Common Sense Health: Unsung Sentinels of Home Healthcare

The British author and playwright, B.G. Stern, wrote, “Silent gratitude isn’t much use to anyone.” It’s apropos to home healthcare workers, who have been acknowledged as essential, but that’s where the appreciation seems to stop. Personal support workers (PSWs) as they are called in Canada, Home Health Aides (HHAs) or other titles in the U.S., don’t get the spotlight as do doctors, nurses, and other specialists. And they certainly don’t get the pay.

Yet, in the vast realm of healthcare, there exists this group of workers who quietly care for the most vulnerable – the elderly, disabled, sufferers of chronic disease, and people with health issues who can live at home or in long-term care but only with assistance. The profile of these workers can vary from well-trained and experienced caregivers to family members, including aging seniors and young children.

A typical PSW might be a retired woman, working in the industry out of the goodness of her heart and a need for the income. She is fatigued but stoic. Another common profile is the Filipina overseas healthcare worker who has left her country and her family to earn more abroad than she can do at home. She is professional and in demand. Some PSWs are part-time workers, hired by healthcare staffing agencies that offer flexible employment. They are the luck of the draw.

Trends show people are needing more and more care. As the baby boomers age, you can bet your heartbeat there will be a further surge. Some of the trouble could have been avoided. Over the past half century, North Americans should have heeded warnings about smoking, poor nutrition, lack of exercise, and other lifestyle-related factors that cause obesity, diabetes, heart disease, stroke, and cancer. But prevention has not been a priority. Now there are not enough trained home care providers to manage the need.

Wages of home healthcare workers are low despite the demanding nature of the job. This leads to high turnover, demotivation, and a necessity to work multiple jobs or long hours. Some may lack access to comprehensive benefits, such as extended healthcare coverage or retirement plans.

Challenges in their workplaces are legendary. PSWs may work in long-term care facilities where staffing shortages are frequently acute. In private homes, PSWs need to navigate the rules set by employers for safe and suitable conditions while confronting the reality of whatever they encounter. In these precarious settings, they provide intimate and often emotionally taxing care, assisting with tasks like bathing, dressing, feeding, and mobility. They witness the suffering of patients and their families dealing with end-of-life situations. No wonder the job leads to compassion fatigue, burnout, and mental health issues.

All these problems amount to another sad reality in the industry. When high numbers of home healthcare workers are absent or unable to perform their work, the quality of care plummets for individuals in assisted care facilities and homecare settings alike. Stand-in caregivers from employment agencies may be technically competent, but the disruption in work and the lack of familiarity with patients compromises health outcomes.

Given that so many people are destined to need personal healthcare support at some point, it’s surprising that more is not done to shift from silent gratitude to more proactive measures. Investing more in PSWs would be a smart move, as they help prevent falls, infections, and other serious and costly crises.

As it stands, when the time comes, a life-ending heart attack or stroke might be the best of luck. For the rest, it’s time to start thinking about what kind of care you want for a longer, slower decline.

Sign up at to receive our weekly e-newsletter. For comments, Follow us on Instagram @docgiff and @diana_gifford_jones and on Twitter at @GiffordJonesMD and @gifford_jones

Image from Flickr

Leave a Comment

Your email address will not be published. Required fields are marked *