10 ways to be a great PSW

This is an open letter to those who work as personal support workers (PSW). I love you all! Some of you have more integrity than others. (Integrity means doing a great job even when no one is looking!) There are no horrible jobs, but there are some who do a horrible job at their job. I love it when someone is happy doing their work. Working with children or seniors, I have found a great reward in making a difference.
You do make a difference.

garbage under bed, nicotine stains on baseboard

1. Dress for success. Be clean. You can transfer flu, bacteria, or superbugs from client to client if you do not wash your hands and your uniform regularly. After 5 or 6 applications of hand sanitizer, you really need to handwash to effectively remove all bacteria.

2. Groom yourself. Brush or comb your hair. Put on deodorant. Shave. I mean it. It may be cool for an actor, but 5:00 o'clock stubble is disrespectful to a client who is anxious to see you. Do avoid products with perfume. Many have allergies.

3. Show respect. I was shocked to hear people talk to my father as 'Ray'! To those in business in his era, people spoke with respect, and only used 'Mr. Jilks' until asked to do otherwise. You could well be young enough to be a grandchild.

4. Smile. They may be deaf. Your client may have ugly wounds, or scars, or other issues. A smile is most welcome. It is an important part of non-verbal communication.

5. Don't talk about the royal 'we'. You are going to deliver care. They will be the care recipient. "We" don't need a sponge bath. You client does.

6. Talk about what you are going to do. Prepare them for the event. Often it is painful, usually it is undignified, to have a relative stranger give such intimate care. These are men and women who were pioneers, who wrestled with difficult jobs, physical labour and were amazing human beings in their prime. They learned to use computers in an age when the technology has advanced light years.

blood-soaked pillow, garbage in bathtub

7. Ask about their life history. Read my post on Life Review. There is lots to talk about. If, as is the case, your client is hard-of-hearing, see #4: your smile is the only thing they hear. They won't remember what you said, maybe not what you did, but they will remember how you treated them and will be glad to see you the next day.

8. Radiate positive energy and good humour. Do not gossip. Do not complain. Many clients have complained to me that PSWs were grumpy and negative. They don't want to hear this. They don't want to hear you complain about your boss, your job, co-workers, or your spouse. Many are not deaf, and you are in public, in their rooms. If you complain about others who are rude and snarky, this trait will be transferred to you ('trait transfer').

garbage on the floor

9. Focus on the job at hand. Give your client the attention they deserve. When you are doing a two-person lift, for a client with dementia, in a semi-private room, there is another person listening as you are dissing another employee, or your boss, or discussing your sex life. My clients have complained about you to me, perhaps they should complain to your supervisor.

10. Speak truth to power. If you hear things, if you see things, or smell things, report them. Communicate with your supervisor. Family members will appreciate it. You have a great responsibility, with much to do.

looks like a cluttered warehouse - not easy working conditions

This post was inspired by another...by a physician for physicians...
7 ways to make patients like you
1. Begin by walking into the room with a big smile on your face. 
2. Be easily impressed, entertained, and interested in your patients.
3. Have a friendly, open, engaged demeanor.
4. Remember trait transfer.  Whatever you say about other people shapes the way people see you.
5. Laugh at yourself.  This shows vulnerability and a sense of humor makes you more likeable and approachable. 
6. Radiate positive energy and good humor.
7.  Show your liking for others, including your patients. 

PSW wages in Ontario

Wages for PSWs range from $12.00 - $21.00 per hour, between several variables.
They vary within cities and towns, vary rural to urban, and they vary depending upon your employer.

Transfer Payment Agencies, especially the non-profits (e.g., VON, Red Cross), pay lower for PSWs who do Home Care. Long hours, I talked to one who did a shift starting at noon and he didn't finish until 10:30 p.m.

Lanark County Red Cross: $15.03.
Sarnia-Lambton VON home care pays $14.48 per hour, plus $0.39/km mileage.
If you work for an institution, e.g., long-term care (LTC) facility (most are for-profit!) you can make $18 - 20/hour.
Durham (east of Toronto) employees can make from $12 - 21.00/hr., the lower range is for Home Care, the higher paid PSWs work in LTC.
Windsor LTC pay starts at $18.05.
Northumberland County: in LTC. It is under CUPE union and they make $23.26 per hour top pay.
Wawa (in Central Ontario) LTC pays $24.98/hour.


