Senior Care: It's Time to Wake Up

Society, nursing homes, governments, the Ministry of Health, families and communities must stop hiding their heads in the sand. The latest Toronto Star investigation of long term care, funded by the Ministry of Health with our tax dollars, needs to be exposed, says Gail Acton, the Director for the National Association of Certified Caregivers/Personal Support Workers. These issues and stories by The Star have been examined and re-examined by Ministry people who claim they are shocked at behaviour resulting in abuse and neglect in the nursing homes.  This abuse and neglect is not just happening in nursing homes, it is also in our communities with our CCACs and LHINs, all overseeing the behaviour with systems in place that make it impossible to call out the abuse and neglect by government and private run homes, community agencies funded by CCACs, and working with Red Cross front line workers called PSWs.

Shame on you, Health Minister Deb Matthews. Your Ministry has been told repeatedly about the abuse in the homes, community, nursing homes and retirement homes. Who has been telling you are the Certified Caregivers/Personal Support Workers. You are part of the culture of secrecy that creates the serious problems. I have been to your task force with a so called commitment to change the way our seniors receive care. When the PSW reported the stories to your Ministry, through the HPRAC determination of standards for front line health care workers, they were ignored. We shocked them then with diapers not being changed, and seniors not being cared for in government regulated homes. Also reported was how frail elderly clients could not report the behaviours of ill trained PSWs, in case they would be denied services from a CCAC that hired overpaid nurses who could not schedule or give client care themselves.

The Ministry of Health makes a deal with unions and the Ministry of Education and Training to impose standards that do not cover adequate training for PSWs, and then like all abuse perpetrators blames the victims. They ask people to participate in creating a registry of PSW workers, after over 5 years of effort to educate them on the necessity of a registry and ongoing training and certification of PSWs through the National Association of Certified Caregivers/Personal Support Workers. After five years they pass it off to another side show, funded by the association of provincial unions to create a registry of the front line health care workers with conspirators that have no interest in the care of the elderly, until it affects their political appointments or their own frail elderly parent.

Matthews acknowledged that the residents' personal stories had a powerful impact. The investigation also found that residents are limited to one diaper per eight-hour shift in some homes. That is “not acceptable care,” Matthews said. “I can tell you, the people who came today are as appalled as I am,” she said. Well we had these same issues presented to HPRAC and they were appalled as well. Did it change anything?

The fastest way to create change, Matthews said, is for families and staff to report every example of abuse or neglect to the ministry's complaint line. You expedite work to develop a registry and ignore standards for PSWs, an unregulated worker which proves that creating change does not trump making a plan of action with the people on the front lines. Contact the National Association of Certified Caregivers/Personal Support Workers for more information on how this government needs to address the front lines at the bottom of the pyramid. We have been trying to do this with the government for years. The change has been a long time coming. The road to abuse is paved with good intentions by all members of our society.

Your Ministry is also looking at a standard of curriculum for the Personal Support Workers. Presently you have approved course content from the National Association of Career Colleges, and the OCSA. It is our contention that neither of these examples is of a quality to ensure that the PSWs are sufficiently well trained. We offered our curriculum as a third and preferred alternative, because it contains a Module on Human Relations and places emphasis on Anatomy, Physiology and Disease Process. Those additions are truly important, especially in the community model, but also necessary in all aspects of the work of PSWs.

80 Percent of Funding Goes to Bureaucracy

Ontario’s home care system is too bureaucratic, with too much public funding going towards administration and case management costs. "As little as 20% of the funds actually go to front-line service workers" says Gail Acton of the National Association of Certified Caregivers/Personal Support Workers.

Public funds are transferred through multiple levels of administration before any money reaches the front lines of care. A fifty five year old mother of two married daughters, who will remain anonymous, has recently been trying to cope with the palliative care needs of her 80 year old mother. She was told by CCACs to just keep her head above water, and was asked repeatedly to call the CCACs if she needed anything. Assurances were given that the CCACs could be of help, yet out of the other side of their mouth, they were telling her that she had maxed out all of the available care services. In response, the daughter said "I am not trying to keep my head above water, all I am trying to do is keep my mother above the ground!"

Does anyone care out there? These CCAC employees are making big dollars to sit around and talk about what they can do. Their website appears helpful, but they show their true colors when you actually ask them to do anything.

