May 21, 2014 - The recent announcement by the Province regarding higher wages for provincial Personal Support Workers (PSW) is an important step in expanding community and home care options.
Shifting health care from hospitals to communities is an international trend that is gaining popularity for a number of reasons. First, academic research has shown that patients prefer home care to hospital care and that unnecessary hospital stays negatively impact patients’ health. Additionally, governments realize substantial cost savings by shifting care to the home and community levels, which subsequently frees up hospital resources for patients with acute needs. For these reasons, home-based care makes for an attractive option for Ontario.
The discharge of patients from hospitals into the community requires the provision of individualized and culturally relevant care. This makes PSWs central to today’s shifting trends in health care. At present, PSWs are the largest group of workers in Ontario’s long-term care and home care sector. There are an estimated 57,000 PSWs in Ontario who work in the long-term sector, 26,000 who work for agencies that provide community and home care, and about 7,000 who work in hospitals.
Despite its importance, the personal support sector is chronically understaffed. This is largely a result of low pay, irregular hours, and inconsistent coverage of mileage and other expenses related to delivering home care services. In fact, many PSWs receive the minimum wage of $12.50 per hour that has not been increased since 2006. Such problems are particularly acute in Northern Ontario where vast distances and the harsh climate make PSW work even more challenging.
Different work conditions require different training and professional standards in the personal support sector, but such considerations are not in place in Ontario.
Personal Support Work is not a regulated profession in our province. Ontario does not have a governing body to set standards for the skills and knowledge required to practice as a PSW or for the services they provide. At the same time, PSWs can vary considerably in terms of the kind of care they provide. This includes providing medical care such as administering medication as well as providing personal care such as bathing and dressing. In addition, little is known about those who perform such an important, if somewhat unnoticed, job. There is practically no information on their training, identities, and places of work.
This situation has attracted the government’s attention. In May 2012 the Ontario Ministry of Health and Long-Term Care (MOH) announced that it would be developing a PSW Registry to collect information about the training and employment status of the nearly 100,000 PSWs in Ontario in an effort to better understand PSWs. The Registry started collecting information on June 1, 2012.
Recently, the Ontario Government promised to boost the minimum wage of PSWs in the home-care sector to $16.50 per hour. While this commitment aims to improve the Liberal Party’s relations with labour organizations and bolster political support for the upcoming election, it is still a great news for PSWs.
Higher wages should attract more labour to the home-care sector, which has difficulty recruiting and keeping workers. But more is needed to provide Ontarians with quality personal support services.
The Province intends to use information from the MOH Registry to produce general education standards. To ensure a high quality of supportive services, it may be necessary to go further and develop region-specific requirements for PSW registrants. For Northern Ontario, PSWs must be trained to work in remote communities where unique risk factors, such as environmental exposures and social circumstances, are complicated by a shortage of medical professionals. This creates additional responsibilities in assisting patients. Without appropriate training, many PSWs may be unable to provide quality services in Northern communities.
Although a raise in pay may address the issue of PSW shortages in Northern Ontario, it may not improve the quality of services. Generally speaking, region-specific specialized training of PSWs will be a necessary ingredient for improving the quality and effectiveness of home care services provided in the Ontario and in the North. Where the money for such personal support professionals will come from is unclear at this point.
One of the ways the provincial government may improve the efficiency of the home-based care sector in Northern Ontario is to promote greater integration of PSWs into health care teams. This approach can streamline information and best practice exchange among team members, which will provide PSWs with additional training opportunities, raising the quality of their services. To accomplish this, the Province will need to work with the Local Health Integration Networks, Community Care Access Centres, and Community Support Services to find mutually acceptable solutions that can reduce spending while producing better home care options through integration.
How exactly the Province is going to address PSW issues to provide effective home care remains to be seen.
Authored by Leonid Shafir