Palliative Care – a Human Right – so apparent during COVID

Deaths from COVID-19 are approaching 3 million world-wide. Much of the discussion about ethical issues has centered around the availability of ventilators, but little has been said about the need and the responsibility to provide palliative care, ways to integrate a palliative approach for those who are seriously ill, and how to best support those who may or many not get (or want) a ventilator.

In Ontario palliative care specialists helped and provided care in the long term care facilities hardest hit by COVID. But specialist cannot do this in isolation.

In the Journal American Medical Association, article titled, “Integration of Palliative Care into All Serious Illness Care as a Human Right” Rosa, Ferrell and Mason wrote:

“COVID-19 has highlighted that every clinician needs knowledge and skills in the fundamentals of palliative care.“

Palliative care is not dependent on life-saving interventions. It may very well include a ventilator, but it is ultimately structured around the individualized wants and needs of the patient. It includes alleviating suffering and managing complex communications, psychosocial dynamics, fluctuating symptom management needs, and spiritual care throughout the dying process.

Every patient treated with a ventilator also needs palliative care. It is not an either-or clinical proposition, but rather a both-and moral imperative.

COVID-19 has accentuated the need for clinicians to have frequent conversations with patients and families about dying. The pandemic has forced many healthy people to confront rapid-onset, life-threatening trajectories of acute illness. Patients are dying without their loved ones, and families are grieving alone. For every person who dies, an average of 9 others are profoundly affected and grieve.2 COVID-19 has interrupted the cultural and community practices for coping with death, raising concerns about the pervasiveness of grief and loss associated with the pandemic…. 

Access to palliative care is a human right. Our inability to deliver it in the setting of COVID-19 and other serious illnesses is a human rights violation. Education… is needed now.

Personal Support Workers and nurses (both in field and in training), like all health care providers, need the tools and foundation to know how to support individuals living and dying with COVID-19 or living and dying with any life-limiting illness. Now.

Providing Care During COVID

On Monday, Dr David Kenneth Wright spoke during the “FREE WEBINAR SERIES for PSWs about providing care during COVID. I was touched by the stories he shared, by the points that he made, and by the responses/input from those who attended.

Near the end of his presentation he said and asked, “COVID-19 has changed so much in the world, but what should it NOT change?” Participants responded:

  • Love and respect for each other
  • Our level of empathy and kindness
  • Compassion and care
  • Care providers dignity and respect

I am inspired by their spontaneous thoughts. I agree, that DURING COVID we should KEEP our compassion, care and concern.

Then I reflected on the things that changed during COVID that I WANT TO KEEP AFTER COVID. The first two that come to mind are:

  • Doctor appointments online
  • A slower, gentler calendar

Then I reflected on the things that I can’t wait to change after COVID. My first three thoughts are:

  • Hugs – giving hugs, long hugs, group hugs, strangle hold hugs, happy hugs, sad hugs… hugs with people I know and hugs with strangers
  • Seeing, being with, hugging and holding grandkids!
  • Gatherings with more than our bubble – in fact, a bubble bath of bubbles and friends, a dance with CCR, and a pot luck feast.

What are the things that you want to keep now, during COVID? What are the things that you want to keep AFTER COVID? What are the things that you can’t wait to change?

Have a great day!

Free education for PSWs, but at what cost?

The Ontario government plans to train 6000 to 8,000 new PSWs by December 2021, offering free tuition, textbooks and a paid practicum. Given the devastating effects of COVID in Ontario LTC facilities it is so important to increase the numbers of PSWs in each home. But will increasing the pool of available PSWs actually translate into improved care? And what about the PSWs who are already educated – do they have work?

This funding will undoubtedly encourage people to enter PSW programs. It may help people who need to retrain find new work opportunities. Some who enter the PSW program may discover the joy and the rewards that come with caring for elders, they may love the sharing of laughter and tears and stories. 

However, the funding raises many questions. 

What about the PSWs who are already educated and unemployed or underemployed? There are many PSWs who historically worked at two sites to help meet their payments. Since COVID they have had to limit themselves to working at one site, and still many do not have full time work and benefits. The wages earned by PSWs have not been sufficient for many to support themselves and their families. The benefits are too often non-existent.

And the working conditions are difficult.

This July 2021 report about LTC identifies challenges that PSWs encounter in their work. It leaves me concerned that the following challenges for PSWs will not be addressed by the new funding.

Challenge: Keeping PSWs in the workforce

Did You Know? 40% of PSWs leave within within one year of training.  For every 10 people who graduate, 4 of those leave the profession in the first year.

Working conditions and burnout are the main reasons PSWs leave.

  • 50% of PSWs are retained in the health care sector for fewer than 5 years
    • 43% left the sector due to burnout or working short staffed
  • 25 % of PSWs with two or more years of experience leave the sector annually
  • Improved Staffing: Staffing levels need to change so that PSWs can realistically meet the care needs of residents without the risk of burn out. In addition to educating more PSWs, I hope that the next step for the Ontario government is to provide  increased funding for LTC staffing.
  • Valuing PSWs: PSWs need to be fully integrated into the team, including the way that PSWs are treated. PSWs need to be SEEN and HEARD and VALIDATED! As fully integrated members of the team, they need opportunities for leadership and education. 
  • Supporting PSWs: With increases in wages and benefits, and full-time jobs possibilities. I hope that the government now provides  increased funding for PSWs to encourage them to stay in their chosen field of work.

 Changes that would help to retain PSWs are:

Challenge: Preparing PSWs

The report acknowledges that “most residents reach end of life in LTC.” PSWs need education and training so that they can be prepared to care for people who are living, but are also dying. New PSWs must graduate with the skills and knowledge for providing palliative and end-of-life care, and how to integrate a palliative approach.

To fully prepare PSWs to care for people who are living and dying:

  • Provide sufficient education in core curriculum for PSWs to know how to provide palliative care, and integrate a palliative approach.
  • Provide continuing education opportunities on providing palliative care and integrating a palliative approach.

In closing, I raise my hands to PSWs, the work that they do and the care they provide. I hope that this free education will be followed with other changes that will benefit all PSWs, and that PSWs will be best able to provide excellent care.

In closing, I raise my hands to PSWs, the work that they do and the care they provide. I hope that this free education will be followed with other changes that will benefit all PSWs, and that PSWs will be best able to provide excellent care.