Seven years ago, when her daughter, Kiesha, was six years old, Tammy Embrey was in a devastating accident. She was outside her home, helping load Kiesha’s wheelchair on to her school bus, when the family pickup truck rolled out of the driveway and pinned Embrey between the truck and the bus. Embrey suffered multiple fractures—including seven in her pelvis—and spent five months in hospital. When she came home, she needed more help to care for Kiesha, who was born with numerous disabilities and is both non-mobile and non-verbal.
The local CCAC increased the family’s access to home care, with personal support workers coming in more than 16 hours a week. On a daily basis, Kiesha’s PSWs change her, bathe her, play with her and read to her. They’ve been trained to use special equipment installed in the home, including a ceiling track that runs between the kitchen and the living room and allows Kiesha to walk in a Jolly Jumper-like sling. Of the four workers who come to the Embreys’ home in Port Colborne, Ontario, two have been with the family for more than six years. “We’re very, very lucky,” says Embrey.
PSWs help patients with the essential activities of daily life—dressing, bathing, going to the bathroom. Sometimes they are delegated to assist with more complex tasks, such as administering medication or suctioning tracheostomies. They do what no one else in the health care system has time to do, and without them the system would not function. They are also very much the front line of caring for the province’s most vulnerable people—seniors who have severe dementia, for example, and children who have very complex developmental issues. They work in nursing homes, in the community, privately for families, and, increasingly, in acute care hospitals. While no official count has been taken since 2011, it is estimated that there are upwards of 100,000 PSWs working in Ontario. And the need for PSWs increases steadily as the population ages, living longer with more complex needs.
Despite the essential work PSWs perform, there’s a lack of data about them. What percentage are formally trained? How many work in institutions versus the community? Questions such as these were meant to be addressed by a provincial registry that was created in 2012, when Healthy Debate first wrote about the PSW sector in Ontario. At that time, the government had just changed the Long-Term Care Homes Act to include mandatory educational requirements for PSWs working in provincially funded nursing homes. But there was concern that no similar standard existed for PSWs working in home care. And there were other concerns: about understaffing of PSWs in nursing homes, about the level of nursing supervision available to PSWs in long-term care, and also about their income and job security.
Six years later, Healthy Debate revisits the PSW landscape, from training and workload to compensation.
What is the minimum training for a PSW?
In 2014, the Ministry of Training, Colleges and Universities (now known as the Ministry of Advanced Education and Skills Development) laid out a set of 14 vocational standards for PSW programs which include a demonstrated ability to work with clients experiencing dementia and with patients receiving palliative care.
Programs offered by community colleges must all meet these standards and are accredited by the ministry. These programs run for eight months (one academic year), comprise more than 700 hours, and cost about $4,000 to attend. Programs offered by career colleges tend not to be accredited by the ministry, instead following a curriculum provided by the National Association of Career Colleges, which is “based upon” ministry standards. These programs run six-to-eight months in length, comprise more than 600 hours, and cost anywhere from $3,000 to $14,000. The third educational stream for PSWs in Ontario is through municipal boards of education, which adhere to the MTCU’s 14 standards and comprise a minimum of 600 hours (most range between 650 and 800, according to Anita Plunkett, one of two PSW co-chairs with Ontario’s Continuing Education School Board Administrators). They cost somewhere between $1,000 and $2,000.
While long-term care homes require that PSWs meet the standards of and complete one of these curricula and complete a minimum of 600 hours of training, there is no such requirement for PSWs working in home care or privately for families. This means the PSW workforce in the community is “very much a mix,” says Veronique Boscart, the Schlegel/CIHR Industrial Research Chair for College in Seniors Care at Conestoga College. “Some are certified through a college, some come through a private career college, and others don’t have a standardized training.”
What does the PSW registry do?
The PSW registry established in 2012 was meant to determine how many PSWs were working in the province, where they were working and what their training was. It was also supposed to offer a measure of reassurance to families that their parents, children or partners were being cared for by trained, competent workers, as the public could look up PSWs by name on the registry.
But the government shut this registry down in 2016 when an audit revealed that it was not able to adequately track information on the roughly 30,000 PSWs who were registered. “The public and the employers thought that the people on the list were safe to hire, and there really wasn’t any information on them available,” says Boscart. “Which is a little scary.” She points out that it’s very common practice for PSWs to go from one employer to another, especially in home care. “If a PSW provides care and it’s not going well, we have no way of trying to figure out where that PSW is going to work tomorrow.”
