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Investing in personal support workers is essential for future of long-term care

The COVID-19 pandemic has highlighted the public stigma related to aging and long-term care. All too often, older adults are referred to as “frail elderly” and long-term care homes as “facilities”. These terms fail to acknowledge the diversity, strengths, and contributions of older adults. They also conjure images of warehousing older adults in institutional settings. Unfortunately, there is some validity to the image of warehousing older adults, as evidenced by the report on long-term care homes in Ontario released early in the pandemic by the Canadian Armed Forces (CAF).

For decades, the gerontological research community has been advocating for person-centered care when providing formal home care or long-term care for older adults, especially those with cognitive impairments like dementia. A person-centered approach values the unique life history of older adults and considers their preferences during routine care. A person-centered approach also values relationships between older adults and their care partners, whether they be family, friends, or formal health care providers. The report by CAF revealed several missed opportunities for person-centered care, where the dignity of residents in long-term care homes was not a priority. For example, residents were unnecessarily sedated and labeled as “agitated and difficult” when all they needed was social connection. Other residents were observed crying for help with staff not responding, in some cases, for over two hours. These examples should give us pause. Would we want this type of care for our family members? For ourselves?

The CAF report and the extensive media coverage of the impact of the COVID-19 pandemic on the quality of care in long-term care homes offer several tangible areas for improvement. It is timely to use them as a starting point to transform the long-term care system to be person-centered. One of the most important areas that need immediate improvement is training of front-line staff, especially personal support workers.

Personal support workers (PSWs) provide the most direct formal care in both home care and long-term care settings. Yet, the complex care needs of older adults in these settings far exceed the formal education, training and abilities of personal support workers to sustain high levels of quality care. Existing education and training programs for PSW focus primarily on care tasks such as feeding and toileting, with little attention to the communication needs of older adults, especially those whose communication is impaired by hearing, vision, and cognitive declines. 

Communication between staff and residents was characterized primarily as task-focused and overly directive in the CAF report. Indeed, educating and training front-line staff is a key focus under Canada’s recent Dementia Strategy. Personal support workers spend considerable time with residents and home care clients compared with other health care professionals. Equipping PSWs with evidence-informed dementia education and training can directly enhance the quality of life of residents and home care clients and reduce overall health care costs (e.g., reduce staff burnout, reduce overuse of medication). 

The COVID-19 pandemic has underscored the importance of communication and social connection for all members of society, especially older adults requiring formal care, both in long-term care homes and within their own homes. All care activities, from personal care (e.g., helping with feeding or toileting) to assessment of pain, require communication. Staff training that is person-centered is essential during a pandemic. Using over 25 years of evidence combined with recent funding from the Future Skills Centre (FSC), the Centre for Aging and Brain Health Innovation, and the Fahs-Beck Fund for Research and Experimentation, our research team has developed and tested a person-centered communication training, called Be EPIC, for front-line staff who care for persons with dementia. 

We begin our training with the impact of both age-related and dementia-specific stereotypes on interactions with persons with dementia. This approach values the dignity of persons with dementia and does not treat the most vulnerable among us as expendable. A person-centered communication approach is foundational to all clinical care encounters. This is especially critical during a crisis. For example, sudden changes related to outbreaks, such as relocating a person with dementia from one room to another in a long-term care home, can trigger behaviours such as restlessness, repetitive questions, or constant requests for help. These behaviours are ways that persons with dementia communicate unmet physical and/or emotional needs or communicate a problem with their physical or social environments. Staff who are trained to use a person-centered approach would be able to prevent or minimize these behaviours by ensuring the resident’s needs are met prior to making the room transition. This requires knowing the unique social history of the resident, including likes/dislikes and meaningful mementoes that bring comfort. 

We are pleased that the Be EPIC project is receiving an additional round of extended funding of $1.021 million from FSC, as announced on May 12, to scale the project using virtual reality in an innovative approach to training. This is proof positive of the value of this approach to dementia care. 

It is important that we invest in person-centered training for all long-term care staff. Such an investment does two things. First, it values older adults as important members of our society. Second, it values frontline staff, especially personal support workers, as key members of the health care team and more importantly, as providers of meaningful social interaction and engagement for older adults. Our treatment of both older adults and front-line health care staff during this pandemic is a reflection of our existing stigmatizing views towards the care of older adults. Let us use the lessons learned from COVID-19 to invest in the most vulnerable and progress as a society.

Marie Y. Savundranayagam, PhD, is an associate professor in the School of Health Studies and director of the Sam Katz Community Health and Aging Research Unit, Faculty of Health Sciences at Western University.

The views, thoughts and opinions expressed here are the author’s own and do not necessarily reflect the viewpoint, official policy or position of the Future Skills Centre or any of its staff members or consortium partners.