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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.

PSWs working in long-term care homes are required to work under the supervision of a registered nurse or registered practical nurse

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.

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.

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.

a PSW Registry to collect information about the training and employment status of the nearly 100,000 PSWs in Ontario

Long-Term Care Task Force on Resident Care and Safety

“a registry is a mechanism of counting and it doesn’t ensure anything about quality, preparation or standards.”

in the past two months there have been stakeholder consultations around educational standards for PSWs

Catherine Richards, Cause for Concern: Ontario’s Long Term Care Homes (Facebook group)

“PSWs have high expectations put on them but very little support to do their jobs.”

In my opinion, what we need most is a ministry (MOHLTC) that will demonstrate leadership by clarifying the role of the PSW in long-term care, nursing homes, hospitals and yes, home care, and to consistently enforce high standards of care

PSWs should feel able to rely on consistent supervision and clear guidance from registered nursing staff and management, yet from my observation there is a lack of communication between PSWs and RPNs/RNs in a long term care home setting, and rarely in my experience is honest communication encouraged to include patients/residents and families. In home care, PSWs have even less support or supervision which should concern people.

PSWs are rarely afforded the time to properly perform the necessary tasks assigned to them and they often bear the brunt of complaints

it is the leadership that must accept the bulk of responsibility when PSW care standards are low

Ombudsman oversight would provide an immediate and direct incentive to elevate care standards

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.

CUPE addresses these issues in Our Vision For Better Seniors’ Care: http://cupe.ca/privatization-watch-february-2010/our-vision-research-paper

having someone help you bathe, dress, eat and even wash your hair is as important as the medical care

I have worked in a Long-Term Care Facility for four years and have many concerns

it doesn’t take a rocket scientist to figure out that some point of care is being neglected

need to have more PSW staff on the front line

“it is like an assembly line here in the morning”

I don’t think these people are getting the dignity and respect they deserve.

We want to stop responsive behaviours, we need to know what triggers are. what is the root cause

We can’t do this with having less than 15 mins per resident for care.

I also believe that registering PSW’s will eliminate those who are in the career for just the money.

I have been a PSW for 8 years

Every year they talk more and more about residents rights, dignity ect ect … and yet every year, residents have been given less one on one time, poorer quality of meals, cut backs on activities and more than anything else, a lessened quality of care provided by over worked PSW’s.

Residents have floor mat sensors, wheelchair sensors, wander guard door alarm sensors, bed alarm sensors and add that to the endless stream of call bells and psw’s pagers sounding, it sounding like you are living inside a firestation with non-stop fire

they do not provide the staff to PREVENT the resident from falling

bell fatigue

This registry is just another cash grab

Now, it will be that much easier to put the blame on us.

When we do our 1.5hrs worth of charting every night they tell us to lie and say we have done restorative care and other tasks which had no time to do so they can provide funding which never seems to result in more staff.

for the Cupe reps reading this. You make me sick. Your union doesn’t back us up in the slightest and you have allowed for MANY additional tasks to be put onto psw’s without any increase in pay.

In the past year alone our charting has become computerized and went from 25mins to 1.5hrs. We now provide restorative care like rehab workers and now are officially responsible for applying and charting for medicated creams, not to mention the additional time spent now that prn behavior meds were discontinued and restraints removed created chaos

when your union reps come into meeting with us to “support” us, they side with our managers

about this registry

my sister works for 12 dollars H in Retirenment home

she has over 40 Residents

you should work in Long Term Care then, you will make a few buck more, still have 30-40 residents but at least you have a partner. On the other hand though, unlike retirement homes, for those 30-40 people, you will be dealing with aggressive behaviors, resistive residents, dementia, 75% of your residents will require a mechanical lift, you will have 1-2hrs worth of charting to do on top of your already hectic work load which they will not provide you more time to complete it, so only expect to get one 15min break in an 8 hr shift and often stay late to finish your charting.

As long as retirement homes are privily own they will always be run under the landlord and tenant act. That’s why they can work you like a dog and get away with it.

My 95 year old Dad is in LTC.

PSW’s simply do NOT have time to maintain, let alone enhance seniors’ quality of life.

there are NO rules or regulations about what the ratio of PSW staff to residents “should be”

quality is more than assistance with daily hygene, feeding, dressing, providing meds, getting people up in the morning, putting them to bed in the evening

psw’s are not only caregivers/ nurses we r also sometimes ONLY friend

The solution to our problem begins at the top, and this all seems very backwards to me.

Personal support workers are one of the back bones of the health care system.

Eleven years later, and nothing has changed? Something’s wrong here!

But I will not let this discourage me from taking the course, because no other job I’ve had has even come close to being as rewarding or fulfilling

is to many P.S.W in Ontario,and is not respect for them

Too many PSW’s are working as a Casual Employee

The pay is better in Long Term care as we know but PSW’s work for that extra few dollars more an hour

Most of us enjoy the field but more work has to be done to take care of your PSW’s and a pat on the back is just not going to do it.

administration has to stop being greedy with their big wages and start finding more money to invest in your front line, the PSW

In 2012, age-related needs were identified as the single most common problem requiring help from caregivers (28%) (Chart 1). This was followed by cancer (11%), cardio-vascular disease (9%), mental illness (7%), and Alzheimer’s disease and dementia (6%).

The majority of caregivers reported providing transportation to their primary care receiver, making it the most frequent type of care provided in the last 12 months (73%)

Most often, caregivers spent under 10 hours a week on caregiving duties. In particular, one-quarter of caregivers (26%) reported spending one hour or less per week caring for a family member or friend. Another 32% reported spending an average of 2 to 4 hours per week and 16% spent 5 to 9 hours per week on caregiving activities.  

The most common types of care were not always the ones most likely to be performed on a regular basis (i.e., at least once a week). For instance, despite the fact that personal care and providing medical assistance were the least common forms of care, when they were performed, these tasks were most likely to be done more regularly.

Emotional support often accompanied other help to the care receiver. Nearly nine in ten caregivers (88%) reported spending time with the person, talking with and listening to them, cheering them up or providing some other form of emotional support. Virtually all caregivers (96%) ensured that the ill or disabled family member or friend was okay, either by visiting or calling.

