Sunday, January 11, 2009

Home Care & PSW Training

The Ontario Government has had a big push on to provide more support for seniors in their homes. This is a fine idea, but one that requires careful homework, whether on the part of the senior, or their families who may be bearing the burden of care.

There are many agencies, and much press, devoted to Elder Abuse. Unfortunately, or not, with all the attention devoted to this issue, the real issues go unnoticed.

What are the real issues?

Access to human, financial and physical resources in the home.
We do not have enough health care providers.
We do not have enough trained home care staff - Personal Support Workers (PSWs), available to provide the services seniors need.
We have seniors who deny the need for such services- which impacts family members who provide care (25 % or so is by sons and daughters) who face personal stress in delivering such care.

The needs of seniors include
  • transportation to complete IADL
  • in-home services: personal, hygiene and house-related chores, meal preparation, laundry
We provide licenced, trained Early Childhood Educators (ECE) to work with young children. Seniors, with increasing comorbidities, are looked after by PSW who have minimal training, with a high school education and a series of course modules designed to train them in all things related to seniors, delivered in Community Colleges or on-line.

Centennial College has a 700 hour curriculum. Algonquin's course offers a more holistic model: with health and safety, meal preparation, cognitive and emotional health, and working with families during 355 'clinical hours' of training, and a practicum placement. George Brown, for example, offers the following courses, with the 2nd semester being palcements and no training hours.
Role of the Personal Support Worker, Assisting with Mobility, Household Management and Meal Preparation, Assisting with Medication, Intervention Strategies for Client Groups, Providing Optimal Support and Personal Care, The Body – Changes and Conditions, Safety and Abuse, Building Supportive Relationships

Where are the courses on the social aspects of working with seniors, death and dying, working with families, biology, physiology, and human relations? ECE degrees require sociology, psychology, a knowledge of human growth and development, and a level of education that goes beyond high school. With a two-year college degree, we have some security that our grads who work with children have a level of knowledge, skills and understanding that goes beyond high school. There are PSWs whose training, and PD, and life experiences allows them to deliver a level of care that meets particular standards. But current training standards do not assure this level of expertise. These courses are not regulated, there is no standard, and 'graduates' can come out without an inkling of what it means to be a senior, socially, emotionally and physically ill, and housebound.

We show little respect for our elders if we do not ensure high standards of care and training. And training does not stop with graduation. We must ensure accountability, not at the level of the employer, which is the current Ministry of Health and Long-Term Care thrust, but at the individual level, for personal accountability. I believe that PSWs should be registered and be monitored for excellence. They should be paid commensurate with their training and experience, not at the whim of the employer. Ministry subsidies must reflect this reality. When you pay people for what they are worth, you can demand a high level of competence. And our seniors deserve the best we can afford.

Once a graduate is out in the community, there is no gaurantee that they continue to meet the standards required by society. Those who are fired, due to incompetence or other issues, can seek employment elsewhere. They can move from agency to agency, and non-profit sector to profit, they can seek private employment and commit the unproven statistics of 2 - 10% of elder abuse that gives the entire profession a bad name.

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