Personal Support Network of Ontario PSW NEWS. Violence Against PSWs in Long Term Care Understanding the Independent

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1 Personal Support Network of Ontario PSW NEWS Volume 2, Issue 2 July 2008 Inside this issue: Scope of Practice: What it Means Continuing Education Scholarship Voices from the Front Line Saint Elizabeth Health Care Best Practices in Personal Support Strategies for Preventing Restraint-related Deaths Long-Term Disability Insurance for PSWs PSW Training Toronto PSW Conference Set for October 20th Feel the energy in the air - more than 500 Personal Support Workers from southern Ontario will gather at the Sheraton Parkway Toronto North on Monday, October 20th for fullday conference featuring professional develop workshops, networking and motivational experiences. Come and meet fellow practitioners and help raise the profile of PSWs at the 2nd Annual PSW Conference, Monday, October 20 at the Sheraton Parkway Toronto North. Workshops include: Strategies to Reduce Work Related Injuries Through Practical Ergonomics Handle With Care: Client/ Resident Handling I Don t Want a Bath! End of Life and Communication Violence Against PSWs in Long Term Care Understanding the Independent Living Movement Effective Communication for Seniors with Hearing Loss Tips and Tales for Excellence in End of Life Care Stress Unleashed Sheraton Parkway Toronto North In addition, the Personal Support Network of Ontario, will present the PSW of the Year Award to an outstanding PSW as recognized by fellow PSWs. The day will conclude with an interactive drumming experience with Drum Café, an experience not to be missed. Register now! Conference fees are: $149 (PSNO - PSW Members) $174 (PSNO - Manager/Instructors) $199 (non-psno members) Join PSNO and save $25 on Conference fees. Group reservations for service providers available. For more information, please contact Sarah Blakely at / , ext. 244 or sarah.blakely@ocsa.on.ca. Watch for announcements on conferences in Ottawa in November 2008 and London in March 2009.

2 What Can a PSW Do - Scope of Practice By: Lynelle Hamilton Lynelle Hamilton specializes in program planning and development, program evaluation & innovative education & training for people who work in human services settings. With 30 years experience in the human service field, Lynelle has presented over 700 workshops, and has provided ongoing training to many not-for-profit organizations. She has published articles on care giving, group work with cognitively -impaired persons, and has published the first Canadian text book on personal support, soon to be in its third edition. Personal support workers have a unique role in Ontario. It is different from that of any other health care or support provider. Simply put, PSWs do for a person the things that the person would do for herself, if she were physically and/or cognitively able. Chances are, if you compare what you do with what your co-workers do, you ll find that there are differences in both what you do and how you do it. Support work is highly individualized. It s not just using techniques and procedures; it s all about supporting the person in the ways he or she needs to be supported. In 1994, the province of Ontario and the Ontario Community Support Association led a provincial working group to determine the role and scope of a PSWs work. This is a part of what they said: The range of services provided by persons trained as...personal Support Workers depends upon the individual needs and preferences of each person they support. These services may include assistance with: 1. home management (including shopping, house cleaning and meal preparation); 2. personal care (including dressing, personal hygiene, mobility, and other routine activities of living in accordance with the Regulated Health Professions Act); 3. family responsibilities (including routine care giving to children) 4. social and recreational activities There are three limits on this: legislation, employer policies and training. The Regulated Health Professions Act sets out certain acts that may only be done by specific health professionals. There are only a few circumstances where a PSW may perform some of these acts. There are also specific guidelines to follow if you are asked to do one of these acts. Although it s not law, many employers also limit the activities that a PSW may do. For example, a PSW may legally give a client who lives in her own home a pill. However, the PSW s employer may not allow this. As a PSW, you must always work within your employer s guidelines. Finally, you must know how to do what you are asked to do. Nothing is safe (or proper to do) if you are not trained to do it, or have not recently practiced the skill. As a PSW, you have a professional obligation to work to the best of your ability and to not put the client at risk. If you re not certain what you re doing is permitted, or uncertain that you have the skill and knowledge, you have the obligation to raise your concerns with your supervisor. Continuing Education Scholarship for PSWs We are dedicated to supporting ongoing learning for phenomenal talent within community health care. PSNO in partnership with Saint Elizabeth Health Care and the Ontario Community Support Association (OCSA), will award a $2,000 scholarship annually to assist a PSW pursuing career advancement in the home and community support field. The scholarship is made possible by a very generous donation by St. Elizabeth s Health Care. We are dedicated to supporting ongoing learning for phenomenal talent within community health care, says Nancy Lefebre, Senior Vice-President, Knowledge and Practice, St. Elizabeth Health Care. We are proud to be offering this opportunity to all Ontario PSWs, with the assistance of the Personal Support Network of Ontario. The application deadline for this year s bursary was July 15th. We received an overwhelming number of applications and the recipient will be announced this fall. For more information, please call Sarah Blakely at ext Page 2 PSW News

