Care workers lack oversight: critics

Ontario has no regulatory body for many who tend to the elderly

Arborists, hairdressers, even swine herders are governed by a regulatory body in Ontario, which holds them to professional standards. But personal support workers — who make up the backbone of the increasingly overtaxed long-term health care system — are not.

The lack of a college or regulatory body for personal support workers — something other health workers have — is both puzzling and worrisome, says Michael Hurley, president of the Ontario Council of Hospital Unions and a vice-president of CUPE Ontario.

The recent assault of an elderly resident at Ottawa’s Garry J. Armstrong long-term care facility by a personal support worker — which was caught on video camera — is shinning a light on the need for a regulatory body, he said.

The personal support worker was fired and pleaded guilty to assault.

“I would say the overwhelming proportion of personal support workers are loving, compassionate people who try to do a great job for the people they look after … even though they are stretched to the limit. But in any profession, there will be people who have mental illness, who have addictions, people who are not suited to work in the profession,” said Hurley.

“Because so many people are being cared for by (personal support workers), because the care requirements have changed dramatically, because the expectations of society have to be that these people are well-trained and that they are emotionally and mentally suited to the work, there has to be some sort of regulatory framework that provides protection to the public, something that exists for pretty much every other profession.”

Hurley said he believes one of the reasons there is no regulatory body for personal support workers is to keep health-care costs down at a time when people are being pushed out of hospital beds into either long-term care or the community.

“They underpay them, they deny them full-time employment by working through contract agencies. These (workers) are being exploited and if they were to be regulated there would be increased pressure for the province to pay them better,” Hurley said. “I believe that is the motive.”

In 2006, the Health Professions Regulatory Advisory Council, in answer to a question from the provincial government, wrote that personal support workers should not be regulated, in part because they “as a group have not convincingly demonstrated … widespread support, willingness or likelihood of compliance with regulation.”

The advisory council also noted that the profession is largely overseen and directed by nurses, who are regulated professionals and the long-term-care industry is highly regulated.

Regulatory bodies such as the Ontario College of Nurses or the Ontario College of Physicians and Surgeons are responsible for the registration and oversight of practitioners. They also set restrictions and handle discipline.

Hurley also noted that many personal support workers are hired on a casual or just-in-time basis, meaning they do not have full-time work or dependable schedules. Many work at multiple institutions, as a result. A similar phenomenon in nursing was cited as a contributing factor in the spread of SARS in Ontario.

Meanwhile, Dr. Shawn Whatley, president of the Ontario Medical Association, called long-term care the “canary in the coal mine” of the province’s health-care system for the most vulnerable. It is already stressed and the numbers of seniors in Ontario is expected to skyrocket in coming years.

“Physicians are deeply concerned,” he said.

Staffing levels in Ontario longterm-care homes are the lowest in the country, according to CUPE, at the equivalent of 3.15 paid hours per day per resident, compared to 3.67 hours in the rest of the country. This comes at a time when residents of long-term-care homes are sicker and need more complex care than in the past.

“We are threadbare on the staffing side,” Hurley said.

OMA head Whatley said longterm care reflects trends throughout the health-care system.

“They are our most vulnerable patients. I believe the quality of our system is really measured by how well we care for our most vulnerable patients.”

He said physicians play a crucial role in the long-term-care experience for patients, and should play a role in solving some of the growing problems surfacing in care for the elderly.

Until the province’s doctors have a contract — they have been without one for three and a half years — it is difficult to work on such issues.

“We need to have a working relationship with the government to solve some of the thorniest problems.”