Some PSWs are hired privately, by family members who want to supplement the care and increase support for a loved one. These are the fortunate families. CCACs Home First program will pay for extra support in order to allow a loved one to leave the hospital and manage at home. This support ends after 30 days.

It is an interesting job, but requires fortitude, adaptability, and initiative. You are often on your own, you seldom communicate with the other Home Care staff, as you visit the same client at different times.

For more information go to OPSWA.ca

You may be required to change adult incontinence products, give a sponge bath, do light housework, such as laundry, a few dishes. Basically, the activities of daily living (ADLs) that a client is unable to do for themselves. Sometimes you are simply holding a hand, or giving respite to family members.

case study

I have an interesting new client. The son lives upstairs, mother downstairs with stroke, paralysis, vascular dementia.
He's been getting three CCAC people in per day, 7/week, an emergency situation and emergency funding, with the agreement that he place her on a LTC wait list. He declined to do so. I cannot imagine leaving her at home, in the reclining chair, all day while he works with strangers coming into his home.
The system is supporting him, but at what cost to someone who needs these services. He rants about the lack of services, yet imagine the expense of sending PSWs around to her home, miles out of town, to care for her. She has three visits each day, an hour each. Due to the lack of funds and personnel, they are withdrawing the noon, lunchtime visits on weekends. I have been asked to volunteer there on the weekend. I turned up, and so did a PSW from Red Cross. Then this man emerged from his suite, in his flannel pajamas, rubbing his eyes.

There are myths around long term care, and I cannot imagine leaving this woman alone all the time, let alone having her eat her lunch alone. She is angry, agitated, aggressive, and difficult to work with, especially on one's own.

I'm going to be going in to feed her on the weekend, i.e., take a sandwich out of frige, give her her meds, go with her as she goes to the toilet.
I hope to advocate on her behalf. she needs better care than this. Groups care is the most effective, and gives the most for tax payer dollars. She could well have a fall, and end up in hospital again. These are unsafe conditions. Rural placements are easier to find.

Institutional Food

Hospitals try to overcome bad food reputation by going local

July 25, 2011

some Ontario hospitals are trying to change that by serving fresh, locally produced food. On Wednesday for the first time St. Michael’s Hospital will feature Ontario-grown produce on its patient menus. Dessert will be a fruit crisp made with blueberries from the Cedar Lane Blueberry Farm in Simcoe.
Local food advocates also want hospitals and long-term-care facilities to spend more on patient meals. St. Mike’s spends a daily average of $7.69 per patient on three meals and two snacks, an amount in keeping with other hospitals surveyed in Toronto. Long-term-care facilities spend $7.33.

Malpractice fears drive US system

I wonder if this is the case in Canada?
I recently read the book, A Bitter Pill; How the medical system is failing the elderly, by Dr. John Sloan.

(US) Docs admit malpractice fears lead to overly aggressive care

By Dina Overland

Doctors admit to being part of the healthcare problem, confessing that they provide too much medical care in a US survey published in the Archives of Internal Medicine. Malpractice concerns, current reimbursement structure, and quality measurement systems drove them to practice more aggressive healthcare. Of 627 surveyed physicians, 42% said their patients "were receiving too much medical care" Another 28 percent said they had ordered more tests and made more referrals to specialists than they would like.

Drivers of their more aggressive practices

Fear of malpractice lawsuits (76%)  Clinical performance measures (52%) Claimed don't spend enough time with their patients to figure out what's wrong, so they ordered tests and consultations to provide answers. (40%) Could be sued if they didn't order a test that was indicated (83%) Doctors thought other primary care physicians driven by extra income from ordering more tests (40%) Yet, only 3% said this was *their* influence.

"Reimbursement model for most healthcare encourages utilization in a variety of ways."

To learn more: - check out the study - read the Wall Street Journal article - check out the Los Angeles Times article - read the Reuters article

Mammograms

Mammography screening reduces mortality rate: study

"For every 1,000 to 1,500 mammograms, 1 breast cancer death is prevented" 

The Swedish trial followed more than133,000 women, with researchers dividing them into two groups -- those who received an invitation to a mammography screening, and those who received usual care.

