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This minimum wage rise came right on the heels of a campaign in which Ontario healthcare workers advocated for a $14 minimum wage. Healthydebate.ca had a lively debate between Dr. Ritika Goel and Mike Craig. Dr. Goel and other advocates argued that increasing the minimum wage would increase the income of the poorest patients, thereby improving their health.  While this seems like a logical argument, does the evidence agree? The answer might surprise you.

Although Health Minister Eric Hoskins has vowed that this year's portion of the raise will eventually be doled out retroactively to April 1, the delay has caused "a lot of confusion, uncertainty and frustration," among PSWs in the home and community care field, according to Kelly O'Sullivan, the chair for CUPE Ontario's health-care workers. "It adds to the ongoing precarious nature of this work," she said. "You can't even depend on a wage increase that's been promised to you by the government."

The government's PSW Workforce Stabilization Strategy was designed to make home-care work less precarious, not more. PSWs deliver more than half of all home-care services, helping clients to dress, bathe, prepare meals, tidy up and manage medications, among other tasks. Yet their paycheques are traditionally smaller and their schedules more erratic than those of PSWs who work in hospitals and nursing homes, making it difficult to retain quality workers in home and community care. Persuading PSWs to choose the home-care field is essential to the Ontario government's efforts to keep people out of hospitals and nursing homes for as long as possible - a way to stretch increasingly scarce health-care dollars and respond to the public's desire to heal and age at home.

People interviewed for this story were quick to praise the Liberals for trying to improve the lot of home-care PSWs and their clients by raising their minimum wage to $16.50 an hour from $12.50 over three years. The intention was laudable, they said. The execution of the plan was not. "This should be the best news story ever," said Deborah Simon, the chief executive officer of the Ontario Community Support Association, which represents hundreds of non-profit agencies that help people at home. Instead, Ms. Simon said, the Byzantine rules around the pay hike have created an "administrative burden" for organizations.

At the heart of the problem is which workers - and which kinds of work - qualify for the government-funded pay bump. While the government set a wage floor of $16.50 an hour as of 2016-17, it delivered the public funds through a "wage enhancement" that only applies when PSWs are providing "personal support services" funded by Local Health Integrated Networks (LHINs), the province's regional health authorities.

That means time spent in training, travelling to clients' homes or performing tasks such as food preparation do not qualify for the higher rate. Initially, even statutory holidays were paid out without the increase, although that has been reversed. Jason Lye, national head of independent living services at March of Dimes, says his agency spent months clarifying provincial rules, only passing on the first phase of the raise retroactively to workers in February in the form of a "blended rate" that takes into account how they historically have divided their time.

"The way I like to interpret it is when you see the whites of the clients' eyes, you are paying the $1.50," Mr. Lye said. There were other complications. The raise goes to all PSWs doing work that qualifies, meaning the $4 increase goes to everyone, whether they are making a base wage of $12.50 or $22 an hour. That has put pressure on employers to give raises to others, such as registered practical nurses and supervisors.

The rules also exclude some PSWs because of where they work or because the provincial funds that pay for their services do not flow through the province's 14 LHINs. The result is that PSWs within the same organization can be treated differently. Kingsway Lodge Fairhill Residence in the southwestern Ontario town of St. Marys chose to reject the increase because it would create an untenable disparity in its already well-compensated PSW work force. Hourly wages there range from $17.73 to $20.44. The organization operates a nursing home with round-theclock care, a retirement home and six supportive-housing suites where residents receive a few hours of personal support per day. The wage enhancement would have applied only in the supportive apartments. "There would be no way to do it because our staff flow between the three levels of care," said Theresa Wakem, the facility's administrator. At Traverse Independence, an agency in Kitchener that serves adults with physical disabilities and acquired brain injuries, management had to find $27,000 in a $6-million budget to give eight PSWs working in a day program the same raise as their colleagues. "It was a hardship," said CEO Toby Harris. The agency eliminated half a supervisor's job to cover the increase.

The wage enhancement helped a little bit, but we're still on the losing side," said the PSW, who asked not to be named. The company's London employees are not unionized. The PSW said some workers in London are refusing to serve clients outside the city because they are paid so little to travel there. "If I drove six hours in the county, I'd be lucky to get paid for three hours," the PSW said. Dr. Hoskins said before the Liberals committed to the pay increase, "we didn't have a tremendous amount of information about our PSWs - who they're working for, how much they're being remunerated."

