Photo Credit: Canadian Career College
The New York Times reported recently that according to the Bureau of Labor Statistics analysis, among the 10 occupations expected to grow the most through 2026, personal care and home-health aides will require the most new workers, with 1.2 million new positions between them. About 10,000 baby boomers turn 65 every day, and more than half will need long-term care, according to the Pew Research Center.
Home-care agencies and elderly-care facilities are apparently struggling to recruit. Last year, 26 percent of personal-care aides and home-health aides in the U.S. were foreign born, according to the Conference Board. In New York, 62 percent of home aides were foreign born. In California, Massachusetts and New Jersey, foreigners represented nearly half of them. That is why a recent bill introduced by the Republicans and supported by the White House to create a point system for admission based on factors including education, English skills and job offers in the U.S., which would cut the overall number of green cards awarded each year by half, worries employers who rely on immigrant labour. Senior-care agencies particularly are worried because many are dependent on Medicaid and Medicare and so cannot easily raise wages to make their jobs more attractive to native-born workers. According to a Washington think-tank, the Center for Global Development, the U.S. needs far more new low-skilled workers than high-skilled workers. Only three of the 10 occupations expected to grow in demand require university degrees, all of them digital or data-focused: software developers, statisticians and mathematicians.
In Ontario, Canada, to meet the increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Findings from a recent review of home-care service user charts in Ontario, Canada, indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex-care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. As the population ages in Ontario, the demand for PSWs performing more complex tasks is only going to increase substantially.
That is why the Liberal government in Ontario is creating a new provincial agency called Personal Support Services Ontario that could eventually serve hundreds of thousands of patients in the province. CBC News reported that this move would mean PSWs will become provincial employees. It also has the potential to take a significant portion of the $2.5 billion in annual publicly-funded home care away from the for-profit and not-for-profit agencies currently providing it. The government says creating the agency would give home-care clients more choice in selecting a PSW and more control in determining their care schedule. As with other new government policies, there are supporters and naysayers.
The plan is laid out in a Ministry of Health document dated October 2017 which says Personal Support Services Ontario will be created soon to deliver home care in the spring. It also says the new provincial agency will directly recruit, screen and employ PSWs. Some 729,000 people received provincially-funded home care services in 2015-16. Nearly all of that care was delivered by nurses and PSWs employed by outside agencies, both for-profit and not-for-profit. The document says that the new provincial agency would initially provide PSWs to clients who need a high volume of home care – at least 14 hours per week.
We all know that in 2015, the auditor general criticized the regional agencies that coordinated home-care services, the Community Care Access Centres (CCACs). Critics also questioned how much of the CCAC budget went into administration instead of home care and found that nurses employed directly by the CCACs were paid more than those employed by agencies. This all prompted the government to eventually dismantle the CCACs effective as of April last year.
While the creation of Personal Support Services Ontario seems to be a good idea, more time and work should be dedicated to providing better training to the PSWs and improving the efficiency of home-care delivery. We do not need a new provincial agency to reinvent the wheel and recreating a similar bureaucracy to the CCACs while thousands of seniors continue to be on the waiting list for the services of PSWs. With the upcoming provincial leadership elections, it would be interesting to see how the Wynne government would tackle this important new policy.