After three decades of study, the researchers found that among the women who were invited to a screening, there were 30 per cent fewer breast cancer deaths.

MORE DETAILS
	Radiation: Impact of Mammographic Screening on Breast Cancer Mortality during 3 Decades

	RELATED STORIES
	Extra radiation lowers risk of breast cancer recurrence Indian experts question practice of regular mammograms Some late-stage cancer patients get unneeded tests New study finds mammograms lower death risk in 40s

Barriers to a good death

Yes, I've seen a few. And while the system isn't 'broken', there are barriers to having a good death.
The primary one being having money, and a patient navigator.
The next is that healthcare only works well five days a week. Truly. This barrier is a brick wall on weekends.
What makes a good death?

• Communication between agencies, continuity of care, PSWs who smile, comfort measure, compassion, nurses who go beyond the call of duty, physicians who make house calls, adequate pain management, physicians who understand geriatrics, treatment plans, care plans that work, palliative pain management nurses, a functional family, respite for family caregivers, friends who know what to say or do.

What are the barriers?

• Disrespect between healthcare professionals, nurse bullying, nurses who state "This isn't my job", physician ignorance, physician abandonment ("I'll prescribe pain medication, but I'm not going to do anything else."), infected wounds, pros ignoring the signs of pain, PSWs who won't speak to the powers-that-be.

One simple barrier is home care that sends one personal support worker (PSW) at a time to a client, who is a two-person lift. In some situations they can roll the patient, but if you are already in pain, upset with being woken up to be turned every two hours, you get grouchy. Who blames them?

Another barrier? Transfer Payment Agencies who are unable to communicate effectively, e.g., Bayshore health who sends a nurse, Red Cross who send a PSW). Not that they are NOT doing their jobs, but they don't seem to communicate with one another. There are no case conferences. I tried having one for my Dad, but the doctor had to go to an accreditation meeting for the hospital. He was very hard to reach.

And while we know there is disrespect between doctors and nurses, imagine the disrespect that occurs between nurses and PSWs! Job descriptions are very specific these days.

Now, the nurse talks to the doctor, after seeing the patient, and requests that the doctor send order for, say, morphine. Every palliative client in pain sees morphine as their friend. The doctor doesn't return calls, isn't available, isn't at the [insert one: office, clinic, hospital] ______ and staff won't take a message. This isn't uncommon, either. I fought 3 days to get morphine for my dad. It took a pharmacist who counselled me at a break during choir practice. Fight for your dad, he said.

Since GPs may not be a pain specialist, or isn't familiar with the case, or hasn't treated this particular condition before, or hasn't done a house call in weeks, s/he may have no idea what is what in the home. Some see this nurse as interfering with the doctor doing their job, and won't put the patients needs upppermost.

Friends have written extensively about the competition between healthcare pros: doctors and nurses, as well as nurse practitioners (NP) and physician assistants (PA).
In a hospital, LTC or larger center, the behaviour is there for all to see. Nurses Behaving Badly, or Nurse attitudes, for example.

Palliative home care; shameful lack of care plans

hoarding is a difficult mental health issue

Yes, home care works for many, especially if you are used to delegating, supervising employees, and understand the basics of personal care. That leaves out many of us.

many do not have the wherewithal to take control

fecal-stained mattress

For those, unfamiliar with ADLS, living in poverty, it is a different story.
For those unable to navigate those treacherous waters around and access to a doctor, we may hit a snag. Many physicians are unavailable in the wee hours. For this reason, a family member is wise to have a Pain Management Kit on hand, with standing orders. Some of us may want to be given doctor's orders to delegate medications to a family member.

Many of our seniors are of the stoic generation, where pain is a normal part of living. This is not the case in end-of-life care.

The care plan should be specific. No one should be in pain at 2 a.m., when no one is on hand to administer morphine to a frail, palliative senior in pain. And why wouldn't someone have pain in end-of-life care? Shameful that our doctors do not understand pain management in end-of-life care.

A nurse, through the LHINs ad CCAC, can be called to do pain assessment and pain management. The care plan should have this plan in mind.

Celebration of life: Michele, Ma Belle!

