As nursing homes prepare for pandemic emergency orders to wind down, operators want a permanent role for new, lower-paid workers — although some advocates question the value of inexperienced staff around vulnerable residents.
Called “resident support assistants,” the entry-level job was approved by a “temporary” order in March 2020, part of the Emergency Order and Civil Protection Act. Now, more than 18 months later, the Ontario Long-Term Care Association wants the government to enshrine the role in its new legislation.
“They’re not doing direct (hands-on) care,” said Donna Duncan, CEO of the Ontario Long-Term Care Association, which represents for-profit and not-for-profit homes. “They’re supporting — doing COVID screening, delivering snacks, taking linens, watering plants or holding iPads so a resident can have a virtual visit with their family member.”
The 2007 Long-Term Care Homes Act is being opened this fall with a promise of four hours of direct daily care by 2025 and tougher oversight, even though the government doesn’t always enforce the rules that exist. Long-Term Care Minister Rod Phillips has promised to hire 27,000 workers to meet those daily care staffing requirements.
Released on Thursday, the OLTCA submission for changes to the Act cites roughly 50 recommendations, although Duncan said they are still being refined.
Among the changes suggested, the OLTCA wants legislation to recognize the role and rights of the “essential caregiver,” many of whom provide hours of care and emotional support for their loved ones. It is calling for stricter accountability with “stepped, transparent penalties for neglect and abuse, leading up to license removal.”
And it aligned with Advantage Ontario, which represents not-for-profit, municipal and charitable homes, calling for legislation that supports residents’ individual, emotional and cultural needs over the current system that focuses on the completion of tasks instead of people. The Ontario Long-Term Care Commission into COVID-19 said the government should support and fund people-first models and philosophies in homes.
Advantage Ontario’s CEO Lisa Levin said association also wants resident support workers, calling the job designation “a great option that many homes have used during the pandemic to help improve the quality of care.
“We feel their role should continue.”
Not all agree.
“We want more skilled workers, not less,” said a manager in a municipal home.
CUPE Ontario secretary-treasurer Candace Rennick said: “Care for residents can only improve when more of the jobs are made full-time and wages go up on a permanent basis, so top-notch, trained, skilled staff want to work in long-term care.” Her union represents front-line staff.
And Jane Meadus, a long-time lawyer with the Advocacy Centre for the Elderly, said the lesser role — even with accelerated training — is counterintuitive in an industry that “keeps saying people in long-term care are sicker, they are more frail, they have way more dementia.
“And then they want to water down the staffing?”
For an industry struggling through a “human resources crisis” worsened by COVID, Duncan believes these jobs are part of a solution. But resident support workers will not provide residents with hands-on care “until they become PSW’s,” she said.
“We see this as an important entry-level role to introduce people, individuals who are curious about working in long-term care to come in and see if this is the place where they would like to be.”
New legislation, she said, can lead to on-the-job training, turning a resident support assistant into a personal support worker with “accelerated” training from community or private colleges. Many traditional programs train personal support workers for roughly eight months.
Laura Tamblyn Watts, CEO of CanAge, a national seniors advocacy group, believes there is a basic role for resident support assistants in homes — with some training.
“There’s a difference between health care and social care,” Tamblyn Watts said. The entry-level workers might have some physical contact such as holding a resident’s arm to help out of a chair, but she said that is something a family member or volunteer might do.
It comes as no surprise that the push for regulatory change from industry groups is met with cynicism from some, said Tamblyn Watts, a lawyer. Meadus, for example, argues in favour of keeping the regulations as they are written, saying homes have shown they need prescriptive oversight.
Tamblyn Watts believes that many advocates and families have been left with “fury and despair,|” because the current regulatory system is broken, with little accountability. At the same time, few families can find solace for a home’s negligence in the civil courts, which place little monetary value on the lives of older people.
The current system, Tamblyn Watts said, “is tick-box, outdated, super-prescriptive and not flexible enough to allow for emotion-focused care.”