Saturday, January 15, 2011

Regulate PSWs - provide consistent, individual care

An Elder Abuse workshop in Muskoka
The Ombudsman's report continue to highlight issues in Ontario long-term care (LTC) homes.
Read the report (PDF) I think it boils down to for-profits delivering services, trying to save money, and services delivered by workers who are not monitored, regulated or consistently trained.

Here is the key issue:
The standards being used to monitor long-term care homes were inconsistently interpreted and applied.  With 450 different criteria to check, ranging from minor to serious, the Ministry’s compliance staff were often overwhelmed, the Ombudsman found.  Largely due to inadequate and inconsistent training of staff, serious deficiencies tended to be lumped in with less serious ones and follow-up was spotty, as was enforcement.  “Inconsistency in the application of standards can result in dangerous situations continuing unchecked,” Mr. Marin warned the Ministry.

I have written about this issue for years. Staff, specifically unregulated Personal Support Workers (PSWs) receive a wide variety of training in various institutions. Many employers give in-service training, bless them. Mentoring is a good way to ensure the highest quality delivery of services.

That said, employees are not monitored, after they graduate with a certificate. In fact, I do not believe a certificate is enough to ensure that workers providing the most intimate of care to our loved ones give the type of care that each individual deserves. Midwives get more training, and make house calls. I have long advocated for midwives for palliative patients. They need help ushering themselves out of this world, as much as entering the world.

That is not to say that there aren't exemplary professional caregivers in the 513 for-profit institutions in Ontario. There are about 640 non-profit institutions in this province alone. What is criminal is that in the for-profits decisions are based on the bottom line, not what is best for the client/residents.

One of my favourite PSWs
In addition, PSWs who are poorly trained, or simply poor choices for this type of work may be fired, but can freely go from employer to employer with no consequences. Issues of theft, inappropriate treatment of residents and clients, elder abuse and neglect, and sexual abuse of clients will go under the radar as a for-profit institution avoids the police and gives the PSW a half decent reference to get her off their staff. The for-profits are avoiding negative publicity and the non-profits must feel the same way.

It is appalling.

When I was Family Council chair of my father's LTC institution (a legal requirement in Ontario, like Parent Councils in schools), many of the complaints revolved around the ways in which all of the PSWs treated all of the clients the same way. It was hard to convince them, for example, to put an undershirt on my Dad under his sweatshirt. He was cold all of the time. I left sticky notes on his armoire. I spoke to staff. With all of the paperwork, many didn't have time to prebrief for these small problems. Those with behavioural issues, as well as serious health issues had all the attention.

My father in LTC was there for dementia and a brain tumour. The woman across the hall, a paraplegic (I wrote about them both in my book), was required to get out of bed and come to meals. Neither wanted to do so. In my father's case, he was palliative, and despite my protestations, they would haul him down to a meal he did not want. 

Add to the mix, another resident in her 30s, who was there with brain damage from an accident. She yelled, stole from residents. My father pulled the fire alarm, and had fist fights with other men in wheelchairs. The benign senior in LTC is a myth!

These are our precious family members. It is time the government regulated these workers. We need care suited to the client, not the institutions or managers desperate to save a buck by limiting the number and timing of adult incontinent product ('diaper') changes. We need to know that institution managers interpret Ministry rules properly. Each resident is entitled to individual care suited to his or her medical issues.

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