Enlisting a personal support worker is one of the most effective ways to make aging in place feasible.Anchiy/Getty Images
Canada’s population is rapidly aging. The Globe and Mail’s Aging Well series explores the country’s longevity economy, how people are living healthier and happier lives as they age and how to support older adults.
A few years ago, Judith Cain and her husband were travelling through the U.S. in their camper when the call they had been dreading came. Her mother’s personal support worker had gone on medical leave – and the company didn’t have anyone available to fill in.
Cain’s mother, who was 89 at the time, lived alone in Sackville, N.B., and relied on daily help. Leaving her without that support was not an option, so Cain enlisted friends to check in on her until she could return home. “We cut short the trip by about a week to come back and organize the next transition,” Cain said. While the family doctor was eventually able to arrange home nursing visits, Cain said the scramble to find care for her mother was nerve-wracking.
I think my aging parent needs to move out of their home. Now what?
Across Canada, many families are struggling to find reliable home health care support for an aging population and a growing preference to stay in familiar surroundings. In one 2020 government report, 96 per cent of Canadians aged 65 and older said they would do “everything they could to avoid” moving into a long-term-care facility.
So how can older adults get the help they need? While not always a perfect solution, enlisting a personal support worker (PSW) is one of the most effective ways to make aging in place feasible – particularly when care needs increase and become more than family can manage alone.
“They’re your clinical eyes and ears in the home,” said Kathryn Nichol, president and CEO of VHA Home HealthCare, a Toronto-based not-for-profit organization that provides primarily publicly funded home health care in Ontario.
Still, it can be confusing to know how to find that personalized help given the patchwork of public and private supports, which vary widely by province. Should you turn to a public agency or hire privately? What does it cost? What credentials matter when someone is providing day-to-day care? And what about having a backup plan for when things go sideways?
If you’re looking for home care for a loved one, here are some things to keep in mind.
It can be confusing to know how to find personalized home-care help given the patchwork of public and private supports, which vary widely by province.FG Trade/iStockPhoto / Getty Images
What home care workers do (and don’t do)
Whether they’re called personal support workers (such as in Ontario) or health care assistants (in B.C.), home care workers assist with daily tasks such as bathing, dressing, meal prep, laundry, grocery shopping, transferring from bed to wheelchair and helping older adults get out of the house for walks.
They also help manage medications. With the right credentials, some can administer medication, while others can remind clients to take the right dose on time.
Generally, PSWs do not perform medical nursing-related tasks. However, public care may arrange for nurses or other health workers such as physiotherapists or speech therapists to come to the home if needed.
When to bring them in
There often comes a time when it’s clear extra help is needed for an aging loved one. Maybe their home is particularly messy and home maintenance is neglected. Or perhaps they have become reclusive, unable to leave home easily. Or maybe they have ended up in the emergency department – again – because of a chronic health condition that is no longer being adequately managed at home. These are all signs it’s time for more support.
Bringing in a personal support worker can also help ease the pressure on family members who are acting as caregivers and allow them to spend relaxed time with their relative instead of constantly managing care. In the case of adult children helping aging parents, it also helps protect parents’ dignity.
“It is hard for an adult child to start helping a parent with toileting. It’s a whole hurdle to get over,” said Nichols.
How the system works
There are several types of home care offered in Canada: public care provided by provincial, territorial or municipal governments; local programs offered by non-profit or charitable services such as United Way, including Meals on Wheels or free housekeeping services; and private home care that is paid for out of pocket. It’s possible to cobble a few of these together, but it takes planning and co-ordination.
To access publicly funded care, contact your provincial organization – in Ontario that’s Ontario Health atHome, for instance – and ask for an assessment. It can take weeks, though, for this to be scheduled, so be prepared to wait. If the assessment shows your parent or loved one is eligible for help, a home-care worker will have their first visit soon after.
To find additional supports, research government and community options online – such as adult day programs or assisted living services. If your loved one has been assigned a social worker by the province or territory to help co-ordinate care, they can also be an excellent resource for finding additional programs.
Know what questions to ask
Particularly if you plan to hire a PSW through a private agency, have a list of questions ready before signing the contract. Questions might include: How many years has your agency been in business? What is your screening process for applicants? Do you do police checks? Are caregivers available 24/7 for emergencies? How are the caregivers trained? Will the same person visit regularly, or is it a revolving schedule? Who can you call with questions or complaints?
PSWs are not regulated
Personal support workers are not regulated, meaning there is no regulatory body overseeing the industry and ensuring everyone adheres to standard practices. As a result, there’s wide variability in skills, training and fees. While the median hourly wage for personal support workers is $20 in Canada, they can earn between $15 to $53, based on skills, experience and location.
Alicia Davies, co-ordinator of the practical nursing program and PSW program at Fanshawe College’s London, Ont., campus, says that means it’s particularly important to ask questions before hiring a care worker from a private agency. (You typically do not get a choice in the public system.)
While programs such as Fanshawe’s offer a diploma after eight months of training in everything from palliative care to communication, some private programs popped up after the pandemic – and are only weeks long, she says. Always ask where the PSW was trained, then check the program to be sure it’s legitimate.
There are signs that change is coming – at least in Ontario. In 2024 the province introduced the Health and Supportive Care Providers Oversight Authority database, which lists registered PSWs in the province. Registration is currently voluntary, but it is the first step toward potentially creating a regulated industry.
Be the squeaky wheel
Speak up. That’s Cain’s advice for anyone trying to find home care for an aging loved one. If you’ve made a phone call inquiring about care and haven’t heard back after a day or two, phone again.
“I see some of my friends dealing with this and they’ll say, ‘We haven’t heard anything yet.’ And it has been weeks and weeks!” she said. “Well, call them back. Yes, they’re busy, but so are you.”