My friend requested that I create a movie for her funeral from photos she had taken. She has not yet passed over, and wanted to talk about her life. This is an important part of end-of-life care.

We talked about her life, and did a life review, which is an important part of palliative care.

Michele is in LTC. I felt badly moving far away from her where she lives in LTC in Muskoka. I would visit her during dinner, as she was unable to get up to get into the dining room every day.

I wrote about her in my book, and she is proud as punch.

She was a nurse in B.C., in the days when nurses wore uniforms and caps! For the PPT slides click here.
"I was determined to be a nurse. My parents wanted me to be a teacher. I went for an interview to supplicate them. I recall the expression on the nun’s face when she found out both my parents did not go to university. That ticked me off and I left the room. That was the end of the interview. Going into teaching was the furthest thing from my mind.

I was accepted by Windsor and I graduated from the diploma nursing in 1962. From Hotel Dieu hospital, in Windsor, Ontario. "

Depression in seniors

One of the most insidious mental health issues is depression. Unseen, untreated, unidentified, it can make a life not worth living. It is

For some of us seniors, we are able to retire. Many of us are able to do so, and volunteer in order to give back to our communities. We find health and happiness, a purpose in life.
Approximately one-fifth of Canadian men and women aged 55 to 64 and 65 to 74 report that they are satisfied with their life and that they are in good health (Statistics Canada, 2005).

Some suffer from clinical depression.
Mental illness is often identified earlier than in our golden years.

Symptoms of clinical depression can accompany other illnesses common later in life, such as Parkinson’s disease, heart disease, cancer, and diabetes.  Without work, a purpose in life, love, or the loss of family and friends, loneliness and isolation can lead to depression.

But the stigma associated with mental illness often prevents seniors from seeking treatment, and without treatment, depression can lead to destructive behavior and thoughts of suicide. Our inability, as family members, to identify depression in loved ones prevents a diagnosis.

Comprising only 12% of the U.S. population (13% of the Canadian population), individuals aged 65 and older account for 16% of all suicide deaths, with white males being particularly vulnerable.
Depression isn't necessarily a result of illness, but caused by changes in life circumstances.

When it comes to senior suicide, don't be afraid to ask tough questions...

24 Mar 2011 – Globe & Mail

In the 65 - 74 age group, suicide went down.

2003 - 247

2007 - 217

During the same five-year period, there was a gradual increase in suicides involving Canadians between the ages of 75 and 89.
2003 - 172
2007 - 221

National Depression Screening Day, held tomorrow (October 6) at 1,500 sites nationwide, gives people access to an anonymous validated, screening questionnaire and provides referral information for treatment. Visit www.HelpYourSelfHelpOthers.org to find a local organization offering depression and anxiety screenings, or take a free, anonymous screening online.

Other Sources

• Conn, David. (2002). An Overview of Common Mental Disorders among Seniors. Writings in Gerontology. National Advisory Council on Aging.
• MacAdam, M. (2000). Home Care: It's Time for a Canadian Model.HealthcarePapers (1[4]: 9-36). Retrieved from www.longwoods.com.
• Ontario Seniors' Secretariat (2005). A Guide to Programs and Services for Seniors in Ontario. Toronto: Ministry of Citizenship. Available atwww.citizenship.gov.on.ca/seniors.
• Public Health Agency of Canada, Division of Aging and Seniors, www.hc-sc.gc.ca/seniors-aines.
• Statistics Canada (2005). General Social Survey - Aging Well: Time Use Patterns of Older Canadians. Available at www.statcan.ca.

Fearmongering - now it's B12

Yes, seniors are being warned to ensure that they have enough  B¹². I worry that this is another bandwagon, and that we ought, simply, to be focusing on healthy eating.

Brain Takes Multiple Hits from Low B12 Levels

---

Low levels of vitamin B12 may contribute to cognitive problems for older adults in more than one way, according to a cross-sectional study.

Markers of B12 insufficiency all predicted lower global cognitive scores over nearly five years of follow-up, Christine C. Tangney, PhD, of Rush University Medical Center in Chicago, and colleagues found.



But I ask you, aren't there enough natural sources? Yes. It is something found in meats and alternates. Only vegans have to be worried that they do not get enough. Healthy eating is something we can teach those who have not learned these lesson.