Overall, caregivers spent a median of 3 hours a week caring for an ill or disabled family member or friend. This climbed to a median of 10 hours per week for caregivers assisting a child and 14 hours for those providing care to an ill spouse (Chart 3).

In addition, about half of caregivers (51%) reported that they performed tasks inside the care recipients’ home in the last 12 months, such as preparing meals, cleaning, and laundry. Another 45% reported providing assistance with house maintenance or outdoor work.

For some, caregiving was a large part of their life - equivalent to a full time job. Approximately one in ten caregivers were spending 30 or more hours a week providing some form of assistance to their ill family member or friend.  These caregivers were most likely caring for an ill spouse (31%) or child (29%).5

The actual time spent performing tasks is often combined with time needed to travel to provide care. Approximately three-quarters (73%) of caregivers indicated that they did not live in the same household or building as their care receiver, meaning they often had to travel to reach the care recipients’ home. Just over half (52%), however, reported having to travel less than 30 minutes by car.  Roughly 12% of caregivers provided help to a family member who lived at least one hour away by car.

Certain health conditions required more hours of care. This was the case for developmental disabilities or disorders, where 51% of these caregivers were spending at least 10 hours a week providing help

Caregivers have multiple responsibilities beyond caring for their chronically ill, disabled or aging family member or friend. In 2012, 28% of caregivers could be considered “sandwiched” between caregiving and childrearing, having at least one child under 18 years living at home

Four provinces had rates above the national average of 28%, including Ontario (29%), Nova Scotia (31%), Manitoba (33%) and Saskatchewan (34%) (Textbox Chart 1). The higher levels of caregiving in Ontario, Nova Scotia and Manitoba were largely related to caring for a loved one suffering from a chronic health condition or disability, whereas in Saskatchewan, the higher level of caregiving was attributed to aging needs. 

Historically, caregivers have been disproportionally women (Cranswick and Dosman 2008). This was also true in 2012, when an estimated 54% of caregivers were women.

Although the median number of caregiving hours was similar between men and women (3 and 4 hours per week, respectively), women were more likely than their male counterparts to spend 20 or more hours per week on caregiving tasks (17% versus 11%). Meanwhile, men were more likely than women to spend less than one hour per week providing care (29% versus 23%) (Chart 5).

For instance, they were twice as likely as their male counterparts to provide personal care to the primary care receiver, including bathing and dressing (29% versus 13%).

Caring for an ill or disabled family member or friend can span months or years. For the vast majority of caregivers (89%), their caregiving activities had been going on at least one year or longer, with half reporting they had been caring for a loved one for four years or more.

The aging of the population, higher life expectancies and the shift in emphasis from institutionalized care to home care may suggest that more chronically ill, disabled and frail people are relying on help from family and friends than in the past. Using the GSS, it is possible to examine the changes in the number of caregivers aged 45 years and older, recognizing that methodological differences between survey cycles warrant caution when interpreting any results.

Bearing in mind these caveats, results from the GSS show that between 2007 and 2012, the number of caregivers aged 45 and over increased by 760,000 to 4.5 million caregivers, representing a 20% increase in the number of caregivers over the five years.

Having less time with children was an often cited outcome of providing care to a chronically ill, disabled, or aging family member or friend. About half (49%) of caregivers with children under 18 indicated that their caregiving responsibilities caused them to reduce the amount of time spent with their children.6

Overall, the vast majority of caregivers (95%) indicated that they were effectively coping with their caregiving responsibilities, with only 5% reporting that they were not coping well.7 However, the feeling of being unable to cope grew with a greater number of hours of care. By the time caregivers were spending 20 or more hours per week on caregiving tasks, one in ten (10%) were not coping well.  

In addition, while most were able to effectively manage their caregiving responsibilities, 28% found providing care somewhat or very stressful and 19% of caregivers indicated that their physical and emotional health suffered in the last 12 months as a result of their caregiving responsibilities.

The health consequences of caregiving were even more pronounced when caregivers were asked specific questions on their health symptoms. Over half (55%) of caregivers felt worried or anxious as a result of their caregiving responsibilities, while about half (51%) felt tired during the past 12 months (Chart 8). Other common symptoms associated with providing care included feeling short-tempered or irritable (36%), feeling overwhelmed (35%) and having a disturbed sleep (34%).8

The financial impacts related to caring for a loved one can be significant. Lost days at work may reduce household income, while out-of-pocket expenses, such as purchasing specialized aids or devices, transportation costs, and hiring professional help to assist with care, can be borne from caring for a loved one. In many cases, financial support, from either informal or formal sources, can ease the financial burden associated with caregiving responsibilities. Overall, about one in five caregivers (19%) were receiving some form of financial support. 

St. Albert physician Dr. Darryl LaBuick said while a bit more money for home care will help the situation, it barely scratches the surface in addressing the biggest issues facing healthcare in Canada. "We've got a huge increasing requirement for seniors care. We look at home care, we look at long-term care, we look at assisted living care, palliative care," he said. "We look at all those areas nobody has looked at closely from a political point of view to address some of the issues." The importance of home care is something stressed by Dr. Kim Fraser, a nursing professor at the University of Alberta and expert on the topic.

She said while seeing the commitment to improve home care in the province is a step in the right direction, simply throwing more money at the problem won't be enough. Instead, we've got to rethink how home care in Canada is provided. "Co-ordinated home care programs first came into effect in the late '70s and 1980s in Canada, and our approach to home care has not changed since that time," she said. "It's really kind of episodic, targeted, taskspecific care rather than a more comprehensive integrated care approach." So rather than simply having more home-care aides providing this kind of task-oriented service to patients in their home, we should look at providing a higher level of care to patients with more complex needs.

"We have got just so many more patients going into that system," she said. "I think funding will help the growing home care problem, and will help provide, perhaps, more professional nursing services from RNs and LPNs in the community." Alberta Health Minister Sarah Hoffman said she was pleased to see the commitment to home care on the federal agenda, noting it was one of the main pieces of the NDP platform with respect to the healthcare system. "Home care is certainly one of the pieces we're focusing our effort on as a government, and I look forward to working with the new federal government to make that a reality," she said. When pressed for specific details about what form home care may take, she said she couldn't talk about specifics until they're released as part of the provincial budget next week.

