The Expanded Role of Personal Support Workers

The demand for Personal Support Workers is at an all-time high. 

In addition, the role of PSWs has expanded to include care activities previously performed by Registered Healthcare Professionals (RHPs).

As a result of this expanded role, many new employment opportunities have emerged that never existed before. 

Why is this task shift taking place now?

The aging population is growing at exponential levels in Ontario and is only expected to continue to increase over the coming years. 

Therefore, healthcare demands for in-home and community-based care are expected to rise. 

Tasks that are usually carried out by regulated healthcare professionals such as nurses and physiotherapists are now being moved to the duties and responsibilities of the PSWs.

What is home care?

Home care refers to healthcare services that are provided for clients within their homes. 

Services are performed via in-home health agencies through regulated and unregulated healthcare professionals including nurses, social service counselors, rehabilitation specialists, volunteers, PSWs, respiratory therapists, and several other professionals depending on the agency. 

In-home services can include restorative care with the intention of providing clients with tools and intervention for recovery, and home care services can include palliative or end-of-life care. 

What is community-based care?

Community-based care encompasses healthcare services that can be performed within a client’s home. 

Regulated and unregulated healthcare professionals come into a client’s home rather than consult with the client in a medical facility. 

Furthermore, these professionals have access to referrals and resources for additional community services and for transitional information in the event that clients are needing to move to other facilities such as the hospital or long-term care. 

What roles do PSWs typically play in home and community-based care?

PSWs are considered unregulated healthcare providers who perform personal and supportive care for a wide variety of clients under the supervision of their regulated employers.

As an unregulated position, PSWs have no clean-cut scope of practice so duties will vary amongst home care facilities. 

However, examples of typical PSW duties may include:

  • assisting with activities of daily living (dressing, hygiene, showering, toileting),
  • mobility,
  • basic wound and pressure care,
  • light housekeeping,
  • psychosocial care (i.e. respite, companionship),
  • basic medication assistance, and
  • basic prosthetic and brace care. 

What are the additional skills recently adopted into the PSW role?

Additional skills that are being transferred from regulated healthcare professionals to PSWs include:

  • range-of-motion and home exercise programs,
  • bowel and bladder care (ostomy and catheterization),
  • tube feeding,
  • oxygen administration,
  • application of topical medical creams,
  • assistance with inhalers and drops,
  • skilled wound care,
  • donning/doffing compression stockings, and
  • more in-depth prosthetic and brace application. 

Again, these skills were observed in-home care settings so there is some expected variation in client care in other healthcare facilities.  

What measures need to be taken to provide adequate care?

PSWs are traditionally expected to carry out duties that they have been sufficiently trained to carry out during their certification programs

In order for PSWs to legally and ethically take on additional tasks that are usually assigned to regulated health professionals, there needs to be a specific form of delegation of these services. 

Delegated services are supposed to be highly routine, repetitive activities that can be carried out with training and appropriate supervision.

However, has come to the attention of the researchers that PSWs in certain home care placements are taking on non-traditional client care activities (tube feeding, restorative care such as exercise programs, medication application, etc.) that are not part of their core skillsets. 

This is common amongst working with older clients who have extremely complicated plans of care and medical histories. 

Although it may be cost-effective and time-saving to push these additional activities onto the PSWs, there needs to be a consideration for intervention effectiveness and safety of the patients.

First and foremost, there needs to be consistent communication amongst regulated and unregulated healthcare staff in care planning for each and every client. 

Tasks that are delegated to PSWs need to be regularly monitored and updated so that staff can carry out the tasks safely and make sure that there are no personal and supportive needs being unmet.  

Care plans should be developed thoroughly and in a timely fashion so that PSWs are not left in the dark when they enter their client’s homes.

There also needs to be a distinct tier of supervision so that regulated staff members are still making the primary decisions regarding skilled, regulated activities that are being delegated to PSWs. 

What type of training is needed to smooth this task shift and to continue safe, high-quality client care?

Training for added skilled activities needs to be implemented to protect vulnerable clients and unregulated staff members. 

It is more likely for PSWs to take on these added tasks when working with medically complex cases.  

Supervisory clinicians who are delegating these tasks over to PSWs are ethically and legally obligated to sufficiently train PSWs in tasks that are outside of or more demanding than their core skillsets. 

Each home care agency needs to be consistent in assigning added activities to PSWs and to avoid making sudden and unexpected changes to their duties just because new caseloads demand it.

Due to the ever-increasing population of older adults who require healthcare services in Ontario, home care is ever-changing in care planning to accommodate for unique medical needs. 

This means duties and responsibilities are being shared or shifting in response to regulated and unregulated health professionals being spread thin. 

Task shifting for PSWs can be effectively and safely carried out in home care. 

However, employers and regulated health professionals must carry out supervisory and delegatory roles accordingly to keep clients safe and to continue high-quality care.

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Avlin is passionate about helping aspirants become better personal support workers. He is an entrepreneur and runs a clinic in Toronto.

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