New report finds some PSWs face unethical working conditions
A new community report by TMU sociology professor Naomi Lightman is uncovering the experiences of home care personal support workers (PSWs) in Toronto.
The research shows immigrant women PSWs – who make up the majority of home care PSWs in the Greater Toronto Area – face the worst working conditions in the sector.
“The status quo is shocking and appalling,” said Professor Lightman. “It's unacceptable that these women are treated so poorly. They have so few employment protections, no benefits, no job security, and they're doing the most essential work.”
Home care PSWs help individuals with medical conditions, disabilities and injuries maintain their ability to live at home and in their communities.
Without them, more people will unnecessarily be in full-time care facilities or end up in hospitals, driving up health care costs.
In 2023-24, home care PSWs provided 36.7 million hours of care to Ontarians through the provincially funded system.
Working for free to provide proper care
Professor Lightman and her co-researchers at Social Planning Toronto, a nonprofit community-based agency, interviewed 25 immigrant women PSWs working in Toronto, as well as seven individuals involved in labour and community organizing in the sector.
Many PSWs said they don’t get enough paid time with each client to provide quality care. The women worked unpaid hours so they could provide safe, dignified care for their clients instead of rushing through visits.
“These women are subsidizing our health care system. They’re working for free by doing additional unpaid work because they don’t get enough hours in the care plan to provide the kind of care their clients need,” said Professor Lightman.
Travel time was another major issue. The women typically care for multiple clients each day and spend hours travelling between homes – without pay or with minimal pay. They work a full day but only earn part-time wages.
When the home care PSWs did get paid, their average wages were the lowest among workers in the home and community care sector. Home care PSWs make 17 per cent less than PSWs working in long-term care and 21 per cent less than those working in hospitals.
Precarious and dangerous work
By 2032, Ontario will need 50,000 more PSWs in home care, long-term care and hospitals. But despite labour shortages, precarious employment is the norm.
Home care PWSs said they face no guaranteed hours and unpredictable schedules, which means unreliable incomes.
For example, PSWs lost hours when their client loads decreased or after the PSWs took vacations or extended leave. Some PSWs also lost pay when clients were not home for a scheduled visit or cancelled last minute.
When the PSWs did have work, they faced hazards on the job. The women often worked alone in private homes that weren't always safe.
Some of the women experienced anti-Black racism, sexism and harassment.
Others cared for clients who could be violent, including unintentional violence from clients with dementia.
Their work is physically demanding and comes with the risk of physical injury. But PSWs said inadequate access to paid sick time created additional health risks for themselves and their vulnerable clients.
Three ways to fix the system
Professor Lightman and her co-researcher identified three urgent changes policy makers can make to address the current inequities in the system:
1. Increase funding and modernize the home care funding model
This includes equal pay for the different types of PSWs, guaranteed work hours and compensation for all work hours including travel time. They also call for home care PSWs to have access to employment benefits, protections from anti-Black racism and discrimination and better protections for injured workers.
2. Create systemic change
The researchers recommend creating a comprehensive public non-profit home care system. They also call for the end of private profit in Ontario’s publicly funded home care system. To fund the system, they suggest adopting a grant-based funding model to support the full cost of care provision. As part of the systemic change, they also call for the development of employment standards for home care PSWs and improved public transparency and accountability in home care.
3. Support collective power
The researchers also call for barriers to unionization for PSWs to be reduced and increased awareness of PSWs worker rights. They also recommend increased support for leadership development opportunities for PSWs.
These changes would improve working conditions and create a more stable workforce with less turnover and better quality of care.
“These women care about the jobs they're doing. They want to have enough hours with clients so their clients can flourish. It's really a system level problem. It's not about individuals. Without real transformation in the sector the status quo will only get worse,” said Professor Lightman.
Read the report, Caring about Care Workers: Centring Immigrant Women Personal Support Workers in Toronto’s Home Care Sector. (external link)
This research is supported by the Social Sciences and Humanities Research Council (SSHRC).
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