"The pillars of the platform should be reflected in the work we're doing," Hoffman said. LaBuick also identified the importance of a national drug strategy that would cover the cost of prescriptions for all Canadians. Seniors still must pay a portion of prescription drug costs, and many young adults without health benefit plans are left in a position where they must pay the full cost or simply go without; it's something he's seen in his own practice. "We see young folks that don't have a good prescription plan, or any prescription plan," he said, "And the Blue Cross plan doesn't cover everything either, so there's gaps within that system, too."

It's a concern echoed by Friends of Medicare director Sandra Azocar, who spoke with the Gazette prior to the election and said a national drug plan was high on her organization's agenda. She expressed concern that the Trans-Pacific Partnership, a trade deal negotiated by the previous government behind closed doors that has yet to be approved by Parliament, could make it more difficult to get cheaper generic drugs. "We see that as having a negative impact for generics to be available in the market, and people will pay significantly more for drugs," she said. "I don't think medicine should be a luxury, it should be available for all people who need it. These are huge concerns we have." Hoffman said bringing down the cost of prescription drugs is something she's heard is important to Albertans, but is also significant within her own ministry when it comes to budgeting. She said a provincial prescription drug plan is something worth considering, but it's not going to happen in the near future.

"I think it's a great long-term objective, but in the short-term I need to address the immediate pressures of drug costs," she said. "I think we can find ways to do bulk buying and find other efficiencies in a pan-Canadian strategy, and look at other partnerships in taking it further so we can maximize those savings and pass those savings on for an increased benefit to all Albertans." Health Accord Azocar identified the need to renew the Canada Health Accord as an important component of what the federal government must do to support healthcare in the country.

"We need to go back to the level of leadership in our healthcare system for it to be functional all across the country," she said. "That's not something we've seen coming from some of the parties." The Liberal platform includes a commitment to renew the waccord, and to include a long-term funding agreement. This is a crucial element, Azocar noted, because in tough economic times federal funding in health care tends to decrease to the detriment of Canadians. "People don't stop needing health care when the economy is down, in fact it's the reverse," she said. "Studies have shown people need more services when the economy is down, so it's a situation that doesn't play well for the sustainability and the long-term planning that health care needs across the country."

Hoffman said she's unsure what negotiating a new accord might look like, as she hasn't been through the process before, but said it's something she looks forward to working on with the federal government. "We were elected not too long ago and they were elected more recently, and I think Albertans deserve to have the very best public health-care system," she said. "I look forward to working with the federal government to make that a reality." Elephant in the room One element of the discussion around health care that is absent and has been for quite some time, LaBuick suggested, is the "elephant in the room" of increasing private delivery as a way to reduce the budget impact of health care. "The minute we start to talk about it, they catastrophize the whole conversation," he said. "The reality is we need to talk about it because we simply can't afford it."

He noted roughly 30 per cent of health care in Canada is already provided privately - things like dental, vision, psychology, and private insurance plans. Furthermore European countries that blend public and private have better outcomes. LaBuick suggested the way forward is to look to European models that provide universal health care with a blend of public and private delivery - many of which have better outcomes at a lower cost than the Canadian model. He's not optimistic, however, that a federal Liberal government or provincial NDP government will engage in that discussion.

We have all of these areas that are private, but nobody talks about it," he said. "Nobody talks about a strategy around how it can benefit all citizens, for the betterment of everybody."

were meeting the guideline, while 33 facilities were exceeding it. (Information is missing on another 10 for a variety of reasons. For example, some were new.) The directory's data shows that a quarter of seniors in the homes have a diagnosis of depression and nearly one-third are being given anti-psychotic medication without a diagnosis of psychosis.

Your questions show we have some work to do here," she said. "I will specifically be writing to each Health Authority and the government on this issue. We have a target of care hours and here's how many of your facilities are at that or under that." Mackenzie said her office will also analyze the Residential Care Facilities Quick Fact directory data to determine whether facilities with low staffing levels may also have more seniors who are depressed or who are prescribed antipsychotics medication. She also wants to study whether these homes offer fewer amenities to boost quality of life such as recreational and occupational therapy. Mackenzie said the Quick Facts Directory, available online, provides numbers to back anecdotal evidence that quality of care has declined in many B.C. seniors homes. The directory will be updated annually, but does not include data on private nursing homes that receive no government funding.

"Anecdotally, everyone was saying hours (for staff) were being cut, but now you have quantitive evidence. For policy shifts (in government), they want to know the magnitude of the issue. Let's have a discussion on how we can fix this. Before you can deal with what homes are not providing recreational therapy and OT (occupational therapy), for instance, you have to fix the hours of care first," said Mackenzie. Whiteside said the figures showing the vast majority of government-funded homes are below ministry staffing guidelines prove what HEU members have been saying for years - that they are rushed in trying to care for seniors in nursing homes and concerned that seniors are suffering and workers are placed in dangerous situations when a senior acts out violently.

A recent Vancouver Sun series on violence in nursing homes found more than 1,000 physical assaults by seniors in long-term care facilities last year. And in the past four years in B.C., 16 seniors in care have been killed by other seniors suffering from dementia. "There's simply not enough time for them (care aides) to do their job and provide the care seniors need. When we establish what the level of care needed is, it needs to be mandatory. Clearly, there needs to be more strenuous accountability in this system for seniors - many of whom are frail," said Whiteside. Nor was she surprised to find 74 per cent of the privately owned and operated businesses failed to meet ministry guidelines. "The system is set up so Health Authorities are contracting with private providers and some of those private providers are subcontracting out some of the care to other contractors and at each phase there needs to be a profit made. It's not the kind of system to have for frail seniors. It's quite shocking to think this is the system we have for them," said Whiteside.

A Vancouver Sun request to interview Health Minister Terry Lake was not granted. However, the ministry sent an email stating there are no plans to introduce mandatory staffing levels. The recommended 3.36 direct care hours is a number used "as a starting point for planning decisions," the email said. "The standard that we want care providers to meet is high quality care at whatever level is most appropriate for an individual patient," the ministry email states. "Direct care hours are dependent on the individual's needs and are determined through a comprehensive assessment process involving the client, their family and staff. Experts all agree that having a legislated or policy requirement for staffing ratios and staffing hours is not appropriate, because of the complexity of patient needs." Daniel Fontaine, the CEO of the B.C. Care Providers Association, whose members represent approximately 60 per cent of the government's contracted-out beds, said home operators would be happy to provide 3.36 direct care hours, but the government funding isn't enough to reach this level.

