Personal Support Workers Research Articles

The evolution of the Kelley community capacity development model for palliative care.

This oral presentation will describe the conceptual evolution of the Kelley model for Community Capacity Development [2000-2016]. It will illustrate how and why the model changed to become a powerful Canadian example of a public health approach to developing community based palliative care programs. Based on conducting participatory action research in rural, First Nations communities and long-term care homes, the perspective of "community" gradually expanded beyond health care professionals to include natural helpers, front line care providers, formal and informal community leaders, and social services. The Kelley model has potential to be applied internationally since it builds a context specific palliative care program that is grounded in the local community and uses existing informal and formal resources. The Kelley model is a theory of change and can be used to guide a process of developing community-based palliative care programs. The model includes a series of four incremental but non-linear phases. Development is a bottom-up process that is grounded in the unique needs, vision, culture and values of a specific community. Community change is made from inside the community and not from outside. Development builds on existing resources, relationships, strengths and assets. Based on participatory action research and applying the model in rural communities, First Nations communities and long term care homes, the definition of the "community" in the model gradually expanded from registered health care providers and health services only. Supportive community members, often taken for granted by health care professionals but critical to the success of community palliative care, gradually became more visible through the research. The Kelley model of the palliative care community grew to include natural helpers, front line providers such as personal support workers, formal and informal community leaders, and social services. The Kelley model is a Canadian model that can be used to guide community based palliative care development in many diverse geographic, organizational or cultural communities. It can be applied internationally since it creates a palliative care program that is grounded in a unique local community and uses existing informal and formal resources.

Family care conferences in long-term care: Exploring content and processes in end-of-life communication.

A total of 24 FCCs were held for residents with a Palliative Performance Scale score of 40% (nearing death). Data were collected from conference forms (i.e., Family Questionnaires, Care Plan Conference Summaries), site-specific electronic chart documents, and fieldnotes. Directed content analysis of data was informed by the Canadian Hospice Palliative Care Association's Square of Care Model, which describes eight domains of care: disease management, physical, psychological, social, practical, spiritual, EoL, and loss/bereavement. The FCCs addressed an average of 71% of the content domains, with physical and EoL care addressed most frequently and loss/bereavement addressed the least. Two goals and five interventions were documented and planned on average per FCC. Examination of the processes supporting EoL communication found: (1) advantages to using FCC forms versus electronic charts; and (2) high levels of multidisciplinary participation overall but limited participation of personal support workers (PSWs) and physicians. Communication around the end of life in LTC can be supported through the use of FCCs. Description of content and FCC processes provides guidance to persons implementing FCCs. Recommendations for tailoring conferences to optimize communication include use of specific conference forms, increased bereavement discussion, and further engagement of PSWs and physicians.

Personal Support Workers in Canada: The New Precariat?

There has been much recent discussion internationally about the emergence in modern society of a new class of workers – the precariat – with a common consciousness based on features such as low wages, insecurity, short-term jobs, minority status and restricted rights. This paper critically explores the extent to which the growing, large-scale group of personal support workers (PSWs) can be viewed as part of a new precariat in terms of their position in the healthcare labour market. Drawing on currently available empirical data, this issue is examined particularly with reference to PSWs in Canada – drawing out some of the implications for government health policy in this sphere.

The evolving role of the personal support worker in home care in Ontario, Canada.

To meet increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Much of the research examining this shift focuses on specialty programmes, with few studies investigating the daily care being provided by PSWs, frequency of care activities being provided by PSWs, and characteristics of the population receiving more complex tasks. Between January and April 2015, a review of 517 home-care service user charts was undertaken in Ontario, Canada, to: (1) describe the range of tasks being performed by PSWs in home care, (2) identify tasks transferred by RHPs to PSWs, and (3) examine characteristics of service users receiving transferred care. Findings indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. Although there is potential for the expansion of home-care services through increased utilisation of PSWs, healthcare leadership must ensure that the right provider is being utilised at the right time and in the right place to ensure safe and effective quality care. Thus, several actions are recommended: PSW core competencies be clearly articulated, processes used to transfer care activities from RHPs to PSWs be standardised and a team-based approach to the delivery of home-care services be considered. Utilisation of a team-based model can help establish positive relationships among home-care providers, provide increased support for PSWs, allow for easier scheduling of initial training and ensure regular reassessments of PSW competence among PSWs providing added skills.