There are 14 Community Care Access Centres spending $500 million a year for administration and impression management.  There are few within this system who seem concerned about the damage created from care that is too little, too late. The CCACs have 700 contracts with provider agencies that employ the heathcare workers. These workers include nurses who visit and make assessments without taking any action, leaving Personal Support Workers to attempt to fill in the gaps in service for clients. The PSW is battling unorganized and overpaid nurse supervisors who can neither schedule or care about what happens to the client. The CCACs do not care about this overburdened woman who is trying to assist her mother and allow her to pass away with dignity and decency.

The competitive bidding process that takes place every three years leaves the PSWs with lower salaries, patch work scheduling and fewer client hours. As a result, there is improper service delivery and inconsistent care. The supervisors still get paid their full rate, in spite of the fact that they downsize the number of care hours for an 80 year old woman with a colostomy. She wants to stay in her own home rather than moving to a nursing home, but with her limited financial resources, she has to rely on the services of agencies who are caught in the downward spiral of bidding and lowballing eachother for contracts.

Due to inefficient restructuring by the provincial government, aging at home now means begging for care. Jobs for supervisors are created, but no additional care is provided.  The home care funds pass from the Ministry of Health to Ontario's 14 local health integration networks (LHINs, which oversee the delivery of care). This is not good, as we now have new overseers overseeing the poor planning and unfair distribution of care.  There is now an additional level of oversight as the overseers of the agencies oversee the front line health care worker.  Taxpayers are footing the bill for an unorganized, incompetent health bureaucracy who has no interest in doing anything beyond their 9-4 office hours. God help you and your family if you do not die suddenly and quickly. Is anyone listening out there? Does anyone care?

The Cost of Education Today

Students and their parents are often unaware of the cost of education and training.

For many, the cost is not justifiable. For example, a student pays $30,000 towards his or her chosen program, and loses income from being in school while registered to take a semester that holds only one or two courses. The student has all the costs of living for one semester in exchange for such a small result from taking those courses of study.

Along with tuition, students face a variety of additional challenges in financing their education. Ancillary fees, books, supplies, residence fees, rent, food and other living expenses all push up the cost of education.

If a student comes from a lower income background, the cost of tuition and living expenses may prove to be one of the greatest barriers. This issue is exacerbated by current inadequacies in the financial aid system in Ontario, and may have a significant impact on both student debt and overall accessibility of the system.

Interest charged on student debt makes tuition even more expensive!  The following numbers were calculated using the HRSDC student loan calculator, assuming an average prime interest rate of 4.5%, a standard 10-year (114 month) repayment period and a loan of $30,000:

• if the Floating Interest option is selected, monthly payments will be $361.02 (principal and interest), resulting in total payments of $41,156.77 ($30,000 principal + $11,156.77 interest) over the life of the repayment.


• if the Fixed Interest option is selected, monthly payments will be $400.50 (principal and interest), resulting in payments of $45,657.54 ($30,000 principal + $16,657.54 interest).

Beyond the specifics of tuition fees, there are major concerns and cost analyses that most parents and students need to evaluate:

1. Does the Education Cost justify the potential wage and actually lead to a job?


2. The cost of living in residence, or in off-campus housing assessed by the Canada Millennium Scholarship Foundation, was $17,400 in 2003-04.


3. The average debt load for a student who studies locally (with no additional living expenses) is still $9,000.


4. Increased costs of education in the 1990’s were shifted from the government to the students and consumers of education. This also raises the question of value to the consumer for the education and training they are receiving in 2011.


5. The average cost of tuition is $5,381 a year. The international student, because they are not subsidized, pays an increased cost of $10,500 a year. If the course is studied out of the area in which the student lives, the added cost for additional living expenses is $17,000 a year. The cost of a two year college degree is $45,000. For an RPN with two years of college and an earning capacity equal to the Ontario average of $21.91 per hour (and only being able to access part time work), educational prices do not add up to be a cost effective alternative. The student loan interest rate is approximately prime plus one percent, and does not take into account that the RPN usually can only access part time work, as stated, because the government-operated agencies employ most of the staff for less than 20 hours a week to avoid the exorbitant costs paid out for benefits.


6. The average cost for training a PSW, who is doing most of the Front Line Health Care Work both in Institutions and Community Care, is $3,000 to $5,000. Specifically reviewing one community college for a 700 hour course, the tuition is $4,342.42 including books. For one private college course that is 600 hours of study, we have a tuition fee of $3,500.  The placement hours for both private and community options range from 350 to 368 hours, and these hours are completely unpaid. The PSW candidate loses money while basically "volunteering" for the nursing home placement! Your time is money, and at today’s costs this equals $5,500.00 of lost income. In addition, you have the OSAP cost added to the student fee, and as mentioned earlier, you can add another $17,000 if you are living away from home. This puts the cost of study for the PSW at $21,342 plus lost income of $5,500.  In total, this equals $26,842. This is a lot of money for a college experience!