We can only do what we are funded to do," said Fontaine. "While the government and health authorities are trying to bring those on the lower (staffing) levels up, it's been a slow process." One of the solutions could be to take some of the money spent in the acute care system and shift it into continuing care so seniors in long-term care facilities benefit, Fontaine said. Lorri Chmilar, who retired from nursing last year after working mainly for the Interior Health Authority, said the most stressful place she worked during her career was nine months spent in geriatric care. "Anyone who has worked in public care facilities has seen a decrease in staffing, decrease in activities, and decrease in quality of meals. What has increased is the amount of time in recording statistics, and basically CYA (cover your ass)," she said. "Understaffing is also a result of the poor mix of residents. It only takes one or two residents with severe dementia or severe physical impairments to increase the workload significantly to the detriment of the rest. To increase staffat this point, or to transfer a resident to a different care area is a major undertaking that requires much justifying and time. Nurses are derided for asking for extra assistance, if there is any to be had, and roadblocks to transfers are numerous. I fear for my family, and others, and the grey wave of us to come."

THE NUMBERS DRUGS WITHOUT DIAGNOSIS In B.C. facilities, an average of 31 per cent of residents were given antipsychotics without a diagnosis of psychosis. 133 facilities were above this average. 11 were at the average.

136 were below the average, but just one reported zero cases of providing antipsychotics without a diagnosis of psychosis. DAILY PHYSICAL RESTRAINTS In B.C. facilities, an average of 11 per cent of residents have daily physical restraints placed upon them. 116 facilities are above the average.

9 are at the average. 155 are below the average, of which 27 made no use of physical restraints. Source: Office of the Seniors Advocate, Province of B.C. © 2016 Postmedia Network Inc. All rights reserved.

As long as the objective is to as quickly as possible get them back to their home community, then it can be the best choice in some circumstances," said Schick. Under the new protocol, someone seeking long-term care will retain their spot on the wait-list to eventually move into one of their three preferred care facilities in the city. They could otherwise return home and utilize home care services, or move into a private personal care home. Corinne Pauliuk sees the latter as a poor solution.

"Not all care homes are equipped to accommodate those of a higher level of care," said Pauliuk, president of Regina and District Personal Care Home Association. Her own care home, Sunrise Country Haven near McLean, is one. "Once individuals here meet the criteria for a longterm care facility, I can't meet their needs safely, so I wouldn't qualify as a care home to look after those individuals, period, and I'm not sure how they could function with home care because usually it's 24-hour care that is required," she said.

Pauliuk knows of at least 25 care homes that would be unable to accommodate a resident with serious care needs. NDP health critic Danielle Chartier said home care and private care are not viable alternatives. "Your only other option is to use this government's already-stretched-thin home care and supplement with private care and many people can't afford private care," said Chartier.

"We have the concern in home care that they're pretty much maxed out in regards to workload," added Scott McDonald, president of CUPE 3967, which represents care aides. Chartier thinks of her own parents, who are 82. "I couldn't imagine having them moved 150 km from home, both from their perspective getting to see their family less, but also from my ability as a daughter" to make a long drive to see them often, said Chartier. Pauliuk agrees.

"I can't see family members being able to do that when they're already working full time ... They'd be lucky if it was once a week," she said. Chartier said government should enhance home care, create more long-term care spaces in the city and implement proper staffing. For the past 12 years, rural clients have received the first available long-term care bed 150 km from their home within the RQHR. Five other health regions in the province have a first available bed policy regionwide. Five others, including Saskatoon, are some distance within the region, from a 45-minute drive to 150 km away. amartin@leaderpost.com Twitter.com/LPAshleyM

One challenge in understanding the extent to which people in health care are injured at work is that injuries tend to be underreported. Generally the data used to measure health care worker injury is through workers’ compensation claims. A study of Canadian health care workers found that of 2,500 health care workers who experienced an injury, less than half filed a workers’ compensation claim.

Recent data from Alberta shows that about 3% of health care workers are at risk of a disabling injury in 2012, compared with 1.45% of workers in the mining and petroleum industry.

A study of health care worker injuries in three British Columbia health regions from 2004 to 2005 found that injury rates are particularly high for those providing direct patient care – and highest among nursing or care aides (known as health care aides in Alberta, and personal support workers in Ontario).

However, there have been efforts to mechanize some of the dangerous aspects of health care. Musculoskeletal injuries are the leading category of occupational injury for health care workers.

83% of health care worker injuries were musculoskeletal in nature.

Evidence suggests that this is the case – a 2009 British study of over 40,000 workplace injury claims found that 89% were made by women, and 11% by men.

Gert Erasmus, senior provincial director of workplace health and safety for Alberta Health Services says that “health care is a people intensive business – combine that with physically demanding jobs and an aging workforce.”

The Canadian Federation of Nurses’ Unions notes nurses retire around the age of 56 – compared to the average Canadian worker at 62.

Experts also point to the changing work environments for many health care workers. There is a worldwide trend towards moving health care services out of hospitals into patients’ homes. Thease are uncharted waters for workplace safety and prevention of injury. Little is known about how often workers in peoples’ homes are injured and the kinds of injuries they are sustaining.

Gert Erasmus notes the tremendous insecurity of providing health care inside patients’ homes. “They [health care workers in homes] work in an environment that is not controlled at all, which is fundamentally different than most industries and workplaces.” In this environment, workers are more likely to be alone, lacking back up from colleagues, and the help of aids such as mechanical lifts.

Miranda Ferrier, President of the Ontario Personal Support Worker Association says that each time a personal support worker enters a new patient’s home – they enter into the unknown. “You are lucky if you know anything about a client when you go into the home” she says.

Last week, the Parkland Institute - which is based out of the University of Alberta - released its report Losing Ground: Alberta's Elder Care Crisis. It was an update of another Parkland report from 2013. The report states that as of March 31, 2016, there were 14,768 longterm (LTC) beds in Alberta and 9,936 designated supportive living (DSL) beds, as well as 243 palliative care or hospice beds.