Attracting and retaining personal care assistants into the Western Australia (WA) residential aged care sector

ABSTRACTThe Australian population is ageing, with around one quarter being 60 years and older, and the proportion is expected to grow in the future. These trends have led to government projections for the number of personal care assistants (PCAs) needed to meet the demands of the ageing population, estimated to be more than double the current workforce by 2050. Consequently, the challenges associated with attracting and retaining PCAs in the aged care sector need to be urgently addressed. This qualitative study is based on a large and distributed residential aged care organisation located in Western Australia. Its focus is on the employment conditions of PCAs, their satisfiers and dissatisfiers, and the human resource management practices which might assist the organisation and its sector to better address PCA concerns, leading to more effective PCA attraction, selection and retention. A number of strategies have been proposed that are intended to help advance policy and debate, including attention to various HRM practices and factors relating to job quality.

Home-based care: barriers and facilitators to expanded personal support worker roles in Ontario, Canada

ABSTRACTTo accommodate the increasing demand for home care in Ontario, Canada, some care tasks traditionally performed by regulated health professionals are being transferred to personal support workers (PSW). However, this expansion of PSW roles is not uniform across the province. Between December 2014 and April 2015, barriers and facilitators to expansion of PSW roles in home care were explored in a series of 13 focus groups. Home care staff identified seven categories of factors affecting the expansion of PSW roles in home care including: communication and documentation; organization and structures of care; attitudes and perceptions of the expanding PSW role; adequate staffing; education, training and support; PSW role clarity and variation in practices, policies, and procedures. Addressing barriers and promoting facilitators at the funder and employer levels will enable the provision of safe, effective, and equitable care by PSWs.

Assaulted and Unheard: Violence Against Healthcare Staff.

Healthcare workers regularly face the risk of violent physical, sexual, and verbal assault from their patients. To explore this phenomenon, a collaborative descriptive qualitative study was undertaken by university-affiliated researchers and a union council representing registered practical nurses, personal support workers, and other healthcare staff in Ontario, Canada. A total of fifty-four healthcare workers from diverse communities were consulted about their experiences and ideas. They described violence-related physical, psychological, interpersonal, and financial effects. They put forward such ideas for prevention strategies as increased staffing, enhanced security, personal alarms, building design changes, "zero tolerance" policies, simplified reporting, using the criminal justice system, better training, and flagging. They reported such barriers to eliminating risks as the normalization of violence; underreporting; lack of respect from patients, visitors, higher status professionals, and supervisors; poor communication; and the threat of reprisal for speaking publicly. Inadequate postincident psychological and financial support compounded their distress.

Person-centered care and engagement via technology of residents with dementia in aged care facilities.

Touchscreen technology (TT) is a resource that can improve the quality of life of residents with dementia, and care staff, in residential aged care facilities (RACF) through a person-centered care approach. To enable the use of TTs to engage and benefit people with dementia in RACFs, education is needed to explore how these devices may be used, what facilitates use, and how to address barriers. We sought to provide education and explore RACF staff views and barriers on using TT to engage their residents with dementia. An educational session on using TT with residents with dementia was given to staff from three long-term RACFs in Melbourne, Australia. A cross-sectional convenience sample of 17 staff members (personal care attendants, registered nurses, enrolled nurses, allied health clinicians, and domestic staff) who attended were administered questionnaires pre- and post-sessions. As a result of the education seminar, they were significantly more confident in their ability to use TT devices with residents. TT, and education to staff about its use with residents with dementia, is a useful strategy to enhance RACF staff knowledge and confidence, thereby enhancing the use of technology in RACFs in order to improve care standards in people with dementia.

