A reflection by Maureen Russell

Today I met with a wonderful group of Health Care Assistant students from Capilano University. In preparation for the time together they sent me a list of questions, and I in turn considered the questions and what I might share. I shared with them a reflection written by Maureen Russell, a psychosocial care provider who lives and works in southern Ontario.
This reflection was inspired by a man whose experience with a Personal Support Worker helped him to trust, to open up, and prepared him to eventually be able to meet with Maureen in the last weeks of his life. Maureen was adamant, that without the work of the PSW the man never would have been able to open up with her and address some of the deeper issues that he carried.

Reflection—Undressed 

You entered, and my heart sank. Today would be the first day I would allow a stranger to bathe my broken body. 

How could I have come to this…this moment of unwanted dependency? 

I cringe with despair. A tear dares to sneak its way from beneath the mask of courage I so sheepishly hide behind. 

Who are you, Stranger? Who are you they send to enter my intimate space? 

Do you know ME? Do you know who I am? 

How do I let go into your hands, that which has only been felt by the gentleness of my mother’s touch oh so long ago? 

I shudder as you draw near. My decrepit body tenses and my stomach churns. I close my eyes and turn away, anticipating your cold and callous touch. 

I wait…I wait… 

Till broken is the air by your slow and soft voice…“This must be difficult for you. How can we best do this together?” 

How     can       we       best     do        this            together?  you asked…. 

Breath releases, body relaxes and my facade of courage slips.  Tears flow. I let go. And the waltz begins… 

In the weeks and months to come, we danced every day as you cleaned and cared for my declining body with the utmost respect and compassion. 

Within this place of “the intimate” that I so desperately feared had morphed a space of trust. I felt safe to wonder aloud with you…“How will I die?” “Have I mattered?” “How will I be remembered?” “What is the purpose of it all?”  

You quietly listened without judgement or a need to fix…For that, I thank you.  

And then, you offered me another partner, a counsellor, who could take these new steps and dance the dance of purpose and meaning with me. And because of you, I could accept her help.

I could let go of my masks and facades and bare my true self on my last waltz. 

Little did I know when you entered that being undressed would allow me to be naked.  

Deep gratitude to YOU who cared for my body and gave space for my spirit.   

Contributed by Maureen Russell 

Thank you Maureen for sharing this wonderful reflection with us!

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.

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.

 

How do you infuse love in your organization?

Several years ago I was inspired as I read writings from Stephen Post and Thomas Kitwood defining love in dementia care.

“Love within the context of dementia care includes comfort in the original sense of tenderness, closeness, the calming of anxiety and bonding.” (Kitwood, 2003)

“Altruistic love involves both a judgement of worth, and a related affirmative affection. Love is manifest in care, which is love in response to the other in need; it is manifest in compassion, which is love in response to the other in suffering; it is manifest in companionship, which is love attentively present with the other in ordinary moments.” (Post 2003)

As I reflected on their writings, I thought of my esteemed colleague Misha Butot – Fourteen years after graduating as a social worker, while working as a counsellor, educator and yoga teacher, she recognized that love was a theme in all of her work. As a masters student Misha approached people across Western Canada who were involved in social justice work. She asked them if love was relevant in their work and what love in professional practice looked like for them. Even though they were diverse in age, gender, work and focus, ten common themes emerged. Fourteen years later, I approached Misha and asked if we could revisit those themes and translate them into plain English.

As we worked on this “translation” we were inspired by the stories from the research participants, we reflected on our own lives and we wrote a personal commitment to love in our professional practice.

This year, as we consider the most important theme of cultural safety in health care, I am inspired by the thoughts of Dr. James Makokis, an indigenous physician, “Racism is hate. The opposite of hate is love.” and he asks, “How will you infuse love into your organization?”

Racism is hate. The opposite of hate is love.” and he asks, “How will you infuse love into your organization?

Dr James Makokis

In this month of February, as many celebrate Valentine’s Day, love and friendship, I invite you to consider:

What does love look like in your practice?

How do you infuse love into your organization?

I’d love to hear your thoughts.