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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

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

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?

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."

"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.

According to the registry, 527 patients were billed a total of $40,775 between Feb. 15 and Aug. 2015. Respondents noted feeling indignant about the injustice of having to pay amounts they considered exorbitant for medical care. Some said they couldn't afford to pay - they needed the money for groceries or rent. User fees for insured medical services covered by the provincial health insurance board are illegal. But there's a grey zone, and for years many physicians and clinics have quietly been applying extra, arbitrary or excessive fees for exams and medications covered in hospitals. Led by the clinic's Comité de lutte en santé, the registry also showed that rates for medical services levied on patients varied among professionals, the clinic's co-ordinator Luc Leblanc said Sunday.

"It's a two-tiered system. One for those who can pay and one for those who can't," he said. Data analysis shows the average amount demanded by family doctors was $63, and the average for specialists was $91. The biggest category is medications or anaesthetics, followed by administrative charges like photocopies or filling forms. Adopted last week, Quebec Health Minister Gaétan Barrette's Bill 20 included a set of amendments to legalize fees charged to patients in clinics for insured services, commonly called "accessory fees." The list of regulated ancillary fees will come later, after the government hires an independent accounting firm to determine real costs.

But Leblanc noted the public wasn't consulted because "initially Bill 20 made no mention of the possibility of accessory fees," Leblanc said. And there are no prior government studies or surveys to determine the scope or impact of current fees on patients, he added. The introduction of user fees is a serious threat to universal care, critics said, including the Canadian Medical Association, Quebec Medical Association, Canadian Doctors for Medicare, and Médecins québécois pour le régime publique (MQRP), who asked Barrette to hold offon regulating fees in October.

Charging patients at doctors offices and clinics for medically necessary care isn't acceptable, said Isabelle Leblanc, president of the pro-medicare group, Médécins québécois pour le régime publique. It strikes at the heart of the principle that access to health care should be based on need rather than ability to pay, she added. The clinic's health committee is calling on Barrette to suspend extra fees and on the new federal Health Minister Jane Philpott "to act immediately to force Quebec to respect the Canada Health Act," said Louis Blouin of the committee. The committee is continuing to document billing in its online registry. It can be found on the Pointe-Saint-Charles clinic website cfidelman@montrealgazette.com twitter.com/HealthIssues

Miranda Ferrier President Ontario Personal Support Worker Association

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.