Healthcare assistants and aged residential care: A challenging policy and contractual environment

IntroductionHealthcare assistants (HCAs) play a crucial role in the delivery of care and the well-being of older people living in aged residential care (ARC) facilities. In New Zealand (NZ) there are approximately 31,452 nursing support workers and personal care assistants working in nursing homes and in the community, with HCAs making up the majority of this workforce (Statistics New Zealand, 2013). Direct care in ARC is mainly provided by HCAs who are unregulated; a marginalized workforce, due to undervaluing of aged care services and low wages (McGregor, 2012). This aging, gendered and ethnically diverse workforce is expected to grow in response to the demands of the aging population (Kiata, Kerse, & Dixon, 2005; Ravenswood, Douglas, & Teo, 2014). There are concerns about recruitment and retention (Badkar, Callister, & Didham, 2009; Badkar & Manning, 2009; Grant Thornton New Zealand Limited, 2010; Ravenswood et al., 2014) but of equal concern is the landscape of care into which the HCA is recruited.Registered nurses (RNS) in aged care settings are responsible for the care delivered by HCAs and need to have an in-depth insight into the contemporary and evolving roles of HCAs, and the diverse challenges experienced by this workforce. Healthcare assistant responsibilities and workloads are expanding as they work with residents who have complex health conditions. Influential factors that shape the working environment of the NZ HCA were identified in a thorough review of the existing grey literature, current national policy, district health board (DHB) contract agreements and New Zealand Nursing Organization (NZNO) collective agreements. This article presents an overview of the role of HCAs in the current residential aged care environment. The authors argue that RNs need to be cognisant of the socio-political, economic and educational factors that influence HCA's ability to navigate the complexity of the aged care environment and the delivery of personcentred care in the New Zealand aged care context.Demand for aged caregivingThe demand for ARC is increasing, as are the associated costs for care and demands placed on the workforce. There were approximately 33,006 residents in aged care facilities for 2015-2016. This number is projected to increase to 40,619 for the period 2026-2027, and to 60,080 in 2031-2032 (Technical Advisory Services [TAS], n.d.-a). Currently there are 669 certified aged care facilities in NZ offering 38,742 beds (Ministry of Health [MOH], 2016a) with 90% overall occupancy rates for dedicated rest home beds, 88.8% occupancy for swing or dual beds which serve either rest home or hospital level care and 87.6% for specialist dementia beds (Kana, 2015). The DHB expenditure for the support of older people was $983 million with $590 million directed to ARC in 2016 (MOH, 2016b). The government weekly contribution for long term-residential care for individuals differs for each territorial district with the highest funding of $971.53 for Auckland City and the lowest $884.03 for Otorohanga, South Waikato, Buller, Grey, Waimate, Southland and Gore districts including Goods and Services Taxes (Chuach, 2016).The demand for ARC persists even with ageing-in-place initiatives aimed at reducing the need for rest home level care. The workforce that supports care in the home overlaps with the ARC workforce and shares similar issues. The 2002 Health of Older People Strategy (MOH, 2002) was created in response to ageing population projections and the need for a positive ageing strategy. Initiatives within the 2002 Health of Older People Strategy and the replacement Healthy Ageing Strategy (Associate Minister of Health, 2016) include improving community support so that older persons can stay in their homes longer and avoid costly ARC services. Care aimed to restore functional status is provided in the home or in the community by paid caregivers, delaying or preventing ARC admissions (Parsons et al. …