3 Voices from the Frontline - Carson Elliott Personal Support Worker - Cornwall, Ontario In our continuing series on outstanding personal support workers across the province, we profile Carson Elliott, a personal support worker who hails from Ingleside, a small community west of Cornwall on the St. Lawrence River. Carson works for a large home care services provider out of Cornwall. How long have you been working as a Personal Support Worker? I received my PSW certificate with honours in 2004 from St. Lawrence College in Cornwall. Prior to becoming a PSW, I worked 25 years in various positions in the food processing industry. It was one of those mid-life career changes. Why did you become a Personal Support Worker I have always been a compassionate and caring person who was drawn to helping others. As a lifelong volunteer, I was able to experience the satisfaction of making our community a better place to live in. An unfortunate event in 1997 influenced my decision to move toward caregiving my wife developed and died of cancer. During her illness, I became her primary caregiver and had wonderful support from VON, observing firsthand the role and importance of a PSW in an end of life scenario. After my wife died, I did some soul searching about what I wanted to do with my life. At the urging of my oldest daughter, Karen, I decided to become a PSW through the certificate program at St. Lawrence College. By the way, Karen is also a PSW. What kind of services do you provide to your clients/ residents? I work primarily with clients who have either suffered a stroke or have dementia. My primary work includes serving residents in supportive housing in Cornwall. This facility is home to anywhere from 5 15 residents who have suffered strokes. I m usually there for 1½ hours per week helping my clients with getting up in the morning, feeding and taking their medications. In addition, I am on the road throughout eastern Ontario making home visits mostly to patients that have had a stroke or suffer dementia. I have visited patients anywhere from Kemptville in the west, Ottawa in the North and the Quebec border in the east. What is your greatest strength as a PSW? Like many of my PSW colleagues, I am a compassionate and caring person. I don t think anyone can do this job without those intrinsic qualities. But this job is more than about caring. It is about providing professional services that can only be gained though education and ongoing learning. In addition to my certificate training, I try to take advantage of every opportunity to learn more about how I can do my job better for my client, whether it is taking a course on new developments such as medications or refreshing skills that I learned in taking the certificate course at St. Lawrence College. I take pride in being technically proficient at what I do as a PSW but strive to continuously learn. What is the most difficult part of your job? I think all PSWs face difficulties in working with clients who are in decline and eventually die. Because of the frequency with which we see clients, we develop relationships with them and their families. We need to grieve and there isn t always time. Another challenge for me is having my job as a PSW recognized and acknowledged. Many see us as homemakers. We are trained and skilled members of the health care team. This is one of the reasons I think PSNO is such a great idea as it gives us a voice and face. Did you have any role models or mentors in your development as a PSW? My daughter, Karen, was my role model of a PSW. She really got me interested in making it a career. My instructor at St. Lawrence College, Joanne Roberts, the PSW program coordinator was another individual who played a large role. If you would like to share your experiences as a PSW with others, please contact David Hughes at PSNO at david.hughes@psno.ca or / , ext I take pride in being technically proficient at what I do but strive to continuously learn. Volume 2, Issue 2 Page 3

4 An Exciting Spring for PSW Talent at Saint Elizabeth Health Care By: Gale Coburn, Supportive Care Resource Clinical, SEHC PSNO Congratulates Saint Elizabeth Health Care on 100 years of delivering community care services. It s been an exciting spring for Personal Support Workers at Saint Elizabeth Health Care. To help mark the organization s 100 years of leadership in community health care, special Spring Symposiums were held for staff at the Ottawa and Durham Service Delivery Centres. The one-day sessions featured a variety of programming including an interactive team building workshop by Soul Drums, which used rhythm and drumming to emphasize the significance of a team coming together to realize a common goal. Other sessions consisted of presentations on Hospice Palliative Care, which focused on the use of ESA and PPSA assessment tools for symptoms of pain, nausea etc. in the palliative client. An experiential learning exercise called Through the Others Eyes offered participants the opportunity to experience life with some form of disability, while U-me First and P.I.E.C.E.S. training provided them with a framework for effective care of clients with dementia and other cognitive impairments. Nancy Lefebre The Durham Symposium featured a keynote address by Nancy Lefebre, SEHC s Senior Vice-President of Knowledge and Practice, about the current external environment and the advancement of the Personal Support Worker Program. Maureen Hennessy, vice president, learning and development, closed out the day by acknowledging the ongoing contributions PSWs make to their clients, the community and the health care system. Spring also marked the launch of a $2000 scholarship award developed in partnership with the Ontario Community Support Association (OCSA) and the Personal Support Network of Ontario (PSNO). The award is open to PSWs working in Ontario who are seeking to further their education in the area of health care with a focus on Home and Community Care. Applications are available through OCSA, PSNO and SEHC. It s an exciting year for Saint Elizabeth Health Care, and we look forward to many more great initiatives with our Personal Support Program in 2008! To learn more, please visit Does your agency or institution have a story to share with the network? Forward your submissions to: David Hughes david.hughes@psno.ca Soul Drums Page 4 PSW News

