The evolving role of the personal support worker in home care in Ontario, Canada
Corresponding Author
Margaret Saari RN, PhD
School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, Canada
Saint Elizabeth Research Centre, Saint Elizabeth Health Care, 90 Allstate Parkway, Suite #300, Markham, ON, Canada
Correspondence
Margaret Saari, School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, Canada.
Email: [email protected]
Search for more papers by this authorErin Patterson RN, PhD
School of Health & Life Sciences and Community Services, Conestoga College, Kitchener, ON, Canada
Search for more papers by this authorShawna Kelly RN (EC), MN-NP Adult, CNN(C)
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
Krembil Neuroscience Program, University Health Network, Toronto, ON, Canada
Search for more papers by this authorAnn E. Tourangeau RN, PhD
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorCorresponding Author
Margaret Saari RN, PhD
School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, Canada
Saint Elizabeth Research Centre, Saint Elizabeth Health Care, 90 Allstate Parkway, Suite #300, Markham, ON, Canada
Correspondence
Margaret Saari, School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, Canada.
Email: [email protected]
Search for more papers by this authorErin Patterson RN, PhD
School of Health & Life Sciences and Community Services, Conestoga College, Kitchener, ON, Canada
Search for more papers by this authorShawna Kelly RN (EC), MN-NP Adult, CNN(C)
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
Krembil Neuroscience Program, University Health Network, Toronto, ON, Canada
Search for more papers by this authorAnn E. Tourangeau RN, PhD
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorAbstract
To meet increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Much of the research examining this shift focuses on specialty programmes, with few studies investigating the daily care being provided by PSWs, frequency of care activities being provided by PSWs, and characteristics of the population receiving more complex tasks. Between January and April 2015, a review of 517 home-care service user charts was undertaken in Ontario, Canada, to: (1) describe the range of tasks being performed by PSWs in home care, (2) identify tasks transferred by RHPs to PSWs, and (3) examine characteristics of service users receiving transferred care. Findings indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. Although there is potential for the expansion of home-care services through increased utilisation of PSWs, healthcare leadership must ensure that the right provider is being utilised at the right time and in the right place to ensure safe and effective quality care. Thus, several actions are recommended: PSW core competencies be clearly articulated, processes used to transfer care activities from RHPs to PSWs be standardised and a team-based approach to the delivery of home-care services be considered. Utilisation of a team-based model can help establish positive relationships among home-care providers, provide increased support for PSWs, allow for easier scheduling of initial training and ensure regular reassessments of PSW competence among PSWs providing added skills.
REFERENCES
- Axelsson, J., & Elmstahl, S. (2004). Home care aides in the administration of medication. International Journal for Quality in Health Care, 16, 237–243. https://doi.org/10.1093/intqhc/mzh041
- Barken, R., Denton, M., Plenderleith, J., & Zeytinoglu, I. (2015). Home care workers’ skills in the context of tasking shifting: Complexities in care work. Canadian Review of Sociology, 52, 289–309. https://doi.org/10.1111/cars.12078
- Berta, W., Laporte, A., Deber, R., Baumann, A., & Gamble, B. (2013). The evolving role of health care aides in the long-term care and home and community care sector in Canada. Human Resources for Health, 11, 25. https://doi.org/10.1186/1478-4491-11-25
- Briar, C., Liddell, E., & Tolich, M. (2014). Still working for love? Recognizing skills and responsibilities of home-based care workers. Quality in Ageing and Older Adults, 15, 1–13. https://doi.org/10.1108/QAOA-04-2014-0006
10.1108/QAOA-04-2014-0006 Google Scholar
- Bystedt, M., Eriksson, M., & Wilde-Larsson, B. (2011). Delegation within municipal health care. Journal of Nursing Management, 19, 534–541. https://doi.org/10.1111/jonm.2011.19.issue-4
