February 2021

Long-term care homes overflow, and community services struggle. There aren’t enough workers to provide care to Ontario’s seniors. It’s tempting to blame COVID-19, but the gap has been growing for a long time. COVID-19 simply made us pay attention.

Nearly 60% of the people who care for the elderly are personal support workers (or PSWs). They are the largest workforce in Canada, and there aren’t enough of them. Some work in hospitals, some in long-term care homes, and some in the community. Many are middle-aged to older women whose first language isn’t English. Many also identify with racialized communities. They find jobs where and when they can, often working at more than one so they can earn a living. Part-time hours can add up to full-time work, but without the benefits full-time employees receive. We call them heroes, the backbone of the system, but they can’t take a day off when they are sick. They are tired, burned out, and afraid for themselves, their families, and their clients.

It’s not an easy job, and many can’t take it for very long. About 40% leave health care within one year after graduation. Each year, about 25% of PSWs with at least two years of experience leave long-term care, and only about half stay in health care for five years or more. Early in the COVID-19 pandemic, poor pay and lack of full-time jobs drove some away. Many never returned. Now, the system employs 30% fewer PSWs than before March 2020. We have some catching up to do even before we can meet the needs we know are coming.

Personal support workers in home care have it particularly hard:

• On average, they earn about $1.75 (or 9.2%) per hour less than PSWs in long-term care homes and about $3.57 (or 18.7%) less than those working in hospitals
• They have fewer benefits
• They travel between clients’ homes – sometimes at their own expense and often on public transit
• Their schedules can be inconsistent and hours irregular

It’s taken Ontario time to do something about it. Quebec, in contrast, began in the spring of 2020, with new recruitment and training programmes and incentives for support workers. In September, facing the pandemic’s second wave, Ontario rushed to recruit 2,000 PSWs. It offered bonuses to new graduates to work in long-term care. Now it has released a long-term care staffing plan.

The plan pledges large amounts to improve education and training, career paths, and working conditions. But there’s a catch. These are for PSWs who work in long-term care homes. What’s missing are the PSWs who work in clients’ homes. There are funds for home and community care, but only to delay admission to long-term care homes. There is nothing to help keep people out of institutional settings altogether.

Ontario wants to make working in long-term care an attractive career. It’s already much less attractive for those who work in the community. If PSWs in long-term care homes are the only ones who get higher pay and better working conditions, even fewer will choose home care. When Quebec offered better pay and recruitment incentives to workers in long-term care homes, some left the community to work in those homes. Home care organizations had to cut back on services and charge clients more.

Improvements in long-term care homes don’t have to come at the expense of home and community care clients and workers. It’s not an either/or situation. Long-term care homes and home care aren’t two systems. They are one. Clients move back and forth between their own homes, hospitals, and long-term care homes when their needs change. PSWs also move between home and institutional care settings. A true long-term care staffing plan has to consider all personal support workers.

Care Watch recommends developing a broad, integrated strategy and plan for building a pool of people to work in long-term care, wherever that care is needed. As a start, this plan needs to include:

• Consistent pay, benefits, and recruitment incentives
• Consistent education, training, and career opportunities
• Improved working conditions for all personal support workers
• More full-time jobs for those who need and want them

When home and community services are strong:

• There is less pressure on long-term care homes, because there are other alternatives.
• We have time to look into the best ways to care for elderly people. Other places have successful programmes that keep seniors in their communities and support their family caregivers. Some groups in Ontario – for example, people with developmental disabilities – live in shared arrangements that can serve as models.
• Government can hold long-term care homes to account. It’s easier to impose effective sanctions and force long-term care homes to meet standards when there are accessible home and community support alternatives. Home care clients suffered less from COVID-19 than those in long-term care homes. If Ontario had acted on the evidence from the pandemic’s first wave and invested in home care, the pandemic’s second wave would have been less devastating to seniors.

What can you do?

Government says it will take “concerted and cooperative effort” to solve the staffing problem. This is the perfect time.

• Stay alert. Watch what government promises and what government does. Check the announcements, check the news.
• Don’t be dazzled by large amounts of money. How will that money help all seniors, not only the ones in long-term care homes?
• Speak up whenever you can. Talk about seniors to politicians, newspapers, friends, and neighbours.

When changes are coming, have a voice in those changes.