Standardized training for personal care workers could help fix long-term care crisis, says advocate

A key part of fixing the crisis in Canadian long-term care homes is regulating personal support workers (PSWs) as a profession, says advocate Laura Bulmer.

Over the last 15 years, Bulmer —  a registered nurse and a professor at George Brown College in Toronto — has been calling for an organization that formally oversees the work and training of personal support workers. 

On Tuesday, members of the Canadian military deployed to work in long-term care homes during the pandemic described disturbing details of neglect and mistreatment in five Ontario centres. 

Bulmer told Day 6 host Brent Bambury that nursing homes' response to the pandemic would have been different if care workers had standardized training and incentives to stay in their profession. 

Here's part of their conversation:

When you heard the details of what Canadian Forces members witnessed in long-term care homes this week, what was your reaction?

Well, certainly not surprised, yet shocked at the amount of allegations for such a short time. I'm certainly glad to see a formalized report that will hopefully get some attention. I have some fear that PSWs will be made the scapegoat in all of this. 

On a positive note, [I'm] a little relieved that finally we're … hopefully heading in a direction where actions are going to be taken to protect our vulnerable seniors.

Let's talk now about planning and implementing some change. I certainly hope to be a part of that.

The details of what we learned this week are very disturbing. How do you feel about sending your students into a crisis as grave as this? 

Well, here's the thing. It's certainly a questionable area. Would we want to send students to a situation where they're already in crisis mode and not working at optimum level? That's not a great way to learn, but that's not something new for us. 

The things that came out in the report are not ... new in this sector. Our goal is to hopefully be able to look at alternative ways of delivering education for PSWs in particular.

Given the things that have been described, are you worried about their mental health?

Absolutely. Having been a clinical instructor for many years myself, it certainly took a toll on me as well. I had to take a break from teaching in the clinical environment because I was bringing a lot of those concerns home and couldn't get over it. 

It is a difficult situation, especially when you're teaching students in an environment like, "This is how things are supposed to be," and then when you bring them to a location where now it's the exact opposite. So a lot of the past, with my clinical placements, have been working with students on how to cope with it and using them as examples, these situations, of what not to do and to try to advocate.

Is that the reason you think that something like a third of PSWs leave the profession every year? Because of the stress?

Oh, without a doubt. You know, there is compassion fatigue. I was talking with a colleague of mine saying, "Can you imagine?" We hear all the reports of people that have died in long-term care. For PSWs, each one of those residents is like a family member. So to have that … many family members die and then still have to go back to work? I can't imagine what it is like right now being in that situation. 

And certainly before COVID came to us, it was challenging with having not enough staff on hand. The ratio of residents to PSWs is nowhere near where it should be, and there's many reasons for burnout.

You've been advocating for regulation of PSWs and standardization in the profession for a long time. What is the main difference you think regulation would have made to this crisis in long-term care homes now?

One of the things I think that is really important is having established educational standards. Right now, [you] can become [a PSW] from many different avenues, whether it be through a high school, a private college or community college. So just that fact alone means you're going to have a different level of a PSW. 

I know that in community colleges, the first thing that we do is teach infection control. So proper PPE [is the] very first thing off the bat. I'm not saying that other facilities don't do that. Having standards ... would definitely regulate what all graduates would have to have.

You said that you're worried that PSWs might become scapegoats after this latest report. Do you think that they will be blamed, the frontline workers, for the breakdown in care?

I certainly hope not. It kind of makes me a little worried that, you know, they are part of the frontline "let's thank all of our heroes." And then, you know, a lot of the things that were detailed in the military report were specific to regulated or non-regulated staff. Residents wandering in a unit, that's not unusual. Certainly, if you don't have enough staff in an environment where the training is different, people take shortcuts.

We've been living through this crisis for a couple of months, but you have been making this case for 15 years. Do you think what's happening now might finally be the catalyst for change?

Oh, my gosh,  I certainly hope so. I really do. 

OPSWA, which is the Ontario Personal Support Worker Association, they have been actually changing their infrastructure to house and to be the regulatory body for self-regulation. So I'm hoping with the attention that it's getting now, I know that regulation is certainly a strategy towards positive change. 

Written and produced by Yamri Taddese.

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