Medical versus social work-places: constructing and compensating the personal support worker across health care settings in Ontario, Canada

Abstract

This article explores the role of place in explaining variation in caregiver compensation. Using the labour category of Personal Support Worker (PSW) in Ontario, Canada, it contrasts wage rates across three health care settings: hospitals, long-term care facilities and private homes. An evaluation of current literature from disciplines spanning geography, gender studies, political science and sociology is combined with a critical analysis of policy documents and wage data to reveal that, despite holding similar qualifications and performing comparable job duties, hospital-based workers receive higher wages than home-based workers. I theorize that this wage disparity is partially attributable to the historical privileging of hospital settings in Canada, based on a medical-social continuum of health care valuation. Given that the hospital is constructed as a highly medical place, whereas the home is considered to be a social place, caregiving work enjoys greater financing protection in the former. I argue that these constructions stem from deeply gendered historical roots which view the marketplace as a male-dominated setting for productive waged labour, and the home as a femaledominated setting for unpaid social pursuits. Thus, when personal support services shift from public institutions into private homes, these activities become invisible to the state, and their provision beyond its purview. I conclude that the medical versus social nature of the duties performed by PSWs has become secondary to the medical versus social nature of the setting in which these activities take place. This has translated into lower wages for home-based PSWs, effectively resulting in wage discrimination.

The problems of a ‘dirty workplace’ in domiciliary care

“…Equally there is a lack of policy focus on the 'home' in domiciliary care, and in particular maintaining the 'space' of care is not adequately considered by policymakers around the world (Dyck et al, 2005;McKeever et al, 2006, Lilly, 2008, and therefore resources are not allocated to this activity. Many English policies such as Domiciliary Care,…”

“…These competitive pressures between providers are linked to domiciliaries' low pay and poor working conditions (Lilly, 2008).…”

The Regulation of Paid Care Workers’ Wages and Conditions in the Non-Profit Sector: A Toronto Case Study

“…Apart from home-making duties undertaken by home carers, both personal service workers and home carers perform a similar a range of duties primarily relating to personal hygiene and grooming, assisting with dressing and toileting. A recent study shows this group of workers earns significantly different wages according to their employment setting and it is the setting rather than factors such as educational qualifications and difficulty of work that explains this difference (Lily, 2008). In 2005 the mean hourly wage for Toronto-based personal service workers working in the homes of elderly clients was $12.24 compared with those working in government or quasi government hospital settings who received a mean hourly wage of $16.38.…”

“…This is clearly related to unionization with hospital-based personal service workers generally unionized and those working in homes non-unionized. Thus the role of place both underscores and reinforces the role of industrial regulation in maintaining wage inequality (Lily, 2008). The wage differentials also clearly relate to the different funding models and markets for the provision of institutional care and care in home settings.…”

The Personal Support Worker Program Standard in Ontario: An Alternative to Self-Regulation?

“…There are an array of training programs offered in public, private and vocational colleges, school boards and online, as well as an established practice of on-thejob training, creating a complex educational landscape. scholars and community groups note that there is remarkable variability in the content among PsW training programs, resulting in differential skills, responsibilities and knowledge (HPRAC 2006;Keefe and Légaré 2011;Laupacis and Born 2012;Lilly 2008). In 2012, the Association of Canadian Community Colleges (ACCC)argued for a national educational standard to address worker mobility and international training (ACCC 2012;NACC PsW 2013).…”