The need for community care workers is expected to double in the next decade.

In Ontario, personal support workers (PSWs) provide a great deal of the direct care services provided in peoples’ homes, and in long-term care settings.

With increased demands on PSWs and a growing need for their care, there remain unresolved issues around training, scope of practice and work environment for these workers.

May 16 is Personal Support Worker Day. PSWs are increasingly providing the majority of direct care services to elderly or ill patients who live in long-term care institutions or who receive home care.

Catherine Richards, whose mother spent the final months of her life in a Toronto-area long-term care home recalls how extremely busy the PSWs were. Over the course of a long shift they were responsible for getting 8 to 15 residents out of bed in the morning, to the bathroom, dressed and ready for breakfast with only a few minutes for each resident. Versions of this routine were repeated again every few hours over the course of an 8 hour shift. Richards noted that “they [PSWs] are constantly on the go … they have very little time to actually sit down and provide comfort to residents and build that important relationship between themselves as caregivers with the residents and their family members”.  Richards says that in her experience, the most important qualification for PSWs is “being kind and patient with the high needs people” they care for.

There is a great deal of variation in what PSWs do, where they work, and how they are supervised. This has made many argue that there must be more standardized training and regulation of PSWs. Others point out that it is at least as important to ensure that their working conditions allow PSWs to provide the compassionate and high quality care that their clients deserve.

What Do PSWs Do & Where Do They Work?

Unlike most other health care workers in Ontario, PSWs are not a regulated health care profession, meaning there is no governing body which sets standards for the skills and knowledge needed to practice as a PSW, and the services they can provide. Rather, PSWs have a role standard  which says “personal support workers do for a person the things that the person would do for themselves, if they were physically or cognitively able”.

There is a great deal of variation around the kind of care PSW’s provide, with some PSWs providing medical care such as changing wound dressings and administering medication, and others providing  ‘only’ personal care such as bathing, transfers from bed and housework. What PSWs can and cannot do varies based on their training, supervision and employer policies.

An estimated 57,000 PSWs in Ontario work in the long-term care sector, 26,000 work for agencies that provide community and home care, and about 7,000 provide care in hospitals.

Changes to the Long-Term Care Act in 2010 outlined a minimum standard of education for PSWs working in that sector specifically. These changes did not apply to PSWs working in environments outside long-term care such as home care.

Gail Paech, CEO of the Ontario Long-Term Care Association says “there is huge variation among PSWs in the training they have received, so the move to standardize the educational requirements is a very positive initiative” for the long-term care sector. Paech notes “individuals who are admitted to long-term care are older and sicker than ever before, and it is important that there is a work force in place that is well educated and trained to meet these increasingly complex needs.”

Working & Training for PSWs

PSWs working in long-term care homes are required to work under the supervision of a registered nurse or registered practical nurse, although there is a great deal of variation in the staffing ratios of nurse to PSWs . This, along with PSW to resident ratios, have consequences for the quality of care.  Some have suggested that rather than standardizing education for PSWs, more standards should be put in place around PSW supervision, scope of practice and work environment in long-term care and community agencies.

The informal nature of PSW work, and lack of standardized training and skills has meant that many PSWs do not have permanent positions or job security. A 2007 Ontario Ministry of Health and Long-Term Care Report which considered the question of regulating PSWs noted that 92% of PSWs are women, and many work at multiple part time jobs, involving a great deal of shift work.  PSWs are often paid minimum wages with few benefits.

There are many routes to becoming a PSW, with various levels of training. Some PSWs have little or no training. Community colleges, continuing education programs and private career colleges offer courses or programs of varying durations, with no standardized core curriculum across the programs. There is no single body in Ontario that monitors the quality of these programs.

The Ontario PSW Registry:  “A First Step”

In spite of the central role that PSWs play in providing direct care to so many Ontarians, very little is known about these care providers – who they are, where they work, what their training is and what they do.

In response to this situation, last May the Ontario Ministry of Health and Long-Term Care announced that it would be developing a PSW Registry to collect information about the training and employment status of the nearly 100,000 PSWs in Ontario in an effort to better understand PSWs. The Registry is scheduled to open and start collecting information on June 1, 2012.

Lori Holloway, Director of the Personal Support Network of Ontario, an organization that provides resources to Ontario’s PSWs, suggests that better data can help clear up “the gray area surrounding what personal support workers do” . Holloway notes“there is no consistency or comfort around this role, and huge variations in training” , which makes it difficult to understand what the full potential scope of work for PSWs should be.

Gail Donner, a Professor at the University of Toronto Bloomberg School of Nursing, who is leading the Long-Term Care Task Force on Resident Care and Safety says that the Registry is “a first step in getting a handle on who PSWs are and where they are.” However, Donner says “a registry is a mechanism of counting and it doesn’t ensure anything about quality, preparation or standards.”

Zita Astravas, a spokesperson for Ontario’s Minister of Health and Long-Term Care, Deb Matthews, says “in light of the coming Registry, there is a need to consider education standards as a means of defining eligibility for PSW registrants.” Astravas notes that in the past two months there have been stakeholder consultations around educational standards for PSWs. However no further details are available about if, when and how these standards would be put into practice.

In Nova Scotia, a registry was put in place for Continuing Care Assistants (the provinces’ equivalent to PSWs) in 2010 which has been used to communicate directly with CCAs as well as keep track of where they work. In addition, the registry provides resources and the development of a personalized learning plan to help care givers who do not have the provincial CCA obtain further training. British Columbia has also recently introduced a registry for Care Aids and Community Support Workers.

With PSWs being the largest group of workers in Ontario’s long-term care and home care sector, many suggest that once more is known about them through the Registry, further steps need to be taken to ensure that they are equipped to provide high quality care. However given variations in the work environment and type of care that PSWs provide, there are questions around what the appropriate next steps should be.

Maureen Hylton, a personal support worker in the community and long-term care sector in Toronto says “PSWs have high expectations put on them but very little support to do their jobs.”

What should be some next steps for PSWs in Ontario?

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