A critical examination of how Ontario’s home care system policy affects PSW-provided home care and client risk

The demand for home care is increasing as aging populations grow in Canada and internationally. Personal Support Workers (PSWs) provide the majority of the direct home care in Ontario, yet there are longstanding and acute shortages of these workers. Home care client safety is of concern given complex client needs, the unregulated status of the workforce, and the home care setting. This thesis aimed to identify policy gaps related to PSW work, and the resultant risks for home care clients. Investigating policy relevant to PSW work, home care, and client safety created opportunity for a contextually informed examination and interpretive analysis of policy gaps and intersecting aspects of PSW-provided home care that may increase client risk. For the purposes of this thesis, client risk describes potential harm (physical and psychological) stemming from policy governing PSW-provided home care. This meaning of client risk has been used by the UK Professional Standards Authority to define potential harms to patients in a PSW-occupation risk assessment. This study was conducted with qualitative research methods and tools from Yanow’s Interpretive Policy Analysis (IPA). Drawing on the case of Ontario, policies related to PSWs in the home care context were examined. Interviews were conducted with 16 key informants (KIs) experienced in core areas of PSW work, home care, policy, and safety. This study highlighted safety concerns with PSW education, recruitment, hiring, complex care tasks, and supervision. PSW shortages during COVID-19 were found to prompt policy measures such as accelerated, condensed education and rapid recruitment and hiring, further elevating pre-existing worker and client risks. This thesis examines how policy that is contextually situated in PSW-provided home care in Ontario affects client risk, adding a policy-prioritised lens to other research that considers home care workers, client risk or client safety, and worker-client interrelatedness