The number of LTC beds in Alberta has been relatively stagnant - Alberta only has 377 more LTC beds than it did in 2010, an increase of only 2.6 per cent. The number of DLS beds, on the other hand, has increased by 4,770 or 92.3 per cent. As well, the number of continuing care beds classified as DLC as opposed to long-term care beds grew from 26 per cent in 2010 to 40 per cent in 2016.

That means nearly half of the continuing care beds available in the province for elderly Albertans do not have a registered nurse on-site and are not subject to minimum staffing requirements. "Losing Ground" also examines who is operating the LTC beds in the province. About 21 per cent are operated by Alberta Health Services (AHS) or a regional health authority. Another 10,808 were run by for-profit corporations and 8,881 were run by non-profits. In the last seven years, Alberta has lost 333 beds in public facilities while private, for-profit facilities have added 3,255 beds.

The issue is that publicly-run LTC facilities generally provide more health care to residents than privately-run or non-profit facilities. On average between 2011 and 2013, registered nurses, licensed practical nurses and health care aids in public facilities provided four hours of direct health care to residents compared to three and 3.1 hours per day in non-profit and private facilities respectively. The report stresses that all facilities are required to provide 4.1 hours of care per day to residents, which means they are all falling short due to a lack of staff.

The report also notes that the NDP government has fallen far short of its election commitment to open 2,000 new long-term care beds by the end of 2019, including 500 new beds in 2015. The growth in the older population, coupled with a stagnant number of new LTC beds and move towards private care, means the availability of beds for Albertans over the age of 85 has nearly been halved since 2001. "This drop has greatly reduced the province's ability to meet the care needs of its most frail seniors," said report author David Campanella, in a release.

Minister's response In an e-mail, Minister of Sarah Hoffman said they know there is a huge demand for longterm care and dementia beds that stems from "years of neglect" on the need for affordable spaces for seniors under the previous government. "As a result, we are building spaces and putting in the beds Albertans need as we committed to do in the election and we are doing it collaboratively with communities and community partners." Hoffman said that last year, the province did a thorough review of all proposed Affordable Supportive Living Initiative (ASLI) projects, and implemented important changes to proposed projects to address the needs of Albertans.

Every new approved ASLI project has since opened with higher numbers of dementia and long-term care beds than originally planned, she said. "With ASLI now ended, we are developing a new capital program for long-term care with criteria to ensure the right level of care and the right methods of delivery are expanded," said Hoffman. She noted they have $365 million earmarked for senior care in the current budget and that will improve access for families across Alberta. Following the report's release, the Canadian Union of Public Employees (CUPE) issued a statement that it is disappointed by the lack of progress being made reforming the province's system of senior care.

CUPE Alberta president Marle Roberts said the union, which represents 2,600 long-term care workers throughout the province, has repeatedly asked the current and previous Alberta governments to shift its focus to publicly-delivered services. "This study confirms what others have indicated before - caregivers in public facilities have more times for patients and deliver better outcomes," said Roberts.

We are disappointed that the number of private beds continue to increase, while the number of public beds has dropped ... We are letting patients down by not offering them the care they need," she added.

A report from the Parkland institute claims there has been a trend away from publicly- run long-term care beds, such as those at the Westlock Continuing Care Centre (seen above). The number of long-term care beds offered by private organizations or non-profit organizations, on the other hand, is on the rise.

“We know that our most valuable health resources are the people working within the health care system. The Model of Care Project will ensure that the effort they put forth produces optimal results across the system,” said Minister of Health, Doug Currie. “We need to find ways to operate as a team and to create opportunities to leverage the collective skills and talent of our team.”

Model of Care Design Team members come from across the province and represent a wide range of health care skills and perspectives, including physicians, nurses, support staff and associations.

will empower health care providers to work collaboratively to the full potential of their abilities and training

detailed planning will take place over the summer for the implementation of the redesigned model.

The Model of Care Project, referred to officially as the Collaborative Care Team Project, is looking into the ways in which health care providers and support staff can operate as a team.

The model will ensure that the most appropriate member of the health care team can provide the most appropriate service at the most appropriate time and place.

The 2008 review of the health system reveals that the existing care delivery system is limiting the capacity of these care providers to work to the fullest extent of their abilities.

National research and best practices show that Model of Care strategies are being used to reduce health system barriers by creating and supporting interdisciplinary, collaborative care delivery environments.

£7 an hour, receives an extra £1 an hour for a night shift and £2 an hour for weekends.

"The NHS encourages you to have these NVQs, all this training, improve your knowledge, and then they [private care companies] come along and it all comes to nothing.

Care UK expects to make a profit "of under 6%" by the end of the three-year contract

£700,000 operating profit in the six months between September last year and March this year,

In 1993 the private sector provided 5% of the state-funded services given to people in their homes, known as domiciliary care. By 2012 this had risen to 89% – largely driven by the local authorities' need for cheaper ways to deliver services and the private sector's assurance that they could provide the answer. More than £2.7bn is spent by the state on this type of care every year. Private providers have targeted wages as a way to slice out profits, de-skilling the sector in the process.

1.4 million care workers in England are unregulated by any professional body and less than 50% have completed a basic NVQ2 level qualification, with 30% apparently not even completing basic induction trainin

Today 8% of care homes are supplied by private equity-owned firms – and the number is growing. The same is true of 10% of services run for those with learning disabilities

William Laing

report on private equity in July 2012

"It makes pots of money.

Those profits – which are made before debt payments and overheads – don't appear on the bottom line of the health firms' company accounts, and because of that corporation tax isn't paid on them.