In the provincial budget of 2017, the Ministry of Health and Long-Term Care announced that it would create a new PSW registry, and in September it announced that this registry would be run by the Michener Institute, a post-secondary institution in health sciences education in Toronto. Michener launched a registry website in January and is currently collecting data from PSWs who are working for a “registered employer” and have completed a community or career college program in 2016 or later. Registering will be mandatory for all PSWs by 2019, and the registry intends to verify their credentials. The website recently posted a code of ethics, a set of roles and responsibilities, and a complaints process, suggesting that registered PSWs will be held accountable to these professional standards. But how, exactly? If somebody breaks the code of ethics, “will [the registry] then have the power to actually withhold somebody from the registry and say this person has not met the professional criteria to be a PSW?” says Boscart. “This is not clear right now.”
Rather than a registry, the sector needs a regulating body, says Laura Bulmer, registered nurse and professor in the PSW program at George Brown College’s Sally Horsfall Eaton School of Nursing in Toronto. “Having this many workers, and dealing with the population they’re dealing with, there’s no doubt in my mind that they should be regulated. They have to keep up their skills, be life-long learners, and maybe a license. And if you do not follow certain guidelines, ethics, scope of practice and standards, then [there should be disciplinary action and possibly] your license gets removed.”
Miranda Ferrier, president and founder of the Ontario Personal Support Workers Association, agrees. “A registry is not going to fix the issues of standardization of education, recognition, oversight and accountability,” she says. Ferrier has for years been lobbying the government to give OPSWA the mandate to govern PSWs. OPSWA currently has 31,000 members who pay a $150 fee annually, and this covers a background check, a criminal record check, verification of schooling, liability insurance and whistleblower protection. “We really believe that in order to speak for a profession, you need to be of that profession,” says Ferrier.
Are PSWs spread too thin?
A recent episode of CBC’s Marketplace told the disturbing story of a long-term care resident who died after being attacked by a fellow resident who was suffering from severe dementia. The program suggested that the low staff-to-resident ratios in long-term care might be a factor leading to negative outcomes for residents.
In fact, says Boscart, nursing homes do have regulated ratios. The numbers are not as simple as “X number of PSWs per resident”; instead, they are carefully calibrated to reflect the acuity of resident needs. “There are mandatory assessments [known as resident assessment instruments, or RAIs] done on every resident in long-term care every three months,” she says. Based on these assessments, nursing homes calculate resource allocation. “It’s not a body count, it’s how much work is needed,” says Boscart. She explains that RAIs are also done at admission and anytime something goes wrong, like a fall or a sudden decline. Then the assessments are used to calculate quality indicators for specific long-term care facilities, and these results are posted publicly by CIHI for all to see. “Nursing homes are the most regulated environment in Canadian health care,” says Boscart.
Still, she says, it can be very difficult to find staff to hire, and some nursing homes do not always meet the requirement for staffing. “We don’t have enough nurses, we don’t have enough PSWs, we don’t have enough practical nurses to provide care to older people. We don’t have enough people trained. There is money for those people, there are positions for those people. We just need to find them.”
Are PSWs paid enough?
When she greets a new crop of students, Bulmer, professor at George Brown, always has a “reality chat” with them, telling them not to expect to pay off their OSAP loans too soon after entering the workforce. “I don’t think a lot of people realize how little PSWs get paid,” she says. “They’re very much like daycare workers.”
That said, PSWs do better in long-term care. They may start just a little above minimum wage, says Boscart, but she says workers who stay in one setting for several years can make up to $25 and even $30 an hour. In institutional settings, PSWs may also be unionized and part of benefit plans, and they are also able to do shift work, which brings additional compensation.
Home care compensation, on the other hand, is considerably less lucrative, “known to be hovering around minimum wage,” says Boscart. (In January, minimum wage in Ontario jumped from $11.60 an hour to $14; Bulmer says it’s yet to be seen how this will affect home care.) The other issue with compensation in home care is that many agencies do not pay their PSWs for travel from one care recipient to another, says Boscart. “Most PSWs probably don’t have money to buy a car, [so] we’re talking about a group of employees that goes by bus from one house to another,” she says. “If you’re only paid for the number of care hours you provide, that’s about half of the time you put in.”
