Canada is staring at an imminent crisis in terms of having enough trained care workers to support the country’s ballooning population of senior citizens.
The number of Canadians aged 75 or older is expected to more than double from 2022 to 2052, and triple by 2073. But despite this demographic surge, the number of students entering relevant training programs remains flat. In some regions it’s actually dropping.
This scenario should be sounding an alarm about whether we’re preparing enough personal care workers (PSWs – also called health care aides or HCAs; personal care providers; continuing care assistants; nursing assistants, etc.) to take care of this aging population.
PSWs most commonly work in home care settings, hospitals and residential care homes, with most of the last group comprising long-term care homes (sometimes called nursing homes). When the COVID-19 pandemic threw long-term care homes into quarantine lockdowns, isolating elderly residents from support or even from visits by family members, it shone a new light on the crucial support that PSWs provide to so many Canadians. It also prompted governments across the country to increase investments into training programs, and led the federal government to develop a national occupational standard for personal care providers.
Yet a recent survey conducted for the Canadian Association for Long-term Care (CALTC) found that PSW training program applications, enrolments, and completion rates have either stagnated or declined since the pandemic.
Why do we need more trained PSWs?
As the population growth rate for seniors outpaces that of younger age groups, this shift will place ever-increasing pressures on the existing personal support workforce who provide a large proportion of direct care services to older adults.
As of 2022, approximately 350,000 PSWs were employed across all sectors in Canada, but province-specific projections indicate that we’ll need to more than double that number by 2032 in residential care, as well as home care and hospitals.
While there are some efforts by governments and training organizations to address the shortage of trained staff, there is little evidence that current recruitment and delivery methods are improving the outlook. Meanwhile, population aging continues.
The good news is that some employers and governments are actively experimenting with new approaches to training with the aim of improving not just recruitment but retention.
Government investments into personal support work education
With the goal of growing that workforce, several provincial governments have made new investments in personal support work training programs. For instance, Alberta’s HCA Education Bursary Program offers students up to $9,000 to complete their education and work as certified HCAs. Ontario has made several million-dollar investments to encourage PSW education enrolment, including providing free tuition and workforce-entry bonuses.
Yet despite governments spending millions over the past five years to help more students complete PSW training, there are signals that it may not be working. Nationally, most community colleges and other training programs reported either no change or a decrease in applications from 2018-19 to 2022-23 (Figure 1). Similar trends were observed for enrolment numbers, with over a third of training programs reporting fewer students since the pandemic.
The silver lining is that the number of programs reporting increased applications, enrolments and completions exceeds the number reporting declines in each (Figure 1). Overall numbers are going up, but the increases are not yet sufficiently widespread across different schools.
Although most programs reported no change in completion rates, completion rates remain high, with 83 per cent of full-time students completing the programs they started. Further, the percentage of programs reporting an increased completion rate exceeded the percentage with a declining one.
Of course, high completion rates may not translate into sustained growth of the PSW workforce. Voluntary employee turnover in the sector is quite high. In Ontario, for example, 40 per cent of PSWs leave long-term care jobs within a year of graduation.
Strategies to boost enrolment could include more flexibility
Offering more programs on a part-time basis could increase application numbers, although that typically involves a longer training period between enrolment and completion. (Only 28 per cent of colleges who responded to the survey offer part-time personal support training programs.) Options such as ‘living classrooms’ — where students learn on-the-job in care facilities, mentored by qualified staff — are also being tested and hold promise. Other enrolment-boosting approaches that are being evaluated include work-integrated programs in which learners train where they will eventually work.
In the United Kingdom, “earn as you learn” paid apprenticeships help students overcome financial barriers while also strengthening employment prospects. The U.K.’s adult care worker apprenticeship lets trainees earn wages from day one while completing off-job training, with government sharing training costs. Canada’s employment insurance (EI) apprenticeship stream could learn from this and become better integrated with living classroom-style PSW training.
For rural regions — which often face the steepest challenges in attracting PSWs — making learning more available through online courses (apart from necessary hands-on training) could introduce important new possibilities for more students
PSW training remains a critical component of the country’s health workforce planning.
As Canada confronts the serious shortage of PSWs that are needed to meet the growing needs of an aging population, we must be creative in exploring new ways of offering skills development and fostering retention.
