Laura Bulmer is a PSW advocate, registered nurse and professor at George Brown College in Toronto.
Before COVID-19, we did not have enough personal support workers in Canada. This life-threatening shortage is the result of long-ignored retention and recruitment obstacles. According to Miranda Ferrier, president of the Ontario Personal Support Worker Association, a 2017 survey of PSWs revealed the workforce is diminishing at an alarming rate of 30 per cent quarterly. Those surveyed identified factors such as low pay (ranging from $15-23 per hour depending on the setting and whether it receives government funding), working short-staffed, safety concerns, compassion fatigue and injuries as reasons for leaving the profession or being on modified work or medical leave. A report commissioned by the Ontario Health Coalition and released in January 2020 found that long-term care (LTC) homes in Ontario were routinely operating with one or two too few PSWs per shift and were short by as many as 10 workers in a 24-hour period. The situation in community settings is no better as patients are discharged from hospitals to their homes needing care, and there are not enough PSWs to meet the demand.
Now, as we begin to recover from the first wave of the pandemic, PSW educators across the country predict the shortage will be exacerbated. Negative media attention related to LTC and apprehension about getting sick does not make this already undervalued profession an appealing career choice. In my opinion, acknowledging the crisis is not enough. To recruit and retain an adequate PSW workforce and to properly protect the public, we need to initiate a revolution. A revolution that includes regulation of PSWs.
As a registered nurse, I worked alongside PSWs on a palliative care unit in a downtown Toronto hospital. I started teaching PSWs and facilitating their clinical experiences more than 20 years ago. I became a PSW advocate after realizing that the dedication and genuine big-heartedness of student and working PSWs goes virtually unnoticed. It is not uncommon to see student graduates ask to continue visiting their “first patient” or employed PSWs come in early for a shift to ensure residents are cared for in a less rushed manner. PSWs are the pillars of the health care delivery team. They provide personal care, medication management and basic assessment of clients, and work in a variety of care settings including the community (adult day programs, supportive housing, retirement homes), private homes and LTC. PSWs are among the front-line workers being thanked by millions around the world; if they walked off their jobs today, the framework of our health care system would be disrupted in epic proportions. Vulnerable Canadians would suffer. And yet, these workers are not regulated in Canada. They do not have licenses, they do not have a governing body overseeing their practice and they do not have standardized training.
PSWs do not even have a recognizable name. This type of worker can also be called a personal care assistant, resident care aide, certified health aide, home attendant, clinical assistant, and tens of other names. This creates confusion about and diminishes what PSWs do. Regulation would provide a standardized title for this worker, which would help give Canadians assurance about who is providing their care.
Canada’s elderly population is expanding, and seniors often have co-morbidities (multiple illnesses) that can be complex. It would be safer to have their care provided by regulated PSWs who receive standardized education. Currently in Ontario, PSW training is offered at community colleges, private colleges, and district school boards. Each has its own standards, length of program (600—750+ hours), cost ($1,000—$15,000), content delivery format, and evaluative measures. Stunningly, there are large variations in the clinical hours required to safely graduate. Non-standardized education leads to a non-standardized graduate.
I was approached several weeks ago by a company researching the feasibility of creating a six-to-eight-week online PSW course. I understand the need to replenish the PSW workforce; what I do not support is providing an abbreviated online course. You cannot safely and effectively provide students with the knowledge and skill development they need solely via computer—it is not safe or ethical. If PSWs were regulated, this quick-fix approach would not even be considered.
The primary function of regulation is to protect the public. Regulation would implement measures to ensure that only qualified, competent, and professional PSWs are providing care. A PSW regulatory college, like those of nurses and physicians, would serve as the governing body for PSWs, establishing PSW standards of practice and making members’ professional obligations clear. Entry to practice would be regulated. PSWs would have to meet criteria to be licensed and to keep their licenses.
Licensing PSWs would also provide a great resource to the public: a registry. This would allow for data collection and a better understanding of who comprises the workforce and where the market demands are. A registry like this would be useful during emergencies like the COVID-19 pandemic where a formalized “call to arms” could be issued and PSWs could be deployed to areas in need. Having a license to practise comes with responsibilities such as committing to being a lifelong learner and following a professional code of ethics and professional standards of practice. The college of PSWS would be a place for the public to bring concerns and complaints and see that discipline, if appropriate, was delivered should a PSW not uphold their responsibilities. Regulating PSWs would keep Canadians safer, providing workers with the legitimacy of an overseeing body and the public with a route to recourse.
If regulation of PSWs had happened 15 years ago, when advocates first began lobbying for it, there is no doubt the situation in LTC through the pandemic would have been different. There would be more PSWs, better paid PSWs and standardized PSWs slogging on the frontlines.
In my opinion, resolving the PSW shortage is imperative, and regulating PSWs is an obvious strategy. As Canadians, we are collectively responsible for this. Regulatory infrastructure requires investment. Federal and provincial officials have offered financial support to Canadians in various ways through this crisis; we also need their commitment to see that PSWs are regulated. Through demanding regulation and better compensation for PSWs, we can demonstrate our commitment to securing a safer future for Canadians. In other words, by investing in PSWs, we invest in ourselves.