Task Shifting in the Provision of Home and Social Care

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Restructuring of the hospital sector in the mid-1980s has meant that patients are now moved back into their homes “quicker and sicker.” The increase in the number of patients at home and limited human resources has, in turn, resulted in an increased use of unregulated home care providers such as personal support workers (PSWs) to undertake some of the tasks that were previously performed by regulated health care workers. A recent study examined the impact of this shift on Ontario’s health human resources.

PSWs form the majority of the home care workforce and play an integral role in providing care to seniors by assisting with activities of daily living such as, personal care, mobility transfers, light housekeeping, meal preparation, shopping and assistance with recreational activities, along with delegated tasks as assigned and supervised by regulated health professionals.

wps winter 2011 1Defining Task Shifting

Task shifting is defined as a process of delegation of tasks to less specialized health workers. In home and social care, this may mean transferring of skills from a regulated professional, such as a nurse or therapist to a PSW, or it could mean the delegation of tasks to these workers.

The most common skills that are transferred or delegated to PSWs include transfers, simple wound care, exercises, catheterization, colostomies, compression stockings, G-tube feeding and continence care. When tasks are shifted to a PSW, a supervisor usually teaches these tasks during one or more home visits, depending on the complexity of the task and amount of training required.

Study Findings

The study participants generally agreed that task shifting:

  • provides a more efficient use of health resources in home and social care;
  • increases job satisfaction and retention of PSWs in their organization; and
  • improves the quality of care and clients’ quality of life, through improved consistency of care and enhanced comfort levels.

Concerns around task shifting included potential impacts on:

  • the health and safety of PSWs through increased stress and physical demands;
  • the quality of client care due to PSWs’ lower levels of medical knowledge; and
  • risk to clients’ health and safety.

Perhaps the greatest concern expressed by study participants was related to the lower levels of medical knowledge, skill or judgement among PSWs. Concern was expressed that they may not know the impact of a change in a client’s condition and this may put the client at risk. While, nurses and therapists are trained to assess clients on an on-going basis, PSWs follow care plans as specified.

Given the increase in the task shifting and the delegation of acts, the variability in PSW training, lack of standardized training for PSW supervisors and an increase in client acuity level with the emphasis on “aging at home” it is essential that both educators and employers ensure that that the PSWs are being provided with the competencies they need to provide for the health and safety of the client.

PSWs are the eyes and ears of the status of their clients, in some cases, spending more time with the client than do family or friends. While the PSWs may notice changes in mood, appetite and mobility, they do not have the training to assess what factors are contributing to these changes.

wps winter 2011 2Work Force Implications

Employers and educators need to ensure that both PSWs and their supervisors are familiar with the competencies necessary to carry out new tasks. This may mean additional orientation training to ensure a base line of expertise, as well as ongoing professional development.

The authors suggest the following:

  • More rigor in supervision to better support the client and the PSW;
  • Consideration of formalized guidelines beyond the standard supervisory visit with the first 14 days of service provided by a PSW;
  • Continued client monitoring by regulated workers to make any necessary changes to the delegated act or task;
  • Regular checking in, on the part of PSW supervisors, with the PSW on the status of the client in relation to these tasks and delegated acts;  
  • Preparation among CCAC case managers to adjust the number of service hours allocated to the client, depending on their changing status.

Other issues noted for future consideration include:

  • the issue of fair compensation for PSWs whose job duties and training is being expanded;
  • the need for a sufficient number of health professionals to provide the required selection, training, supervision, and continuing education of PSWs; and
  • Regulations for task shifting to be set with the professions involved.

Next Steps

A provincial study of task shifting and the delegation of acts should be undertaken to establish base line data, and upon which to base provincial recommendations to support the necessary competency development for the PSW occupation and support client health and safety.

Reference: Denton, M., Brookman, C., Zeytinoglu, I., Plenderlieth, J., Ducak. Task Shifting in the Provision of Home and Social Care: Implications for Health Human Resources:  Exchange Working Paper Series, Volume 2, Number 1. University of Ottawa, Ottawa, Canada. Available at rrasp-phirn.ca.