WHERE HAVE ALL THE PSWs GONE? As the population greys across the country, long term care homes are bursting at the seams, and it’s only going to get worse with an influx of aging baby boomers. The average resident—an 85 year-old with dementia, two major health problems, and 11 different medications—requires a high level of care, and the right kind of person to provide it.
Unfortunately, as the number of people with complex care needs has risen, the number of personal support workers (PSWs) has declined.
Walk into any long term care home in Ontario, and you’ll find the same scene playing out. PSWs—the unsung heroes of healthcare—run ragged from resident to resident. There simply aren’t enough of them on the floor to handle the workload and provide the compassionate care they strive to give.
So what happens when these healthcare heroes suffer a systemic crisis of conscience? What does it mean for the residents, and the workers themselves, when working short becomes an everyday occurrence? How do they continue caring when burnout is inevitable?
I spoke with three CLAC members to get a glimpse into how Ontario’s PSW shortage affects their work and lives, and how they cope with chronic understaffing and the problems this creates for residents.
I also spoke with Trish Douma, CLAC regional director in Chatham, Ontario, and Michael Reid, CLAC Ontario healthcare coordinator, about what can be done to help heal a hurting system.
CLAC direct member, steward
Local 304 member, steward
Local 304 member, steward
Why did you want to become a PSW?
Ashley: In my early teens, my grandmother became terminally ill. As I observed the care and compassion she received from healthcare providers, it shone a light in my direction, and in that moment I knew I wanted to give back. I wanted to ensure other people’s family members would be taken care of with that same level of respect, care, and compassion I had witnessed with my grandmother’s caregivers.
Andrea: I helped my family care for my grandmother when she was fragile and old. I enjoyed it so much because I felt like I was making a difference in her life, and I wanted to make a career out of it.
Mary: I became a PSW because my mom was diagnosed with multiple sclerosis and I was a caregiver for her since I was 12. So it was a natural career progression.
How long have you worked at your facility? What has changed since you started in long term care?
Ashley: I’ve worked at my facility for 11 years. When I started, there were a lot more PSWs, but that number is dwindling. There was much more of a positive team environment in the home, but now because of the shortage of workers, there’s been a huge decline in teamwork, and negativity has overpowered what was once positive.
Mary: I’ve been in the field for 16 years.
It was hard at first to even get a job as a PSW because you didn’t need a certificate, and now you do.
Andrea: I’ve been in healthcare for 12 years and everything has changed dramatically. Back then, we were a dime a dozen, and now we’re not.
Why do you think so few people are becoming PSWs today?
Andrea: There’s such a high turnover rate—we could orientate nine people, and at the end of the day, only two will stay from that orientation. There’s such a huge disconnect between what people learn in PSW certificate programs and the reality of long term care. People fresh out of the program think that they’re going to be able to talk to seniors all day and learn from them, but realistically, there’s no time to do that. It’s just rush, rush, rush all the time. They want to get to know the residents on a personal level and have meaningful interactions with them, but there’s no time.
Mary: These new PSWs also aren’t aware that some residents will verbally and physically assault them. They’re expecting to care for sweet grandmas and grandpas, but that’s often not the case. They don’t warn new PSWs what they’re getting into.
How does Ontario’s PSW shortage affect you and your coworkers?
Ashley: The shortage has a huge impact on every one of us and on every aspect of our lives. When we work short, we’re fatigued and run down, leaving us with very little to get us through the day. Although most of us would like to think we can hide how tired we are, our residents pay attention and know we’re working short by the amount of times they see us here, there, and everywhere—it’s unfair for them to see that going on within their home. Staff will become irritable with each other while coping with that feeling, and it creates a very negative work environment.
I’m a mother of two amazing kids, and when I come home from work, I’m so drained and feel as though I don’t have energy for them—I’ve had to expend my energy all day at work, and they just don’t understand. At the end of the day, I have no doubt that each of us PSWs have pushed ourselves to our limits in fulfilling our expectations as an employee, a spouse, a parent. Many of us suffer the effects of this by becoming ill, injured, and unhappy.
Andrea: When you’re working short, things get missed and you’re not necessarily meeting the emotional needs of the residents because you’re busy just meeting their physical demands. We also don’t have time to do sensory activities with them like puzzles, playing with clothespins, putting beads on a string. They’re not getting stimulated so then they display behavioural issues and act out, and dealing with that gets us even more behind.
We used to have a sense of pride when we came home from work, and we would feel good about the job we did. But when we’re short-staffed, that’s out the window, and all we have is overwhelming guilt.
It causes a lot of stress and all the staff are on edge because of the demands of the job. It’s very hard to work in an environment like that.
Mary: So many people are getting hurt because we’re working short. Sometimes, we’ll pull someone from another unit, but then they get hurt, and we’re down even more people. It’s a vicious cycle. If everyone is taking time off for injuries, or has modified duties, who takes care of the seniors then?