The ministry is gathering data so it can "fine-tune" the second year of the program, including whether future increases should apply to all PSWs, even those already earning much more than $16.50 an hour, he said. He added that nearly 500 health-service providers have passed the increase on to their PSWs and the government expects the 27 holdouts to follow suit. As for Revera's changes, "I find that unacceptable," Dr. Hoskins said. "The ministry would be looking into those circumstances if they were brought to our attention." Ms. O'Sullivan, the CUPE representative, called the program's rollout "a reflection of a broader problem" with home and community care in Ontario.

If we can't figure out - we as in the government, the agencies and the unions - how everyone should be getting something as simple as a wage increase in an equitable way, can you imagine if you are a family member or a patient needing care, what the system must be like?" This is the first article of a Globe investigation into the challenges of moving health care out of hospitals and into the home. If you have a personal story to tell, contact Elizabeth Church at echurch@globeandmail.com and Kelly Grant at kgrant@globeandmail.com.

Mayor Michael Bloomberg is fighting this change

A similar law enacted in 2003 in Los Angeles requires companies receiving city subsidies to pay workers $10.42 an hour or $11.67 without benefits. Despite warnings that the city would lose projects, Donald Spivack, a development official in Los Angeles, said at a Council hearing last month that those predictions were wrong and that he was unaware of any project that was canceled because of the wage requirement. The Center for American Progress found that 15 cities with living wage laws, including Los Angeles, Philadelphia, Cleveland and San Francisco, “had the same levels of employment growth” as other similar cities without the requirements.

Mayor Bloomberg’s arguments against this modest wage increase contrast with his endorsement of a 2002 city law that now sets a minimum of $10 an hour for about 60,000 workers employed by service contractors hired by the city, many of them home health care workers. Home care workers got a similar increase as part of Gov. Andrew Cuomo’s Medicaid redesign this year.

“They work hard and play by the rules,” President Obama said

“Today’s action will ensure that these men and women get paid fairly for a service that a growing number of older Americans couldn’t live without.”

These workers, according to industry figures, generally earn $8.50 to $12 an hour, compared with the federal minimum wage of $7.25 an hour. The White House said 92 percent of these workers were women, nearly 30 percent were African-American and 12 percent Hispanic. Nearly 40 percent rely on public benefits like Medicaid and food stamps.

many do not receive a time-and-a-half premium when they work more than 40 hours a week. Twenty-two states do not include home health care workers under their wage and hour laws.

PHI PolicyWorks, a nonprofit group that seeks to improve conditions for home care workers

six million of the 40 million Americans older than 65 now need some form of daily assistance to live outside a nursing home. That number, government officials say, is expected to double to 12 million by 2030

the proposed rules, which might be modified after a 60-day public comment period

some companions employed by individuals for activities like helping them take walks or engage in hobbies would still be exempt from minimum wage and overtime coverage

estimated that Medicare or Medicaid, which cover 75 percent of the nation’s home care costs, would pay $31.1 million to $169.5 million more each year toward home care aides, which she said would represent 0.06 percent to 0.29 percent of federal and state outlays for home care

In 1974, the Labor Department exempted “companionship” workers from coverage under the Fair Labor Standards Act, a move that focused on baby sitters at a time when the home care industry was in its infancy.

In 2007, the Supreme Court issued a decision involving a New York home care aide, Evelyn Coke, who often worked 70 hours a week, ruling that she was not entitled to overtime pay under existing regulations. The court said it was up to Congress or the Labor Department to change the rules.

nearly 90 percent of the nation’s home care aides work for agencies

Only four years ago, when fast-food workers first began holding marches to demand a $15-an-hour minimum wage, they were dismissed as impractical dreamers. Now, in a twist that has surprised economists and activists alike, that dream is becoming a reality in some parts of the country.

Portland, Ore.

If there are costs as a result of the higher wages, the question is how they compare with the benefits, said Ben Zipperer, an expert on the minimum wage at the Washington Center for Equitable Growth. “Both [costs and benefits] may arise,” he said. “How people feel about the trade-off is more complicated.”

