Color & Control:

In praise of PSWs

By Pat Irwin

We bang the pots and pans every night to honour our frontline workers — the doctors, nurses, emergency responders and hospital staff who have emerged as the heroes of the COVID-19 pandemic. But there are other heroes who are also giving their all — and usually unnoticed — Personal Support Workers (PSWs).

What exactly is a PSW?

A Personal Support Worker is a trained healthcare professional who provides direct, non-medical care to those requiring assistance with Activities of Daily Living (ADLs) — dressing, grooming, personal hygiene, elimination, mobility and other routine daily activities.

PSWs may also do light housekeeping, menu planning and meal preparation, transportation for shopping and errands and accompanying clients to appointments. They may assist a client with taking medication which has already been prepared by a pharmacist or family member, although they cannot dispense medication directly.A PSW may work in a hospital, nursing home, retirement home, for a public health authority, in the client’s own home and in institutions where adults require personal care.

PSW training

PSW training is extensive, including physiology and anatomy, and patient care techniques for bathing, dressing and transferring a person from a bed to a chair or wheelchair. Techniques are taught relating to specific patient types, such as those with dementia or requiring palliative care. The course includes conflict management and family communication. Students do exams and a clinical placement to obtain their certificate.

PSW training may be offered by private agencies, specialist institutes and provincial community colleges. Admission requires a Secondary School Diploma or equivalent, and a grade 12 English credit. Programs may be online or in-class. Typical costs of a 4-month community college semester are $1,800–$2,000 for domestic residents and $7,800–$8,000 for international residents; two semesters are required to complete the program.

PSW salaries vary by employer; average starting salaries are around $28,000 per year. Many PSWs are free-lance and have a few jobs at $18–$20 per hour for experienced workers.

PSW as a career

PSW candidates come from all walks of life; many are immigrants with healthcare qualifications from their home country. Others might be looking for an entry level into nursing; some are re positioning from a career in childcare.

Personal Support work is a very versatile career path, can be practiced in many countries and is definitely a growth industry in our aging society. Flexible hours and locations make it ideal for combining work with family life or education.

Many PSWs are immigrants with qualifications from their home country.

Concerns in the PSW profession

Personal Support Workers are a nonregulated profession; they are not part of any province’s Regulated Health Professions Act. As a result, there is no standard scope of practice to guide PSWs. The duties assigned and the permitted scope of practice depends upon the employer, work setting and client needs. This may lead to a PSW’s time being misused, or overused. They are not guaranteed any medical protection such as PPE (personal protective equipment), nor physical protection in the case of an abusive or uncontrollable client, which are not uncommon when working with dementia.

The important role of the PSW, contrasted with lack of recognition and low pay has been the focus of recent media attention. Poor pay may require caregivers to hold multiple jobs in order to make a living wage and meet the financial responsibilities they often have to their families, possibly at the risk of their health and mental well-being.

National professional associations exist, such as the Canadian Support Workers Association (CANSWA) — — offering education and local support in major centres across Canada. Most provinces also have professional associations.

Making change going forward

There is a Bill of Rights for residents of retirement homes and nursing homes, and operations are directed by government legislation. Professional regulatory bodies are well placed to lobby for the nursing profession. However, there is no bill of rights, or professional status for caregivers! This would be an excellent place to start — many caregivers don’t think they have rights at all.

The next step would be for PSWs to create, or ally themselves with, a regulated health profession, whose governing body would set a curriculum, enable continuing education, test and register members, receive, investigate and address complaints, create and administer a quality assurance program, and provide a voice for the profession.

What you can do now

Now that you know more about the skills, experiences and challenges of a PSW, change your thinking, and influence other family members. Do you know the caregiver’s name? Their marital and family status? Their background, language and goals? Find out! Use their name, thank them, point out their importance in your family’s well-being. You couldn’t do this without them, so let them know they’re appreciated! Be aware of their duties, be sure they’re not being overworked or denied the protection they need. Talk about their role — do they have opinions, ideas, best practices from their training and experience? Listen!

How many obituaries thank the ‘wonderful caregivers’? Lots – so don’t wait that long! Make your PSW a partner in your family’s wellness and be sure to give them the respect they deserve.

Pat M. Irwin, BA, AICB, CPCA, is president of ElderCareCanada, offering expert opinions, eldercare mediation, options for housing and care, moving and house clearing, and care management—

Let’s look at some PSWs, their challenges and opportunities.

Gina works in a hospital. She enjoys her job because her role and responsibilities are clearly defined, it gives her sufficient hours to make a good living, and provides benefits. She is applying to become a permanent resident of Canada and plans to bring her children here as soon as possible.

Javier works in a private home. He needs more billable hours to make a living wage, so he works the 11pm-7am overnight shift at a nursing home, then has an hour’s sleep before his daytime job starts at 8am, all to meet his financial commitments back home. Javier’s daytime job is difficult since his client is a very large man with advanced dementia. His management requires tact, knowledge of the disease, physical strength and stamina. The family often pressures him to do duties outside what he considers to be his scope, but having no professional guidelines, he tries to do everything and more.

Maria works for an agency that has a contract with the public health authority, so she goes into numerous private homes via public transit. Traffic often makes her late, so her clients are angry; there are often extra things she would like to do, but doesn’t have the time or authority to do.
She is especially nervous about personal protection; some clients are insulted if she wears a mask in their home, ‘as if we’re dirty’, even though it’s company policy.

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