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The Ontario PSW Registry: We've proven the numbers are countable, now let's make the numbers accountable

Posted Jul 27th, 2015 in News, Long-Term Care

The Ontario PSW Registry: We've proven the numbers are countable, now let's make the numbers accountable

PSWs (personal support workers) have been in the forefront of many medical news stories for as long as I can remember, whether there are issues with wages, staffing, outcomes of care, or other concerns.  All too rarely, a good news story surfaces, although I know there are many devoted, health care workers, providing great services everyday.

Back in the day, I remember working in nursing homes, (as they were then called), with a blend of service providers: HCAs (Health Care Aides), Nurses Aides and Orderlies, as well as Regulated Care providers.

With time, Personal Support Workers (PSWs) became the growing workforce for eldercare, as the realization set in, that there needed to be some system in place to look at standardizing educational practice. The population accessing the highest demand for service tended to be the most vulnerable in society, our frail elderly.

Let’s reflect on a PSW’s role in an Ontario LTC Home:

The PSW is the person who will see me naked, help me with personal care, insure if my bladder and bowels fail me, that I am clean and comfortable, and will be accountable for all facets of me feeling, and looking my best. Registered staff and others also have roles, but the highest percentage of face time will be with my PSW care providers.

Think that’s a tall order…keep reading

The PSWs will feed me at mealtimes, and report if there is anything amiss with my behaviour, skin integrity, or health, that may signify a change in well being.   I will rely on them to have a cheery disposition, and a universal acceptance of my quirks, anomalies, and idiosyncrasies, while embracing the fact that my dependency on them impacts my quality of life.

Personal Support Workers are an integral member of the team.

I have worked with, and supervised some amazing PSWs. I have seen heartfelt compassion, empathy, and amazing caregiving skills. I have seen laughter, when sharing a story with an elder, and tears evoked by the deterioration in health, of a client.  I have seen PSWs sit at the bedside of a dying resident, in the absence of family members, long after the paid shift was over.


I have encountered some really ineffective PSWs who were removed from workplaces for a plethora of reasons.  Although all legal and legislative obligations were met, the question remained, where did they end up next?

In May 19 2011, the MOHLTC under the McGuinty Government made an announcement addressing the concept of developing a PSW registry in Ontario.

"PSWs provide care to seniors, people with disabilities and those with complex health needs. This registry will enable the government to work in partnership with PSWs to better meet the health needs of these vulnerable groups, leading to improved health outcomes."

The registry was developed through the efforts of OCSA (Ontario Community Support Association), who was the contracted lead in this project.  They were tasked to work with a Steering Committee of stakeholders, to conceptualize, and bring this concept to fruition.  The premise was to initially register PSWs working for employers who are funded publicly: through the MOHLTC (Ministry of Health and Long-Term Care), the LHIN (Local Health Integration networks) and the CCAC (Community Care Access Centre)

The results of these efforts were launched on June 1 2012. http://www.pswregistry.org/Pages/en/Default.aspx

Unfortunately, with 30,000 plus members, the PSW registry does not capture issues with conduct, or other concerns addressed in a dismissal, that may have a direct impact on the next care recipient, nor has it captured all workers in this vocation. 

So what happened to those care providers, flying under the radar?

The development of the PSW registry is a starting point, but now it's time to consider pushing the accountability envelope.

Care providers that are regulated, such as Doctors and Nurses, are held to a higher level of accountability, public,  and employer scrutiny.  Take a moment and visit the web sites of the College of Nurses, or Physicians and Surgeons.  Practice restrictions are clearly visible for review.

If we are truly going to improve quality of care for seniors, we need more accountability checks and balances. 

Here are some thoughts as to possible next steps for the Registry:

1.  Let's be transparent, and explain to citizens what the registry has accomplished, and what future plans are in place to develop this tool
2.  Let's be very clear about the scope of practice for PSWs, and mandatory education requirements, regardless of the workplace.  (Including upgrades and continuing education)
3.  Let's insure all PSWs are required to be a part of a registry: following the lead of regulated health care professionals
4.  Let's provide a legislative framework about what is required reporting to the registry, to protect vulnerable seniors
5.  Let's be certain that all employers of PSWs are part of the legislation requirements
6.  Then, Let's educate the public as to how to use the registry to review care providers

A registry is a starting point to building PSW accountability in the provision of elder care, but I wonder how relevant it is to the end user, in the current format?  
Let's hope the promised analysis of the Registry this year, yields further recommendations to improve and expand, the current function.  We can all agree that quality care outcomes, have a high dependency on frontline staff.  

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