Personal support workers say caring for the elderly is a privilege, but Ontario's workforce is low paid, short staffed and burnt out
When Crystal considered getting back into the workforce, she thought about a few different career paths before landing on personal support worker. She just knew she wanted to help people.
She’d heard that the hours could be difficult and that it was not unusual for PSWs to have to work multiple shifts in a row. But “it seemed like a very rewarding job, the kind of job where you feel good going home,” she says.
Crystal – who has now worked as a PSW for 16 years, most of that time in long-term care homes – says while it’s still a fulfilling experience, the job can be “very exhausting.”
Crystal asked that her last name not be used and is currently employed in Toronto. She has seen countless PSWs leave the field, either to pursue further education in health care or switch to something else altogether.
“It’s a lot of wear and tear on your body,” she says.
The health care industry’s struggle to retain workers is just part of the reason why Ontario has been facing a major staffing shortage in long-term care. But those in the field say the shortage points to a wider issue – the chronic undervaluing of PSWs despite being considered an “essential” job during the COVID-19 pandemic.
A report published by the Ontario Health Coalition in January 2020 found a “major” staffing crisis has only increased workload demands on PSWs. Long-term care homes were often short anywhere from five to 50 PSWs in a given 24-hour period.
The Ford government has devoted some $24 million to the training of PSWs and to encourage recent health-care graduates to commit to working in the field.
But in a field heavily dominated by women and racialized folks, PSWs have been undervalued for decades, facing low wages, no benefits or sick leave, unstable hours and no guarantee of full-time employment.
Palliative care experts say fixing the staffing crisis is crucial to addressing the issues of care in the nursing home system, particularly in for-profit long-term care, where there’s a growing disregard for eldercare.
On February 24, the province took steps to meet the demand by offering free tuition to students who enrol in personal support worker programs at publicly funded colleges this spring.
The recruitment push will fund an accelerated education – six months instead of eight – for 6,000 and offer 2,200 current students $2,000 tuition grants, as well as money to cover job placement costs.
Minister of Long-Term Care Merrilee Fullerton has said Ontario needs 27,000 positions for nurses and PSWs to meet her commitment provide an average of four hours of care per resident per care.
To do that, Ontario needs to not only improve working conditions for PSWs but encourage students preparing to enter the field to stay the course.
“Over the years, half of a class would be leaving their training before they graduate,” Fullerton said after announcing the recruitment push. “[Of] the portion that did graduate, half of those would be gone from the sector within two years.”
Now more than ever, PSWs are receiving praise for the important work they do. In practice, PSWs still have yet to be treated as essential. Taking care of our elderly should be one of the best jobs in the world.
Becoming a PSW in Ontario involves earning a diploma, usually in under a year. It’s a quick way to get into a field that is desperate to hire as Ontario’s population ages. So why has the province struggled to recruit new hires to address the growing senior population?
Linda Di Paolo, a PSW who has been working in palliative care at a hospice in Toronto for almost nine years, says it’s a “privilege” to go to work every day to support patients in their end-of-life care.
“There’s the little self-reflection I do at the end of the day before I leave,” she says. “I ask myself, ‘Did I do my best work? Did I help make someone comfortable? Did I make a difference in someone’s life?’”
Di Paolo says her job comes with a major responsibility – supporting patients and their families through the last few days of life – and it takes a toll when you’re constantly short-staffed. “If I haven’t been able to do my best, that is a huge weight,” she says.
Sharleen Stewart, president of the Service Employees International Union Healthcare, which represents workers in hospitals, home care, nursing and retirement homes, says the SEIU has been bargaining for better job protections for PSWs for years. But changes in the industry haven’t kept up with the greying population.
“This job has been allowed to stay precarious forever,” she says. “They’ve been essential for a long time. The type of care that these workers are providing is much more advanced now than it used to be a couple of decades ago,” she says.
The Ontario Health Coalition notes levels of acuity or complexity of care needs, have risen in the past decades. “Today, long-term care residents are medically complex and frail… they require peritoneal dialysis, wound treatments, palliative care, postoperative care, pain management, suctioning, and so on,” the report argues.
Di Paolo says that lack of recognition is something she has felt, especially throughout the pandemic.
“To see a lot of people leave the industry, I’m not surprised. You feel like just a number, you don’t feel like a person,” she says. “We’re out there being compassionate and worrying about others, but we don’t feel that from our own employer.”
She worries the exodus from the industry may get worse, especially with the lack of paid sick leave available for PSWs and workers constantly in contact with high-risk and vulnerable populations.
“If there is the potential of being exposed and I have to self-isolate, even though I’m full-time as a PSW, I’m not paid because I’m still at the discretion of my employer, the agency. I’ve lost a week of pay even though it’s not my fault [I got sick],” Di Paolo says.