7. Workplace training has translated into higher costs for students. The average debt for an individual living in residence to take a PSW course is $26,842 (refer to point F).  This cost will be even higher once interest is taken into account.


8. Home study materials and a work placement for the Certified Caregiver/Personal Support Worker (CPSW) course that we offer cost a total of $2,700 (including books). The student's earning capacity begins at week two of the program, and there are no extra expenses for living away from home. If a student was to work 16 hours per week at $15/hour while completing the training, they would have $11,520 after 48 weeks.   If you take this $11,520 in potential earnings and subtract the $2,700 for the course, you have approximately $8,820 in profit by the time you complete your certification.

Government Bureaucracy Harms Workers

Canada is facing a critical shortage of competent and compassionate caregivers. This will have an impact on all of us.

Public and private colleges, schools, and agencies are all getting into the business of training, which is being driven by the financial realities of a critical shortage of caregivers. Education and training of values and skills are shorted because of the competition that exists to attract students for the lowest cost.  This can only lead to a much less knowledgeable worker.  Without effective teaching of workplace standards and competency, they have put thousands of ill prepared workers into the marketplace.  As a result, the vulnerable members of our society, the ill, elderly and frail are facing compromise.

We have a Ministry of Training Colleges and Universities who is accessing Employment Insurance dollars, purporting to be a consumer protection ministry, and presenting a false notion to the public that the National Association of Career Colleges (NACC) is a national examining board in the interests of Personal Support Workers. There is no board exam offering quality standards and protection of workers or the public under the National Association of Career Colleges. It is simply an exam that some participating private schools, in the membership of the Ontario and National Association of Career Colleges, believe is mandatory, and is providing a government regulated standard. In reality, it is designed for the purpose of taking more money from an unsuspecting consumer.

The community colleges do not participate in this, nor can they offer diplomas, because the program is less than the two year qualifying period needed to offer a diploma. All Community Colleges now have what they refer to as a third party exam within their own structure.  You can hardly call this a third party exam towards certification.

There is no follow-up within the agencies for ongoing training, registry of the workers, or even a third party removed from the benefits of either the private schools or colleges.

The Ministry of Training Colleges and Universities/Ministry of Health, in their attempt to create standards and regulations for unregulated health care workers, have recently put together a notice through the Ministry of Health that takes effect in July of 2011.  It states that all PSW workers are to have come through training with a registered private college who offers a registered PSW course, or that they must have written the third party exam offered by the National Association of Career Colleges.  Now we have the Ontario Community Support Association attempting to sell the same curriculum to schools while exploiting the students and front line health care workers.

Private and public colleges in Ontario offer PSW training at costs between $3,500.00 and $5,000.00 for 640 hours of training in a private sector school or 700 hours in a community college.  The training remains inadequate because, when you remove the placement hours, you're left with just 300 to 400 hours of study.  In total, there is a minimum of only 40-60 hours of anatomy, physiology, and disease process education. At $5,000 per course for an average of 350 classroom hours, it is an absolute rip off when you consider that university courses are $6-$10 an hour.  PSW students pay $14-$15 an hour even though they make less than or equal to that amount after they enter the workforce.

With honesty and transparency, why not sell a 300 hour course without the essentials of anatomy and physiology and with no placement hours? Students are paying for over 55% of the course cost in placement hours. They give up almost $5,250.00 worth of billable work time for this work placement.

Why is the Ministry of Health willing to accept a Personal Support Worker who doesn't have the sufficient academic studies in anatomy and physiology that would make them a knowledgeable caregiver?

What about the provision of training for those who are working? Currently, PSWs who do not reside in Toronto and live in rural areas cannot work and upgrade or train as a PSW unless they give up their income and go back to school full time.  This costs them as much as $10,000.00 in time and course costs.

Thirteen years after first implementing the PSW program, I am disappointed to report the gross negligence in training, and the greed and exploitation of necessary front line health care providers. There is victimization and abuse of workers practiced among educators and health care professionals against the person being paid the least and giving the most – the PSW.

The National Association of Certified Caregivers/Personal Support Workers is exactly what it says, a national body of 5000 Front Line Health Care Workers offering you the consumer protection you deserve.

The NACC/PSW provides ongoing training for all PSWs through the Association. We are providing insurance benefits for all registered and certified PSWs with critical care coverage. In addition, we provide and encourage self-employment with discounted professional and general liability insurance.

