Health care’s ‘hid­den army’ short staffed

Regina Leader-Post - - News - TOM BLACK­WELL

TORONTO — They oc­cupy the front lines of Canada’s crowded nurs­ing homes, pro­vid­ing the bulk of care to in­creas­ingly chal­leng­ing, de­men­tia-suf­fer­ing res­i­dents.

But the work­ers known as health-care aides have limited train­ing, no reg­u­la­tion and “wor­ri­some” lev­els of burnout, a new study sug­gests.

The study’s au­thors call for ur­gent ac­tion to op­ti­mize the cru­cial work­force of an es­ti­mated quar­ter-mil­lion, de­scribed as ded­i­cated and hard work­ing. They rec­om­mend fund­ing for more on-the-job ed­u­ca­tion and ex­am­in­ing the dy­nam­ics of multi-eth­nic em­ploy­ees serv­ing clients of largely Western Euro­pean back­ground.

“Care aides, who are look­ing after your mother or your fa­ther who’s in a very frail, dif­fi­cult state, aren’t re­quired to have any on­go­ing up­grad­ing,” said Ca­role Estabrooks, a Univer­sity of Al­berta nurs­ing pro­fes­sor and the study’s lead au­thor. “And we’ve got pretty good ev­i­dence that reg­u­lar, in-ser­vice train­ing helps them pro­vide bet­ter care.”

The au­thors tout their survey of 1,381 aides in three western prov­inces, pub­lished in the Cana­dian Jour­nal on Ag­ing, as the first sci­en­tific study of a group who has been called health care’s “hid­den” army.

The survey in ur­ban ar­eas of Saskatchew­an, Man­i­toba and Al­berta found more than 60 per cent of the care aides were born out­side Canada and just un­der 50 per cent had a first lan­guage other than English. That is “in stark con­trast” to the oc­cu­pants of nurs­ing homes, the study says.

“We shouldn’t ig­nore it, we should look at what it means for us,” Estabrooks said. “Be­cause some­one can con­verse and live and sur­vive in Canada doesn’t nec­es­sar­ily mean they have enough con­ver­sa­tional skill to in­ter­act in a com­plex health-care sys­tem.”

Si­enna Cas­par, a post-doc­toral fel­low at the Univer­sity of Bri­tish Columbia who has shad­owed care aides on the job as part of her re­search, said the key is­sue is that the work­ers face a dra­mat­i­cally changed res­i­dent pop­u­la­tion.

With more el­derly peo­ple treated at home or in out­pa­tient clin­ics, they are sicker by the time they en­ter nurs­ing homes than in the past, she said.

And the most common and chal­leng­ing health prob­lem the aides en­counter is de­men­tia, said Cas­par, who was not in­volved in the new study.

“I asked them if they felt their ed­u­ca­tion and train­ing had pre­pared them and, by and large, they said ‘No,’ be­cause there is such a small com­po­nent on de­men­tia,” Cas­par said. “And that’s where the vast majority of the work is.”

But Govind Rao, a re­searcher with the Cana­dian Union of Pub­lic Em­ploy­ees, which rep­re­sents care aides in some prov­inces, ar­gued that the work­ers are, in fact, “very skilled” and well-qual­i­fied to do the work.

The prob­lem, Rao said, is that there are not enough of them.

“We have care aides who are over­worked, and they’re not able to get their work done and an­swer pa­tients when pa­tients need them.”

He also said it was “of­fen­sive” to even raise the is­sue of the work­ers’ eth­nic makeup, say­ing there is no ev­i­dence that hav­ing English as a sec­ond lan­guage would af­fect their skill as care­givers.

It is es­ti­mated — no one knows the true num­ber — that as many as 250,000 care aides, also known as per­sonal support work­ers, are em­ployed in Canada, pro­vid­ing 70 per cent to 80 per cent of the di­rect care to nurs­ing-home res­i­dents. Most prov­inces re­quire some kind of ed­u­ca­tion and cer­ti­fi­ca­tion to work in the field, but the stan­dards dif­fer widely, Estabrooks said.

Un­like nurses, phys­io­ther­a­pists and other pro­fes­sion­als in the sec­tor, they are not sub­ject to reg­u­la­tion. Mean­while, the num­ber of regis­tered nurses has been dwin­dling, partly be­cause of cost-cut­ting, ex­perts say.

The aides’ tasks can be me­nial, in­clud­ing wash­ing, feed­ing and chang­ing res­i­dents, but they also act as the eyes and ears of more highly trained work­ers, Estabrooks said.

The survey, con­ducted in 30 ur­ban nurs­ing homes, found that almost all their sub­jects had a high school ed­u­ca­tion, most were mid­dle-aged or older women, and less than half had re­ceived any con­tin­u­ing ed­u­ca­tion after start­ing work.

They voiced a high level of job sat­is­fac­tion, but also el­e­vated feel­ings of burnout com­pared with nurses and other work­ers in the sec­tor, the study in­di­cated.

JOHN MOORE/Getty Images

The work­ers known as health-care aides have limited train­ing, no reg­u­la­tion and ‘wor­ri­some’ lev­els of burnout, a new study sug­gests.

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