Di Paolo says she feels the pressures of being a “caregiver” spill over from work into home life, and vice versa, as a mom.
“Am I taking care of myself? Or am I just being that caregiver? And I always feel that fear of burnout, and fear of bringing that energy home to my family,” she says. “Just in general, as a mother, caregiver, wife… it’s a very fine balancing act.”
Julie Bennett / AP Photo
Stewart points to an underlying issue that she says contributes to the continued exploitation of PSWs – the fact that the job is predominantly filled by women, and a “large majority” of them are immigrants whose first language is not English.
In 2009, the Canadian Research Network for Care in the Community conducted a survey of PSWs in Ontario. The network of academics and policymakers, which is affiliated with Ryerson University, found that 96 per cent of those who responded to the survey were women and 42 per cent were people of colour.
Amit Arya, a palliative care physician who specializes in long-term care and is a co-founder of Doctors for Justice in Long-Term Care, calls this an “underlying root cause” of the crisis in long-term care.
Caregiving, whether of children or the elderly, is viewed as “women’s work.” And “because we see this as women’s work, we see this as not skilled, we see this as something that’s not worthy of decent wages.”
Arya says this is reflective of how society doesn’t value people who don’t provide “economically productive work.”
“Whether it’s frontline health workers or family caregivers, we have to make sure that this is actually an economic priority. We have to give them good pay, we have to value these jobs in our society and we have to give people adequate training,” he says.
Arya and more than 1,000 physicians, researchers and health care advocates are calling on the Ontario government to implement a minimum pay standard for frontline long-term care staff, ensuring at least 70 per cent of staff are full-time and all staff are permanent and receiving paid sick leave and benefits.
A study published in the Canadian Medical Association Journal in November compared British Columbia’s long-term care response to COVID-19 to Ontario’s. The authors noted that BC – which saw only 156 long-term care resident deaths as of September 10 compared with 1,817 in Ontario – implemented “better coordination between long-term care, public health and hospitals. The province also provided greater funding of long-term care, more care hours for residents, fewer shared rooms, more nonprofit facility ownership and more comprehensive inspections.”
PSWs currently make anywhere from $14 to $23 an hour. The province provided a temporary “pandemic pay” wage increase of an additional $2 to $3 per hour back in October for PSWs, which is set to last until the end of March, possibly beyond.
Stewart agrees the changes are essential for making the field attractive to prospective workers and for retaining current staff. She says that 30 per cent of PSW staff with SEIU who left the profession during the first wave of COVID-19 have not returned to frontline work.
Arya says it’s difficult for the public to conceptualize what being short-staffed actually looks like, so he compares it to hospitals, as someone who has worked in and studied both environments.
Hospitals, he says, will have one nurse looking after maybe six or seven patients at one time. In long-term care homes, that number is closer to 30 residents per PSW, which sometimes doubles at night.
A report published in December by the Ontario Health Coalition found that 65 per cent of frontline staff working in homes with large outbreaks said they did not have enough staffing to provide daily hands-on care to residents during current outbreaks.
“Staff report that bathing and grooming cannot be completed at all in some homes,” the report says. The report noted other work that could not be done because of staff time being eaten up by the COVID crisis, including providing emotional support for residents, cleaning rooms and social work.
Arya argues that the government’s response to the COVID-19 crisis in long-term care and staffing problems in the sector are steeped in ageism and ableism.
“We wouldn’t allow this to happen in any other area of the health-care system,” he says, pointing to daycare regulations that mandate a certain ratio of caregivers to children. “Here in the long-term care sector, there’s no minimum staffing standard, and undoubtedly that’s a scenario that would lead to neglect.”
Crystal says staff shortages are something she has come to expect, but that doesn’t make it any easier. “It’s stressful not knowing if everything’s gonna get done, or if you can do your job properly.”
Di Paolo says many PSWs leave the job because of burn out.
“The expectations sometimes are not even within the job description.”
Sanja Radin / Getty Images
While staffing issues also plague municipally run nursing homes, both Stewart and Arya pin the blame for most of the problems in long-term care on the for-profit sector.
In Ontario, 57 per cent of all long-term care homes are owned by private for-profit organizations. Nursing homes are excluded from provincial public health systems, which has led to an overemphasis on private funding.
An August study published in the Canadian Medical Association Journal found that for-profit long-term care homes fared worse than their not-for-profit counterparts when it came to their response to COVID-19. The extent of outbreaks and number of resident deaths due to the virus were more severe in for-profit homes, which the study attributed to chain ownership of such homes, as well as outdated design and standards in for-profit facilities.
Arya says for-profit LTC homes are also more likely to hire part-time casual staff. “They’re not going to be giving people benefits and they’re less likely to have paid sick leave.”
