Ontario’s Homecare Crisis: Structural Problems Need Real Action

By Ian DeWaard, Ontario Director 

The following op-ed appeared in the St. Catharines Standard on April 18, 2026:

I left a recent meet­ing on homecare and read the pro­vin­cial budget with alarm in a region with one of the highest con­cen­tra­tions of seni­ors in the province.

Not because people in the room or the budget doc­u­ment did not reflect care—they clearly did—but because it remains unclear, des­pite a com­mit­ment to “engage with stake­hold­ers to trans­form healthcare,” whether there is a real man­date to address struc­tural prob­lems facing the sec­tor.

Without clear own­er­ship from the province, the issues will per­sist and the pres­sure on our local health­care sys­tem will con­tinue to build.

Homecare is the linch­pin of Ontario's aging strategy. In Ontario, nearly 75 percent of people wait­ing for long ­term­ care beds are receiv­ing home­care sup­port, help­ing them remain in their homes longer while redu­cing unne­ces­sary hos­pital stays.

The fiscal argu­ment is clear. Accord­ing to the Min­istry of Health, it costs Ontario tax­pay­ers

• $730 per day to house patients in hos­pital beds,
• $201 per day to care for them in a long­ term ­care home, and
• only $103 per day to provide homecare.

But homecare is also the most fra­gile part of Ontario and Niagara's health sys­tem. For years, the sys­tem has relied heav­ily on inter­na­tion­ally trained work­ers and new­comers. Recent changes to immig­ra­tion path­ways and inter­na­tional stu­dent pro­grams, designed to address pres­sures else­where in the sys­tem, are now restrict­ing the sup­ply of essen­tial work­ers.

Recruit­ment cam­paigns and train­ing pro­grams can­not solve the deeper struc­tural chal­lenges affect­ing the work­force. Mean­while, many front-­line home­care work­ers are quietly leav­ing the sec­tor because the eco­nom­ics do not add up. Across Ontario and the region, per­sonal sup­port work­ers in homecare earn between $18.39 and $23.99 per hour, often with incon­sist­ent bene­fits and pen­sion bene­fits, far lower than other health­care set­tings.

The deeper dys­func­tion lies in how the work itself is struc­tured. Home­care work­ers spend a sig­ni­fic­ant por­tion of their day trav­el­ling between patients. In Niagara, this often means nav­ig­at­ing between urban hubs like St. Cath­ar­ines and rural com­munit­ies like West Lin­coln or Wain­fleet. Yet mileage reim­burse­ment can be as low as 38 cents per kilo­metre, far below the cost of oper­at­ing a vehicle.

Travel time is also treated incon­sist­ently, often paid at a reduced rate. When travel con­sumes sev­eral hours a day, these policies slash take­-home income. Work­ers in Niagara can put in sev­eral unpaid hours per day to earn a full day's pay.

When work­ers leave, the con­tinu­ity of care breaks down, leav­ing our neigh­bours and vul­ner­able patients with a revolving door of new faces and fam­il­ies with a loss of con­fid­ence in a sys­tem that is sup­posed to provide sta­bil­ity.

The encour­aging news is many of these issues are fix­able. What is needed is a mod­ern­iz­a­tion of how home­care con­tracts are struc­tured and issued. The cur­rent frame­work has cre­ated a patch­work of rules that vary largely between pro­viders.

A mod­ern con­tract­ing approach would estab­lish clearer stand­ards for mileage reim­burse­ment. It would ensure travel time between patients is con­sist­ently recog­nized as part of the work­day. By ensur­ing these costs are covered by the sys­tem, rather than the indi­vidual, we can stop the mass exodus of home­care work­ers and sta­bil­ize our most cost-­effect­ive tool for older adult and vul­ner­able per­son care.

It is also worth remem­ber­ing why many people choose to work in homecare in the first place. Work­ers value the one-­to­-one con­nec­tion with patients, and registered care pro­fes­sion­als appre­ci­ate being able to use the full scope of their train­ing in the com­munity. There is deep mean­ing in help­ing people remain in their homes. But mean­ing alone can­not sus­tain a work­force.

Most of us will even­tu­ally see the face of a home­care worker from a hos­pital bed or a liv­ing room chair. Whether that worker is there to meet us depends on whether the province chooses to recog­nize the real­it­ies of the work. If we don't value the people, we won't have the care in Niagara.

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