Full bibliography

Precarious work is becoming more common globally and the healthcare sector in Ontario, Canada is no exception. Aspects of precarious work such as low wages and job uncertainty have negative influences on work quality. Digital platforms (DPs) introduce the threat of gig work as a form of precarious work. With the growth of precarious gig work and its expansion into healthcare, it is important to understand how platform technology shapes actual work practices and the work-related protections for workers. This dissertation focuses on unregulated personal support workers (PSWs) who use DPs to find work. Specifically, there are two aims of this research: first is to examine the precarious work experiences of women PSWs who seek eldercare work via a DP model in order to understand socio-technical implications of DP; second is to examine the work-related protections that apply to digital platform care workers and how these shape work conditions. Using Institutional Ethnography as a guiding methodology, in 2023 and 2024 in Ontario I conducted semi-structured interviews with 20 PSWs who used DPs to find gig care work; I also interviewed 10 key informants who were in various positions of expertise about gig care work platforms. This included end-users of DPs such as clients and companies. Additionally, I observed workers demonstrating their use of DPs and examined screen shots from DPs. These PSWs face precarious work conditions, with precarity deepened by the technology of DPs. In the three papers comprising this thesis, I cover socio-technical elements of the DP model of care and portray how this form of work makes both workers and clients vulnerable. In the first manuscript, I describe two different models of gig care work platform, (marketplace and on-demand platforms) and explicate how each model is found in a separate sector of healthcare: marketplace models are found only in homecare, and on-demand models are found exclusively in long-term care and hospital organisations hiring workers. In the second manuscript, I describe the risk to hospital and LTC organisations in hiring gig care workers. In the third manuscript, I explore trust as I write about how homecare workers using DPs experience this work and how a couple of clients experience hiring workers. This thesis allowed me to closely examine how platform technology shaped the actual practices of women using DPs and their work circumstances. The primary contribution of this dissertation is revealing day-to-day experiences of gig care workers, filling a gap in the literature on location-based care platforms. The findings of this thesis underscore that DPs increase precarity for already-precarious PSWs. I demonstrate that instead of being neutral technology, DPs introduce a governing text of entrepreneurial self-employment which involves risk for the workers and clients using DPs. Organisations may not have opportunity to properly vet staff, train staff, or insure staff. Private clients gain access to more services when they use DPs, but then they shoulder all the risk when something goes wrong. Overall the DP form of gig care threatens growing precarious work, dodges social security and employment protections, and undermines publicly-provided care employment in Ontario, Canada.