“We Only Own the Hours”: Discontinuity of Care in the British Columbia Home Support System

Sharman, Zena; McLaren, Arlene Tigar; Cohen, Marjorie Griffin; Ostry, Aleck

doi:10.3138/cja.27.1.089

Cited by 22 publications

(47 citation statements)

References 21 publications

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“…Poor pay, inconsistent hours, limited opportunities for advancement, and a lack of benefits are critical to understanding the challenges reported by workers (Denton, Zeytinoglu, Davies, & Hunter, 2006;Fleming & Taylor, 2007;Sharman, McLaren, Cohen, & Ostry, 2008). Researchers have referred to working conditions that include "managing crises" (Lilly, 2008), characterized by little guidance (Aronson & Neysmith, 1996) and abusive situations (Neysmith & Aronson, 1997).…”

Section: Introductionmentioning

confidence: 94%

Workers’ Experiences of Crises in the Delivery of Home Support Services to Older Clients

et al. 2011

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In the provision of care to older clients, home support workers regularly confront, avert, and manage crises. Semistructured interviews were conducted to explore the nature, type, and management of crises from the perspective of home support workers (N = 118) of older persons in British Columbia, Canada. The delivery of home health care occurs within a context of unpredictability related to scheduling, time constraints, variability of client need, and changing work environments. These events are experienced by 91% of home support workers and range from a serious medical incident (e.g., fall, death) to an interpersonal dilemma (e.g., client refusal of service, argument between worker and family member). Home support workers use a variety of strategies to manage these incidents. The analysis of crises enables us to better understand how agency and care policies may be more responsive to circumstances that challenge care work in home health settings.

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Section: Introductionmentioning

confidence: 94%

Workers’ Experiences of Crises in the Delivery of Home Support Services to Older Clients

et al. 2011

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“…This transfer of more advanced care activities to PSWs has been labelled “task‐shifting” in the literature (Barken et al., ; Denton et al., ; Zeytinoglu et al., ). Care activities identified in the literature as being shifted to PSWs in home care include assistance with medications including eye drops and injections (Axelsson & Elmstahl, ; Craftman, Hammar, von Strauss, Hilleras, & Westerbotn, ; De Vliegher et al., ; Denton et al., ; Moorman & Macdonald, ; Sharman et al., ; Swedberg et al., ; Zeytinoglu et al., ), wound and stoma care (De Vliegher et al., ; Denton et al., ; Moorman & Macdonald, ; Sharman et al., ; Swedberg et al., ; Zeytinoglu et al., ), complex lifts and transfers (De Vliegher et al., ; Denton et al., ; Zeytinoglu et al., ), home exercise routines (Denton et al., ; Zeytinoglu et al., ), enteral feeding (De Vliegher et al., ; Denton et al., ; Zeytinoglu et al., ), catheterisation (Denton et al., ; Zeytinoglu et al., ), and assistance with complex home‐care technology such as feeding pumps, glucose monitors and home ventilators (Craftman et al., ; De Vliegher et al., ; Denton et al., ; Moorman & Macdonald, ; Sharman et al., ; Swedberg et al., ; Zeytinoglu et al., ).…”

Section: Introductionmentioning

confidence: 99%

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

Saari

Patterson

Kelly

et al. 2017

Health Soc Care Community

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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.

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“…Sharman et al . 's () qualitative study of home‐care restructuring in British Columbia argues ‘the casualisation and intensification of work in a context of increasing client acuity levels have diminished both continuity and quality of care’ (p. 89). The Ontario government acknowledged this as a problem in their PSW Workforce Stabilization Strategy, promising to ‘Develop measures to create more permanent and less casual employment for PSWs’ (Ontario Ministry of Finance , n.p.).…”

Section: Discussionmentioning

confidence: 99%

Exploring experiences of Personal Support Worker education in Ontario, Canada

Kelly

2017

Health Soc Care Community

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There is growing attention to the training and education of Personal Support Workers, or PSWs, who work in community, home and long-term care settings supporting older people and people with disabilities. In Ontario, Canada, amid a volatile policy landscape, the provincial government launched an effort to standardise PSW education. Using qualitative methods, this study considered the question: What are the central educational issues reflected by students, working PSWs and key informants, and are they addressed by the PSW programme and training standards? Phase one was a public domain analysis completed between January and March 2014 and updated for major developments after that period. Phase two, completed between August 2014 and March 2015, included 15 key informant interviews and focus group discussions and mini-phone interviews with 35 working PSWs and current PSW students. According to the participants, the central educational issues are: casualisation of labour that is not conveyed in educational recruitment efforts, disconnect between theory and working conditions, overemphasis on long-term care as a career path, and variability of PSW education options. While the standards should help to address the final issue, they do not address the other key issues raised, which have to do with the structural organisation of work. There is thus a disconnect between the experiences of students, PSWs and key informants and the policy decisions surrounding this sector. This is particularly significant as education is often touted as a panacea for issues in long-term and community care. In fact, the curriculum of some of the PSW programmes, especially those in public college settings, is robust. Yet, the underlying issues will remain barring a structural overhaul of the organisation of long-term and community care sectors founded on a social revaluing of older people and the gendered work of care.

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“We Only Own the Hours”: Discontinuity of Care in the British Columbia Home Support System

Cited by 22 publications

References 21 publications

Workers’ Experiences of Crises in the Delivery of Home Support Services to Older Clients

Workers’ Experiences of Crises in the Delivery of Home Support Services to Older Clients

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

Exploring experiences of Personal Support Worker education in Ontario, Canada

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