And dozens of occupations, some that you've never even heard of, are exempt from basic rights entirely. "Keepers of fur-bearing mammals" have no right to minimum wage. Sod layers have no limits on their daily hours of work. Shrub growers don't get a lunch break. The system is so complicated that the Ministry of Labour has developed a special online tool to help decipher who's entitled to what. But as the province reviews its antiquated Employment Standards Act, critics argue that its confusing web of exemptions makes it harder for the so-called precariously employed to defend their rights - and easier for bosses to ignore them.

"When you distil it down to what these exemptions are seeking to achieve, really they are to give employers more control over work and more control over wages," says Mary Gellatly of Parkdale Community Legal Services. "It sends the message to employers that they can get away without complying." The Act was first introduced in Ontario in 1968 to set basic work standards, especially for non-unionized employees who don't have a collective agreement to provide extra protections. But there are at least 45 occupations in Ontario that are exempt from a variety of its fundamental entitlements, many of them low-wage jobs in industries where precarious work is rife.

The Ministry of Labour says many of the exemptions are "long standing" and related to "the nature of the work performed." But York University professor Leah Vosko, who leads research into employment standards protections for the precariously employed, says exemptions have come at least in part from industry pressure, leaving the Act a "complex patchwork that is difficult for workers and even officials to comprehend." Even when there are clear violations, speaking out can come at a cost. Reprisal is illegal under the Act, meaning bosses can't penalize employees for exercising their workplace rights. But the Act gives workers no protection against wrongful dismissal. Employers do not have to give cause for firing someone.

Unionized employees are generally protected by their collective agreements, and workers can sue employers if they think they have been unfairly terminated. But most precarious, low-income employees are not unionized, and most do not have the money to take legal action against an employer, says Parkdale's Gellatly. "It's the big reason why many people can't do anything if they're in a workplace with substandard conditions, because they can get fired without cause." Linda Wang, who worked at a Toronto cosmetics manufacturer for four years, was fired less than two weeks after asking her employer for the extra pay she was owed for working a public holiday. She says no reason was given for her termination. Wang, a mother of two, claims her employer repeatedly bullied her and her colleagues, and says she believes she was dismissed for asking for the wages.

She has filed a reprisal complaint with the Ministry of Labour, but Wang cannot afford to take her employer to court. "I feel the system is against workers," she says. "It's in favour of employers." "Whatever job you have, you put so much of yourself into it," adds Gellatly. "The fact that employers can just fire you without a reason is incredibly devastating for folks." The Act also contains significant gaps when it comes to sick leave and overtime. The legislation provides most workers with 10 unpaid days of job-protected emergency leave, which means they can't be fired for taking a day off due to illness or family crisis. Critics call this measure subpar by most standards, since it still causes many workers to lose a day's income for being ill. An estimated 145 countries give employees some form of paid sick leave.

"Unfortunately, we stand out for our inadequacy," says Brock University professor Kendra Coulter. But the 10-day protected leave doesn't apply to almost one in three of the province's most vulnerable workers. An exemption that excludes employees in workplaces of fewer than 50 people from that right means 1.6 million workers in Ontario are not even entitled to a single, unpaid, job-protected sick day. Fast-growing, low-wage sectors such as retail, food services and health care are most likely to be exempt according to a recent report by the Workers' Action Centre. While many small businesses voluntarily give their employees paid sick days, the loophole leaves many workers - especially the precariously employed - exposed.

Toronto resident Gordon Butler asked his employer, a small construction company in Markham, for one day off work after he sliced his thumb open on the job. He says his boss told him not to come back. "I didn't believe him," says Butler, 44, who has an 8-month-old child. "I tried to plead with him, and he said 'No, too bad.'" "The way it's stacked up right now is there are very few options for people who are in low-wage and precarious work to actually take sick leave when they're sick," says Steve Barnes, director of policy at Toronto's Wellesley Institute, a health-policy think-tank. "They not only have to worry about lost income, but the potential for losing their jobs," adds Brock's Coulter. "It's unkind and unnecessary." The stress caused by the province's meagre sick-leave provisions is compounded by exemptions to overtime pay, to which around 1.5 million don't have full access.