- College of Nurses of Ontario. (2015). Practice guideline: Authorizing mechanisms. Toronto, ON: College of Nurses of Ontario. Retrieved from http://www.cno.org/globalassets/docs/prac/41075_authorizingmech.pdf
- College of Nurses of Ontario [CNO]. (2013). Practice guideline: Working with unregulated care providers. Toronto, ON: College of Nurses of Ontario. Retrieved from http://www.cno.org/globalassets/docs/prac/41014_workingucp.pdf
- College of Occupational Therapists of Ontario. (2011). Standards for the Supervision of Support Personnel. Toronto, ON: College of Occupational Therapists of Ontario. Retrieved from https://www.coto.org/docs/default-source/standards/standards_supervision_personnel.pdf?sfvrsn=2
- College of Physiotherapists of Ontario. (2016). Standard for professional practice: Physiotherapists working with physiotherapist assistants. Toronto, ON: College of Physiotherapists of Ontario. Retrieved from http://www.collegept.org/Standards/PTAs
- Community Care Access Centres [CCAC]. (2014). Client services contract performance framework. Schedule 3 – Personal support and homemaking services. Retrieved from http://healthcareathome.ca/serviceproviders/en/Procurement/Contract-Templates/Client-Services
- Craftman, A., Hammar, L., von Strauss, E., Hilleras, P., & Westerbotn, M. (2015). Unlicensed personnel administering medications to older people living at home; a challenge for social and care services. International Journal of Older People Nursing, 10, 201–210. https://doi.org/10.1111/opn.12073
- De Vliegher, K., Aertgeerts, B., Declercq, A., & Moons, P. (2015). Exploring the activity profile of health care assistants and nurses in home nursing. British Journal of Community Nursing, 20, 608–614. https://doi.org/10.12968/bjcn.2015.20.12.608
- De Vliegher, K., Declercq, A., Aertgeerts, B., & Moons, P. (2016). Health care assistants in home nursing: The Holy Grail or the emperor's new clothes? A qualitative study. Home Health Care Management & Practice, 28, 51–56. https://doi.org/10.1177/1084822315589563
- Denton, M., Brookman, C., Zeytinoglu, I., Plenderlieth, J., & Barken, R. (2015). Task shifting in the provision of home and social care in Ontario, Canada: Implications for quality of care. Health and Social Care in the Community, 23, 485–492. https://doi.org/10.1111/hsc.12168
- Giosa, J., Holyoke, P., Bender, D., Tudge, S., & Gifford, W. (2015). Observe, coach, assist, and report: An emerging framework for integrating unregulated healthcare providers into interdisciplinary healthcare teams. Journal of Research in Interprofessional Practice and Education, 5, 1–20.
10.22230/jripe.2015v5n2a200 Google Scholar
- Health Professions Regulatory Advisory Council [HPRAC]. (2006). Regulation of health professions in Ontario: New directions. Retrieved from http://www.hprac.org/en/reports/resources/New_Directions_April_2006_EN.pdf
- Herber, O., & Johnston, B. (2013). The role of healthcare support workers in providing palliative and end-of-life care in the community: A systematic literature review. Health and Social Care in the Community, 21, 225–235. https://doi.org/10.1111/j.1365-2524.2012.01092.x
- Hewko, S., Cooper, S. L., Huynh, H., Spiwek, T. L., Carleton, H. L., Reid, S., & Cummings, G. (2015). Invisible no more: A scoping review of the health care aide workforce literature. BMC Nursing, 14, 1–17. https://doi.org/10.1186/s12912-015-0090-x
- Ingleton, C., Chatwin, J., Seymour, J., & Payne, S. (2011). The role of health care assistants in supporting district nurses and family carers to deliver palliative care at home: Findings from an evaluation project. Journal of Clinical Nursing, 20, 2043–2052. https://doi.org/10.1111/j.1365-2702.2010.03563.x
- Kelly, C., & Bourgeault, I. L. (2015). The personal support worker program standard in Ontario: An alternative to self-regulation? Health Policy, 11, 20–26. https://doi.org/10.12927/hcpol.2016.24450
- Landi, F., Tua, E., Onder, G., Carrara, B., Sgadari, A., Rinaldi, C., … Bernabei, R. (2000). Minimum data set for home care: A valid instrument to assess frail older people living in the community. Medical Care, 38, 1184–1190. https://doi.org/10.1097/00005650-200012000-00005
- McBride, S., Beer, J., Mitzner, T., & Rogers, W. (2011). Challenges for home health care providers: A needs assessment. Physical & Occupational Therapy in Geriatrics, 29, 5–22. https://doi.org/10.3109/02703181.2011.552170
10.3109/02703181.2011.552170 Google Scholar
- Moorman, S., & Macdonald, C. (2013). Medically complex home care and caregiver strain. The Gerontologist, 53, 407–417.
