The Québec health sector is facing profound macroeconomic and macro-organizational changes. This article addresses the impact of these changes on the work of home health aides (HHAs) and their occupational health and safety (OHS). The study was carried out in the home care services of four local community service centers (CLSCs) with different organizational characteristics. It is based on an analysis by triangulation of 66 individual and group interviews, 11 work days, and 35 multidisciplinary or professional meetings observed, as well as administrative documents. HHAs are experiencing an erosion of their job because the relational and emotional components of their work are disappearing. This results in an increase in musculoskeletal and psychological health problems. This study also shows that managers' decisions can reduce or increase the HHAs' work constraints. Stability in the clientele served and the possibility of organizing their routes are good examples of positive impacts.