Elder-care, assisted living, and nursing homes - with an average annual revenue of $30 million, were most likely to employ RNs (76.9%). RNs were least likely to be employed in home care or hospice (7.5% and 9.9%, respectively). These results are consistent with other studies conducted in Canada ([@b14-ijt-08-20]) and internationally ([@b11-ijt-08-20]; [@b7-ijt-08-20]). The high rate of employment among home care services can be attributed to the low level of wages that nurses receive in the workforce ([@b2-ijt-08-20]). Moreover, the low wages in the eldercare sector have caused nurses to work long and irregular hours, making the profession unappealing to nursing students ([@b5-ijt-08-20]; [@b12-ijt-08-20]). According to [@b12-ijt-08-20], "it is often assumed that home care is low paying and that professional nursing personnel do not want to be employed as home care nurses. The problem lies in the fact that the wages for home care nurses are low, with an average income of \$29,000 per year (RCN-Canada). However, according to a study done by [@b9-ijt-08-20], nurses in home care were highly motivated and satisfied with their job in spite of low wages. Nurses believed that they were paid well relative to other occupations because they have to be a self-starter. Nurses have to be highly organized and meticulous in order to handle emergency situations, making their work highly stressful and physically demanding. In addition, if patients are discharged early (i.e., discharged without any signs of improvement), nurses must find out the reason for the poor health and develop a plan to help the patient recover ([@b11-ijt-08-20]; [@b14-ijt-08-20]). Another factor that may have contributed to nurses' low participation in home care services is the low wages and poor benefits compared to the eldercare nursing industry. Home care nurses get little or no benefits ([@b14-ijt-08-20]). According to [@b2-ijt-08-20], "the poor compensation of home care nurses and the lack of any additional remuneration \[other than the fee for services\] are a major disincentive to nurses pursuing a home care career" (p. 4). In comparison, the average nurse's earnings in hospitals were three times higher than in home care settings ([@b5-ijt-08-20]). [@b14-ijt-08-20] also noted that when nurses are on the job, they do not receive any compensation or benefits. Nurses indicated that they do not have sick leave or health benefits, have to pay for their own uniforms, cannot use their own personal vehicles on the job, and do not get paid vacation or paid sick days. Nurses' lack of recognition for their work led to nurses quitting their jobs. [@b7-ijt-08-20] report, for example, a case in which the employer did not pay overtime, holidays, and personal days. For more than three years of continuous work with the same employer, the nurse made only \$38,000 and the overtime wages amounted to \$17,000. The nurse was paid \$13 per hour for overtime hours, and when the employer did not pay overtime, the nurse had to accept the shifts or work longer hours. The author also cited that in the eldercare setting, nurses are often assigned multiple people to care for and need to do housekeeping and laundry as well as complete paperwork. Home care nurses described working 12-hour shifts, six days a week (12 hours each day) with no regular breaks or day off. [@b6-ijt-08-20] reported that home care nurses were "the lowest paid, highest turnover rate \[and\] most at risk nurses" (p. 2). In addition, the nurses spent three times longer than other nurses on patient care and three times longer than other nurses on communication. Home care nursing has become a stressful and frustrating work, especially for a nurse's first shift. The job can be stressful due to the fact that the home care nurse has no control over any of the patients' needs. Because these patients can be very stubborn, the nurse is often blamed if a patient is not doing what they want ([@b14-ijt-08-20]). Similarly, hospital-based nursing has become increasingly complex and stressful in which nurses must meet the demands of the healthcare system, the workplace environment, and complex human factors that affect nursing care ([@b9-ijt-08-20]; [@b7-ijt-08-20]). In addition to a shortage of nurses in home care, [@b13-ijt-08-20] suggested that to address increasing needs for health services, the government should consider implementing a task-shift approach to the workforce. They stated that this task-shift approach allows nurses to work in different work settings to provide both quality care and increased capacity in the nursing workforce. According to the author, a task-shift approach allows nurses to work in different work settings such as home care, long term care, community care, hospital-based care, as well as in public health and educational roles. Task-shifting also contributes to efficiency in the healthcare system by using individuals with different competencies to conduct tasks ([@b13-ijt-08-20]). As the demand for home care services continues to grow, home care agencies may soon be short of qualified staff. While the eldercare nurse can often manage all the tasks of the care that are required by an elderly individual, more nurses are needed to provide the basic care ([@b13-ijt-08-20]). Task-shifting helps home care agencies hire and retain nurses who can fill the current gap in the health care system. According to the findings of this study, nurses employed in home care, assisted living, or nursing homes were more likely to be employed by small businesses, whereas nurses in nursing homes were more likely to be employed by large enterprises, such as home care agencies. Similar findings have been reported by other studies ([@b5-ijt-08-20]; [@b2-ijt-08-20]). According to [@b5-ijt-08-20], a lack of adequate education, training, and support from both employers and trade unions have led to poor work environments, low pay, and low job satisfaction in the home care setting. In fact, employers do not pay home care nurses anywhere near what the nurses would earn if they had the same skills working in a hospital. Home care nurses can get a better paying job by working part time, because they can work one or two days a week and take time off when they have to care for family or to see a sick person. The authors argue that home care is a 24-hour business and they do not want to work on holidays, and do not get paid for overtime. According to [@b5-ijt-08-20], home care nurses feel that they cannot refuse work. The authors cited that their response is, "I'm just trying to earn enough money to survive". Despite the limitations of this study, the findings of this study are relevant and important to the local home care industry in that they provide insight into the employment characteristics of home care nurses. The fact that nurses employed in small businesses were more likely to be working in home care than in nursing homes suggests that nurses are reluctant to work for large enterprises. More research should be done to understand why nurses are reluctant to work for large enterprises. Nurses in small businesses receive some degree of personal recognition, they are not overwhelmed with work, they have a chance to grow, and work more flexible hours. The nurses working in small businesses have the opportunity to learn a new job, because they start in the role of assistant. Further study should be undertaken to determine the best way to attract and retain nurses in the workforce. [@b2-ijt-08-20] propose that if the government were to create a task-shift approach to the nursing workforce, nurses could fill positions as required to meet current and future demands in the healthcare system. Currently, older people often find it difficult to find a willing caregiver to take care of them at home. There are many issues faced by the eldercare sector that need attention. First, older people are the fastest growing segment of the population and many of them will be requiring the kind of care that home care agencies provide. Secondly, an increasing number of older people are living in the community, which requires support services. Thirdly, the public sector needs a solution to the nursing shortage. Home care is a viable option, but it requires trained and experienced nurses to administer. Lastly, and perhaps most important, is that the government need to create a system that recognizes nurses for their work in the home care setting. CONCLUSION ========== This study examined nurses' characteristics and current employment conditions in the home care industry. The analysis found that the home care setting employs high percentages of migrant nurses from Asia and South America. Most nurses are employed by small companies and earn less than nurses in the eldercare and home health settings. Home care nurses also work the longest hours, and are paid the least for their work. The nursing shortage continues to worsen and this shortage is not likely to be alleviated in the near future. The study suggests that home care settings are short-staffed, and that to further address this shortage the government needs to implement