By Zaid Noorsumar
When she first began working as a home and community care nurse twenty years ago, Anne* had a regular 40-hours a week schedule. Today, Anne is working between 12 and 14-hour days at least three times a week and every other weekend.
“I see 12 to 14 patients a day and am on call for 24 hours, twice a week,” she says. “I’m paid by the number of visits, not hours. I spend six to eight hours doing reports on days off. There is no work-life balance. Welcome to profits over patients.”
Impact of Harris-era reforms
The decline in Ontario’s home care system is a direct result of the 1996 reforms instituted by the Progressive Conservative government of Premier Mike Harris. The subsequent Liberal government tweaked and tinkered with the system, but never addressed the fundamental problems.
From 1996 to 2009, Ontario operated a competitive bidding process that allowed for-profit firms to win government contracts by outbidding non-profits.
From providing 18 percent of personal support services in 1995, the for-profits controlled 64 percent by 2011. The Ontario Health Coalition believes that number has only increased.
The for-profit companies reduced the cost of their bids by lowering compensation for workers like Anne. This also meant driving out the unions. Only 32 per cent of home care workers in Ontario are currently unionized. By comparison, hospitals are almost entirely unionized. Most home care workers are employed part-time and forced into patchwork employment.
Nurses like Anne who began their careers with stable employment are now scrambling to make ends meet.
Instead of working an 8am-4pm shift, workers only get paid for time spent with clients (with minimal travel compensation). In some cases, they get paid per visit, and are incentivized to cut visits short and deliver a poorer standard of care.
According to research by the Canadian Centre for Policy Alternatives, 89 per cent of home care workers are women. The workforce is also disproportionately racialized – 27 per cent compared to 13 per cent of the entire workforce.
Lack of public home care
The Harris government’s competitive bidding process not only helped private firms win contracts and destroy the livelihoods of workers, it also reduced government health care costs.
Moreover, the Harris government’s funding cuts led to reduction in the hours of service clients could receive. Suddenly, seniors and younger people with disabilities had to get by with less assistance, increasingly from workers they were not familiar with. That trend continues to this day.
As NDP’s health critic Frances Gelinas told me, “Employers who cannot recruit or retain a stable workforce, keep sending different workers to peoples’ homes.”
“Grandpa doesn’t like to strip naked in front of 20 different strangers every month because there’s a different PSW [personal support worker] at his door every time to give him his bath,” she said.
At the same time, the massive reduction in the number of hospital beds across Ontario (which is now tied with Mexico in terms of hospital capacity) has meant that patients are quickly offloaded from hospitals so they can be transferred back “to the community.”
This has been a neat way for governments to reduce costs as home care is funded at less than one-tenth the rate of hospitals. But as home care is reserved for people with the most severe needs (often those waiting years for long-term care), people are routinely excluded from it.
That helps sustain a private market (distinct from the publicly-funded sector), where people must purchase services out-of-pocket through for-profit and non-profit agencies.
These include many of the same providers contracted by the government such as CarePartners and ParaMed, who pay workers lower hourly rates for private-pay clients.
According to the Canada Community Health Survey from 2015-16, only 62 per cent of home care services in Ontario were paid for by the government.
The rest were purchased privately. Considering that a personal support worker visit can cost about $26-30 per hour, care is unaffordable for a large number of people.
Burden of caregiving on women
Because home care recipients are often only eligible for a few hours of service each week, the burden of care shifts from the government to the individual and whatever network of supports they might have.
Family and friends stand-in as informal caregivers to the detriment of their own financial and emotional well-being. According to Health Quality Ontario, 26 percent of caregivers experienced continued distress, anger or depression (40 percent when taking care of clients who receive services for over 60 days).
But this burden disproportionately impacts women and particularly those from lower-income and racialized backgrounds.
“Women in the home take on most of the care work,” says Natalie Mehra, the executive director of the Ontario Health Coalition. “And women are putting more hours into the workforce than ever in industrial history.”
Mehra points to childcare inaccessibility and greater representation of women in precarious employment as compounding factors.
“How are people supposed to work all day and take care of their children and their elderly parents?” she says. “Women are working multiple part-time jobs or full time plus over-time just in order to maintain their family income.”
Who will care for workers?
The precarious home care workforce is itself susceptible in old age due to the corporatization of the care economy and the erosion of the welfare state.
Linda Soper, a personal support worker in Ingersoll, Ontario, says that she knows workers in her area who cannot afford to retire.
“We have one worker in our area who is 70 because she has to work,” she says. “We have another worker that is single, she’s 64 and she says to me, ‘Linda, I can’t retire. I still have a couple of years left on my mortgage. I have to work.’”
The employer, CarePartners, doesn’t have a pension plan and refused to contribute to the union’s retirement plan at the last round of bargaining.
The CEO of CarePartners, is Linda Knight, who is also the chairperson of Home Care Ontario, the association that mainly represents for-profit firms. So it’s perhaps fitting for CarePartners to epitomize the ruthlessness of privatization in the sector.
*Anne is a pseudonym. Her real name has been changed to shield her from employer retaliation