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Wage disparity between the community and institutional sectors in health care is a serious concern leading to significant recruitment and retention problems for all service providers delivery in home and community health care in Ontario.1 As advocates for the home care sector, the Ontario Home Health Care Providers Association (OHHCPA) and the Ontario Community Support Association (OCSA) have worked collaboratively to advocate for change to address the on-going issues related to wage disparity in compensation.

The wage gap between those employed in home and community care, and those
employed in facility care (long term care, chronic care and acute care) is historic and pre-dates the system-wide health care reform efforts that have occurred over the past decade. Health care reform, particularly in the acute care system, has created a concomitant demand for 24 hour/7 day access home care and an ever-increasing range of complex health care treatments to be provided in the community. Clearly, as the health system continues to decrease its reliance on the institutional sector and transfer care to the home, acuity will increase as will the need for skilled workers.

This paper is intended to alert stakeholders of Ontario’s health system to the wage gap emerging between different sectors in the health care system due to recent compensation advances in the institutional (acute and long term care) sector. These advances are resulting in a migration of skilled home health care workers to other sectors of our health care system to take advantage of opportunities for better compensation packages. As well, there are increased job opportunities in the wider labour market caused by a buoyant provincial economy, which also offers better compensation. All home and community care service providers across the province now report serious difficulty in the recruitment and retention of skilled workers due to these factors. This situation has, in turn, led to an increase in waiting lists for community-based services.