendations in the full report that is available to download from the HSABC website