On Dec. 1, new legislation takes effect in Ontario that will make Resident Support Personnel workers a permanent fixture of the province’s long-term care landscape.
The legislation is “one of the most significant long-term care regulatory shifts to-date,” says Vivian Stamatopoulos, a long-term care expert and professor at Ontario Tech University.
The move is controversial within the industry.
Critics say the province’s increased reliance on Resident Support Personnel reflects the prioritization of cost-cutting over care. Proponents say these low-wage workers can help mitigate staffing shortages and improve patient care.
‘Exactly what they wanted’
At the height of the pandemic, in November 2020, Ontario passed legislation enabling Resident Support Personnel to work in long-term care settings even if they lacked the formal training of Personal Support Workers. Personal Support Workers, or PSWs, are trained to provide care to individuals who require assistance with activities of daily living.
The law was initially introduced as a temporary measure to enable long-term care homes to address critical staffing shortages. But four years later, 1,600 Resident Support Personnel remain employed in care homes across the province.
Nursing homes lobbied for the creation of RSPs at the start of the pandemic, says Ricardo McKenzie, director of long-term care at SEIU Healthcare, a union representing 60,000 health workers.
“The government gave corporations exactly what they wanted,” he said.
The government initially made assurances that Resident Support Personnel would not replace Personal Support Workers in clinical roles. Resident Support Personnel were there to offload the burden on Personal Support Workers by assisting with non-medical tasks, such as providing companionship and cleaning patients’ rooms.
But online job postings for RSPs — which are often listed under vague job titles such as “health-care aide” or “attendant” — suggest these workers are now performing direct care duties.
However, unlike Personal Support Workers — who must complete a 600-hour training course and be provincially certified — RSPs are not subject to any provincially-mandated training requirements.
Wages for Resident Support Personnel are thus considerably lower than those for Personal Support Workers, hovering around the provincial minimum wage of $17.20 an hour. Personal Support Workers, by contrast, earn between $23 and $34 an hour.
“[RSPs are] a cost-cutting measure,” said McKenzie.
McKenzie says many Resident Support Personnel are recent immigrants who are recruited through private staffing agencies or even apps, where — like Uber drivers — they are classified as independent contractors, rather than employees. This means they receive fewer protections under Ontario employment law.
In internal ministry documents obtained by The Trillium publication, Ontario’s Ministry of Long-Term Care acknowledged a “potential wage compression issue between RSPs and PSWs” and noted care homes might reduce their reliance on Personal Support Workers as Resident Support Personnel take on more work.
The documents also note that Personal Support Workers and nurses often use “low-risk tasks” — such as helping residents with everyday activities — to check patients’ health status. As Resident Support Personnel take on more of these duties, clinically-trained staff lose opportunities to conduct informal health assessments.
Daniel Strauss, a spokesperson for the Ministry of Long-Term Care, said in an email that Resident Support Personnel “support the work of PSWs by taking on everyday tasks that don’t require specialized training.”
The ministry did not respond to questions about how it plans to prevent the erosion of quality of care or address concerns over worker exploitation by staffing agencies.
‘Everyday tasks’
For the Ontario Long Term Care Association, an advocacy organization representing 70 per cent of the province’s care homes, the introduction of Resident Support Personnel into the workforce is good news.
“[RSPs] enhance resident quality of life by providing companionship and helping with everyday tasks,” said Donna Duncan, CEO of the association.
Duncan supports Ontario’s move to make Resident Support Personnel permanent. They will free up clinically-trained staff such as nurses and Personal Support Workers to focus on more specialized tasks, she says.
Duncan also says the RSP role serves as an entry point for workers who later pursue careers as nurses or Personal Support Workers — often through occupational training programs and bursaries offered by the province.
However, Stamatopoulos, of Ontario Tech University, says the growing use of RSPs signals a trend toward the de-skilling of long-term care work.
“This is something the for-profit [long-term care] lobby has wanted for a long time,” she said. “What we’re seeing is the progressive exploitation of a vulnerable workforce, hired under the guise of emergency measures.”
‘Particularly attractive’
The legislation that takes effect Dec. 1 will make what was a temporary, pandemic-era exemption permanent: untrained Resident Support Personnel will continue to be authorized to provide support services to long-term care patients.
Critics point to a number of concerns with the legislation.
One concern is that long-term care homes will have discretion over which tasks Resident Support Personnel can perform unsupervised. This approach effectively deregulates long-term care staffing, prioritizing corporate interests over resident safety, says Stamatopoulos.
The legislation also does not define the responsibilities of long-term care homes when using workers from temporary staffing agencies. This risks further incentivizing the outsourcing of care.
In an interview, Ontario Liberal Health Critic Adil Shamji noted that temporary staffing agencies have proliferated since the pandemic, with some engaging in “unscrupulous and predatory practices.” Last year, he introduced legislation to regulate these agencies. It did not pass.
Shamji said there is a risk of long-term care homes viewing low-paid Resident Support Personnel as “particularly attractive” when compared with the alternative of employing more highly-trained staff.
“This issue hasn’t yet entered the public discourse, but it needs to,” Shamji said.
Personal support workers often make a lot less than $23. A lot of PSW jobs in Welland pay around $18-$19 per hour.