Want More Health-Care Workers? Help Them with Housing

Burnout and disengagement often are cited as the primary causes of Canada’s deepening shortage of health-care workers. But to build a strong and sustainable system, affordable housing must be treated as essential workforce infrastructure.

This starts with recognizing that supporting frontline health workers means ensuring they have access to safe, affordable and stable places to live, especially in communities where care is most urgently needed.

While housing is widely accepted as a social determinant of health, its role in supporting the people who deliver health care is often overlooked. This is particularly concerning given the predominant demographics of frontline health-care workers.

More than 75 per cent of health-care professionals in Canada are women, and an increasing share are newcomers. For example, in 2021, newcomers accounted for 22 per cent of nursing and support occupations, compared with 16 per cent of the total employed population. These groups are often concentrated in low-wage, high-demand roles, already face systemic barriers to accessing housing and are more likely to experience housing precarity.

Now add the fact that full-time health-care work often doesn’t pay enough to afford housing in many parts of Canada. In 2023, registered nurses earned an average of $34 per hour, licensed practical nurses earned $27.85, and nurse aides earned $21.85.

By comparison, the hourly “housing wage” (the income required to afford a modest two-bedroom rental without exceeding 30 per cent of earnings) was $22.40 nationally. In many urban areas, the housing wage is much higher. For example, in 2018 the housing wage in Toronto was $33.70. Thus, even a full-time health-care worker may be unable to afford housing close to their workplace. And for many, that’s exactly what is happening.

This mismatch between wages and rental costs results in many health-care workers commuting long distances or living in inadequate housing. For workers juggling night shifts, caregiving responsibilities or multiple part-time jobs, this adds to exhaustion, stress and mental health strain. A 2022 study of personal support workers in the Greater Toronto Area found that 86 per cent were precariously employed, nearly half reported poor mental health, and more than one in five met clinical criteria for depression with many citing housing stress and economic instability as major contributors.

Yet, housing remains largely peripheral in health-care workforce policy and planning. Burnout is often overstated as a cause of the high turnover rate among medical staff, with limited empirical evidence and little exploration of housing insecurity or financial strain as key factors.

Rural and remote communities bear the burdens of the health workforce crisis acutely. From 2013 to 2022, the proportion of all nurses across Canada working in these areas dropped to 9.6 per cent from 11.1 per cent.

The shortage is especially evident in frontline roles. For example, nurse practitioners make up the largest share of the rural nursing workforce, with one in seven practising in rural or remote settings (compared with about one in 10 for other nurse types). Yet, their presence has decreased to 14 per cent in 2022 from 18 per cent in 2013.

Barriers to higher staffing in rural areas include limited training capacity, underinvestment in the northern workforce and, critically, a shortage of adequate housing. In some regions, no rental units exist within commuting distance of work. In others, housing prices are driven up by tourism or seasonal demand.

In reporting on health worker retention in underserved rural areas, the World Health Organization identified housing as a critical component of infrastructure, emphasizing that bundled, place-based interventions that include housing are the most effective tools in improving workforce recruitment and retention.

It’s time Canada took that advice seriously.

There’s no one-size-fits-all solution. But several promising models are emerging:

• Employer-led solutions: SE Health is taking a leading role in workforce housing innovation, from providing place-based accommodations near a supportive living facility in Alberta, to partnering with developers in Ontario to create affordable home-ownership opportunities for staff, to connecting employees with flexible home-share arrangements.
• Housing near care sites: The University Health Network is helping develop affordable homes for essential hospital workers and their families as part of Toronto’s Coach Terminal redevelopment.
• Fractional ownership: Emerging Canadian startups like Ourboro partner with first-time homebuyers, co-investing up to $250,000 to bridge the down-payment gap by sharing equity (and eventual gains or losses) when the home is sold.

Meaningful change is possible when employers, governments and communities come together to prioritize health workers’ housing. What’s needed now is the will and the co-ordination to scale and spread these efforts.

At the federal level, initiatives like Build Canada Homes and recent investments through the National Housing Strategy show that large-scale, innovative action is possible. These programs are aimed at building affordable homes, supporting new housing models and partnering to address the housing crisis. Workforce housing must be part of this vision.

An aging population, growing regional disparities and deepening housing insecurity are threatening the stability of our health systems. Treating housing as separate from health will only widen care gaps, fuel burnout and undermine equity.

A care system cannot function if those who power it cannot afford to live in the communities they serve. If we are serious about building a system that works, we must start with something basic: ensuring every frontline worker has a safe, affordable place to call home.