Environmental Scan on Personal Support Workers/Lay Health Workers involved in Homecare and Long-Term Care in Ontario: A Rapid Literature Review

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Author

Sara Torres, PhD Candidate Institute of Population Health University of Ottawa, and Ontario Training Centre (OTC) Fellowship in Health Services and Policy Research

Abstract

cps spring 2011 1Personal Support Workers (PSWs) are pillars of in-community care and long-term care homes in Ontario. In Canada, the United States, and other industrialized countries, 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 workforce is unregulated, yet PSWs are increasingly asked to perform medical tasks (digital stimulation, catheter care, medication reminders, and administration of suppositories), especially in homecare, so they have less time for prevention activities, such as cleaning and social activities. However, wages do not reflect these new tasks. Because immigrants or temporary foreign workers who are not fluent in English or French have difficulty in communicating with those they are caring for, it appears urgent that PSWs and agencies become culturally competent with respect to seniors’ cultures. PSWs under the Live-in Caregiver Program (LCP) are foreign workers with temporary immigration status, which may put them at risk of contract and labour rights violations. In regards to the Ontario legislative and policy context, two new initiatives show promise in standardizing the care provided by PSWs to clients: 1) Since 2010 long-term care facilities are legally required to hire PSWs who meet vocational standards approved by the Ministry of Training Universities and Community Colleges (MTUCs), the National Association of Career Colleges (NACC) and the Ontario Community Support Association (OCSA); and 2) in 2011 the Government of Ontario announced the creation of an electronic registry for PSWs who provide services and direct care in homes of ill seniors, people with disabilities, or clients with chronic medical problems.

Acknowledgements

Thanks go to the participants who took part in the individual interviews and quick telephone survey. Special thanks to the Policy Practicum’s supervisors: Ms. Catia Creatura-Amelio at the MOHLTC and to Dr. Ivy Bourgeault at the OHHRRN for their guidance and support, which made the success of this practicum possible. The content of this literature review is the responsibility of the author and the views expressed in this paper do not necessarily reflect positions of the MOHLTC

Executive Summary

This paper provides a quick scan of the state of knowledge about health human resources issues for Personal support workers (PSWs), with special emphasis on Ontario’s publicly funded homecare and long-term care homes, and deals with practice in private homes. In Ontario, PSWs provide services and direct care to individuals in hospitals, long-term care homes, group homes, retirement homes, supportive living environments, and clients’ homes. PSWs work with clients who have a broad spectrum of conditions and health care needs (www.health.gov.on.ca, 2010).

Several health human resources issues affect employers and PSWs caring for our aging populations, which have implications for policy-making in this area:

First, for policy purposes the importance of PSWs contributions’ to caregiving must be recognized. For example, in homecare service delivery alone, approximately 432,000 Ontarians are served annually. Over 23 million units of service to clients, of which the largest category by far is personal support, followed by nursing, are provided. Units of services provided by PSWs 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 and oxygen therapy) (Government of Ontario 2011).

Second, recruitment and retention of PSWs in long-term care homes and especially in homecare is a longstanding issue and one which the literature indicates should also be seen as a priority. Canada, the United States, and other industrialized countries emphasize 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.

cps spring 2011 2Third, the working conditions of PSWs in homecare and long-term care homes vary in the areas of supervision, wages, health and safety and medical tasks performed by these workers. For example, PSWs working in homecare generally have less desirable working conditions than those working in long-term care homes; therefore, this sector may be at higher risk of experiencing a PSW labour shortage in its workforce. Also, PSWs, especially in homecare, are increasingly providing medications to residents and dealing with medical tasks (e.g., digital stimulation, catheter care, medication reminders) without appropriate training.

Four, the composition of the workforce in long-term care homes and private homecare varies. For example, a large number of PSWs in homecare are immigrant women. The majority of PSWs in longterm care homes, however, are not immigrant women. In homecare, communication in English between immigrant PSWs and their clients is a problem because many of these workers lack English skills. In addition many of these workers lack understanding of Canadian seniors’ culture, pointing to the need for greater focus on cultural competency.

Fifth, it is generally agreed that PSWs involved in private homecare, especially temporary foreign workers who entered Canada under the Live-in Caregiver program are more likely to have their work contract violated because of working and living in their employer’s homes. A significant portion of the literature indicates that workers’ temporary status also leads to labour rights’ violations.

Sixth, given the shortage of nurses and health professionals in many countries, an emerging policy focus is on shifting some tasks from more specialized highly skilled professionals to less-qualified, lower-cost workers. In Ontario for instance, the PSWs health workforce is unregulated. As a result, in 2006, Ontario’s Health Professions Regulatory Advisory Council (HPRAC) conducted a review of this workforce and found that PSWs do not meet the current requirements for regulation and recommended that a PSW registry was not required. Since then, the Government of Ontario has made two directives, which have implications for both employers and PSWs:

  1. As of July 2010, long-term care facilities are legally required to hire PSWs who meet vocational standards approved by the Ministry of Training Universities and Community Colleges (MTUCs), the National Association of Career Colleges (NACC) and the Ontario Community Support Association (OCSA),
  2. On May 19, 2011 the Government of Ontario announced the creation of an electronic registry for PSWs who provide services and direct care in homes of ill seniors, people with disabilities, or chronic medical problems. This registry will detail, among other things, PSWs’ work experience, education and contact information and will be completed by the end of 2012.

This paper provides a detailed elaboration of health human resources issues identified above.

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