There’s a question no physician is trained to answer.
Cassandra Hoggard, a healthcare governance leader, shared one recently on LinkedIn: a caregiver asked their doctor whether they should become disabled in order to keep caring for a parent at home.
Not out of desperation. Not because they were failing. But because after four years of holding together a family touched by dementia — coordinating care, navigating scarce respite, doing what the system could not — the math of survival had become that brutal.
That question is the sound a system makes when it breaks quietly, from the inside.
Two Invisible Workforces
Canada’s ability to care for its aging population rests on two groups of people. One group is unpaid. The other is underpaid. Both are burning out.
Family caregivers — predominantly women, largely invisible in policy discussions — provide the majority of care that allows older adults to remain at home. Their labour doesn’t appear in GDP calculations or healthcare budgets. But without it, both would be unmanageable.
Alongside them are Personal Support Workers: the largest front-line workforce in Canadian healthcare, and arguably the least visible. PSWs help people bathe, eat, move, take medication, and live with dignity. They are the human infrastructure of an aging society.
Both have been underfunded and undervalued in ways that have been documented, analyzed, and debated — and left largely unchanged — for nearly a decade.
What Eight Years of Research Reveals
In 2017, a paper in Healthcare Policy described Canada’s PSWs as part of a new “precariat” — a workforce defined by low wages, job insecurity, fragmented hours, and limited labour protections. The authors called for policy attention and pointed to the risks: not just to workers, but to the quality of care that vulnerable Canadians depend on.
In June 2025, the CSA Public Policy Centre published Revaluing Personal Support Work in Canada — a national study drawing on surveys of nearly 400 current and former PSWs.
The findings are striking. Not because they reveal something new, but because they repeat, almost word for word, what was said eight years earlier.
Heavy workloads. Insufficient staffing. Burnout, anxiety, and a pervasive sense of working without support. More than half of currently employed PSWs surveyed intend to leave the profession in the near future. Almost two-thirds have considered leaving or already left in the past two years.
When research findings repeat themselves across nearly a decade, it is not a research gap. It means the system understands the problem. What it lacks is the will to change the structure.
The Passion-to-Precarity Gap
One of the most striking findings in the CSA report: 86% of PSWs reported being satisfied with the work itself. Focus group participants described genuine calling and deep fulfillment.
And yet more than half intend to leave.
This is not a contradiction. It is a structural warning. People love the work. But the system around the work is consuming them.
A typical PSW in community care might conduct eight to ten short client visits in a day across a large geography, with unpaid travel between them and schedules that change without notice. When staffing shortages worsen, the response has too often been to shorten visit lengths and increase client loads. More visits, more travel, more fragmentation. In other words, a job already structured like a gig economy platform becomes even more fragmented. A symptom of worker strain addressed by adding more strain.
It’s a remarkably coherent failure of imagination — treating human exhaustion as inputs into a scheduling problem.
When the paid workforce is stretched this thin, family caregivers absorb the difference — quietly, without formal recognition, and without support until they collapse. By that point, the only funded options are often a disability designation or a long-term care bed. Both cost the system money. Neither is what the family wants. And a physician is asked to sign the paperwork.
What Care Infrastructure Actually Looks Like
Here is the framing that still hasn’t landed in the right rooms.
In the 20th century, societies invested in physical infrastructure — roads, power grids, hospitals — not as social programs but as economic foundations. The foundations for everything else. In the 21st century, an aging society must build something different: care infrastructure. That means investing in the people who provide care — paid and unpaid — not as a cost to be managed but as a system to be designed.
We already know care work can be structured differently. In 2006, a Dutch nurse named Jos de Blok founded Buurtzorg — “neighbourhood care” — in response to a homecare system that looked remarkably like Canada’s today. His answer was structural: small self-managing teams, full-time employment, a defined geography, and the authority to make care decisions without layers of approval above them. Turnover fell to half the industry average. Hospital admissions dropped by a third. Overhead ran at 8% versus the 25% typical of conventional agencies. The workforce stayed. None of this required new funding or political breakthroughs. It happened because the structure of the job was redesigned to stop consuming the people doing it.
The principles aren’t complicated. Full-time employment with guaranteed hours. Small stable teams with a lead who mentors rather than manages from a distance. Clear pathways from front-line worker to senior roles. Versions of this are already being piloted in Canada — in Ontario worker co-operatives, in emerging team-based homecare models, in organizations willing to treat care work as a profession rather than a gig.
The evidence points in one direction. What’s missing isn’t the model.
The Question Worth Asking
Cassandra had the courage to share a story that most of us would find too uncomfortable to tell. That discomfort is exactly the point.
The system isn’t failing because of bad people or absent compassion. It’s failing because of how the work is structured — and structures can be changed.
We don’t have to keep asking caregivers to absorb the cracks in a system that was never designed to support them. We don’t have to keep publishing research that repeats itself every eight years while the workforce shrinks and the population ages.
We can build something different. We already know how. The only question left is whether we are willing to redesign the system around the people who actually make care possible.
This post draws on Zagrodney & Saks (2017), “Personal Support Workers in Canada: The New Precariat?”, Healthcare Policy; and the CSA Public Policy Centre (2025), “Revaluing Personal Support Work in Canada.“
About the Author
Robert Stanley is the Founder and CEO of Stay at Home Nursing and CHAH Technology, where he is focused on advancing Comprehensive Healthcare at Home — a model designed to shift care from reactive, institution-centric delivery toward predictive, preventative, and person-centred care delivered closer to home.
His work explores how modern data, AI, workforce redesign, and home-based care models can address many of the structural inefficiencies described in this article. A more detailed discussion of these ideas is outlined in the white paper Comprehensive Healthcare at Home: An Industry Call to Action.