The theory is a good one. Ensure you have all the necessary vitamins and minerals. The preference is, always, that you get these form natural sources. Many unnatural sources cannot be readily absorbed and seniors are wasting their money.

Primary source: Neurology
Source reference: Tangney CC, et al "Vitamin B12, cognition, and brain MRI measures: A cross-sectional examination"Neurology 2011; 77: 1276–1282.
High vitamin B₁₂ level in elderly individuals may protect against brain atrophy or shrinkage, associated with Alzheimer's disease and impaired cognitive function.^]" ^ Vogiatzoglou A, Refsum H, Johnston C, et al. (2008). "Vitamin B12 status and rate of brain volume loss in community-dwelling elderly". Neurology 71 (11): 826–32.doi:10.1212/01.wnl.0000325581.26991.f2. PMID 18779510.

Physicians and healthcare pros to watch out for

Manotick chiropractor fined over treatment of female patient
Ottawa Citizen - 1 day ago

A Manotick chiropractor was ordered to attend a gender sensitivity course and to pay a $5000 fine in a disciplinary ruling made by the College.

Tell me that this is way more that being insensitive, and a sexual violation of this patient. Putting his hand down her underwear. She left the office feeling ashamed, and this isn't anything to do with gender, but violating her person.

What is bizarre, is that my former neighbour was arrested and convicted of molesting patients. We were living near Manotick, in North Gower. The man was working at Perth Hospital at the time, where we lie now.

This type of story just upsets me so much:  Punish the Nurse.
 When a nurse speak up in the nature of a whistle-blower, but gets in trouble. 
Then there is this old story.

Who is protecting patients?

Martin Gillen

 Not the College of Physicians if they grant this man his licence back.

He is tried to get back his licence to practice medicine, despite being convicted of molesting a patient.

This man is my former neighbour, his then-wife (now his ex-wife) babysat my sons. I recall talking Mr. and Mrs. Gillen one day as I picked up my children from their care. I was speaking of false accusations of abuse by teachers and he told me to my face that he understood about 'false accusations'. I didn't know the story at the time, as it hadn't hit the news. I was so shocked much later when I found out. By then we had moved away, thankfully. 

Their FAS, adoptive son was yelled at as much as my child. I heard the young boy went back to foster care when they couldn't manage his behaviour. This child dumped their horse manure onto our sand pile. Their dogs got loose and went after our kids. Their horses got out one night and were hit by a car. The wife claimed she couldn't manage, Gillen was out working, and sent one of her kids over so I could deal with the police and the veterinarian for her. I should have had a clue.

My son refused to go to their house the next year he was in 1/2 day kindergarten. I had to quit my 1/4 time teaching job to stay home half days with him and taught only half days. 

How to live with dementia

This ia a fabulous article, by Carol. She has lived this and understands what it takes. As a family caregiver, as I have been, she understands that you do what you have to do to get through the day.

Volunteering with those who have dementia, I have learned to transfer my experiences to share with others.
We have to live in the care recipient's world, as we all know, those of us who successfully work with dementia patients. My father's brain tumour changed him and I had to change the way I interacted with him. It was not possible for HIM to change.

Carol bought into her father's world: acted as his secretary, taking memos for him. Many role play along with a client. You have to. Fighting with them isn't an option. They can become angry and argumentative. There is no need to respond in kind. Just love them. Become who they think you are: long-lost family member, friend, employee. You will make your life easier, and theirs.
One woman, in a place where I volunteered, kept losing her 'baby', a doll she dressed and cuddled. It was comforting. I suggest you do the same as a caregiver, paid or unpaid!

When a Cure Is Not Possible We Sometimes Have to Settle for Contentment

by Carol Bradley Bursack

I drew from my heart a type of "therapy," now recognized as validation therapy. It works. I was scolded by psychiatrists at the time, because what I was doing - validating my dad's thoughts and feelings at any given moment and taking myself into his world rather than demanding he come back to mine - was considered just plain wrong. Five years into Dad's care, I was complimented by another psychiatrist. He asked me where I learned how to do this with Dad -get into his world. I just looked at him and said, "He's my Dad. I had no other choice. I wasn't going torture him by demanding of him something that he obviously couldn't do." That psychiatrist shook my hand and smiled. Read more