Ontario to allow PSWs to administer some medication in long-term care

A proposal put forth by the Ontario government will allow personal support workers (PSWs) to administer certain medications to long-term care residents, prompting concerns from advocates who are worried about safety and overall accountability in the facilities.

New proposed regulations submitted earlier this month show the government is looking into allowing PSWs who have received training in drug administration to be able to provide long-term-care residents with non-controlled medication.

A non-controlled medication includes over-the-counter medications like Tylenol or those prescribed for certain common ailments, such as high blood pressure or diabetes.

“It's not IVs. It’s not needles. It is topical medications,” Minister of Long Term Care Paul Calandra told CTV News Toronto in an interview.

“They're not prescribing … they're not dispensing. That'll still being done by a doctor or a nurse.”

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Calandra added that nurses are taking on a greater role in long-term care, so allowing PSWs to handle non-controlled medications will free them up to deal with more pressing needs.

“It does allow the nurses on site to continue to deal with the more complex cases that we're starting to see in long-term care, frankly, and it's honestly a reflection of many of the changes that are part of the Fixing Long Term Care Act, which includes the movement to four hours of care.”

The regulation also stresses that in order to administer medication that is not a controlled act—loosely defined as an act that could cause harm by an unqualified person—the PSW must be “authorized by a member of the registered nursing staff.”

PSWs began temporarily administering certain medications in April 2022 under the Fixing Long-Term Care Act. That provision is set to expire on April 11, 2023.

As it stands, there is no concrete list of medication PSWs can, and cannot administer. The Ontario Personal Support Workers Association, who has said it supports the regulatory amendments, has said no formal training has been developed yet in terms of drug administration.

That detail is what has some advocates concerned.

“The positive effect is we already know that many basic medications are quite easy to deliver,” Laura Tamblyn Watts, founder of CanAge, said.

“The concern however, of course, is that in long-term care are often dealing with very complex health needs. So we're going to make sure that there's additional training and support for those types of medication management. All medications are not the same. And that means that not everyone should be able to get everything.”

Speaking with CTV News Toronto, long-term care researcher Dr. Vivian Stamatopoulos stressed the new regulation will add more responsibility onto an already overburdened workforce.

“It's an unregulated workforce that has, historically, issues with insufficient training and supervision. And it sets up these workers to work in conditions where they fail,” she said. “There's just far too many preventable injuries and errors that happen in long-term care as is because we don't properly train and pay these workers.”

“If there's already insufficient nursing levels in these facilities, and this is presumably part of the reason they're doing this, well then who's going to be there to actually supervise and delegate this very important responsibility to the PSWs that will be chosen for this??”

Instead, Stamatopoulos argues the government should be hiring more nurses for long-term care, and paying both nurses and personal support workers more money.

Dear lord I just got word from an #LTC staffer that proposed regulations are underway to allow PSWs to provide medication. Waiting to learn more but this would sound like a real insidious lobby sector ploy to remove nurses altogether from #LTC. Care to comment, @ONlongtermcare?

— Dr.VivianS (@DrVivianS) February 3, 2023

Calandra says the idea that allowing PSWs to administer medication would allow long-term care homes to reduce nurse staffing is “categorically false.”

“We know that we're asking nurses to do a lot more in the homes as part of the care teams, and this is a reflection of that,” he said. “The challenges that we're seeing in long-term care are different, right. It's not we're starting to deal with much more complex cases.”

He said the government is hiring 27,000 additional health staff for long-term care, including nurses, PSWs, dietitians, and other allied health-care workers.

“Nurses are an incredibly important part of this,” he said. “It pisses me off, frankly, because it just absolutely … saying the opposite thing to what we're wanting to accomplish on long-term care.”

Advocates, meanwhile, argue that while personal support workers play an integral part in Ontario’s long-term care system, they may not all have the knowledge necessary to understand how medications, even simple over-the-counter drugs, may interact with others.

The Registered Nurses’ Association of Ontario (RNAO) says a proposal like this will not only put residents at risk, but also make PSWs more vulnerable.

“First of all, the resident may not even fully know that this person is not fully trained,” RNAO CEO Doris Grinspun said. “So, the resident is vulnerable and … so is the PSW because if he or she feels that they are not well prepared to do so, but now there is a regulation that says you can do it and if they speak up, they may be let go.”

Residents have until March 8 to provide their feedback on multiple long-term care regulations under the Fixing Long Term Care Act.

Other regulatory proposals include:

• Adding COVID-19 vaccines to immunizations that must be offered to residents
• Creating a $25,000 fine for homes that do not have air conditioning in resident rooms
• Requiring licenses to ensure an assessment is always completed when a resident experiences a fall
• Clarifying the rules for when a dietician should assess a resident’s skin conditions
• Clarify requirements that supports placement of an ALC patient into their preferred accommodations