Personal Support Workers are Valuable Members of the Canadian Healthcare System
HealthCareCAN Submission to Immigration, Refugees, and Citizenship Canada
EXECUTIVE SUMMARY
Canada’s aging population is rapidly increasing demand for personal support workers who are essential to helping seniors remain in their homes and communities. As frontline providers of hands-on care, personal support workers (PSWs) support independence, assist families, and play a central role across home care, long-term care, and community settings.
For the federal government, strengthening the PSW workforce is not only a healthcare issue. It is a practical, fiscally responsible workforce strategy that supports seniors’ care, reduces pressure on hospitals, helps Canadians age at home and aligns immigration policy with Canada’s most urgent labour market needs.
PSWs are essential healthcare workers and must be explicitly recognized in federal immigration, temporary foreign worker and permanent residency pathways for healthcare workers.
Despite their importance, PSWs are undervalued and inconsistently recognized in federal immigration policies. Current classifications and pathways often exclude them, limiting access to permanent residency.
Many PSWs are already living and working in Canada, filling critical roles in long‑term care, home care, community care and hospitals. Treating permanent residency as a retention tool, rather than a recruitment mechanism, would allow Canada to keep workers who are already contributing to the health system.
At a time when the federal government is seeking to keep immigration levels sustainable while increasing the share of economic immigration, PSWs represent exactly the kind of workforce Canada should be retaining: trained, employed, already integrated into communities and directly supporting essential public services.
HealthCareCAN recommends that the federal government create a dedicated health support worker immigration stream under the Express Entry program that explicitly includes PSWs, as well as reclassify PSWs within NOC/TEER to reflect their essential role and enable access to existing permanent residency pathways.
These recommendations will help ensure health workforce stability and growth, while enabling better seniors’ care, aging-in-place, long-term care stability, and enhanced system efficiency.
WHY PSWS MATTER TO FEDERAL HEALTH AND WORKFORCE PRIORITIES
Canada is expected to reach more than 10 million seniors before the 2040s. In other words, about one-quarter of Canada’s population will be aged 65 years and older in a decade from now.[1] Most seniors want to remain in their homes and communities for as long as possible, but to help seniors keep their independence as they age, and support families when they most need it, personal support workers will be critical.
This directly supports the federal objective of helping seniors age with dignity, at or closer to home, with access to home care, long-term care and palliative care. A stable PSW workforce is one of the most concrete ways to make that commitment real for families.
PSWs are an essential part of health and social care in Canada and have been for decades. The health sector relies on PSWs to provide care and companionship to seniors, people with disabilities, children, and others who may need assistance eating, cooking, bathing, and dressing. They deliver the majority of hands‑on support in long‑term care, home care, and community health settings, yet remain undervalued, inconsistently regulated, and chronically understaffed.
Seniors account for almost half of healthcare spending in Canada.[2] To reduce pressure and costs on the healthcare system and on taxpayers, having a stable PSW workforce is essential. PSWs observe their clients and can catch problems early on, such as, pain, changes in mood, infections, dehydration, and medication non-adherence. They help families keep loved ones out of institutional care longer, prevent caregiver burn out, and allow patients to be discharged from hospital sooner with support. Keeping seniors at home with support provided by PSWs frees up hospital beds and long-term care spaces for those who need it the most.
Without a stable PSW workforce, demand for care does not disappear. It shifts to unpaid caregivers, emergency departments, hospital wards and long-term care waitlists. This makes PSW retention a low-cost, high-impact lever for improving system productivity, protecting hospital capacity and delivering better value for federal, provincial and territorial health investments.
In rural and remote areas, PSWs are even more important. These regions often have fewer healthcare services and people often travel long distances to access care. PSWs can help people stay in their community longer as they age, and reduce unnecessary travel for services.
Strengthening and retaining the PSW workforce is one of the most direct, high‑impact ways to stabilize Canada’s healthcare system and improve quality of life and dignity in aging for seniors.
For a government focused on affordability, productivity and building a more resilient Canada, this is a practical workforce solution: retain the workers already here, reduce avoidable institutional care, support families and improve the functioning of hospitals and community care.
[1] Kamrul Islam, M., Gilmour H. (2024). Access to specialized health care services among older Canadians. https://www150.statcan.gc.ca/n1/pub/82-003-x/2024003/article/00002-eng.htm
[2] Canadian Institute of Health Information. (2025). National Health Expenditure Trends. https://www.cihi.ca/en/national-health-expenditure-trends/nhex-trends-infographics
WHO PSWS ARE AND WHAT THEY DO
PSWs and home health aides or resident care workers are frontline care providers who support safe, dignified and person-centred care across long-term care, home care, hospitals, retirements homes, community care and supportive housing.