5 Best Practices in Personal Support - Myth Busting: Delirium By: Mary-Lou van Der Horst Myth 1 - Delirium - It s just a bit of confusion Health care professionals often describe an older person with delirium as confused but fail to tell the difference between delirium and dementia. Delirium is an acute syndrome with a fluctuating course of symptoms. Whereas, dementia is usually a gradual course of cognitive decline. The central feature of delirium is the person s inability to maintain focused attention. This is combined with an abnormal level of consciousness (arousal). Delirious residents may be oriented but are distractible, oversensitive to stimuli, anxious, and can t concentrate on environmental sounds and sights. They simply can t keep focused on a conversation, being continuously distracted by irrelevant things. Perception distortions such as hallucinations, illusions, and delusions are common. Language becomes abnormal and there may be mood changes (depression). Delirium is especially common in older people with dementia. It is also the most common complication of hospital admission, 30-50% for older people over 70, 35% after heart surgery, 40-60% after hip fracture surgery, and 64% for those in LTC. Delirium has serious consequences and has been associated with increased death and illness. Estimated in-hospital deaths are over 20% and within 1 year are 35-50%. Survivors of delirium have a risk of nearly 50% permanent neurocognitive impairment. Staff are critical in recognizing delirium symptoms as they have the most frequent interaction with residents. This is important since the diagnosis of delirium rests solely on clinical observation skills, symptoms are often subtle but serious. There are no specific diagnostic tests for delirium. Myth 2 - Delirium Doesn t Happen at the End of Life Delirium (confusion) is the most common cognitive disorder in terminally ill residents, occurs in 40% and can persist until death (restlessness and terminal anguish). This is much higher than staff expect and unanticipated for families. The most likely causes of delirium are medications narcotics), poor hydration or dehydration, liver failure, anemia, urinary retention and constipation. Residents may rapidly and dramatically decline. Many families may find witnessing delirium very emotionally distressing. As such, families appreciate being warned in advance that delirium may develop. It is important to provide care tailored to the resident s and family s needs. Helpful care strategies may include: treat the delirium (consider hydration), respect the resident s current perceptions; treat residents with respect and as unique individuals, explore unmet physiological needs (thirst, hunger toileting); promote meaningful communication (listen closely); facilitate preparation for death; encourage families to stay (modify room); reassure and support families, encourage family to participate in care as desired; and provide information about delirium and its causes for the resident. Myth 3 - You Can t Prevent Delirium Research confirms that there are several prevention strategies that can reverse or reduce the severity, duration and frequency of delirium and its functional/cognitive impact. Delirium prevention strategies: Know the causes of delirium Educate staff on delirium Detect symptoms early Frontline staff are critical, observe daily for changes in behaviour and cognition Treat all potentially reversible causes (e.g., UTI, constipation) Use basic care prevention strategies Push fluids, medication reviews, psychoactive meds, sleep promotion, reduce noise, control pain, wearing of hearing aids/glasses, verbal reminders & orientation, safety, keep daily routines, regular toileting, monitor for infection, family visiting, encourage doing activities, hold something comforting, free movement, wandering, and calm music. Mary-Lou van Der Horst is currently working with the Regional Geriatric Programs of Ontario Central area as a Geriatric Nursing/ Knowledge Translation Consultant and the Ontario Osteoporosis Strategy for Long-Term Care as Project Manager/LTC Nursing Consultant. Previously, she was the Regional Best Practice Coordinator in Long- Term Care for Central South Ontario with the Ontario Ministry of Health and Long-Term Care assisting the longterm care sector to implement evidencebased /best practices care improvements. For other issues of the BP Blogger, please visit or marylou1harold@ xplornet.com Volume 2, Issue 2 Page 5

