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The Ontario government’s plans to fund thousands of new positions in long-term care facilities threaten to create a crisis in the province’s home care system by exacerbating the shortage of personal support workers, industry groups and advocates say.

Late last year the province said it planned to spend as much as $1.9-billion to hire nearly 27,000 workers into long-term care. On Wednesday, Premier Doug Ford said his government intends to train 8,000 PSWs with tuition-free training programs and bursaries and extend a $3-an-hour temporary wage increase for PSWs that was set to expire at the end of March.

But without additional funding for home care, the province risks driving thousands of workers out of that sector and into jobs in long-term care, said Sue VanderBent, chief executive of Home Care Ontario, which represents more than 50 home care companies.

Both industries draw from the same pool of workers. But wages can be as much as $4 to $6 higher in long-term care, a differential that Ms. VanderBent worries could grow even wider under the province’s proposal. “People will have to economically say: I love working in home care, but this is so significant, if [the wage differential] becomes $7 an hour or more, because there’s already this huge inequity,” she said.

While a chronic shortage of PSWs has existed in Ontario for years, it has been worsened by the COVID-19 pandemic as workers have moved into better-paying jobs in long-term care and public health, or left the industry entirely.

Ms. VanderBent said the home care industry has seen its referral acceptance rate – the percentage of qualifying patients successfully matched with a personal support worker – fall from nearly 100 per cent to 60 per cent over the course of the pandemic.

Without adequate numbers of home care workers, patients who could have managed to stay in their own homes may instead end up in hospital or long-term care facilities, stressing the heath care system at a time when congregate settings have been significant drivers of new COVID-19 cases, she said. Home Care Ontario has asked the province to inject nearly $400-million into the industry to attract, retain and train workers and create a 15-per-cent tax credit for families who pay out of pocket for home care services.

After a car accident last June left Matthew Dever with limited use of both hands, the web designer from Carleton Place, southwest of Ottawa, was approved for 22 hours of weekly home care, enough for workers to come twice a day.

But Matthew Dever, who uses the pronoun “they,” has struggled to find workers who will stay. One PSW visits every two or three days for a few hours in the morning. Another had initially agreed to come in the evenings, but instead took a position in a long-term care facility that paid $40 an hour, well above the $19 that their insurance company would pay.

Their 21-year-old daughter moved in to provide extra support, but she is balancing the additional responsibilities with online classes to finish high school. Doctors previously warned the 45-year-old, whose injuries make it difficult to do even basic tasks such as making meals and bathing, that without appropriate support at home they would be better off in a long-term care facility.

“If I had no PSW support at home, it would be something that I would absolutely have to consider strongly,” they said. “It’s unrealistic to say: I’m sure I could manage it at home. I’m struggling as it is to manage with just my limited PSW and my daughter’s support.”

Any additional funding for home care is a positive step, but needs to be coupled with new regulations for the private home care industry, which operates with little formal government oversight and no mandatory standards for minimum credentials or background checks, said Miranda Ferrier, chief executive of the Ontario Personal Support Workers Association.

“Do I think people should remain in their homes as opposed to going into long-term care? Absolutely,” said Ms. Ferrier, whose association represents about 49,000 PSWs. “But I don’t think throwing money at the issue is going to fix it. It’s a temporary fix.”

A wage hike alone won’t keep PSWs in the home care industry, she added. As many as 70,000 trained PSWs have already left the profession for jobs in other industries because of burnout, stressful working conditions and a lack of support from employers.

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