'An assembly line of care:' new study addresses concerns in long term care system

A new study from the faith-based think tank Cardus looks at recommendations to improve the long term care system for Personal Support Workers, including taking away 'redundant' paperwork tasks.

Study says PSWs spend 32 minutes per shift filling out paperwork, meaning less time for patient care.

One of the main findings of the study is that Personal Support Workers spend approximately nine minutes on documentation or charting per resident. That's 32 minutes in an eight-hour shift that a PSW could be spending taking care of a resident.  (Myriam Fimbry/Radio-Canada)

Maximizing efficiency may seem like the right way to go in the manufacturing sector, but not so for those who take care of Ontario's aging population, such as Personal Support Workers (PSWs).

That's one of the arguments made in new research from think tank Cardus, titled "People Over Paperwork." Cardus is a non-partisan, faith-based, registered charity that conducts independent research, according to the organization's website.

One of the goals is to get the attention of government, long term care providers and union leaders for health care providers on how to overcome some of the difficulties in the current system. 

"The challenge in the long term care system is that, with how it's structured, it often comes down to [Personal Support Workers] having x minutes per day to care for a person," said Brian Dijkema, co-author of the study. 

"We want to make sure we're treating our elderly people with care, as human beings, and not as parts on an assembly line." 

Every minute counts in a PSW's day

One of the main findings of the study is that PSWs spend approximately nine minutes on documentation or charting each interaction with a patient. That's 32 minutes in an eight-hour shift that a PSW could be spending taking care of the person. 

"Any time you're taking a PSW away from [hands-on] tasks, you're exacerbating an already really tough challenge," Dijkema said.

The study also shows that 44 per cent of front line care workers reported working short-staffed on a daily basis. 

Dijkema suggested that whenever an industry is suffering, governments tend to add more regulations, which require having to chart adherence to those regulations. In this case, that takes time away from more valuable tasks. 

"According to evidence, the best way to achieve best outcomes for people in long term care is to increase the amount of time support workers are spending with them hands on," he said. "We're talking about having a little more time to comb an elderly women's hair or spend more time reading them a letter." 

To illustrate the importance of minutes spent on residents, the study looked at a campaign conducted by private-sector union which revealed that most PSWs have just six minutes to get residents ready in the morning because they have to quickly move on to the next resident in order to have everyone ready for breakfast. 

Other key findings

  • Declining wages: Study reveals that in comparison to 2009,  the wages of PSWs have declined just over 6 per cent.
  • Staff shortages are widespread: A 2018 survey conducted by the Ontario Long-Term Care Association, representing nearly 70 percent of LTC homes in the province, reports 80 percent of respondents said that they struggled to fill shifts
  • Burnout and job dissatisfaction are a threat to PSW shortage: The study cites an Ontario Personal Support Workers Association survey indicating PSWs who left the field were more than twice as likely to say that they did so because of burnout than because of pay issues.
  • LTC workers report lower job satisfaction when they feel they are unable to provide quality care:With limited staff, the study suggests that staff are stretched thin trying to meet the demands of the rising resident acuity. Particularly, the study says staff  are frustrated by excessive documentation requirements instead of caring for residents face to face.

The study outlines certain recommendations for the government, long term care providers and the unions representing the workers in order to improve the conditions PSWs face on a daily basis. 

The recommendations include looking at increasing wages, giving PSWs access to technology, such as iPads, to lower the administrative burden of staff, determining which data is vital to ensure better health outcomes and which is redundant and identify and address better ways to attract and retain a skilled labour force. 


Sofia Rodriguez


Sofia Rodriguez is a multimedia journalist with CBC News in London. You can email her at