She wanted a union

Conditions in home care were getting worse.
One PSW decided to organize a union.

By Zaid Noorsumar

The drive north from Oshawa to Haliburton County in Central Ontario takes two hours. There were times when Laura Borden* would travel that distance to meet her co-workers – and end up sitting alone at Tim Horton’s.

“Sometimes I’ve sat on for an hour at Halliburton, an hour in Minden and an hour in Lindsay and met up with nobody,” Borden says. 

She would announce her visits on the Facebook group she created to network with her Personal Support Worker colleagues, and then take off in her car to meet them during gaps in the workday. If the timing was off, or if her on-call colleagues had to scram, Borden’s trips would be fruitless.

“But that’s okay,” she says, pointing out that the home care workers in rural areas have unique challenges. “I didn’t want them to think I don’t care. I do care.”

After 15 years of witnessing the working conditions deteriorate at the Oshawa branch of her employer, ParaMed, Borden was determined to fight back. 

She wanted a union. 

The work of caring

Home care services are provided by a range of professionals including nurses and therapists and Personal Support Workers (PSWs) who visit people in their homes. Their clients include people of all ages including seniors, people with disabilities and post-acute care patients.

According to business lobby group Home Care Ontario, about three quarters of the services are provided by PSWs like Laura. About 90 per cent of PSWs are women, and across Ontario, they are disproportionately racialized. Young people and newcomers seeking a career and employment can become a certified PSW with a college diploma.

PSWs help clients with personal care and grooming responsibilities such as eating, bathing and dressing up, but are also accustomed to tasks delegated to them by nurses.

Unions have had great difficulties in the sector, as the workers rarely have a chance to meet each other in a centralized location. They work on their own schedules, commuting in their private vehicles or public transit across big cities or entire counties.

Lower costs, lower wages

Home care has often been cited as the future of healthcare. This is based on the humane idea of helping people age at home instead of in institutional settings. 

The idea became more attractive to provincial governments in the 1980s and 1990s as they sought to contain hospital costs. According to Home Care Ontario, home care per person costs about $42 a day compared to $126 for long-term care and $842 for hospital care. 

The cost-reduction is partly to do with the fact that home care workers are poorly compensated. Even after 16 years, Borden makes just $19 an hour for client visits and hasn’t received a pay raise since 2016.

Her base wage ($15.65), which she receives for all other duties aside from client visits (such as attending meetings) has been about the same for 10 years, she says. 

Borden is reasonably satisfied with her own compensation as her job accords an RRSP plan, decent benefits and full-time hours, but that’s not the case for most co-workers she’s encountered.

“There’s people that are working that are 68, 69, 70 years-old themselves,” Borden says. “And because they have no pension, they continue to work. They can’t afford to stop.”

One of the most contentious issues in home care is travel pay. At ParaMed’s Oshawa branch, some workers are paid hourly wages (around $15) while they travel between homes, while others are compensated only for mileage. 

Neither form of compensation is adequate, as workers can easily clock 100 kilometres a day. Besides, the mileage rates are not standardized, and can be as low as 22 cents per kilometre. 

“We are underpaid for travel,” says Christa Baker*, a PSW on the verge of quitting after more than a decade. “So we’re eating the cost of travel in between clients as we are not paid for that, and we are underpaid in the first place.”

Borden says after factoring vehicle maintenance costs, they make close to minimum wage. 

The year of the big change

Although wages and working conditions in home care eroded as a result of the reforms undertaken by the previous Ontario PC government and left unaddressed by the Liberals, Borden says she noticed a major change in 2014. 

That was the year Extendicare, ParaMed’s parent company, took over the home care operations of a fellow competitor, Revera for $83 million. In its 2014 annual report, Extendicare said:

“With over 95% of expanded ParaMed’s initial revenue coming from government contracts, the home health care business provides Extendicare with a high quality revenue stream, with relatively low capital requirements, along with an opportunity to expand the private-pay segment of this business.”

The takeover doubled ParaMed’s business, but it precipitated a change in management that led to increasing challenges at work.

Previously, if a worker had to take time off for bereavement or for a family emergency, Borden says, they were treated with compassion. Now, she says it’s not uncommon for workers to have their vacation days cancelled arbitrarily, or have management deny them time off.

Borden cites the example of a co-worker who struggled for time off to attend her daughter’s wedding.

“They said that they were short staffed, and could she not at least work in the morning?” Borden relays. “And she replied that ‘No, this wedding is out of town. And I need to be at my daughter’s wedding.’ Anyway, she fought it but by the time she got her time off, she was so stressed she barely enjoyed her daughter’s wedding.”

ParaMed’s business

The Ontario government funds home care at a rate of $35.83 per hour of personal support service, from which employers have to pay wages and travel costs as well as administrative expenses. 

The funding is certainly not adequate, as it is predicated on hourly rates of service which precludes salaried positions. However, companies like ParaMed are in the business of making profits.

Due to the structural reforms introduced by Premier Mike Harris and his Ontario PC government, for-profit companies increased their control of the home care market from 18 per cent in 1995 to 64 per cent in 2009, based on calculations by Ontario Health Coalition. 

In the process, due to sophisticated policy maneuvers, the unions were wiped out as well. Currently, only 32 per cent of the sector is unionized.

Meanwhile, Home Care Ontario, the association that mainly represents for-profit employers such as ParaMed, lobbies against unions and welcomes anti-labour legislation, such as the Ford government’s Bill 47.

Although the business of home care continues to be healthy, it’s having a profoundly damaging impact on workers, whose tendency to jet has created a perpetual staffing crisis.

“We’re short staffed because you don’t treat us well,” Borden say. “And we are losing PSWs left, right and centre. [But] there would not be a shortage of PSWs in home care or long term care if we were treated with respect and paid well.”

It was these changes, and her determined quest to seek justice for her fellow workers, which compelled Borden to organize a union.

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*Names changed for privacy and protection