Tammy Embrey, mom of Kiesha, doesn’t know how much the PSWs who come to her home are paid, but she’s confident that it isn’t enough. “They go way above and beyond,” she says.
That’s what we would all want for our family members receiving care from PSWs. And more and more of them—and us—will, over time. There’s a lot at stake for Ontarians when it comes to the training, monitoring and compensation of personal support workers. And there are still plenty of challenges ahead.
Correction: A previous version of this article incorrectly reported that school board PSW programs follow a curriculum set out the Ontario Community Support Association which comprises less than 600 hours. The article also previously reported that the cost of school board programs range from $500 to $1,500.
The comments section is closed.
My mother is 99 years old and living in a Retirement Home. She is hearing and visually impaired, has mobility issues and dementia. The LHIN sends in PSW from three agencies.
They will not send in a female PSW although requested numerous times. The agency maintains this is discrimination because the male PSW is black. Mom has been offered 3 male different PSw in her time at the Retirement Home. Two white and one black. She has refused all three. She accepts care from black female Psw. The PSW oftentimes do not show up especially on weekends. The agency said that they are not required to fill out the flow sheet.
My mother can’t tell me if the agency showed up and provided any care. My Mom’s teeth are black due to lack of prompting her to brush her teeth. I had to phone the agencies numerous
times to ensure she was being showered as the schedule given to them from The LHIN specifies.
PSW should have a standardized education to make sure that they are equally educated and
qualified.
PSW must be regulated and licensed if they are allowed to provide care whether in a hospital,
Longterm Care, Retirement Home or n the community. There is no accountability in a profession that is assuming responsibility for the frail elderly who cannot advocate for themselves. Licensing and Regulations would also help to protect PSW in their workplace.
It is a failure of the government to not require licensing of an organization that provides care.
Doctors,nurses, physiotherapist, massage therapists, chiropractors, dentists, teachers all required regulation.
I am a health care aide, I have not worked as a health Care Aide in 22 years, I was just wondering if I would have to do more schooling to become a P.S.W.
Thank you
GOOD INFORMATION TO UNDERSTAND THE INDUSTRY.
I am a p s w. We need a organization to register. And we need a union for all p s w.we doing very dangerous job. We put our life frontline. But we never be look affter. If you work in garbage man they get goo pay and union. Why is frontline workers be panisht by employers. We are not slavery. I hope someone will helped us..this is the time to happen!
PSW’s need the extra help at night at their jobs — not by themselves. And especially not just one Nurse on shifts either. We’re all human, we’re not machines.
Today the Ford Government announced a pay freeze in the public sector….are psws that work for homecare agencies part of this? Today we had a vote with our union and our union rep said to accept it bc of the Ford governments announcement….is he correct in this or was he just wanting us to vote yes with the deal?…our vote ended up in declining the offer but still wanted to know? Thanks :)
Please correct your article: This is what your article states, and you should research all the facts prior to publishing : the third educational stream for PSWs in Ontario is through municipal boards of education, which adhere to a curriculum set out by an organization called the Ontario Community Support Association. These programs vary in length and comprise less than 600 hours. They cost somewhere between $500 and $1,500.
I work for a school board and our program is an accredited program and is 720 hours in length and has an excellent reputation in our county and surrounding areas. The Ministry of Training, Colleges and Universities (now known as the Ministry of Advanced Education and Skills Development) laid out a set of 14 vocational standards for PSW programs which include a demonstrated ability to work with clients experiencing dementia and with patients receiving palliative care. The school board programs follow all of the requirements set out and also was active in asssisting setting up these standards.
I also work for a school board, and am familiar with other school board programs. We meet the same vocational standards that community colleges do, but at a significantly lower cost, while also allowing students to earn a high school diploma (if needed) at the same time. I do not know of any school board programs that are under 600 hours in length – the ones I know of are all significantly over that minimum requirement. Our standards are high and our graduates are excellent PSWs successfully enjoying rewarding careers working in the community, Long Term Care Facilities and many other health care settings.
I have paws for over 10 years.They don’t do anything but gossip.Today as usual one did laundry and took it back to me (wet) then hang it everywhere.I am very ill with double lung cancer,damaged heart from radiation and many more problems including multiple sclerosis.I call the supervisor and she doesn’t get back to me. I even had my pain medication stolen many times and the girl still works there.Just saying the truth that you can’t trust some of them
Excellent article. Very informative. I would love to see this article printed in all newspapers to offset all the negative press that PSWs receive. This negative press is making it harder to recruit PSWs. Families and friends would also benefit by reading this article to help them understand the issues and become advocates for changes to improve the quality of care and life for those who need assistance with their daily living.
