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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. 

£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

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all workers who are PSWs that are employed by publicly funded employers.

The Ontario government has established a Personal Support Worker (PSW) Registry. 

Initially affecting PSWs (and associated classifications) in home care, it is scheduled to roll out to long term care and hospitals

CUPE successfully fought for a seat on the Registry Steering Committee, but unfortunately, despite objections from CUPE and other labour representatives, employers and government consistently pushed the Registry in new directions for which there was no consensus. 

The Registry has been put under the leadership of an employer organization.   There is inadequate protection of the privacy of PSWs.    There is no fair process for the removal of PSWs from the Registry list – yet PSWs will not be able to work for publicly funded employers unless their name is on the Registry. The Registry also enables ‘self-directed care'.   The Registry has an "optional" section on the application form where PSWs can sign up to work for private individuals who receive funding through a parallel system to Medicare. The Registry is serving to help weaken Medicare as private individuals often pay workers less with poorer quality care.

CUPE Ontario and OCHU have stepped down from their seat on the PSW Registry steering committee

The organization at the heart of this controversy, the Ontario Community Support Association, has been paid more than $5 million by the health ministry since 2011 to create and maintain the registry. The association's CEO, Deborah Simon, told the Star it "is absolutely not true that anybody could register." Simon said the agency checked educational backgrounds by requiring a certificate when applying to the registry. She said staff would then check to make sure the school listed on the registrant's application existed. The result, she said, is a "major achievement" in that the registry has provided "very valuable demographic information that's never been aggregated before."

Simon said the ministry played no role in strengthening registry data during the last year. "I don't know what other strengthening of data the ministry would be involved in because they're not involved in day-to-day decision making around registration," she said. "I'm not clear on what they're specifically talking about ... We're always refining our registration process." One such process, Simon said, has been figuring out how to remove names from the registry. Why would a name need to be removed?

"For a number of reasons," Simon said. "For data we're aware is not correct. For concerns that have been raised around issues that a personal support worker might be involved in." Neither Simon nor the ministry has said how many names had to be removed from the list since it became operational in 2012. By March 18, 2016, there will be no trace of the registry online. That day won't come soon enough for Gélinas.

"It has done nothing but make the OSCA richer," she said. The registry "has all of the DNA of e-health," Gélinas said, referring to the scandal that saw provincial government spend more than $1 billion trying to create electronic health records with little to show for it.