Staffing crisis: Addressing the high turnover rate of personal support workers in Ontario’s long-term care sector

Abstract

Personal support workers (PSWs) serve a valuable role within the health system, providing up to 80% of direct care to residents and clients in the home and community care (HCC) and long-term care (LTC) sectors. According to a report by the Ministry of Long-Term Care, as of 2018, 50 000 PSWs were employed within LTC facilities in Ontario, accounting for the majority of the workforce within this sector. The original purpose of the PSW role was to support residents with activities of daily living such as dressing, toileting, and bathing. However, in an effort to minimize healthcare costs and keep up with the rapidly aging population, there has been a recent shift towards implementing policies that support the idea of aging at home. The criteria for admission to LTC in Ontario was amended in 2010, with individuals now required to have “high or very high physical and cognitive challenges” to qualify for care. As a result, LTC home residents require a greater complexity of care, as reflected by the fact that an estimated 81% reportedly suffer from some form of cognitive impairment. To meet the increasing needs of residents in a sector that is severely understaffed, the role of PSWs has evolved to take on a greater responsibility in resident care and provide levels of support that are often beyond the scope of their training. As unregulated healthcare professionals, PSWs operate under the direct supervision of a nurse practitioner (NP) and face limited autonomy, strict reporting requirements, low wages, and minimal opportunities for further advancement. These factors contribute to the high staff turnover rates that exist for PSWs in LTC; 25% of PSWs leave the sector after just two years of work experience and 40% leave within the first year of graduation. This article will investigate the various factors that contribute to the high rate of PSW turnover, examine the COVID-19 pandemic and the staffing crisis, and highlight possible interventions that may improve staff retention within the LTC sector.