In the wake of leaked recordings that revealed sick workers were continuing to go into care homes during the deadliest COVID-19 outbreak in B.C., a complex picture is emerging about how the “tough it out” mindset persists throughout the province.

Commitment to and affection for the seniors they serve, a reluctance to overburden their colleagues, pressure from short-staffed employers and sometimes denial are all described as factors that lead workers to continue to go back to the job site despite experiencing symptoms.

In a Zoom presentation obtained by CTV News, a Vancouver Coastal Health doctor told families of residents at Little Mountain Place that the care home’s staff members were slipping up when it came to their use of personal protective equipment. The short-staffed facility had also been bringing in staff for double shifts for many days in a row and they had been dismissing fatigue and aches as the product of being overworked; those are classic COVID-19 symptoms as well.

“People who were pushing through things and probably explaining away things in an attempt to really help the site out," said Dr. Andrew Hurlburt in the Dec. 29 recording.

A granddaughter of one of the 41 residents who died in the outbreak compiled a response from several families grappling with loved ones sick or dead from the virus. The response blames the operator of Little Mountain Place for what the families describe as a slow response and inadequate infection controls, but also a reliance on staff for self-diagnosis. They believe Little Mountain had a responsibility to provide a safe workplace culture promoting the well-being of residents and staff, as well as to enforce those of expectations.

“Our members are shocked and a bit disappointed at the way their work has been characterized,” said Health Employees Union spokesperson Mike Old, who first became aware of the admissions in the recordings from media reports. “We were unaware of the analysis from the infection control doctor at Vancouver Coastal … Most workers understand the importance of monitoring their health and not going to work if they're sick, but there's no question that over the last few years, in the face of a very serious staffing crisis, workers do feel some pressure to come into work when they're feeling a little unwell.”

Old’s group conducted a survey of 800 members in April, during the first wave of care home deaths, and found that more than a third felt pressured by their employer to go work despite feeling sick.

The president of the BC Care Providers’ Association disputed that idea.

“Operators that I have talked to have told me of instances where they've actually told people to go home because they don't want people to bring the virus into the (care) home,” insisted Terry Lake, who suggested it’s a misplaced sense of dedication at play. “Don't forget these residents have been essentially isolated from their families for almost a year and those at the bedside have become their family. So, there's a great sense of obligation on the part of long-term care workers for their patients, but also for their team members, because we know everyone is working flat out. They're getting burned out. And so I think there's a real sense they don't want to let anybody down, so that may lead them to downplay some of the symptoms that may be experienced."

Vancouver Coastal Health, which is responsible for overseeing outbreaks at care homes, refused to discuss the recordings when CTV News asked about them. Instead, a spokesperson copied and pasted an email transcript of the response Dr. Bonnie Henry gave when asked about the situation by another CTV News journalist. 

Henry said a culture of “presenteeism” – working while sick to support coworkers and patients – combined with denial that they may have COVID-19, are factors that keep workers showing up even when they should be staying home.

Fraser Health’s top doctor said the pressures can also come from the employer.

"I think there's pressures on multiple levels. It might be coming from the facility, it might be coming from the professional duty people feel, as well as sometimes connection with the teams because people know people have to work harder if there’s staffing challenges,” said Dr. Victoria Lee, who added Fraser Health has a pool of more than 200 workers ready to deploy to care homes experiencing outbreaks.

“We need to make sure there's adequate levels of support and staffing available so that people do not go to work ill."

Old warned that the problem of retaining staff in a career that can be rewarding but also challenging and even dangerous has been going on for years and that huge variations in sick-day allotments remain, despite the province spending millions of dollars on topping up salaries for workers who’ve been underpaid for years and working multiple jobs to make a living. The province put an end to that last year to curb the transmission of COVID-19 infections between facilities.

"At the end of the day, we all have a collective responsibility to try and make sure these workers who are walking into a risky situation every day have the support they need to do their jobs and provide good care," Old said. "We need to treat the elderly who live in these homes and the workers who care for them with more respect."