Home-care in Ontario can’t keep up — and it’s getting worse

Posted on July 31, 2025 in Child & Family Delivery System

Source: — Authors:

TheStar.com – Opinion/Contributors
July 31, 2025.   By Iris Gorfinkel, Contributor

“If the province were to maintain current service levels, Ontario has to hire 6,800 more (personal support workers) PSWs by 2028 to top up the over 100,000 PSWs currently working in Ontario,” writes Iris Gorfinkel. “An additional 51,000 are needed by 2031 in order to service the province’s growing number of seniors.”

Ontario’s home-care is in trouble. There simply aren’t enough personal support workers (PSWs) to go around. It’s a critical shortage that’s stretched thinner by the growing number of private agencies. Vulnerable Ontarians are caught in the middle of a widening chasm between what they need and what’s publicly available.

Two years ago, the home-care required by some 650,000 Ontarians was delivered by Local Health Integration Networks, or LHINs. It’s a system that worked: Provincial surveys showed that over 90 per cent of clients were satisfied with the co-ordination and quality of care they received.

But in June 2024, Ontario’s 14 LHINs were consolidated into a single entity, Ontario Health atHome with the goals of streamlining services and centralizing purchases of home-care supplies.

It’s had serious growing pains.

Within weeks, exclusive supply contracts were awarded to a handful of private vendors. The fallout was immediate: shipment delays, critical shortages and incomplete orders. More than 350 patients — many of whom were palliative — suddenly lacked access to catheters, IV needles, ostomy kits and wound-care supplies. Ontario Health atHome had to reimburse clients over $218,000.

That was just the beginning.

Soon after, a CUPE survey of over 1,000 care co-ordinators revealed what was happening behind the scenes — workplace stress, overwork and a lack of communication from management.

There was an outpouring of complaints describing “chaos, frustration, secrecy and overwork.” Three-quarters of those polled reported an increased work load. Nearly two thirds voiced that for-profit home-care agencies were threatening their jobs.

Barely two months later, Ontario Health atHome was forced to notify 200,000 home-care recipients that their personal health information had been hacked. Translation: their data was at risk of theft, loss and use without their authority. To make matters worse, the breach wasn’t disclosed until several months later when a Liberal MPP made it public.

Over the past year, a growing number of my patients have expressed dissatisfaction with the home-care services they’ve received. It’s understandable when a personal support worker comes later than planned, but failing to show up is less forgivable. Several patients complained that their home-care visits were cut short. Some were disappointed when their worker refused to assist with basic tasks or seemed uninterested in their needs.

Perhaps the most common grievance is that patients have no guarantee the same PSW will assist them one day later. Not knowing who will be coming is tough enough on workers, but is especially difficult for caregivers and those suffering with cognitive impairment. New caregivers are also less likely to recognize subtle changes in health or behaviour.

Ensuring continuity with an experienced PSW commands a steep price. The current going rate in Toronto is up to $30 per hour, a price that’s out of reach for the vast majority of vulnerable Ontarians. Currently, Ontario Health atHome delivers 72 per cent of the province’s homecare.

If the province were to maintain current service levels, Ontario would have to hire 51,900 more PSWs by 2027. The current plan is to hire only 21,700.  That leaves Ontario’s growing population of seniors with a shortfall of over 30,000 PSWs.

In 2022, Ontario committed to a $1 billion investment in home and community care. It’s a start, but it’s less than half of the funding needed to train and retain the PSWs needed to meet the growing demand.

Without a doubt, funding home-care is costly, but Ontario cannot afford the alternative. The average per-day cost of home-care is $103. That same per-day cost for long-term care is $201 and a staggering $730 for alternate level care.

More importantly, home-care supports what 95 per cent of Ontarians say they want — to remain in their homes as they age. Dignity and independence are universal aspirations — but they’re impossible to achieve without sustained investment. Home-care isn’t a luxury. It’s a lifeline.

Iris Gorfinkel is a family physician and clinical researcher in Toronto.

https://www.thestar.com/opinion/contributors/home-care-in-ontario-can-t-keep-up-and-it-s-getting-worse/article_bbeceb0b-46e5-4ff6-a73d-df01388acf65.html?source=newsletter&utm_content=a05&utm_source=ts_nl&utm_medium=email&utm_email=0C810E7AE4E7C3CEB3816076F6F9881B&utm_campaign=top_19004

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