Exploring Personal Support Worker Education, Recruitment, and Retention in Long-Term Care Homes in Ontario, Canada: Protocol for a Mixed Methods Study

Background: Long-term care (LTC) homes across Canada are facing a crisis in worker recruitment and retention. In the province of Ontario, personal support workers (PSWs) make up 58% of the LTC workforce and play a key role in addressing staffing shortages. Despite the provincial training and education standards implemented in 2014, PSWs working in LTC consistently report feeling unprepared and undersupported and a lack of confidence, leading to high turnover rates. Integrated learning approaches such as the Living Classroom may ease the transition from education to practice, supporting recruitment and retention of PSWs into LTC. Objective: This study aims to explore potential relationships between Living Classroom models of PSW training and their recruitment and retention in LTC homes in Ontario, Canada, as compared to traditional, or non-Living Classroom, models and how the experience of the Living Classroom impacts the recruitment and retention of these workers. Methods: We will use a convergent mixed methods study design in which quantitative survey data and qualitative interview data will be collected concurrently. The quantitative arm of the study will recruit new PSW graduates from both Living Classroom and non-Living Classroom programs, delivering online surveys at 1, 6, and 12 months after program completion to assess demographics, employment status and placement, intent to leave, and the changes in those metrics over time. The qualitative arm of the study will recruit PSW students within 8 weeks of program completion for 60-minute semistructured interviews conducted online via Zoom, over the telephone, or in person. Interview transcripts will be analyzed using thematic clustering and line-by-line emergent coding techniques as well as team-based analysis meetings. In addition to an emergent thematic analysis, we will use a priori codes to capture concepts from the quantitative measures, including recruitment into and intent to leave health care and LTC. Data collection and analysis from both arms will be presented in a side-by-side joint display. Results: This research is funded by the Ontario Ministry of Long-Term Care from April 2024 to March 2026. Enrollment began on March 3, 2025, and is estimated to be completed by December 31, 2025. As of June 16, 2025, we had enrolled 35 participants for interviews and 132 participants in the surveys. Data collection and analysis are currently underway, and the first results are expected to be submitted for publication in 2026. Conclusions: The results of this study will inform our understanding of the Living Classroom model for PSW education and its impact on recruitment and retention of PSWs into LTC in Ontario. This evidence will enable educators, LTC administrators, and policymakers to further develop their approaches to PSW training and education as one of many vectors to address the staffing shortages faced by the LTC sector.