ASSESSING FAMILY CARE CONFERENCES IN LONG-TERM CARE: LESSONS LEARNED FROM CONTENT ANALYSIS

End-of-life (EOL) communication in long-term care (LTC) is often inadequate and delayed, leaving residents dying with unknown preferences or goals of care. Poor communication with staff contributes to families feeling unprepared, distressed and unsatisfied negatively effecting bereavement. Family Care Conferences (FCC) aim to increase structured, systematic communication around goals and plans for EOL. FCCs were implemented as part of the ‘Strengthening a Palliative Approach to Care’ (SPA-LTC) project in four LTC sites in Ontario, Canada. The purpose of this sub-study is to evaluate: a) content, b) processes, and c) interdisciplinary engagement using mixed methods. Twenty-four FCCs were held for residents with a Palliative Performance Scale of 40% (nearing death) considered appropriate by staff. Data was collected from FCC forms (i.e., Family Questionnaires, Conference Summaries) and electronic charts. Through directed-analysis, data was analyzed using the Canadian Hospice Palliative Care Association’s ‘Square of Care’ model which includes eight domains of care: Disease Management, Physical, Psychological, Social, Practical, Spiritual, EOL, and Loss/Bereavement. Findings showed on average each FCC documented 66% of domains with physical and EOL care domains being used the most, and content about loss/bereavement documented the least. Use of FCC hard copy forms had benefits over standard electronic charts including: higher proportion of goals, timely completion, category for end-of-life care and accessibility. FCCs were attended by an average of three disciplines prompting holistic content although Personal Support Workers (PSW) and physicians attended minimally. Implications to optimize FCCs include tailoring use of FCCs forms, prompting bereavement discussion, furthering engagement of PSWs and physicians.

CAREGIVER STRESSORS AND DEPRESSIVE SYMPTOMS AMONG OLDER HUSBANDS AND WIVES IN THE UNITED STATES

Framed by Pearlin's Stress Process Model, this study prospectively examines the effects of primary stress factors reflecting the duration, amount, and type of care on the depressive symptoms of spousal caregivers over a2-year period, and whether the effects of stressors differ between husbands and wives. Data are from the 2004 and 2006 waves of the Health and Retirement Study and we included community-dwelling respondents providing activities of daily life (ADL) and/or instrumental activities of daily life (IADL) help to their spouses/partners (N = 774). Results from multivariate regression models indicate that none of the primary stressors were associated with depressive symptoms. However, wives providing only personal care had significantly more depressive symptoms than wives providing only instrumental care, while husbands providing different types of care showed no such differences. To illuminate strategies for reducing the higher distress experienced by wife caregivers engaged in personal care assistance, further studies are needed incorporating couples' relational dynamics and gendered experiences in personal care.

Health and safety matters! Associations between organizational practices and personal support workers\u2019 life and work stress in Ontario, Canada

BackgroundThe home and community care sector is one of the fastest growing sectors globally and most prominently in mature industrialized countries. Personal support workers (PSWs) are the largest occupational group in the sector. This paper focuses on the emotional health of PSWs working in the home and community care sector in Ontario, Canada. The purpose of this paper is to present evidence on the associations between PSWs’ life and work stress and organizational practices of full-time and guaranteed hours, and PSWs’ perceptions of support at work and preference for hours.MethodsData come from our 2015 survey of 1543 PSWs. Dependent variables are life and work stress. Independent variables are: objective organizational practices of full-time and guaranteed hours, and subjective organizational practices of perceived support at work, and preferred hours of work. Descriptive statistics, correlations and ordinary least square regression analyses with collinearity tests are conducted.ResultsOrganizational practices of employing PSWs in full-time or guaranteed hours are not associated with their life and work stress. However, those who perceive support from their organizations are also the ones reporting lower life and work stress. In addition, those PSWs perceiving support from their supervisor report lower work stress. PSWs would like to work in their preferred hours, and those who prefer to work more hours report lower life and work stress, and conversely, those who prefer to work less hours report life and work stress.ConclusionFor PSWs in home and community care, perceived support from their organizations and supervisors, and employment in preferred hours are important factors related to their life and work stress.

What are the differences among occupational groups related to their palliative care-specific educational needs and intensity of interprofessional collaboration in long-term care homes?