In my experience, PSWs are not making $25-30/hr. The few lucky ones who land a job in a city home do, the rest are lucky to make $20. PSWs and RPNs are incredibly underpaid for the important work that they do. As an ADOC I see this daily. The system will fail without PSWs and RPNs however they are the most overlooked groups, most people seem to focus on RN to patient ratio.
I would like to remind everyone that it is possible once every decade or
so for a leftist party to change something that needs to be changed.
Even though I oppose the Liberal party on most everything else, I believe
this (concept in theory) to allow private individuals who
receive homecare the power to choose their own caregivers is an
absolute must. Hear me? AN ABSOLUTE MUST.
My mother receives homecare at my home twice daily, and I can
tell you for a fact that the agencies suing the government
over this (see link below), are involved in daily fraud
of taxpayer’s money that easily runs into the tens of MILLIONS.
They are not accountable in any way
financially to the LHIN offices, they over bill I would
estimate at least 50% or more of what actual hours they actually
provide to clients who are (like my mother) on a daily basis
having their mandated visit time cut in half or more
which is illegal all the while telling the government they
are providing the full hours and billing them and getting
paid for it without ANY verification going on.
Personal/family self directed home care is THE ONLY WAY to stop these
so called “not for profits” from committing fraud upon the taxpayers on a daily basis running
overbilling scams into the tens of millions if not hundreds of millions yearly.
Homecare/PSW agencies to sue government
http://www.cbc.ca/news/canada/toronto/home-care-ontario-lawsuit-kathleen-wynne-1.4544909
I urge everyone to consider the idea that just because the Wynne
government is being sued, does not automatically mean that
it is a legitimate lawsuit.
Of course these agencies are going to sue the government,
THEY DON’T WANT THEIR OVERBILLING FRAUD AND OTHER ABUSES OF CLIENT
AND PSWs AND TAXPAYERS BEING EXPOSED
AND LOSING POWER TO THE FAMILIES/INDIVIDUALS who they currently
are basically untouchable from.
Please support a self directed home care system to take
the power away from these untouchable home care agencies
and put the power of choice back into the families
to choose their own caregivers.
We are in Ontario and this is has become like a horror story. My spouse has been receiving LHIN services for 7 years and never had anything like this before. After his hospital discharge all agencies providing services for him were changed without explanation. Even when we insisted to go back to the agencies that we are familiar with the LHIN staff refused to make the change. We had 39 hours of physio that was not delivered but the LHIN billed for it , PSWs are tracked by an app coming on location chatting and smoking on the driveway littering the neighbors’ loan instead of working, PSWs who trys to boss me around – e.g. engaging in an argument when I ask for help to change my spouse diaper , leaving early but fraudulently recording different time when confronted claiming I have recorded her and trying to intimidate me saying “ it is illegal to record” ( guess what , it is not illegal and the police does it all the time) but if she was to talk nicely to me why would this even be a concern. It looks BAD on the LHIN to have included her libelous statement in my spouse file claiming that it was abusive. I was not abusive and I can prove it! Complained to her supervisor and he tried to shut me up. I had wound care nurse not showing up, wound dressing not changed for 4 days and getting infected. A PSW sitting on my spouse bed , walker and personal devises fiddling on her phone when there is work to do. This is abuse of public funding without control.
As a PSW for over 10yrs. I feel that working 12days straight and 2 days off too much. The government states that the employer can force an employee to work 6 days a week, which gets doubled. This leads to higher employee turnover in the homecare sector, illness, depression/anxiety, childcare worries, burnout and more. The overhead for vehicle cost is much higher than in an institutional setting, insurance is higher, chance of accident or loss of life as well because of changing weather. Our company has experienced both. 5 days on 2 days off should be the norm. Overtime should be voluntary NOT mandatory. The turnover of employees would certainly be less. My father is now in LTC, and the girls there cannot believe I work 12 days straight. They say that 9 is more than they can handle.
Thank you all for raising awareness to society,
It’s also very encouraging to see Professor L.Bulmer contribute to this article!
