Personal Support Workers in Ontario

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About this Article: This article describes a quick scan of the state of knowledge about health human resources issues for Personal Support Workers. While the examination emphasizes Ontario’s publically funded homecare and long-term care homes, it also deals with practice in private homes. Key issues to health human resources are highlighted, along with suggestions for policy and research.

About This Series: The É/Exchange working paper series is designed to facilitate sharing of results and to encourage discussion of concepts, practices, and policies in applied health. This series provides a way to disseminate well-written, but not yet published, reports of research. It is also a way to make research conducted by affiliated community members accessible to a wider readership. The series is co-sponsored by The Population Health Improvement Research Network (PHIRN), Réseau de recherche appliquée sur la santé des francophones de l'Ontario (RRASFO); and the Ontario Health Human Resources Research Network (OHHRRN). Sara Torres

The increasing demands of an aging population are placing new stresses on the health care system, within which Personal Support Workers (PSWs) play key roles. A recent literature review by Torres examined the health human resource issues for Ontario PSWs.

cps spring 2011 1PSW Roles

PSWs work with clients who have a broad spectrum of conditions and health care needs, providing services and direct care to individuals in hospitals, long-term care homes, group homes, retirement homes, supportive living environments and clients’ homes. Services range from assisted daily living tasks (such as personal hygiene, transferring clients between bed and chair, taking medication and doing light housework) to delegated health procedures (such as changing dressings, tube feedings, oxygen therapy, digital stimulation, catheter care, medication reminders, and administration of suppositories).

Issues

The changing tasks and working conditions for PSWs are bringing health human resources issues to the policy forefront. The following issues are emerging:

  • There is a need to better recognize the importance of PSWs’ contributions to caregiving.
  • There is a need for programs that focus on the recruitment and retention of PSWs. Factors contributing to poor retention include low wages, poor job satisfaction, poor working conditions, high levels of part-time employment, heavy workloads, casual hours and perceived employment insecurity. On the other hand, retention and better quality of care may be improved through PSW participation in developing patient care plans.
  • The competitive bidding practice for engaging home care organizations has resulted in PSW job instability.
  • PSWs working in homecare generally have less desirable working conditions, in terms of supervision, wages, health and safety and medical tasks performed, than those working in long-term care homes. As a result, this sector may be at higher risk of a PSW labour shortage.
  • In homes, staff to resident ratios are too low, meaning that PSWs are generally very busy and not always able to address residents’ needs in a timely fashion or respond to calls for assistance.
Personal Support Workers are pillars of in-community care and long-term care homes in Ontario....The literature emphasizes the need to facilitate the continued development of programs designed to enhance recruitment and retention of PSWs in both homecare and long-term care homes to meet the increasing demands of an aging population.
  • The shortage of nurses and health professionals has resulted in shifting some tasks from more specialized, highly skilled professionals to less-qualified, lower-cost workers.
  • There is no single curriculum or training standard for PSWs. Employers develop their own programs and training.
  • PSWs, especially in homecare, are dealing with medical tasks without appropriate training and are increasingly administering medications. There is concern that PSWs do not benefit from the legal protection of registered workers.
  • Assignment of new tasks means PSWs have less time for prevention activities.
  • A large number of PSWs in homecare are immigrant women. These workers need support in acquiring proficiency in English or French, increasing Canadian cultural competency, and improving immigration status, since many workers enter Canada as temporary foreign workers under the Live-in Caregiver Program.
  • PSWs involved in private homecare, especially those with temporary immigration status, may be at risk for contract and labour rights violations.
  • PSWs do not meet the current requirements for regulation and there is no regional or provincial umbrella organization which can speak on behalf of this sector.

cps spring 2011 2

Solutions

Two new initiatives in Ontario show promise in standardizing the care provided by PSWs to clients:  

  • long-term care facilities are now legally required to hire PSWs who meet approved vocational standards, and,
  • an electronic registry for PSWs has been created.

Policy Implications

This research has pointed to policy needs in the areas of:

  • improving human resource planning through multi-ministry coordination and collaboration;
  • bolstering the profile and image of the workforce;
  • provision of economic analysis to identify where current investment will reduce future spending; and
  • provision of enough trained frontline paid caregivers to provide quality care.

Further Research

More research is needed to fully understand the context of this workforce. The gendered and racialized composition of the workforce, which may make workers vulnerable to systemic discrimination, points to a need for further research in the areas of gender, race and class. Secondly, additional study on how this workforce could be better supported to ensure quality care, recruitment and retention is warranted.

Reference: Torres, S. Environmental Scan on Personal Support Workers/Lay Health Workers involved in Homecare and Long-Term Care in Ontario. Exchange Working Paper Series, Volume 2, Number 8. University of Ottawa, Ottawa, Canada. Available at rrasp-phirn.ca.

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