As more Ontarians with age-related changes, illness or chronic disease want to receive care at home, the role of personal support workers (PSWs) has never been more vital. PSWs provide essential care that enhances quality of life, supports families and alleviates strain on hospitals and long-term care facilities. However, the complexity of home care is increasing. Many clients have higher medical needs, limited social supports and financial insecurity—factors that can place PSWs in challenging situations that extend beyond personal care.

Because PSWs visit frequently and often develop deep, trusting relationships with their clients and families, they are often the first to recognize signs of distress. Many face situations where they are asked to provide care beyond their scope of practice, address extreme social isolation or help with unmet basic needs. In these moments, PSWs can feel torn between professional responsibilities, organizational policies and their profound commitment to client well-being.

Champions Driving Change

Ethical challenges at the point of care were the focus of VHA Home HealthCare (VHA)’s 2023-24 Champions of Change Fellowship. This annual nursing and PSW fellowship program empowers care providers to lead quality improvement projects that directly impact client care.

The three PSWs selected as 2023-24 Champions of Change Fellows focused on gathering PSWs’ perspectives on the situations that cause them the greatest moral distress and how they would like to be supported by VHA in these moments.

“To prepare for their work, our Champions of Change participated in education sessions on ethical frameworks, quality improvement and facilitation. They then led focus groups with their peers to identify common ethical- and boundary- related challenges in PSWs’ daily work,” says Dr. Emily King, Director of Research at VHA. “This process helped us understand how PSWs are currently using available resources, what additional support they need and how we can strengthen these systems moving forward.”

As part of this fellowship, several case studies were explored, including one highlighting the challenges of supporting clients experiencing food insecurity.

“PSWs often care for clients immediately after hospital discharge and may find themselves in homes with no food and no caregivers available to provide support,” Dr. King explains. “In these situations, our compassionate PSWs want to help, but policies prevent them from handling a client’s money to purchase groceries.”

“PSWs want to be assured that when a clients’ needs or requests fall outside of their care plan, there’s a clear and immediate pathway to get them the support they need,” Dr. King adds.

From Challenges to Solutions

The Champions shared their findings in an impactful presentation to VHA’s senior leadership. Their priorities include empowering PSWs to address urgent client needs, ensuring responsive human support is available during visits, improving timely connections to community support services and providing clear guidance on boundary-setting to help PSWs navigate ethical concerns with confidence. Their insights highlighted key priorities that have already led to policy and program changes and will continue to drive improvement at VHA.

“To address isolation and unmet client needs, VHA launched an intake line where PSWs can directly refer clients to our Responsive Community Care team for additional services,” says David Fry, Vice President of Integrated Client & Community Care. “We have also increased awareness of our Simple Comforts Fund, which enables providers to be reimbursed for urgent client purchases— such as food or personal hygiene items—without requiring pre-approval.”

“In 2025, our focus is to ensure that PSWs are fully aware of all the organizational supports available to them. Additionally, we are expanding training around medication management and wound care, while strengthening access to urgent clinical support, enabling PSWs to make just-in-time decisions around clinical concerns,” David says.

“By reducing barriers and strengthening support systems, we are not only improving the work experience for our PSWs but also ensuring that they continue to deliver outstanding care every day,” he adds.

The insights gained through the 2023-24 Champions of Change Fellowship have led to meaningful policy, program and practice improvements to help PSWs navigate ethical challenges at the point of care. Through ongoing education, responsive policies and innovative initiatives, VHA remains committed to empowering PSWs and strengthening the quality and safety of care for all clients.