A lot of the seniors understand that it’s not our fault. But a lot don’t, because there are so many with dementia now. Then they get angry with us and aggressive—they feel like we’re neglecting them and we’re not.
How do you cope with the stress of your job?
Ashley: I’m involved in hobbies outside of work that take my mind off work. Although we’re not paid nearly enough for the work we do, it’s still a rewarding job. I try to keep things in perspective. We’re so lucky to be able to be in someone’s home, to be invited in and trusted to provide the care they need. One day, each of us is going to need this level of care, so wouldn’t you want to receive the best care you can get?
Andrea: Breathing exercises help me cope. Just taking deep breaths on my break to soak up positive, clean energy and relax from the busy hustle and bustle of the job. And I try to stay positive. I’ll say to my coworkers, “We’ve got this! We’re going to get through this together!” We really have to be there for each other. And you have to be strong.
Mary: It really makes a difference when you have coworkers who understand you and support you. We all talk through our issues and stress. We make each other feel human again.
You also have to take care of yourself if you’re feeling burned out. When you’re burned out, you get snippy with the residents, and because you’re tired and rushed, injuries happen. This is not a job you can do when you’re burned out. If you don’t take care of yourself, how are you supposed to care for anybody else?
The CLAC Representatives
Ontario Healthcare Coordinator
Why is there a PSW shortage?
Trish: Fewer people are registering in community colleges to become PSWs because there’s not a lot of glory to the job, and new recruits aren’t prepared for the reality of long term care. Back when there was just a healthcare aide program, they knew exactly how to work in long term care. Now, they graduate from the PSW program thinking they’re going to be able to watch sweet old ladies knitting and have a cup of tea and a chat with them. When you’re given a glamourized version of what being a PSW is like in school, and then you actually start working in long term care, it’s a huge culture shock.
PSWs didn’t just up and leave the country. The role of a PSW in long term care has changed so much in the last 15 years—it’s become too institutionalized.
People become PSWs because they want to provide loving care for people. It’s a noble profession and essential to our society. But when they get into long term care, and because the way that it’s funded translates into the way the building is staffed, they have no time to provide the level of loving care that they want to do in their heart. They experience a crisis of conscience.
People can only work against their core values for so long, so then they drop out of the program or quit. I knew someone who left in the middle of her second orientation shift—she just went on break and never came back because she couldn’t take it.
Michael: People become overwhelmed by the job. It’s a job that takes a very special kind of person to do—it requires a lot of energy and compassion.
But this care is compromised by reduced funding, rising acuity, chronically working short, and fewer people enrolling in PSW programs. I’ve had many PSWs tell me that they go home crying at the end of their shifts because they’re worried about what they’ve left undone. It’s distressing because they have empathy—that’s why they take these jobs—but not being able to provide the care they want to give robs the job of dignity.
PSWs don’t have the time to get the real value of their investment of time with a resident and really make their quality of life better. It would be like preparing a meal for your child, putting one bite in her mouth, and then throwing the rest of the food in the garbage. Wouldn’t that be morally distressing for you? And then if your child cries, you have to walk out of the room and say, “Sorry, I can’t take care of this right now. I’ll have to come back later.”
That’s how PSWs feel about the work they’re doing. That’s what lack of funding does.
It’s an emotional injury to the residents and heartbreaking for the PSWs. The conditions of work are the conditions of care, and we are fooling ourselves if we think human beings are strong enough to withstand that amount of pressure.
What can be done to fix the PSW shortage?
Trish: CLAC is advocating for higher wages for PSWs to attract more people to the profession and pay them what they deserve for the work they do. We’re advocating at the government level to get increased hours for resident care to improve staffing levels. We’re making sure management at the facilities are making every effort to recruit new PSWs to relieve some of the burdens without compromising resident care.
Michael: The government needs to seriously consult with PSWs. A basic component of human psychology shows that workers do better when they have some sort of meaningful input and even control over the direction of their work. PSWs have been completely shoved out.
Instead, the Ministry of Health and Long-Term Care has micromanaged them with paperwork, and they do not feel the freedom to make any decisions. The ministry seems to think that by increasing expectations and documentation, it can achieve accountability. Instead, we have only seen an increase in violence, incidents of abuse, and problems.
CLAC submitted a couple of reports to the government recently to address the issues our members are facing in long term care. We have visited MPPs as well as staff at the Ministry of Health and Long-Term Care to let them know that the long term care system is broken and needs to be fixed.
We’re also encouraging our members to call their MPP and describe to him or her in detail the reality of what it’s like to work in long term care. Communication and teamwork are so important—we tell our PSWs to keep talking to each other and help each other through the hard times.
Worth Fighting For
By Hank Beekhuis
When I started with CLAC in the 1970s, I was working in construction. After I was hired, for some strange reason, I ended up representing healthcare workers.
I soon came to care deeply about the injustices that plague the healthcare system. The people who work in the field will always be close to my heart.
