Working conditions for Greater Toronto Area personal support workers during the COVID-19 pandemic

Personal support workers (PSWs) were deemed “health-care heroes” who were essential in caring for high-risk, vulnerable older populations in private homes, long-term care facilities and hospitals during the COVID-19 pandemic. However, there is little understanding of the working conditions that impacted their well-being. The aim of the study was to examine the pandemic experiences of PSWs (a category that also includes home support workers, health-care aides, patient aides and personal care attendants), and to highlight areas of concern that need to be addressed before future public health crises.

The study was conducted between June 2020 and May 2021. It drew on 634 survey responses and 31 in-depth interviews with PSWs in the Greater Toronto Area (GTA). The surveys and interviews were focused on two research questions: 1) How did the early stages of the COVID-19 pandemic impact the work and well-being of PSWs in Ontario? 2) How did PSWs overcome any work-related challenges during the COVID-19 pandemic?

To overcome the challenge of recruiting such hard-to-reach worker populations, the study team used what’s called a “chain referral sampling method.” An initial sample of 24 participants, recruited through the PSW Advisory Committee and online advertising, were offered honoraria for referring up to three eligible peers ($10 per peer referral). All participants were offered an honorarium for completing the survey or follow-up interviews. 

Four themes emerged from the analysis of survey responses and interviews:

1) The pandemic took a significant toll on the health and well-being of PSWs. Health and well-being implications included impacts on mental health, anxiety about contracting COVID-19 and contracting COVID-19. For example, 66 per cent of survey respondents were worried about contracting COVID-19 and 75 per cent were worried about transmitting it to people at home. Fear of transmission often led to physical isolation and feelings of loneliness and depression.

2) The pandemic significantly impacted the job security of PSWs. Reduced hours and lost employment were noted as major contributors to job insecurity during the pandemic. For example, PSWs who worked in home care experienced a reduction in work hours due to patients’ fear of contracting COVID-19. For PSWs who worked in more than one long-term care facility prior to the pandemic, a new Ontario regulation aimed at preventing the spread of the virus meant that they had to limit their employment to a single employer—effectively leading to reduced hours and lower income for many.

3) PSWs still experienced largely poor working conditions despite some improvements brought by the pandemic policies. Namely, the pandemic exacerbated pre-existing workplace challenges. In summary, PSWs’ views on poor working conditions focused on six areas: a) personal protective equipment (PPE) impacts, b) lack of paid sick days offered by employers, c) delayed or inadequate temporary wage increase, d) lost childcare, e) increased workload and extra tasks due to staff shortages, and f) challenges related to lack of management support.

4) PSWs demonstrated resilience by employing several coping mechanisms or strategies during difficult circumstances. These included: a) relying on family and friends for both emotional and logistical support, b) drawing strength from their faith and spirituality, and c) reflecting on their passion for the profession.

Study findings suggest:

• making the temporary wage increases permanent will help sustain the PSW workforce;
• ensuring more full-time, permanent positions with benefits are available to PSWs will help improve their working conditions; and
• addressing staffing shortages and high patient volumes will help improve PSW working conditions, as well as the quality of care for patients.

The study findings are consistent with previous research on PSWs in Ontario, which demonstrated the precarious work conditions and significant stresses that they experience. In addition, the study was able to highlight changes in PSW work conditions during the early stage of the pandemic, based on the perspective of PSWs.

The study is limited to the experiences of PSWs in the Greater Toronto Area, which may not be generalizable to other geographical areas. Comparative analysis was also not conducted across the different work settings, which may present varied contextual challenges. Moreover, the large proportion of Black respondents in the study might not fully describe the experiences of PSWs of different racial and ethnic backgrounds.

The focus of the study on PSW’s point-of-view regarding working conditions during COVID-19 is limited and does not include perspectives of employer organizations (such as hospitals, long-term care facilities or clinics), policy-makers, patients or their families.