6 Strategies for Preventing Restraint-related Deaths By: Ruth Stewart, Vice President, Marsh Canada Limited Organizations must evaluate procedures to help ensure that restraints are only used in an appropriate and safe manner when absolutely necessary after all other measures have been used, reviewed, and deemed to be unsuccessful. It is difficult to obtain statistics on the annual number of restraint-related deaths in Ontario; however, in 2007 alone the Chief Coroner of Ontario reviewed 27 restraint-related deaths. Although organizations generally justify the use of restraints on the grounds of resident safety, it is evident the practice is not benign even when used properly. As of 2001, Ontario facilities are required to have policy regarding the use of both chemical and physical restraints in accordance with the Patient Restraints Minimization Act. Any policy should, at a minimum, include the following elements: the organization s philosophy about restraint; what constitutes a restraint; when a restraint can and cannot be used as well as what alternatives are available; how often a resident must be assessed and monitored; how to care for the restrained resident; and documentation requirements. Restraints should never be used for the sole purpose of facilitating the care of individuals. The decision should be made after consultation with the resident, if competent, and/or family. Except in an emergency situation wherein a resident is considered to be a danger to himself or others, in accordance with the legislation, restraints are not be used without a physician's order. Direct discussion with the resident and family regarding the facility s policy on restraint use, the resident s restraint needs, and the risks and alternatives to restraints should be included in the initial restraint assessment. The resident s and family members understanding of the risk of, and alternatives to, restraint use should be confirmed and documented. When restraints are used, the importance of frequent assessment and observation of the restrained individual and documenting the resident's behaviour cannot be overemphasized. Frequent re-evaluation of ongoing need for restraint should be in consultation with staff and family. A review of need for a restraint order should occur every 48 hours. All staff providing direct resident care should receive mandatory in-service education on the least restraint policy on a regular basis. New staff should be oriented to these policies prior to commencing resident care duties. Organizations must evaluate procedures to help ensure that restraints are only used in an appropriate and safe manner when absolutely necessary after all other measures have been used, reviewed, and deemed to be unsuccessful. According to the Chief Coroner, care/service providers must also be reminded that restraints to prevent fall-related injuries should only be used after all other fall prevention strategies have been utilized and found to be ineffective; and that a lap belt is a physical restraint. Marsh Canada Limited is a member of Marsh, the world s leading insurance broker and risk advisor. Marsh has developed a special Professional Liability Insurance and Abuse Coverage for PSNO Members. For more information regarding this coverage, contact Marie Lofthouse at Marsh Canada at Regardless of an organization s restraint-free goals, the use of restraints may be warranted to prevent serious injury of a resident to himself or herself or another person. This must be done in the least restrictive manner possible. Page 6 PSW News

7 Long Term Disability Coverage for PSNO Members ELIGIBILITY: COVERAGE: PROGRAM HIGHLIGHTS: Available to all member of PSNO Short and long term disability benefit amount $1,000-$4,000 coverage can be for 5 years or to age 70 Injury covered guaranteed at issue Medical underwriting for illness coverage PSW must work minimum 20hrs/wk Waiting period days PSW can have more than one employer CASE STUDY A Jackie Jones PSW works for 10 years. She is 41 years old No insurance. Jackie is injured and can t work CASE STUDY B Before Disability Jackie buys income replacement insurance through PSNO Edge Long Term Disability program. This benefit provides her with $2000 of monthly benefit if she is injured. Benefits start 30 days after disability and is non-taxable. This plan cost $78.00 per month. Before Disability After Disability Total Annual Earnings $37,440 0 Gross Monthly Earnings $3,120 0 Net income per month $2,578 0 After Disability Total Annual Earnings $37,440 Disability benefit $2,000 For more information regarding Long Term Disability Coverage for PSWs, contact Mercer Insurance at or Gross Monthly Earnings $3,120 Income replacement 77.6% Net income per month $2,578 Monthly shortfall $ Jackie is able to replace 77.6% of her income even though she is injured. These payments will continue to age 70 as long as she continues to be disabled. DISABILITY INSURANCE: ARE YOU COVERED?? If you wish to protect yourself against financial loss if injured, please contact Mercer Canada toll free at or Volume 2, Issue 2 Page 7

8 Personal Support Worker Training By: Sue Davidson, Director, Capacity Builders As a Personal Support Worker, you play a very important role in Ontario s health care system. And, just like nurses, doctors and other health professionals, you require ongoing training to learn new skills and knowledge, refresh the skills you already have, and to develop your career. I m pleased to introduce Capacity Builders, an affiliate division of PSNO. Capacity Builders delivers a wide-range of training for many not-for-profit organizations across Ontario, including the PSW bridging program. We have developed many inservice workshops just for PSWs, including sessions on dealing with conflict, health and safety, professionalism and team work. Most of our PSW training is booked by employers and delivered on-site. For more information about Capacity Builders and our training program, please visit our web site at or give us a call at ext. 235 or ext Personal Support Network of Ontario Lawrence Avenue West Toronto, ON M6A 3B6 Phone: / Ext. 0 Fax: sarah.blakely@psno.ca We re on the Web The Personal Support Network of Ontario was established to help personal support service professionals carry out their work more effectively by offering access to information, resources and tools as well as providing opportunities to connect with a network of professionals in their field. Helping PSWs carry out their work more effectively