Care for Care Providers

Slater maintains this attitude even though, on a typical shift, she has eight residents with diverse needs to juggle. One might have had a rough night; another could be dealing with a medical issue; and if any of Slater’s colleagues are absent, she’ll probably have additional clients. “On a difficult day, you have to work harder to be present,” says Slater, reflecting on all the de-escalation and problem solving she must do. “That takes a toll. My mental health is a roller coaster.”

Many care providers are in this profession because they have similar nurturing mindsets, yet 80 percent have considered changing careers, according to a report published last year by the Canadian Centre for Caregiving Excellence (CCCE).

Across the country, PSWs, direct support professionals (DSPs) – who work with clients with disabilities – and other paid health-care attendants are feeling stressed, overworked, and underpaid. The labour pool consists largely of racialized women, many of whom are newcomers to Canada, and they face high rates of abuse and discrimination on the job.

Working in congregative living facilities and providing home care for a patchwork of public and private employers, the majority are essentially gig workers without benefits such as paid sick days or access to counselling.

Fewer than half of the PSWs surveyed by the joint University of Toronto and St. Michael’s Hospital-based Upstream Lab said their health was good or excellent, which is lower than the national average. More than 20 percent likely had some form of depressive disorder, the researchers concluded in a 2022 paper, “significantly exceeding the prevalence of major depressive episodes among Canadians.”

In a country with an aging population, this is a significant challenge. If we don’t take care of PSWs and other care providers, how can they be expected to look after our most vulnerable citizens?

Risky business 

More than 650 PSWs in the Greater Toronto Area responded to the Upstream Lab survey, which found that:

• 97% are born outside Canada.
• 86% are precariously employed.
• 89% lacked paid sick days.
• 90% are women.
• Many are casual employees, with wages that range from $17 per hour in home or community care to $25 per hour in public long-term care facilities.

This snapshot is representative of care providers across the country, according to the Upstream Lab paper, and their precarity is “significantly associated with higher risk of depression.”

Health-care jobs in Canada have traditionally been secure, but over the last three decades, “disparities in pay and work conditions have grown between registered professionals (such as physicians, nurses) and other staff whose jobs are part-time, temporary, on contract and not unionized,” the researchers wrote. A national focus on discharging people from acute care and aging in place has ramped up the demand for PSWs, who now constitute about 10 percent of all health-care workers. This workforce grew relatively quickly, says Upstream Lab director Dr. Andrew Pinto, without much scrutiny or consideration of the consequences.

These poor working conditions can be detrimental to physical and mental health, says Dr. Pinto, who, in addition to his role as a public health specialist, is also a family physician. In a system that incentivizes “reducing costs” and “doing more with less,” he says that many PSWs fear reprisal from their employers if they raise concerns about problems on the job. Pinto knows this from his research, and from the PSW patients he sees as a physician. “They’re really dedicated to caring for others and take pride in their work,” he says, “but they’re not given the respect they deserve.”