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Health Soc Care Community. 2018 Mar;26(2):240-249. doi: 10.1111/hsc.12514. Epub 2017 Nov 8.

The evolving role of the personal support worker in home care in Ontario, Canada.

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School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, Canada.
Saint Elizabeth Research Centre, Saint Elizabeth Health Care, 90 Allstate Parkway, Suite #300, Markham, ON, Canada.
School of Health & Life Sciences and Community Services, Conestoga College, Kitchener, ON, Canada.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
Krembil Neuroscience Program, University Health Network, Toronto, ON, Canada.


To meet increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Much of the research examining this shift focuses on specialty programmes, with few studies investigating the daily care being provided by PSWs, frequency of care activities being provided by PSWs, and characteristics of the population receiving more complex tasks. Between January and April 2015, a review of 517 home-care service user charts was undertaken in Ontario, Canada, to: (1) describe the range of tasks being performed by PSWs in home care, (2) identify tasks transferred by RHPs to PSWs, and (3) examine characteristics of service users receiving transferred care. Findings indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. Although there is potential for the expansion of home-care services through increased utilisation of PSWs, healthcare leadership must ensure that the right provider is being utilised at the right time and in the right place to ensure safe and effective quality care. Thus, several actions are recommended: PSW core competencies be clearly articulated, processes used to transfer care activities from RHPs to PSWs be standardised and a team-based approach to the delivery of home-care services be considered. Utilisation of a team-based model can help establish positive relationships among home-care providers, provide increased support for PSWs, allow for easier scheduling of initial training and ensure regular reassessments of PSW competence among PSWs providing added skills.


RAI-HC; care activities; home care; personal support worker; task-shifting; unregulated care provider

[Indexed for MEDLINE]

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