Some of that was in payments on loans issued in Guernsey, meaning tax could not be charged. Its sister company, Silver Sea, responsible for funding the construction of Care UK care homes, is domiciled in the tax haven of Luxembourg

Bridgepoint

.voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_1 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_1 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_1 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_1 .ob_clear{clear:both;} .AR_1 .ob_amelia, .AR_1 .ob_logo, .AR_1 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_1 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_1 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_1 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_1:hover .ob_amelia, .AR_1:hover .ob_logo, .AR_1:hover .ob_text_logo{background-position:center bottom;} .AR_1 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } More from the guardian Rogeting: why 'sinister buttocks' are creeping into students' essays 08 Aug 2014 Theatre's decision to ban Jewish film festival is 'thin end of wedge' 09 Aug 2014 Sir Paul Nurse: 'I looked at my birth certificate. That was not my mother's name' 09 Aug 2014 Adventures in contraception: eight women discuss their choices 10 Aug 2014 Child prison deaths 08 Aug 2014 [?] .voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_2 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_2 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_2 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_2 .ob_clear{clear:both;} .AR_2 .ob_amelia, .AR_2 .ob_logo, .AR_2 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_2 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_2 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_2 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_2:hover .ob_amelia, .AR_2:hover .ob_logo, .AR_2:hover .ob_text_logo{background-position:center bottom;} .AR_2 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } /* updated via mysql on 2014-04-08 */ .AR_2 .ob_what { display: block; } /* added via mysql on 2014-06-20 */ .OUTBRAIN:hover .ob_what a { text-decoration: underline; } .ob_box_cont.AR_2 { padding-bottom: 5px; } /* end mysql add */ /* added via mysql on 2014-07-14 */ .AR_2 .ob_org_header span { color: #999; font-family: arial; font-size: 11px; font-weight: normal; display: block; } /* end 2014-07-14 */ More from around the webPromoted content by Outbrain http://paid.outbrain.com/network/redir?p=0iZOm4XuGW6R5uuT6ZFciNevzJlIfmxs0SRwpiMrH7gWrMXoPie4vIA9PlhaEW%2BXNi57pCgl9j8yOE3HuJT75pwCLNj4n18v3EKQDEV0YFQjOBxc46mOs

Combined with other savings and income, that amount might provide some retirees with all they need for decades. But everything changes when, for instance, an aging father struggling with dementia requires more help than his wife and children can manage. Plans that looked solid on paper are no match for their bills. "Within the first year most people are tapped out," said Joe Caldwell, director of long-term services at the National Council on Aging. "Middle-class families just aren't prepared for these costs." Many who can afford it buy insurance to help pay for long-term care years in advance, when insurers are less likely to reject them. But even those with insurance, like Ranzman, come up short. Forced to improvise, they sell the house and lean on family. They move in with their adult children, or arrange for their children to move in with them.

Some can save money by switching to different facilities. On average, a shared room in a nursing home runs nearly $11,000 a year less than a private room, and a room in an adult-family home runs cheaper still. Still, there's not a lot of room for creativity, said Liz Taylor, a self-employed geriatric care manager in Lopez Island, Washington. "The amount of care you need dictates the price," she said, "and there aren't that many ways around it." Hiring an aide to spend the day with an elderly parent living at home is often the cheapest option, with aides paid $20 an hour in some parts of the country. But hiring them to work around the clock is often the most expensive, Taylor said. "Needing help to get out of bed to use the bathroom in the middle of the night means you need a nursing home," she said.

EVICTED To Roslyn Duffy, it seemed that her mother, Evelyn Nappa, had everything she needed. After a stroke made it difficult to live alone, Nappa moved from Arizona to Seattle to be near her daughter and soon settled into The Stratford, an assisted-living facility, where she quickly made friends of fellow residents and the staff. "The care was great," Duffy said. "We loved that facility." With the sale of the house in Arizona, Nappa's savings appeared sufficient to cover 10 years at The Stratford, enough to last until she reached 100. Duffy said that the home's directors told her not to worry about her mother running out of money and winding up on Medicaid, even though the government program pays just a portion of what many facilities charge. After all, many of the same homes that refuse to admit seniors on Medicaid will keep those who spend all their savings and wind up on the program. "'We will keep her here' - that's what they said," Duffy recalls. "But I didn't get that in writing." A representative from the nursing home declined to comment.

As Nappa's dementia progressed, she needed more attention. That meant moving her from an independent unit that cost $3,000 a month, to a dementia unit that cost $6,000. Trips to the emergency room, hearing aids and other costs that Medicare didn't cover added up. Soon enough, the money that was supposed to last 10 years was gone in two. Duffy enrolled her mother in Medicaid, confident that The Stratford's management would keep its promises. Two months later, she received a letter saying her mother had 30 days to find a new home. Duffy protested, writing letters to the management and local newspapers, and succeeded in keeping her mother at the Stratford for two months until social workers helped line up an adult family home willing to take Medicaid payments.

But the stress and the change of surroundings strained her mother's health, Duffy said. Six weeks after moving, she was dead. "She declined so quickly," Duffy said. "Being in familiar surroundings is hugely important for dementia patients. There's no doubt in my mind that the move hastened her death. It was devastating, just devastating." NEW HOME Ranzman's story has a happier ending. Her daughter pulled her out of the Amsterdam Nursing Home and rented a house in Smithtown, Long Island, with a patio and a backyard full of azaleas and trees. It was Ranzman's own space. She had round-the-clock aides, a large window and plenty of sunlight. Her daughter, Goldblum, noticed that Ranzman's memory improved quickly. Her mother seemed happier and more alert. "It was less than half the cost of a nursing home and a million times nicer," Goldblum said. "She showed such improvement." Goldblum paid $36,000 a year for the house and her mother's long-term care insurance paid the home-health aides. The move saved around $250,000 a year in expenses. What's more important to Goldblum is that her mother seemed content when she died in April at age 86, lying in bed and surrounded by family. "It was a wonderful ending," she said.

Approximately three-quarters of B.C. care aides surveyed said they are forced to rush through basic care for the elderly and disabled because of high workloads and reduced staffing. And let's not forget the workers who bear the brunt of health care cuts. Between January 21 and February 26, nearly 1,500 health care workers were laid-off at care homes and hospitals across B.C. because of contracting out or contract flips. Any former workers rehired at these facilities can expect to start at the bottom of the employment ladder. Some will lose their pension, others will receive lower probationary wages and most will have zero-earned vacation time. It's plain to see public health care is going down a bad road.

As we head towards a federal election, Canadians have an opportunity to think about how they can best vote for health care in 2015. The next government in Ottawa can take immediate steps to put our nation's signature social program back on the right track. That means your vote - and the vote of your family and friends - can make a difference in electing MPs that will fight for health care. They say voters get the government they deserve. And we certainly are due for leadership in Ottawa that puts the future of a strong public health care system front and centre in their election promises. To learn more about what can be done to save public health care, please visit saveourhealthcarebc.ca online. Bonnie Pearson, HEU Secretary-Business Manager

The authors tout their survey of 1,381 aides in three western provinces, just published in the Canadian Journal on Aging, as the first scientific study of a group who has been called health care’s “hidden” army.