BackgroundThe purpose of this study was to compare the differences across occupational groups related to their end-of-life care-specific educational needs and reported intensity of interprofessional collaboration in long-term care (LTC) homes.MethodsA cross-sectional survey, based on two questionnaires, was administered at four LTC homes in Ontario, Canada using a modified Dilman’s approach. The first questionnaire, End of Life Professional Caregiver Survey, included three domains: patients and family-centered communication, cultural and ethical values, effective care delivery. The Intensity of Interprofessional Collaboration Scale included two subscales: care sharing activities, and interprofessional coordination. In total, 697 LTC staff were given surveys, including personal support workers, support staff (housekeeping, kitchen, recreation, laundry, dietician aids, office staff), and registered staff (licensed nurses, physiotherapists, social workers, pharmacists, physicians).ResultsA total of 317 participants completed the survey (126 personal support workers, 109 support staff, 82 registered staff) for a response rate of 45%. Significant differences emerged among occupational groups across all scales and subscales. Specifically, support staff rated their comfort of working with dying patients significantly lower than both nurses and PSWs. Support staff also reported significantly lower ratings of care sharing activities and interprofessional coordination compared to both registered staff and personal support workers.ConclusionsThese study findings suggest there are differing educational needs and sense of interprofessional collaboration among LTC staff, specific to discipline group. Both the personal support workers and support staff groups appeared to have higher needs for education; support staff also reported higher needs related to integration on the interdisciplinary team. Efforts to build capacity within support staff related to working with dying residents and their families are needed. Optimal palliative care may require resources to increase the availability of support for all staff involved in the care of patients.

Provider Perception of Patient-Initiated Communication for Non-Essential Tasks

The EPIC MyChart Bedside iPad application aims to make patient-provider communication more personalized and efficient and to provide patients with access to medical education information and electronic health records during their hospital stay. The purpose of this on-going study is to learn the impacts of the application on healthcare provider workflow and satisfaction. Data presented here is from the first phase of data collection which was collected before the implementation of the Bedside application. Observational and survey data was collected from 32 registered nurses (RNs) and personal care assistants (PCAs) (mean age = 33; sd = 12) before the implementation of the Bedside application in three inpatient hospital units of a large hospital in Southeastern Texas. Results highlighted three main issues in provider workflow in regards to patient-initiated communication: 1) providers have insufficient information about the requested task at the time of request, 2) there is no running task list for the provider to refer to and 3) the incorrect care provider is often notified to perform a task. It is hypothesized that the implementation of the Bedside application will mitigate these issues by directly notifying the correct care provider and by populating specific tasks to a task list that the providers can refer to from their workstations.

Assisting Frail Seniors With Toileting in a Home Bathroom: Approaches Used by Home Care Providers

Home care providers experience high occupational injury rates. Improving safety is becoming increasingly urgent as this sector expands to support the aging population. Caregivers identify assisting with toileting as a particularly frequent and difficult activity. This mixed-methods observational study identified and analyzed the toileting subactivities that place care providers at the greatest risk of musculoskeletal injury. Eight personal support workers (home care aides) assisted a frail older adult (actor) in a simulated home bathroom. Overall technique and body postures were analyzed. Exposure to musculoskeletal injury risk factors (low back loads and time in extreme trunk postures) was greatest when removing/replacing clothing and providing posterior perineal care; high loads were also possible during transfers. Exposures can be reduced by lowering the pants only to knee level or squatting to raise them. A bidet seat or attachment can perform perineal cleaning, which accounted for 32% of time in severe trunk flexion.

Characterisation of aggression in Huntington's disease: rates, types and antecedents in an inpatient rehabilitation setting.

