Abstract

Personal Support Workers (PSWs) and Health Care Aides (HCAs) are of increasing importance to the delivery of care to vulnerable individuals in their homes, and in nursing homes. In Canada, PSWs and HCAs represent a significant component of the health care labour force, and are concentrated in nursing home/long term care (LTC) and home and community care (HCC) sectors where they provide up to 80% of the direct care to residents and clients, respectively (Lum et al., 2010). Approximately 100,000 PSWs and HCAs deliver care in the Province of Ontario, where 57,000 work in long-term care facilities and 34,000 work for home health and social care service providers (Lum et al., 2010). As a workforce, PSWs/HCAs have received little research attention; there is much to be learned with respect to their roles, the nature of the practice environments in which they deliver care, their prominence in care delivery in these settings, how they are structured to work with others, and how/if their roles in the delivery of care in the residential long-term care and home and community care sectors has changed since the mid-1990s.

The aim of this study was to improve our understanding of the type and scope of work that PSWs/HCAs do – specifically, to gain knowledge around the nature of the practice environments for PSWs/HCAs; how the work of PSWs/HCAs is structured; and how/if their roles in the delivery of care in the residential long-term care and home and community care sectors has changed since the mid-1990s.

We undertook a focus group with representatives of Provincial and National organizations that employ or represent these workers in the LTC and HCC sectors.

Several key themes relating to the work and future work of PSWs and HCAs were identified by our participants. First, it was anticipated that a number of macro-environmental trends – including imperatives for cost containment and increasing complexity of care – will affect the practice environments of PSWs/HCAs, as well as a general tendency toward “exponentiation” of the work of regulated health professionals with the use of unregulated assistants. Retention and turnover was identified as a particular concern in the HCC sector, but concerns were raised with respect to the future supply of PSWs/HCAs in both sectors. A significant degree of heterogeneity in the training of PSWs/HCAs and the amount of on-the job training provided tended to vary by employers and across sectors, as did task expectations. This was thought to contribute to variability in care quality, and likely limits the job mobility of these workers.

This study is a prelude to a larger mixed methods study that will provide essential information for health human resource planning and policy going forward by exploring: how the use and role of PSWs varies by care sector and the individual, job, and sector characteristics that are likely to influence the retention of PSWs across the LTC and Home and Community Care sectors.

Slides