PSWs assist their clients with activities of daily living, which might include bathing, grooming, dressing, preparing meals and assisting in feeding, assisting with mobility, and managing household chores. They may also perform health-related duties such as changing non-sterile dressings, assisting in the administration of medications under the general direction of a supervisor, as well as monitoring and reporting changes in health status. PSWs also provide a valuable role of companionship and social support for clients and their families.
A PSW’s job is physically demanding, emotionally stressful and comes with real safety risks. PSWs do this work alone in private homes and often with limited ability to control the environment and in long-term care they often support people living with dementia, who can become confused, anxious, and agitated.
Despite being trusted to assist in caring for someone and being part of the team of frontline healthcare workers, working alongside nurses and allied health professionals, PSWs are unregulated care providers in Canada. This means PSWs or related jobs like health care aide, have no legally defined scope of practice and are not licensed by a regulatory health college.[1] Therefore, it becomes the responsibility of each province and employer to determine the scope of practice, their duties and role requirements, including level of education and training.
Education and training for PSWs is not standard across the country or by employers. In Canada, generally, a person needs a high school diploma and completion of a certificate program through a licensed educational provider. Most programs across the country involve classroom learning and clinical placement. Certificate programs vary in length but are normally between five and nine months long. In Ontario, for example, a five-month program is required at minimum. In Nova Scotia, following graduation, students are required to pass the provincial Continuing Care Assistants certification exam (or have equivalent experience) to receive official credentials to work as a PSW in the province.
Notwithstanding the lack of standardization in training, education, and scopes of practice, PSWs make a positive difference in the lives of the people they care for and work with and should be valued as skilled healthcare workers in their own right.
This is precisely why federal immigration policy should not rely only on regulatory status as a proxy for value or skill. PSWs may be unregulated, but they are not unskilled. Their work requires judgment, trust, training, physical skill, emotional intelligence and close integration with regulated health professionals.
[1] College of Nurses of Ontario. (n.d.) Working with unregulated care providers. https://www.cno.org/standards-learning/practice-support/practice-support-faqs/working-with-unregulated-care-providers
THE POLICY GAP: PSWS ARE ESSENTIAL, BUT NOT CONSISTENTLY RECOGNIZED
PSWs are essential to healthcare delivery, but they are not consistently recognized in federal immigration and health workforce policies. While federal immigration policies often highlight “healthcare workers” as a priority group, they tend to focus on regulated professions such as nurses and physicians. This creates a disconnect between the central role PSWs play in the healthcare system and the limited ways they are acknowledged in federal systems that shape immigration, labour mobility, and workforce planning.
This gap becomes clear when examining how PSWs are treated across key federal policy mechanisms. Their NOC and TEER classifications restrict eligibility for many immigration pathways designed for higher‑skilled occupations. Requirements under the Labour Market Impact Assessment and Temporary Foreign Worker Program often place PSWs in low‑wage streams with limited pathways to permanent residency. Even where healthcare immigration streams exist, PSWs are not always explicitly included, and recognition varies widely across federal and provincial workforce planning tools.
If the federal government intends to prioritize healthcare workers to address system‑wide shortages, PSWs must be explicitly recognized within immigration policies. Excluding them undermines efforts to stabilize long‑term care, expand home care, improve hospital flow, and support an aging population. PSWs are one of the workforces most directly tied to these priorities, and federal policy must reflect their essential role.
This recommendation does not require the federal government to abandon its commitment to sustainable immigration levels. Rather, it helps make the existing immigration system more targeted, more economically responsive and more aligned with Canada’s public service delivery needs.
IMMIGRATION PATHWAYS FOR HEALTHCARE WORKERS MUST INCLUDE PSWS
Since 2019, the healthcare system’s reliance on temporary foreign workers has grown sharply.[1] Statistics Canada reported that temporary foreign workers (TFWs) in nursing care facilities and home care services account for much of the TFWs in the healthcare system.[2]
If staffing levels decline due to the loss of TFWs, it will be felt most acutely in community care and long-term care which relies on TFWs to fill nursing (Registered Nurses and Licensed Practical Nurses), PSW, and nursing aide positions.
Shortages in long-term care quickly create pressures elsewhere in the system. When long-term care and home care capacity is constrained, hospitals are forced to care for more patients who no longer require acute care but cannot be safely discharged. This reduces already limited hospital capacity and delays timely access to care for other patients.
Many PSWs are already living and working in Canada, filling critical roles in long‑term care, home care, community care and hospitals. Treating permanent residency as a retention tool, rather than a recruitment mechanism, would allow Canada to keep workers who are already contributing to the health system. When PSWs are excluded from skilled healthcare worker immigration pathways, it sends a contradictory message: that their work is essential to patient care, but not essential enough to qualify for the same immigration opportunities offered to other healthcare workers.
