Arsalan Afzal is currently completing his PhD with the focus on ageing and gerontology with the School of Public Health and Health Systems at the University of Waterloo. He also works for the Local Health Integrated Network (LHIN) in the Waterloo Wellington region of Ontario. He has unique experience in understanding the challenges faced by older adults and ageing population in accessing health and social services particularly in the home & community care sector. His current research includes understanding the role of Unregulated Care Providers such as Personal Support Workers in the Canadian health care system and how it can continue to provide personal care support to the ageing population. Other areas of interest include Program Evaluation, Project Management & Quality Improvement in patient care.
The Role of Unregulated Care Providers in Canada
Many older adults worldwide with chronic conditions and complex needs require assistance with activities of daily livings (ADLs) such as bathing, dressing, feeding, and toileting. In Canada, this personal support is provided by Unregulated Care Providers (UCPs) in both residential long-term and home care settings. UCPs provide up to 80% of direct care for older adults, yet little is known about their roles in the health care system and how these roles may be evolving in response to an aging population and fiscal constraints in a publicly funded health care system. We wished to explore the role of UCPs in the Canadian health care system, and the potential impact of their role on the quality of care.
A scoping review was conducted following the steps outlined by Arksey and O’Malley (2005) and Levac et al. (2010). An iterative search of published and grey literature from January 2000 to September 2016 was conducted, using Medline, CINAHL, SCOPUS and Google. Inclusion and exclusion criteria were applied to identify relevant studies published in English.
The search yielded 63 papers. Results highlight the evolving role of UCPs, a lack of recognition, and a lack of authority for decision-making in patient care. UCPs do not have a defined scope of practice, however, their role has evolved to include activities previously performed by regulated professionals. Variations in education and employment standards have implications for quality of care and patient safety.
For a workforce that provides up to 80% of direct care in the community and long-term care settings, inconsistent education and employment standards, an evolving role, and assuring quality of care, are
serious and challenging policy issues. We outline a set of recommendations that could be implemented at micro (clinical), meso (institutional), and macro (policy) levels.