As a rule, employees should get paid time and a half after 44 hours a week on the job, according to the Employment Standards Act. But in 2014, more than one million people in the province worked overtime, and 59 per cent of them did not get any pay whatsoever for it, Statistics Canada data shows. This, experts say, is partly because enforcement is poor. But in Ontario, a variety of occupations don't even have the right to overtime pay, including farmworkers, flower growers, IT workers, fishers and accountants. Managers are also not entitled to overtime. Vladimir Sanchez Rivera, a 45-year-old seasonal farmworker in the Niagara region, says he has worked 96-hour weeks doing back-breaking labour picking cucumbers and other produce.

We don't have access to protections when we are working in agriculture," he says. "And our employers tell us that." Low-wage workers are even more likely to be excluded from full overtime pay coverage, according to the Workers' Action Centre's research. Less than one third of low-income employees are fully covered by the Act's overtime provisions, compared to around 70 per cent of higher earners, because they are more likely to work in jobs that aren't eligible. Workplaces can also sign so-called "averaging provisions" with their employees, which allow bosses to average a worker's overtime over a period of up to four weeks. That means an employee could work 60 hours one week and 50 the next, but not receive any overtime as long as they don't work more than a total of 176 hours a month.

Critics say the measure means more work for less pay, and paves the way to erratic, unpredictable schedules. "That's a huge impact on workers and their families in terms of lost income and having to work extra hours," says Parkdale's Gellatly. "It's certainly not good for workers, for their families, and it's not good for creating decent jobs in terms of rebooting our economy," she adds. For many of the precariously employed, falling through the gaps ruins lives. "Even now, when I think about the working environment, I feel very depressed," says Wang, who, 10 months later, is still waiting for the Ministry of Labour to issue a ruling on her complaint. "I feel panic."

Sara Mojtehedzadeh can be reached at 416-869-4195 or smojtehedzadeh@thestar.ca. By the numbers 1.6 million non-unionized Ontario employees with no right to an unpaid, job-protected sick day 59%

of Ontario workers who worked overtime in 2014 did not get any pay whatsoever for it 71% of low-wage, non-unionized Ontario employees don't have full access to overtime pay 29%

of high-income employees don't have full access to overtime pay Sources: Workers' Action Centre, Statistics Canada Proposed solutions A recent report by the Workers' Action Centre makes a number of recommendations to rebuild the basic floor of rights for workers. The proposed reforms include: Amending the ESA to include protection from wrongful dismissal

Eliminating all occupational exemptions to ESA rights Repealing overtime exemptions and special rules Repealing overtime averaging provisions Repealing the emergency leave exemption for workplaces with less than 50 people Requiring employers to provide up to seven days of paid sick leave

Since Prime Minister Stephen Harper assumed power in 2006, the number of foreign temporary workers admitted into Canada has grown by 40 per cent. The temporary worker stream is now larger than the stream of permanent workers intending to set down roots and become citizens.

When Canada introduced its temporary foreign worker program in 2002, the governing Liberals vowed never to adopt the European model route in which “guest workers” are paid less than nationals and treated as second-class residents. But under Harper, the country is now moving in that direction.

Earlier this summer, the province announced it would provide a new contract to home-care agencies that would compel them to pay workers a minimum of $11 an hour, up from a minimum of $9.50. It also said it would provide the agencies $16 an hour, up from $15, to run the service. This angered the agencies, both non-profit and for-profit, because they said it wasn't enough to help them make ends meet.

Under the old contract, the province covered 60 per cent of the workers' wages, so the association argued that to maintain that level, the agencies should be paid $18.33 an hour. Following an association meeting in Fredericton last week, about 20 of the 57 home care agencies decided to reject the contract, which the province says must be signed by Oct. 7.

But Hood said the wage hike wouldn't help the workers much. The government's offer to provide the agencies an extra dollar an hour would cover the wage increase, but along with the hike comes an increase in benefits - CPP and EI premiums, statutory holiday hours and vacation pay will all go up, adding to the agency's costs.Her board, she said, would likely claw back the amount they pay the workers for mileage on their cars. Price said many of the other agencies would do the same.

nearly 40 percent of in-home care workers have to rely on food stamps or other forms of public assistance in order to make ends meet

Click here for her testimony.