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The pandemic has infiltrated long-term care facilities, infecting staff and residents alike, and resulting in scores of deaths. Now one University of Toronto Mississauga sociologist is sounding the alarm for a hidden population that is also at grave risk: home-care workers and their clients.

Over the past decade, Cynthia Cranford, an associate professor of sociology, has studied home-based elder care and disability support programs in Ontario and California. She is the author of a new book that shines a light on the vulnerabilities of both care providers and receivers, covering themes of disability, aging, immigration and labour organization.

“As experts question long-term residential care, we should take this opportunity to recognize the importance of acute and ongoing support needs that people need to live dignified lives,” she says, adding that about one million Canadians rely on home-care support for personal hygiene, medical assistance and help around the house.

“Home care is an essential underlying support to our broader health-care system. It is vital to elderly and disabled people to get the assistance that they need with daily activities – like eating, dressing, bathing – in order to live in their homes with dignity.”

Home care also provides short-term acute care to people who can recover from illness or injury at home instead of in the hospital.

Cranford says the global pandemic exposed deep problems within the home-care system, including a fragile labour market and the dependency of people receiving care.

“Home-care labour is at the bottom of the health-care hierarchy,” says Cranford. “And so are the people receiving the care.”

In Canada, home care delivery is administered by for-profit and non-profit companies. Cranford’s research reveals that personal support workers often cobble together work from more than one agency, and may visit up to five clients over a 12-hour day. During the pandemic, many have also been called upon to provide staffing relief in long-term care facilities. Conversely, a home-care client may see several support workers who assist with different tasks throughout the day.

During the pandemic, the lack of centralized labour direction has left personal support workers to work without personal protection equipment, leaving care workers, their clients and the households of both groups vulnerable to contagion. To date, three Canadian support workers have died after contracting the virus.

“Quality of care and quality of work are interconnected,” says Cranford. “This crisis gives us the public platform to really talk about all of the players, and the devaluation of both the workers and the people receiving the care and support.”

Cranford sees hope for the future after the Ontario provincial government recently included personal support workers in the group of front-line health-care workers to receive a temporary pandemic-related pay raise.

Cranford says the time is ripe for a system-wide overhaul, including better job security for personal support workers, flexible-care options for clients and universal federal funding for home-based elder care and disability supports.

“In this moment, it’s very clear that home-care workers are essential to stopping the pandemic,” says Cranford. “We need to continue to have these conversations about the importance of the home-care workers in this sector, and how essential their security is in order to have quality care and safe environments for elderly and disabled people.”