Explicitly including PSWs in healthcare worker immigration and permanent residency pathways would improve retention in a workforce that is foundational to system capacity. It would also align with the federal government’s broader objective of focusing immigration on workers who can support the economy, fill labour shortages and contribute immediately to Canadian communities.
Ultimately, it is patients who suffer the adverse consequences of health workforce shortages. Temporary residents working as PSWs are an important part of a healthcare team delivering high-quality care to Canadians, and they deserve the opportunity to become residents of the country they serve.
[1] Lu, Y. and Hou, F. (2025). Temporary foreign workers in healthcare: Characteristics, transition to permanent residency and industry retention. https://www150.statcan.gc.ca/n1/pub/36-28-0001/2025008/article/00002-eng.htm
[2] Ibid.
TARGETED POLICY RECOMMENDATIONS
HealthCareCAN recommends the Government of Canada:
- Create a dedicated health support worker immigration stream under the Express Entry program that explicitly includes PSWs. Immigration, Refugee and Citizenship Canada should establish a permanent residency pathway specifically designed for unregulated but essential health occupations, i.e., PSWs, with at least one year of work experience in Canada, to align immigration policy with the realities of Canada’s healthcare labour market. This would allow the federal government to target permanent residency to workers who are already employed, already supporting publicly funded care and already helping meet urgent labour market needs.
- Reclassify PSWs within NOC/TEER to reflect their essential role and enable access to existing permanent residency pathways. The federal government should update PSW classifications in the NOC and TEER system so that PSWs qualify for the same immigration pathways available to other healthcare workers. This would correct a structural policy gap that undervalues essential health support work and ensure immigration rules reflect how healthcare is actually delivered across home care, long-term care, hospitals and community settings.
IMPACT ON PATIENTS, SENIORS AND THE HEALTH SYSTEM
If PSWs are not fully recognized and retained, the consequences will be felt across every part of the health system. PSW shortages already limit access to home care, increase pressure on long‑term care, and delay hospital discharges. Families are forced to take on more unpaid caregiving, care teams face heavier workloads, and continuity of care suffers as turnover rises. Patients and residents experience shorter visits, fewer supports for daily living, and reduced quality of life. Employers across all care settings struggle to maintain stable staffing, which undermines safety, efficiency and the ability to expand services.
Retaining PSWs is directly tied to reducing hospital pressures. PSWs enable safe and timely discharge by supporting patients at home, preventing avoidable readmissions and reducing emergency department use. They provide the hands‑on assistance that allows more care to be delivered at home and in the community, helping hospitals operate more efficiently by freeing up beds for acute care and reducing the burden on staff.
PSW retention is also essential to stabilizing long‑term care. PSWs provide most of the day‑to‑day personal care that ensures residents’ safety, dignity and quality of life. When PSW positions go unfilled, long‑term care homes struggle to meet care standards, staff experience burnout, and residents receive less consistent support.
Finally, PSWs are central to enabling aging-in-place. They help older adults remain at home by supporting mobility, nutrition, hygiene, medication reminders and social connection. Without sufficient PSWs, more seniors are forced into institutional care earlier than necessary. Recognizing and retaining PSWs is therefore not only a workforce issue but is fundamental to the functioning and sustainability of the entire health system.
For the federal government, the policy choice is clear: retaining PSWs already working in Canada is a targeted, practical and affordable way to support seniors, stabilize care, improve hospital flow and strengthen the health workforce without increasing pressure on immigration levels.
CONCLUSION
Recognizing and supporting PSWs is essential to meeting Canada’s health priorities. As demand for care continues to grow, ensuring this workforce is properly valued, retained, and integrated into workforce plans will be critical to maintaining system stability and quality of care. Aligning immigration policies with the realities of care delivery will not only strengthen services across home care, long-term care, and hospitals, but also improve outcomes for seniors and families. Ultimately, investing in PSWs is a practical and necessary step toward a more resilient, efficient, and patient-centered healthcare system.
By explicitly recognizing PSWs in federal immigration pathways, Canada can advance several federal priorities at once: a more responsive immigration system, a stronger health workforce, better care for seniors, improved hospital capacity and more sustainable public services. This is a targeted policy adjustment with immediate benefits for patients, families, employers and the broader health system.
ABOUT HEALTHCARECAN
HealthCareCAN is the national voice of hospitals, health research institutes, and health organizations across Canada. Our members are part of the more than 1,200 healthcare facilities that support over two million direct and indirect jobs, account for nearly 12% of Canada’s GDP. HealthCareCAN membership is diverse and made up of a variety of organizations, including research institutes, hospitals, long-term care and home care providers, health authorities, and health sector associations. These organizations are crucial in delivering high-quality care, driving innovation, and contributing to addressing the most pressing issues facing Canada
PUBLISHED
June 2026
FOR FURTHER INFORMATION
Annie Barrette
Vice President, External Affairs
abarrette@healthcarecan.ca