GBC Student
I totally agree PSWS should be paid more but also believe the RPNs also should be paid more they are also doing double duty .1 monitoring psw ,residents ,there family members ,working short ttttthelping the psws with there work plus doing there own work and completing raps coding assessments charting dressings meetings dealing with diffiult family members and staff doing just as much as RN but getting paid half as much the Rpn is caught right in the middle ,you the wonerful psws doing lots of hard core work and above the Psw youthe Rpn then RN so guess who is in the middle with none of the glory yup u got it RPN stuck in the middle like a dog
In many of the nursing homes that I have visited, many PSW’s perform tasks that are not personal care. They empty garbage cans, they collect dirty laundry and put away clean laundry. They change bed linens, make beds, set tables, serve food and clear tables. All these tasks fall under the house keeping heading that individuals themselves pay for, but are performed by PSW’s whose salaries are paid for by health care. The definition of personal care is a gray area in LTC and duties vary widely from home to home.
As a Psw it is nice to be recognized for our hard work but yes we are underpaid and in a lot of cases not appreitated as been called just( ass wipers) that’s degrading.im doing this job going on 18 years and it’s not a easy job.people need to really understand what we do.
I have gone back to school to be a PSW after 27 years in public health. I felt disillusioned working as a public health manager in a job that seemed out of touch concerning addressing any real modern adverse health situations. I can say that the training is very competent and all-encompassing and the clinical practice experience tackles the emotional challenges in a thoughtful manner. The irony is that the discrepancy in pay is the recipricol of my two career experiences but money, status and privilege does not always reflect meaningful work.
PSW’s perform essential work in hospitals and long term care facilities.
At Baycrest Centre, hundreds of PSW’s work PRIVATELY supporting residents in long term care at that institution.
Their work is paid for by the family of the resident.If they were to withdraw from the institution, the institution would have to close! It simply could not provide the necessary care from its per-diem allotment from the MOH.
It is also the case that many residents at Baycrest have private duty nurses.
This also is a fact of life at Bridgepoint health. I have no doubt that these privately funded services are growing steadily over time across much of the province, putting the lie to the myth of free universal health care.
Is it not remarkable that these private but essential services are permitted in Ontario, but privately funded hospitals/clinics
are forbidden and illegal, and recently graduated nurses, educated and trained in Ontario, must seek work in the USA and abroad because they cannot find full-time permanent work in Ontario? I anxiously await a serious discussion of these issues. Respectfully submitted, Keith Meloff MD FRCPC ( Pediatrics and neurology) Toronto.
Here in Alberta we struggle with similar issues. This is a large unregulated workforce that delivers the majority of direct care to our patients/clients.
Our “health care aide” employees work in all areas of care (home care, supportive living, long term care, acute care (hospitals) and group homes. They are a valued member of the health care team.
Alberta recently opened a provincial health care aide “directory” however registration is voluntary not mandatory. Performance issues or conduct is not part of the Alberta HCA Directory. Cases where employees are not performing are handled by the employer, however this does not prevent them from crossing the street and working for another employer undetected.
This problem has been going on since the seventies, when the original Health Care Aide program was established. It was going to be registered. We were all assigned registry numbers to be used for that very purpose.
As to the ratio of PSWs to residents in long term care home, the method of calculation RAIs, is poorly done, as a number of staff bodies who do not assist with personal care, or feeding are brought into this equation. It looks wonderful on paper, but in reality it is disgusting.
Being a Health Care Aide since the seventies,in long term care homes, and home care, along with having parents needing home care, I have learnt a lot about the systems. I was very active in many courses and committees throughout my employment as a Health Care Aide.
I loved my job. However by the time I retired ( 60 ) there was not enough time to give the proper care, respect, safety and human companionship. No time to assist in walking rather than using a wheelchair, toileting rather than using an incontent product, assistant to dress rather than dressing. Even though you are told independence is important,which I believe is absolutely true, time does not allow it.
Enough said. Still too frustrating to think about it. Hope I am never going to be in that position.
Finally! Someone has said the same thing I’ve always said. Thank you Janet. I started in the early ’80’s in long term care and Health care aids were always facing shortages! Even though you can not work as a PSW today without being certified, many LTC facilities even use housekeeping staff, kitchen staff and Activity staff to fill in (as PSW’S) when short staffed. Now THERE’S an accident waiting to happen!
Given the vulnerable population they serve, they need to be regulated.
Compensation should reflect accountability regardless of sector.
Yes -absolutely regulated .
No – not paid appropriately