Despite recent provincial investments, Ontario’s home-care system is still in crisis. Underfunding, rationed care and ideological preferences for privatization of services undermine dignified aging and care for those in need of support at home.
At the same time, home-care providers, who are disproportionately racialized immigrant women, experience precarious, exploitative and sometimes dangerous working conditions.
My newly released research report, entitled “Caring about Care Workers: Centring Immigrant Women Personal Support Workers in Toronto’s Home Care Sector,” is a collaboration with Social Planning Toronto(SPT), a non-profit, community-based agency. In it, we highlight the concerns and preferences of these undervalued workers.
Our report presents data from interviews with 25 immigrant women working as personal support workers (PSWs) in home care in the City of Toronto. Our conversations, conducted between 2023 and 2025, focused on employment conditions and workplace safety, the critical need for systems change and the possibilities for building PSW collective power.
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A vital service held together by precarious labour
Home care provides crucial supports to seniors who want to live in their own homes longer, facilitates the autonomy of people with disabilities and aids in the recovery of individuals following a hospital stay.
Their work both supports widespread client preferences to “age in place” and reduces pressure on hospitals and emergency departments. Yet it is routinely neglected and chronically under-resourced.
PSWs provide the majority of home care services. In 2022, an estimated 28,854 individuals were employed as PSWs in the home-care sector in Ontario. Home-care PSWs collectively provided 36.7 million hours of care to Ontario residents in 2023-24 through the provincially funded system.
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Immigrant and racialized women comprise the majority of home care PSWs in the Greater Toronto Area. Home-care PSW labour is characterized by low wages, lack of employment benefits, health and safety risks and unique challenges associated with working alone in private homes.
Among PSWs in Ontario, those working in the home and community care sector have the lowest average wage, making about 21 per cent less on average than PSWs working in hospitals and 17 per cent less than those in long-term care. Inadequate provincial funding and inequitable and restrictive funding arrangements are the primary drivers that create and exacerbate these unacceptable conditions.
PSWs are absorbing the real cost of care
Our research participants explained how the normal costs associated with providing home care are offloaded onto them in several ways.
First, most PSWs in home care provide personal care to multiple clients each day. Travel between client homes is a requirement of their work. Yet participants shared that they either receive low pay or no pay for travel time between client homes.
One of our participants, Kemi, explained how travel time works in her agency:
“The travel time that we are paid is one hour. If I’m working five hours, that’s six hours I’ll be paid. But the thing is that the travel time amount is not the same as your regular wage… travel time is paid some amount less.”
If it takes more than an hour a day to travel between client homes, Kemi does not receive any compensation for that additional time. Yet this is a reality for her on a regular basis.
Joy, another participant, noted that PSWs in her agency personally pay more than half of their transit costs:
“They give us $1.60 per travel, but the payment we give the TTC is $3.50. I requested the company to make it the same, or at least a free TTC pass for the month. But the employer said it wasn’t appropriate.”
At the same time, many PSWs have long gaps of unpaid time between client visits during their workday. These gaps in their workday result in a full-time shift but only part-time compensation, with many getting paid for only a few hours each day. The result is full time work for a part-time wage.
In addition, participants noted that PSWs can have their work hours and income reduced if their caseload is reduced. This occurs when a client dies, moves, enters hospital or long-term care, switches home care providers or no longer requires services.
Ann-Marie described the precariousness of working in home care:
“You know why the hours are not guaranteed? For instance, I have eight clients, and out of eight clients, I have three clients that passed away. That’s all my hours reduced until they able to find another client to fit into my schedule.”
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Reform must start with fair working conditions
Our report provides detailed policy recommendations targeted to both levels of government, home-care service provider organizations, unions and the community sector.
In particular, we advocate for the creation of a comprehensive public non-profit home-care system where home care workers, Ontario residents receiving care and their families play a central role. Rather than continuing with a fee-for-service model, we recommend adopting a grant-based funding model to better support the full cost of care provision.
We also advocate for developing employment standards for home care PSWs and improvement of public transparency and accountability in home care through data collection and analysis, along with regular public reporting and independent research. And, finally, rather than continuing to allow large home-care companies to extract millions in profit, we want every public dollar to support high-quality care and good working conditions for home care workers.
For the good of everyone in Ontario, it’s essential that the provincial government take bold action to reform the home-care system. The very least we can do for these essential and valuable workers is to ensure fair compensation, guaranteed work hours and good working conditions.
