The evolving role of the personal support worker in home care in O ntario, C anada

Abstract

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.

Unregulated care providers’ engagement in palliative care to older clients and their families in the home setting: a mixed methods study

“…This finding supports studies investigating the benefits of education and training to develop UCPs’ competencies in palliative care, and the recommendation that UCPs receive appropriate training [11, 32]. Although we identified controlled acts within the interventions implemented by UCPs; like others, we found they comprised a small percentage of activities undertaken by UCPs [14].…”

“…In delivering this care, UCPs also provide psychosocial support [10, 13]. Growing demand for home care services and fiscal pressures has resulted in UCPs’ roles evolve from a supportive one to encompass responsibilities (e.g., wound care, exercise and range of motion exercises, bowel and ostomy care, assistance with medications, blood glucose monitoring, and tube feeding), referred to as controlled acts, which are conducted by HCPs, and are delegated by a HCP [14]. However, UCPs do not have a professional designation or accredited training and education; therefore, their competencies and scope of practice are not clearly defined [4, 8].…”

Expanding the Concept of End‐of‐life Care in Long‐term Care: A Scoping Review Exploring the Role of Healthcare Assistants

“…To date, four scoping reviews have focused on the role of HCAs (Afzal et al, 2018; Herber & Johnston, 2013; Hewko et al, 2015; Saari et al, 2018). Herber and Johnston (2013) exclusively explored the role of HCAs in end‐of‐life care provided in a variety of care settings.…”

“…Findings Afzal et al (2018) review, exploring HCAs’ role in a variety of settings, supported the notion that HCAs’ role is unclear, further stating that HCAs’ role is expanding to the provision of care previously provided by regulated healthcare professionals. A review exploring the breadth and depth of international literature on the HCA workforce (Hewko et al, 2015), and a review exploring HCAs’ role in home care (Saari et al, 2018) has also been published in recent years. While these findings greatly contribute to the literature, no scoping review has yet explored HCAs’ role in end‐of‐life care specific to the complex context of LTC or from the unique perspective of HCAs.…”

The role of unregulated care providers in home care: A scoping review

“…UCPs are increasingly being expected to perform aspects of care traditionally performed by nurses and other regulated health professionals, such as physiotherapists (Saari, Patterson, Kelly, & Tourangeau, ). Notably, restricted or controlled acts, typically considered potentially harmful if performed by unqualified persons, are being delegated to UCPs in home care.…”