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The wage increase was designed to attract and retain more PSWs – who help clients and patients with activities such as getting out of bed, dressing, bathing and taking medications – in the home and community care sector, where the pay is traditional lower and the hours more erratic than in hospitals or nursing homes.Thinkstock

The Ontario government is fixing a troubled program designed to increase the wages of personal support workers, who are central to the province's plan to shift more health care into the home and out of expensive hospitals and long-term-care facilities.

A letter to the province's 14 regional health organizations outlines several changes, including limiting the next instalments of a wage increase to PSWs who make less than $19 an hour, and measures to deny new business to employers that refuse to accept the publicly funded raise for their support workers.

The new guidelines come a month after The Globe and Mail reported a litany of on-the-ground challenges uncovered during the program's first year. Concerns from employers and the very unions that had pushed for the raise prompted the Ministry of Health and Long-Term Care to delay the second phase of the increase, an additional $1.50-an-hour, that was due on April 1.

The employers' concerns included the fact that some PSWs were inadvertently excluded, and others were already being paid well above the new minimum.

Some of the organizations refused to accept the raise because they could not apply it to all of their support workers and they feared it would lead to demands for similar increases from employees in other categories.

Eligible workers will get the next increase by Aug. 1, a spokesman for the minister said. It will be retroactive to April 1 and is projected to cost the government $77.8-million – the same as the first instalment.

Ontario's Liberals promised a $4-an-hour raise for PSWs over three years in the dying days of their minority government, and enacted it last year after returning to office with a majority.

A union that represents PSWs who work in home care vowed to challenge the wage cap, saying the Liberals are coming up short on their promise to the mostly female personal support work force. "When we say $19 an hour, that seems like it's not an unreasonable amount," said Kelly O'Sullivan, the chair for CUPE Ontario's health-care workers. "But it's precarious work. It's work where you have no guarantee of hours."

Health Minister Eric Hoskins said on Thursday that the problems arose because his department did not know enough about PSWs in the home-care sector.

"When we went into this, we had so little information about our PSWs in the province, including, quite frankly, how many of them there were and how they were being compensated," Dr. Hoskins told The Globe in an interview. "What we've realized is that we've really benefited from the knowledge we've gained over the course of the last year. So the principle was the correct one. I stand by that."

Opposition politicians slammed the Liberals for not doing their homework.

The difficulties highlight the complex nature of the sector and its lack of transparency, NDP health critic France Gélinas said. "It is symptomatic of a broken home-care system."

The MPP for Nickel Belt also expressed concern that plans to introduce a common rate of pay for PSW visits will threaten service in rural and northern communities because it would not take into account the higher travel demands.

Bill Walker, the deputy health critic for the Ontario Progressive Conservatives, said the handling of the raise points to "an overall lack of good policy."

"I just think the whole thing has been very confusing," he said. "This is the type of thing that drives me crazy."

The wage increase was designed to attract and retain more PSWs – who deliver more than half of all home care, helping clients dress, bathe, prepare meals and manage medications, among other tasks, yet are generally paid less and have less stable working schedules than their counterparts in hospitals and nursing homes.

Rather than simply raising their minimum wage to $16.50 an hour from $12.50, the government also introduced a $4-an-hour "wage enhancement" to most PSWs, regardless of their base salary. It was not long before the ministry discovered that some PSWs were earning more than the new minimum.

Deborah Simon, the chief executive officer of the Ontario Community Support Association, which represents hundreds of non-profit agencies, said that created problems for many of her members, who have other employees such as registered practical nurses who did not get a similar raise. "I think the cap is definitely a step forward," she said.

Capping the raise in subsequent years also will free up money to correct other oversights, Dr. Hoskins said.

The raise will now extend to PSWs working in adult day programs, in overnight respite care and in a Toronto pilot project that had been overlooked. And the ministry will fund an added 22.7 per cent of all employee wages, up from 16 per cent for benefits.

Dr. Hoskins said he hopes some of these changes will bring the remaining holdouts onside. As of last month, 27 mostly non-profit community organizations had refused to accept the increase.