Over the years, I did front-line representation for members in many facilities and witnessed the ever-worsening conditions that healthcare workers were asked to work under. Thirty years ago, residents in long term care were in much better condition than they are today—some of them even drove their own cars!
CLAC did study after study, which always ended up saying the same thing—namely, that if the system is going to improve, it needs to increase the number of front-line caregivers and improve their training and support.
I spent many of those years arguing arbitrations, even though we were clearly working with an arbitration system that was broken. Arbitrators often lacked the courage to break the mold, but a few did make courageous decisions that improved wages and working conditions and gave hope to healthcare workers.
CLAC had some groundbreaking successes representing members in Ontario healthcare, such as starting the first pension plan for long term care workers in 1984, with the industry finally following suit in 1988. We also had the first signed pay equity plan for long term care workers in 1994.
During my 11 years as Ontario director, I was heavily involved with lobbying the government for positive change, but the number of residents and their increasing needs always outstripped the additional resources. This is an ongoing crisis that must be addressed.
The workers are aging and retiring too. Not enough people are enrolling in PSW programs because they can get paid the same amount working in another career with much less physical and emotional stress.
I would like the government to actually take seriously the issue of understaffing. People get into the healthcare field because they have this image of helping the elderly. But when they get there, they find it’s an assembly-line process.
If the government and facilities want to attract people to become PSWs, they’re going to have to give them time to actually do the work well. If they don’t, then they’re always going to have recruitment issues, because nobody wants to deal with that stress on a daily basis. The residents need to be lifted, washed, and changed all the time. For one person to have to do that for a dozen residents means they don’t have enough time to feel good about the work they’re doing and provide loving, compassionate care.
The residents’ best behaviour also doesn’t come out in this situation. They’re frustrated, they feel abandoned by their families, and they’re bored and rushed. They’re upset with themselves because they can’t use the bathroom the way they used to, they have little independence and mobility, and resentment builds. PSWs, as the front-line caregivers, are on the receiving end of residents’ frustration, but there’s nothing they can do about it. They feel powerless as well.
CLAC will continue to fight for justice for our members and the residents they care for in Ontario’s long term care system. In March, I retired after 39 years of representing our members, and Ian DeWaard has taken over as CLAC Ontario director, working from the new Cambridge Member Centre.
CLAC is so much larger, more capable, and more knowledgeable today than when I started. Going forward, it is in a better position to help long term care workers than most other unions. The fight for justice in long term care will not be easy, but nothing worth fighting for ever is.
5 Self-Care Tips for Caregivers
Practicing self-care has been proven to reduce stress, increase happiness, and improve mental health. For those who dedicate their lives to caring for others, caring for yourself is essential.
Much like the instruction to put on your oxygen mask first before assisting another passenger on a plane (see the sidebar on the next page), taking care of yourself first will not only save your own life, but also the lives of those you care for. Here are five helpful ways healthcare providers can practice self-care.
1. Look out for number one.
Schedule time for yourself each week to rest or do something you love. Pencil it into your calendar if you have to. Block off this time and make it as important as a shift at work.
2. Find a hobby.
A hobby outside of work will boost your capacity to provide care. “One PSW I represent has taken up kayaking,” says Trish Douma, CLAC regional director. “Almost every day after work, she goes kayaking for an hour on the Thames River in downtown Chatham.”
3. Broaden your support network.
Develop a broad support network of people who have different jobs and deal with life in a different manner. This will expand your view of the world and help you see your work in a larger context.
4. Get outside.
Studies show that being in nature—even just 10 minutes per day—makes us happier, helps with anxiety and depression, and fuels creativity.
Social media can be toxic, and constantly being on call can be exhausting. Make sure you take a moment to turn off all your devices, leave your work at work, and unwind from the day.
Put Your Mask on First
French aviator Georges Legagneux broke through 10,000 feet in altitude in his biplane on December 9, 1910—the first person to do so. He was also the first person to use an oxygen system when he flew to an altitude of 20,078 feet in 1913. But Germany was the first to develop oxygen systems for their pilots during the First World War to help them reach high altitudes.
The normal oxygen concentration level in the air at sea level is 20.9 percent. At 10,000 feet, it drops to 14.3 percent. The minimum level humans need for most activity is 19.5 percent, and when it dips below that, our cells do not function properly. Mental impairment begins when the level drops below 14 percent, and death occurs when it drops below 6 percent.
Modern aircraft are pressurized to keep the oxygen at a comfortable level. If they weren’t, as the aircraft climbs higher, the lower pressure causes fewer oxygen molecules to be available within the same amount of space. So with every breath, people breathe in less oxygen and develop hypoxia and experience symptoms of altitude sickness, which include nausea, headache, and fatigue. The higher the plane goes, the worse it gets as oxygen levels continue to decline.
When an aircraft’s pressurization system fails, oxygen masks drop automatically to deliver higher concentrations of oxygen to passengers. Without them, the effects of hypoxia debilitate passengers very quickly. Which is why you must always put your own mask on first before helping others.