To systematically review aggression in an inpatient Huntington's cohort examining rates, types and antecedents. Although the prevalence of aggression in Huntington's disease is high, research into this problematic behaviour has been limited. Few studies have investigated the nature of aggressive behaviour in Huntington's disease or antecedents that contribute to its occurrence. A systematic, double-coded, electronic medical file audit. The electronic hospital medical records of 10 people with Huntington's disease admitted to a brain disorders unit were audited for a 90-day period using the Overt Aggression Scale-Modified for Neurorehabilitation framework, yielding 900days of clinical data. Nine of 10 clients exhibited aggression during the audit period. Both verbal (37·1%) aggression and physical aggression were common (33·8%), along with episodes of mixed verbal and physical aggression (15·2%), while aggression to objects/furniture was less prevalent (5·5%). The most common antecedent was physical guidance with personal care, far exceeding any other documented antecedents, and acting as the most common trigger for four of the nine clients who exhibited aggression. For the remaining five clients, there was intraindividual heterogeneity in susceptibility to specific antecedents. In Huntington's sufferers at mid- to late stages following disease onset, particular care should be made with personal care assistance due to the propensity for these procedures to elicit an episode of aggression. However, given the degree of intraindividual heterogeneity in susceptibility to specific antecedents observed in the present study, individualised behaviour support plans and sensory modulation interventions may be the most useful in identifying triggers and managing aggressive episodes. Rates of aggression in Huntington's disease inpatients can be high. Knowledge of potential triggers, such as personal care, is important for nursing and care staff, so that attempts can be made to minimise distress for patients and maximise the personal safety of care staff.

Supportive Supervision and Staff Intent to Turn Over in Long-Term Care Homes.

To examine the association between supervisory support and intent to turn over among personal support workers (PSWs) employed in long-term care (LTC) homes in Ontario, Canada, by assessing whether the association is mediated by job satisfaction and the potential confounding effect of happiness. Cross-sectional survey data of 5,645 PSWs working within 398 LTC homes in Ontario, Canada, were obtained and analysed through a series of multilevel regression models. Overall, analyses support the assertion that the effect of supervisory support on intent to turn over is partially mediated by job satisfaction. However, happiness may act as an effect modifier rather than as a confounder. These results reinforce the importance of supportive supervision for PSWs working in LTC homes and highlight the multifaceted role of nurses in LTC, who traditionally provide the majority of PSW supervision. Nurses must be equipped with competencies and skills that reflect the complex organisational environments in which they work. However, these results must also be interpreted in context with the limitations of cross-sectional data; future research should incorporate prospective data collection and clarify the potential role of happiness.

Exploring experiences of Personal Support Worker education in Ontario, Canada.

There is growing attention to the training and education of Personal Support Workers, or PSWs, who work in community, home and long-term care settings supporting older people and people with disabilities. In Ontario, Canada, amid a volatile policy landscape, the provincial government launched an effort to standardise PSW education. Using qualitative methods, this study considered the question: What are the central educational issues reflected by students, working PSWs and key informants, and are they addressed by the PSW programme and training standards? Phase one was a public domain analysis completed between January and March 2014 and updated for major developments after that period. Phase two, completed between August 2014 and March 2015, included 15 key informant interviews and focus group discussions and mini-phone interviews with 35 working PSWs and current PSW students. According to the participants, the central educational issues are: casualisation of labour that is not conveyed in educational recruitment efforts, disconnect between theory and working conditions, overemphasis on long-term care as a career path, and variability of PSW education options. While the standards should help to address the final issue, they do not address the other key issues raised, which have to do with the structural organisation of work. There is thus a disconnect between the experiences of students, PSWs and key informants and the policy decisions surrounding this sector. This is particularly significant as education is often touted as a panacea for issues in long-term and community care. In fact, the curriculum of some of the PSW programmes, especially those in public college settings, is robust. Yet, the underlying issues will remain barring a structural overhaul of the organisation of long-term and community care sectors founded on a social revaluing of older people and the gendered work of care.

Care and violence through the lens of personal support workers

Using a grounded theory approach, this article contends that violence should be considered a part of, rather than in opposition to, care. This conceptualisation is empirically supported by themes from a qualitative study of personal support worker education in Ontario, Canada: one on violence against workers; another on abuse; and a third on sentimental motivations. This article demonstrates the tensions of care: that it can be at once violent and rewarding. The conclusion considers what to do with the discomfort raised by this tense definition, suggesting that it is an essential starting point for transforming the organisation of care.

Continence Training Needs Assessment of Residential Long-Term Care Personal Support Workers

Continence Training Needs Assessment of Residential Long-Term Care Personal Support Workers