He says the for-profit model has also resulted in the government focusing on the wrong priorities. “All of the actions that I’ve seen them take has been to protect the private for-profit industry and, really, the operators of the long-term care homes; when our sole focus should have been to protect the residents, their families and the health workers above all,” he says.
Krystle Caputo, press secretary to Minister of Long-Term Care Merrilee Fullerton, says in an email response to NOW that the government has “continuously taken immediate actions throughout the pandemic to work with all of our partners to shore up staff, and ensure that homes have the support they need to combat this global pandemic.”
But the province has also been forced to launch an independent investigation into its COVID-19 response in long-term care.
The commission struck last May to carry out that probe released interim recommendations in October, which focused on the staffing crisis.
Its report recommends increasing the number of PSWs in long-term care homes, implementing more full-time positions and permanent investments in long-term staffing.
“Improving the employment environment for workers can enhance the ability to attract people willing to work in the LTC sector and ultimately improve the quality of resident care,” the commissioners concluded.
Stewart says that proper staffing and job protections would make a world of difference for residents and PSWs.
In an ideal world, Stewart says residents in long-term care would receive personal care that would be reliable for families and dependable and safe for both residents and caregivers.
Stewart says the PSWs who are still going into the “war zone” to work during the pandemic are exceptional. She says she hears constantly from PSWs that it’s the dedication to seniors and their families that keep them there.
But if we continue to neglect that kind of compassion, Stewart says it’s going to make the current staffing issues worse. “For people coming out of high school looking for career choices, this is not going to be one of them. And we should all be concerned about that.”
Algonquin College (Ottawa) Personal Support Worker Ontario College Certificate, $4,390.27 total (includes fees). algonquincollege.com
Cambrian College (Sudbury) Personal Support Worker Certificate, $3,625.69 total (includes fees). cambriancollege.ca
Canadore College (North Bay) Personal Support Worker Certificate, $3,954.33 total (includes fees). canadorecollege.ca
Centennial College (Toronto) Personal Support Worker Certificate, $3,577.54 total (includes fees). centennialcollege.ca
Collège Boréal (Sudbury) Personal Support Worker Certificate, $3,823.90 total (includes fees). collegeboreal.ca
Conestoga College (Kitchener) Personal Support Worker Certificate, $4,044.16 total (includes fees). conestogac.on.ca
Confederation College (Thunder Bay) Personal Support Worker Certificate, $3,779 (plus fees). confederationcollege.ca
Durham College (Oshawa) Personal Support Worker Certificate, $3,802.39 total (includes fees). durhamcollege.ca
Fanshawe College (London) Personal Support Worker Certificate, $3,916.68 total (includes fees). fanshawec.ca
Fleming College (Peterborough) Personal Support Worker Certificate, $4,401 total (includes fees). flemingcollege.ca
George Brown College (Toronto) Personal Support Worker Certificate, $3,945 total (includes fees). georgebrown.ca
Humber College (Toronto) Personal Support Worker Certificate, $4,026.51 total (includes fees). healthsciences.humber.ca
La Cité (Ottawa, Toronto) Personal Support Worker Certificate, $4,196 total (includes fees). collegelacite.ca
Lambton College (London) Personal Support Worker Certificate, $3,978.70 total (includes fees). lambtoncollege.ca
Loyalist College (Belleville) Personal Support Worker Certificate, $4,184.43 total (includes fees). loyalistcollege.com
Mohawk College (Hamilton) Personal Support Worker Certificate, $4,264.75. mohawkcollege.ca
Niagara College (Welland) Personal Support Worker Certificate, $4,020.53 total (includes fees). niagaracollege.ca
Northern College (Timmins) Personal Support Worker Certificate, $3,159.56-$3,549.95 total (includes fees). northernc.on.ca
Sault College (Sault Ste. Marie) Personal Support Worker Certificate, $3,833.50 total (includes fees). saultcollege.ca
Seneca College (Toronto) Personal Support Worker Certificate, $3,452 total (includes fees). senecacollege.ca
Sheridan College (Brampton) Personal Support Worker Certificate, $4,469.64 total (includes fees). sheridancollege.ca
St. Clair College (Windsor) Personal Support Worker Certificate, $4,002.62 total (includes fees). stclaircollege.ca
St. Lawrence College (Kingston) Personal Support Worker Certificate, $3,771.71 total (includes fees). stlawrencecollege.ca
With files from Kevin Ritchie
Julia Mastroianni and Dr. Amit Arya discuss the crisis facing Personal Support Workers in the latest episode of the NOW What podcast, available on Apple Podcasts or Spotify or playable directly below:
NOW What is a twice-weekly podcast that explores the ways Torontonians are coping with life in the time of coronavirus. New episodes are available Tuesdays and Fridays.