If you think education is expensive, try ignorance! Review your options for learning and work.

"I forget what I was taught, I only remember what I've learnt."

- Patrick White, Nobel Prize Winner

Overview of Workplace Training

WORKPLACE TRAINING

Workplace training is important in today's knowledge-based economy. 
Workplace training is necessary to help employees develop and use the skills
they need to adapt to changing workplace needs, to promote innovation and 
to help employers remain competitive in the global marketplace.

METHODS OF WORKPLACE TRAINING

There are a wide variety of methods available to support workplace training. 
Some of these include: Classroom, Mentoring, Internships, Coaching.

CLASSROOMS

Most of you are familiar with the traditional face-to-face method of training and learning 
given in a classroom or seminar. It is the oldest method for delivering training and in 
today’s marketplace is the least effective. In classical training delivery, learners and the
instructor are present at the same time. Face-to-face experience provides the trainer and
participant with immediate feedback. It enables participants to discuss and share ideas
with others in the classroom or seminar. The trainer presents materials, manages and
guides discussion; responsibly ensuring that learning is constructive and positive.
Traditional classroom delivery is thus termed teacher centric: an approach to training
that gives the teacher control over learning. 

CCS has developed a cost effective system of giving the control to the learner and 
not the education system. The cost of holding classroom sessions and registration
with the Ministry of Training Colleges and Universities is high and has limitations 
in delivery methods. The cost is also high for students when they have to travel 
or attend classroom sessions when they need to be employed with either part-time
or full time work. Today’s average learner is managing two part-time jobs to realize
the benefits of full employment.

TRADITIONAL CLASSROOM DRAWBACKS

A commonly cited disadvantage of classroom training is determining an appropriate
pace of training and learning. Learner groups are often heterogeneous, made up of 
both experienced and inexperienced staff, among whom there are fast and slow 
learners.

Lectures are typically oriented to the slowest learner, ensuring the inclusion of 
every participant, but resulting in a lack of challenge for many attending. Interaction is 
rarely mandatory, so classroom participants sometimes sit passively, failing to maximize
their classroom involvement. Valuable staff time and motivation can be lost this way.

As companies globalize, and the need to share information increases, traditional 
classroom training delivery is rendered less viable and cost effective.

CONCEPT OF COMMUNITY

The concept of community and participatory development is important to working at CCS. 
Community has always been thought of as a geographic area with members that had little 
more in common than where they resided. Traditional institutions, the Town Hall, the 
Church, the School, the Hospital, no longer suffice, and the alternative outlets and
venues for congregation and self-expression are the Coffee-Shops and the Internet.
Creativity is an effective means of exchanging thoughts, language and the spirit of 
community. The dynamic resources within a community are often overlooked and
in similar fashion the great potential and enthusiasm for change is disregarded,
without the major contributor to the community life force, creativity.

The new appreciation of the community, and its untapped creative resources,
encouraged the proliferation of independent and governmental organizations
working in community development. Creativity is embraced as an important
vehicle in the process of development, where a community could come into
its own through unmitigated, creative self-expression.

CREATIVITY

Creative approaches to community development are essential, requiring the
ability to solve problems progressively over time and apply previous knowledge
to rapidly changing situations. “The nurturing of creativity means finding ways of
helping people to create new and better ways of living and working together"

(Our Creative Diversity). With the Internet becoming an expanding forum for free 
exchange, a public space open to all virtual communities, based on elective communities, 
represent a major challenge to institutions operating within territorial boundaries. 
With this in mind, CCS has developed the system of exchange of community 
information through its web site. 

Community Care Solutions, an information source aimed at disseminating examples of 
best practice and promoting cross-sector links among the fields of arts and culture, 
health, business, environment, regeneration and community development.

The organizations, governments, and individuals chosen to be featured, exemplify the 
range of projects working in cross-sector community development. CCS provides a 
virtual forum for the sharing of creative ideas and experiences among teachers, artists, 
community and voluntary groups, policy makers, training providers, corporate leaders 
and others who have an interest in understanding and promoting creativity in different 
settings.

CCS reviews unique and innovative organizations and projects working all over the 
world. Different in size, implementation and setting, the selected initiatives are 
characterized by the use of creativity, and by the novel ways in which they apply 
knowledge and skills to tackle contemporary problems.

The projects reviewed feature one or more of the following themes:

1. Promoting creativity and cultural heritage

2. Developing human aptitudes

3. Safeguarding creative freedom

4. Promoting participation

5. Encouraging a sense of community

6. Building the future