- Morris, J., Fries, B., Mehr, D., Hawes, C., Phillips, C., Mor, V., & Lipsitz, L. (1994). MDS cognitive performance scale. Journal of Gerontology: Medical Sciences, 49, M174–M182. https://doi.org/10.1093/geronj/49.4.M174
- Morris, J., Fries, B., & Morris, S. (1999). Scaling ADLs within the MDS. Journal of Gerontology: Medical Sciences, 54A, M546–M553. https://doi.org/10.1093/gerona/54.11.M546
- Office of the Auditor General of Ontario [OAGO]. (2015). Chapter 3, Section 3.01 CCACs – Community Care Access Centres – Home Care Program. Retrieved from http://www.auditor.on.ca/en/content/annualreports/arreports/en15/2015AR_en_final.pdf
- Personal Support Network of Ontario. (2011). PSW training organizations comparisons for Ontario. Retrieved from http://www.psno.ca/uploads/1/0/1/9/10197937/psno_summary_of_psw_training_in_ontario_july_2011.pdf
- Prince, M., Prina, M., & Guerchet, M. (2013). World Alzheimer report: An analysis of long-term care for dementia. Retrieved from https://www.alz.co.uk/research/WorldAlzheimerReport2013.pdf
- Saari, M., Patterson, E., Killackey, T., Raffaghello, J., Rowe, A. & Tourangeau, A. E. (2017). Home-Based Care: Barriers and facilitators to expanded unregulated care provider roles in Ontario, Canada. Home Health Care Services Quarterly, Advanced online publication. doi: 10.1080/01621424.2017.1393482
- Sharman, Z., McLaren, A., Cohen, M., & Ostry, A. (2008). “We only own the hours”: Discontinuity of care in the British Columbia Home Support System. Canadian Journal on Aging, 27, 89–99. https://doi.org/10.3138/cja.27.1.089
- Smyth, E. (2015). Assessing the skills of home care workers in helping older people take their prescribed medications. British Journal of Community Nursing, 20, 400–404. https://doi.org/10.12968/bjcn.2015.20.8.400
- Statutes of Ontario. (1991). Regulated Health Professions Act. Ch. 18. Retrieved from https://www.ontario.ca/laws/statute/91r18
- Statutes of Ontario. (2004). Personal Health Information Protection Act. Ch. 3, Schedule A. Retrieved from https://www.ontario.ca/laws/statute/04p03#BK60
- Statutes of Ontario. (2007). Long Term Care Homes Act. Ch. 8. Retrieved from http://www.ontario.ca/laws/statute/07l08
- Swedberg, L., Chiriac, E., Tornkvist, L., & Hylander, I. (2013). From risky to safer home care: Health care assistants striving to overcome a lack of training, supervision, and support. International Journal of Qualitative Studies on Health and Well-Being, 8, 20758. https://doi.org/10.3402/qhw.v8i0.20758
- Swedberg, L., Michelsen, H., Chiriac, E., & Hylander, I. (2015). On-the-job training makes the difference: Healthcare assistants’ perceived competence and responsibility in the care of service users with home mechanical ventilation. Scandinavian Journal of Caring Sciences, 29, 369–378. https://doi.org/10.1111/scs.12173
- Tourangeau, A., Saari, M., & Patterson, E. (2016). The impact of home care nurse staffing, work environments, & collaboration on patient outcomes. Retrieved from http://tourangeauresearch.com/wp-content/uploads/Final-Report-Grant-06692-Tourangeau-et-al-May-2016-Reformatted.pdf
- Tourangeau, A., Saari, M., Rowe, A., Patterson, E., & Villeneuve, M. (2015). The role of nurses in assigning, delegating, teaching, and supervising patient care activities to unregulated care providers in home care: A jurisdictional scan of legislation, regulation and policy in Canada. Retrieved from http://tourangeauresearch.com/wp-content/uploads/Jurisdictional-Scan-FINAL.pdf
- Zeytinoglu, I., Denton, M., Brookman, C., & Plenderleith, J. (2014). Task shifting policy in Ontario, Canada: Does it help personal support workers’ intention to stay? Health Policy, 117, 179–186. https://doi.org/10.1016/j.healthpol.2014.01.004