But Govind Rao, a researcher with the Canadian Union of Public Employees, which represents care aides in some provinces, argued that the workers are, in fact, “very skilled” and well-qualified to do the work.

The problem, said Mr. Rao, is that there are not enough of them. “We have care aides who are overworked, and they’re not able to get their work done and answer patients when patients need them.” He also said it was “offensive” to even raise the issue of the workers’ ethnic make-up, saying there is no evidence that having English as a second language would affect their skill as care-givers.

It is estimated — no one knows the true number — that as many as 250,000 care aides, also known as personal support workers, are employed in Canada, providing 70-80% of the direct care to nursing-home residents. Most provinces require some kind of education and certification to work in the field, but the standards differ widely, said Prof. Estabrooks. Unlike nurses, physiotherapists and other professionals in the sector, they are not subject to regulation. Meanwhile, the number of registered nurses has been dwindling, partly due to cost cutting, experts say.

"People who come to Health Sciences North come from a lot of different areas. I can't jump on the subway and go down to the hospital to make my appointments. Some people come from Blind River, some come from Timmins, we're a referral hospital that's not funded properly and we can't provide the care we expect to be able to provide. We're very proud of what we do and people are struggling. People are going home sick. They're happy to get through a day, not happy to go to work and provide the care they want to provide. We don't think that's proper." According to CUPE, the hospital has cut beds, services and staff because of a five-year funding freeze imposed by the provincial Liberal government.

The union cited an Auditor General's report which estimated hospitals' costs increase by 5.8% annually, rising faster than inflation, because of the soaring costs of drugs provided free to inpatients and medical technologies, among other factors. Thibeault was at Queen's Park in Toronto on Thursday, but forwarded a statement through his communications staff. "I understand that Health Sciences North has made the decision to make changes in its nephrology department, shifting to a model of RNs working alongside renal aides, rather than RPNs," Thibeault said. "I have been assured by officials at Health Sciences North that this decision was made based on surveys of other nephrology departments in Ontario working successfully under similar models, and will not change the terms or quality of patient care.

"I understand that RPNs who choose to stay in nephrology will be re-assigned as renal aides, while those interested in pursuing RPN opportunities in other departments will be offered any additional training necessary. "I have been assured by officials at HSN that no layoffs are anticipated, and that vacancies for RPN positions in other departments are expected. I recognize, as does our government, that nurses are the backbone of our health-care system, and I will continue to advocate for health-care practitioners and patients in Sudbury."

The move to use renal aides alongside registered nurses, rather than the previous model of RPNs alongside RNs, was made to find efficiencies without affecting patient care, HSN spokesperson Dan Lessard said in a statement. "Nothing changes from a patient's standpoint, in terms of the care provided or quality of care," Lessard said. "The RNs assigned to the patient still oversee the process and their care."

The duties of the renal aide will include preparing, starting, and monitoring the dialysis machines, Lessard said. They'll also help transfer patients around the unit and help them with such things as going to the bathroom. "RPNs were doing these duties before, but these duties don't encompass the full scope of practice for RPNs. "For the RPNs affected by this, we're offered them an opportunity to let us know if they would be interested in receiving additional training in order to qualify for other RPN positions within HSN, where they would be working more fully within an RPN's scope of practice." Lessard confirmed that no layoffs are expected.

"In terms of their salaries, they don't get a pay cut," Lessard said. "They will have their salaries red-circled. That means their salaries will remain the same until the pay scale for renal aides catches up to their present salaries, and at that point they will follow the normal progression up the salary grid, but as renal aides, not RPNs." ben.leeson@sunmedia.ca Twitter: @ben_leeson

Registered practical nurses from Health Sciences North and their supporters hold a rally outside Sudbury MPP Glenn Thibeault's office in Sudbury on Thursday.

“They work hard and play by the rules,” President Obama said

“Today’s action will ensure that these men and women get paid fairly for a service that a growing number of older Americans couldn’t live without.”

These workers, according to industry figures, generally earn $8.50 to $12 an hour, compared with the federal minimum wage of $7.25 an hour. The White House said 92 percent of these workers were women, nearly 30 percent were African-American and 12 percent Hispanic. Nearly 40 percent rely on public benefits like Medicaid and food stamps.

many do not receive a time-and-a-half premium when they work more than 40 hours a week. Twenty-two states do not include home health care workers under their wage and hour laws.

PHI PolicyWorks, a nonprofit group that seeks to improve conditions for home care workers

six million of the 40 million Americans older than 65 now need some form of daily assistance to live outside a nursing home. That number, government officials say, is expected to double to 12 million by 2030

the proposed rules, which might be modified after a 60-day public comment period

some companions employed by individuals for activities like helping them take walks or engage in hobbies would still be exempt from minimum wage and overtime coverage

estimated that Medicare or Medicaid, which cover 75 percent of the nation’s home care costs, would pay $31.1 million to $169.5 million more each year toward home care aides, which she said would represent 0.06 percent to 0.29 percent of federal and state outlays for home care

In 1974, the Labor Department exempted “companionship” workers from coverage under the Fair Labor Standards Act, a move that focused on baby sitters at a time when the home care industry was in its infancy.

In 2007, the Supreme Court issued a decision involving a New York home care aide, Evelyn Coke, who often worked 70 hours a week, ruling that she was not entitled to overtime pay under existing regulations. The court said it was up to Congress or the Labor Department to change the rules.

nearly 90 percent of the nation’s home care aides work for agencies

Staffing levels in nursing homes are a concern not only because they are low, but they may not be increasing fast enough to meet the rising medical complexity of patients in nursing homes.

Data from the Canadian Institute for Health Information shows that between 2008 and 2012, the proportion of residents in Canadian nursing homes with disease diagnoses increased for every category of disease.

Dementia is also increasingly common among Canadian nursing home residents, with over three quarters of residents having some level of cognitive impairment. More than one in four residents suffers from severe dementia.

As a result, the care needs of nursing home residents have grown. In Ontario, care needs are assessed using the Method for Assigning Priority Levels (MAPLe) scoring system. The system ranges from a score of 1 (low needs) to 5 (very high needs). In 2012, 85% of new admissions from the community and 78% of admissions from hospital were in the High or Very High (MAPLe 4 and 5) clinical needs categories. Less than 1% of admissions were in the low and mild (MAPLe 1 and 2) clinical needs categories. Projections from the Ontario Long Term Care Association suggest that soon virtually all patients admitted to nursing homes will be from the two highest need categories.

The increasing needs of nursing home residents in Ontario has been driven in large part by the shift from letting individual nursing homes choose their residents, to having Community Care Access Centres determine who is in greatest need of long term care, says Dr Samir Sinha, lead for Ontario’s Senior Strategy

Ontario has begun to increase both the number and skill sets of nursing home staff, while also trying to find efficiencies to free up more staff time for direct patient care.

“One of the most promising initiatives to date has been Behavioral Supports Ontario (BSO),” says Sinha. The BSO initiative is province-wide, and has funded the hiring of 604 new staff (194 nurses, 272 PSWs, and 138 other health care professionals, such as social workers) with specialized skills in caring for and supporting residents with complex and challenging behaviors, such as violence.

Researchers and policy strategists in Alberta believe another key to improving quality in nursing homes is to engage Health Care Aides (HCA in Alberta is the rough equivalent of a PSW) as full members of the care team.

Carole Estabrooks, a Professor of Nursing at the University of Alberta has been researching the engagement of HCAs in quality improvement for the last several years. She believes that too often, HCAs are not treated as members of the care team. “Care Aides typically have the least amount of formal training, and as a result doctors, nurses and others too often assume they have nothing to offer,” she says. Frequently, this means they have little input into the care plans they are expected to carry out.

It is at places like these that PSWs say they're expected to perform duties that go beyond their training and their scope of practice. The PSWs we spoke to are concerned that performing those duties may put their professional well-being and the safety or residents at risk. 

There are no national standards for PSW training programs. 

Health Canada estimates that there are 100,000 PSWs working in Ontario alone.

In Ontario, community colleges, private career colleges, Boards of Education, and Not-for-Profit training organizations operate PSW schools.  The courses - which range between 600 and nearly 800 hours in length - include theory plus supervised practical work experience.

PSWs can assist clients to take their own medications.  That means they may help seniors open pill bottles and blister packs.  According to PSW training, what they shouldn't do is measure medications and administer them to seniors. 

Increasingly, they're being asked to that and more.

"We actually do wound care as well."

"When I started, it was another PSW that was on duty that was training me to do everything."

Natrice Rese is a retired PSW who speaks for the Ontario Personal Support Worker Association (OPSWA).

We're being pushed beyond what our training is, and we're being told if we don't like it, we can leave."

"It was written in the book.  If levels are between this and that, you dose that."

"Everybody that works there is burning out and it's getting pretty scary," says Jen.

"When a mistake happens, then it's the PSW's head that rolls,"

it's not illegal for PSWs to perform duties like injecting insulin or administering narcotics at retirement homes.  But the rules governing what PSWs like Jen and Brenda can do at retirement homes are unclear and open to disagreement.

In 2010, the Ontario Government passed the Retirement Homes Act.  It requires that the people licensed in the province to run retirement homes ensure all the staff employed there have the proper skills and qualifications to perform their duties and that they possess the prescribed qualifications.  However, the Act does not give specifics on what duties PSWs can and cannot perform.

the laws that regulate health professionals do permit PSWs to perform some of these nursing-type duties provided they are part of the resident's routine activities of living

For example, it's probably okay for a PSW to inject the same dose of insulin each day to a resident with well-controlled diabetes because that's part of the resident's daily routine.  But, it would not be permissible to inject insulin where the dose needs to be adjusted frequently.

permission for the PSW to perform a nursing duty under 'exception' provisions must be granted for each resident

Paul Williams, a health policy expert at the University of Toronto says little is known about what kind of medical care is delivered at retirement homes.

Williams was part of an expert panel set up by the Ontario Government to consider how to regulate retirement homes.  He says he sees little appetite for tight regulation of retirement homes.

"If we start to regulate, if we put in quality improvement stuff, if we start to accredit along recognized lines, you're going to push the cost up,"

As for regulating PSWs like the provinces do nurses and physicians, Williams says that's just as unlikely.

When you professionalize a group, you take responsibility for what they do.

"Maybe there's a disincentive to governments to regulate PSWs because quite frankly, it will probably cost you more money.  You can't pay twelve dollars an hour (a typical wage for PSWs) to someone who is professionally regulated."

Last year, BC became the first province to set up a registry of PSWs, known there as care aides and community health workers.  The registry sets province-wide training standards and ensures a fair process for investigating complaints against front line workers.  Earlier this year, Ontario announced plans to set up its own PSW registry.

The issue of who does what while caring for your loved ones will undoubtedly grow in the years ahead.  Given our aging population, would-be residents of retirement homes are increasingly likely to be frail seniors with dementia who require complex medical care.  They will need skilled, competent and well-educated professionals to meet their medical needs. 

That's also below the starting wage of $16.07 for personal support workers, dietary aides, health aides and home cleaners.

Kim Ciavarella, president of St. Joseph's Home Care. “We introduced this new tier so we'd be able to bid on those contracts. It positions us very nicely.”

The 190 workers came close to striking over the two-tier system that sees lower wages go to staff working on any new contracts

“We feel it's a race to the bottom,” said Bill Hulme, community care lead for the Service Employees International Union Local 1 Canada, which represents 10,000 home care workers including those at St. Joseph's.

The low wages, combined with a lack of job security, have made home care the most unstable sector of the health care system and the hardest in which to retain staff, says Jane Aronson, a home care researcher and director of McMaster's school of social work.

“I find it unfathomable that at the same time the provincial and federal governments keep saying home care is very important, it's organized so those who are its front line staff won't have security and in this instance won't even have a living wage,” she said. “It's not a field people can afford to work in very long so we lose people with skills.

home care workers make far less than the hourly wage because they're often not paid for their transportation time between clients

The province halted competitive bidding in January 2008 to try to resolve some of these issues. It's expected something new will be in place this fall.

St. Joseph's Health System is testing what it calls “bundled care,” which involves the province giving a set amount of money to provide diagnostic, hospital, long term care and home care to patients with a co-ordinator overseeing it all and acting as a point of contact.